Article: W.H.O. Reports 25 Percent Drop in Malaria Deaths in a Decade - NYTimes.com

Coordinated efforts through the WHO over the past year have dropped deaths from malaria by 25% according to a recent NY Times article. 

Issues we're still dealing with:  the 600,000+ deaths annually from malaria, a disease that rapidly develops resistance (especially to mono-drug therapy), and continued set-backs related to funding shortages and political instability.  None of these are particularly new challenges in combating this disease or others.

Read the whole article at the link below:

W.H.O. Reports 25 Percent Drop in Malaria Deaths in a Decade - NYTimes.com
http://www.nytimes.com/2011/12/27/health/who-reports-25-percent-drop-in-malaria-deaths-in-a-decade.html?_r=1&partner=rss&emc=rss

(Sent from Flipboard)

Selected Public Health Headlines

-A new method of sterilizing hospital rooms using pulses of UV light was recently studied at a MA hospital and showed promising results : http://runningahospital.blogspot.com/2011/12/cooley-dickinson-kos-c-diff.html?m=1


- An article in the NY Times reported obesity rates on city schoolchildren are down 5.5% over 5 years. http://www.nytimes.com/schoolbook/2011/12/15/obesity-in-new-york-children-on-the-decline-officials-say/

- The CDC recently issued a report on sexual violence in US bsed on a survey of over 16000 adults.  1/4 American women report a violent attack by a husband or boyfriend.  1/5 have been sexually assaulted (rape, attempted rape). 1/6 have been stalked.  Compare this to 1/71 males reporting being raped.  For women, 30% of those raped experience their first trauma berween 11 and 17 years of age; 12 % before 10 years of age.  The full report can be found here: http://www.cdc.gov/ViolencePrevention/pdf/NISVS_Report2010-a.pdf ( the report is exhaustive; the executive summary is brief)


- Adolescents are using more marijuana and less alcohol and cigarettes.  A government report claims 1/15 high-schoolers use marijuana on a daily basis. http://drugabuse.gov/newsroom/11/mtf11overview.html

Publicly Speaking - Dec 2011 Newsletter

CGPH - Publicly Speaking (Dec 2011 Newsletter)

Global Health Scholarship Opportunities

Child Family Health International (CFHI) GLOBAL HEALTH PROGRAMS

2012 SUMMER SCHOLARSHIPS NOW AVAILABLE, 2013 DATES OPEN

CFHI GLOBAL HEALTH SCHOLARSHIPS

Never done before, CFHI is offering scholarships for summer programs, our busiest time of the year. These four (4) partial scholarships in the amount of US $1,000 may be awarded towards participation in any May & June 2012 CFHI Global Health Education Program.

- One scholarship will be designated for CFHI's Opthalmology Rotation in New Delhi, India
- One designated for CFHI's Dental Program in Quito, Ecuador.

All interested in global health are encouraged to apply. Deadline January 16th , 2012. For more details see CFHI's Scholarship Page.

2013 PROGRAM DATES NOW OPEN

2013 program dates are now open and CHFI is now accepting 2012 and 2013 applications on a rolling basis. CFHI continues to offer academic credit and fundraising assistance. For more details on any of CFHI’s 20+ programs, visit the website or contact them.

CFHI - Socially Responsible Global Health Education Programs

Child Family Health International (CFHI) is a nonprofit that offers socially responsible Global Health Education Programs for health sciences students of all levels. Through CFHI participants go on 4-16 week placements alongside local physicians in underserved communities. Participants rotate through clinics and hospitals, attend medical lectures, and become immersed in the healthcare system of the community.

CFHI Blog / CFHI on Twitter / CFHI on Facebook / CFHI on YouTube
Sign up for the CFHI Email Newsletter

CFHI is an NGO in Special Consultative Status with the ECOSOC of the United Nations

A Lesson in Estimating Prevalence

Estimations of the prevalence of behaviors do not necessarily match with reality.

Prevalence itself is the total number of cases divided by the number of people at risk for being cases (Wiki).  If you're calculating from measured numbers, this is easy.  If you're dealing with perceptions -- not so much.

In particular, it is very easy to over-estimate the prevalence of a behavior or a disease that seems particularly dramatic.  Taken one way -- if you see a disease in medical school, you're less likely to think of it as rare (...there are at least enough cases out there that you were able to see it).  Taken another way -- when you were in high school, it probably seemed like everyone was having sex.

The American Academy of Pediatrics published a study on the Prevalence and Characteristics of Youth Sexting  this week that found the prevalence of sending sexually explicit texts was as low as 1.0% (much lower than previous studies reporting the level somewhere north of 10%).

U.S. medical 'trash' saving lives abroad

I'd like to point you towards an article from CNN yesterday dealing with the redistribution of unused medical supplies towards developing countries. While the language is perhaps a bit inflammatory (our trash becomes their treasure), our MSS has discussed this issue at several recent meetings.

Chief among concerns from our section is the thought that folks abroad might be getting second rate medical care by using expired supplies.  In some cases (drugs that expire and may become dangerous or ineffective), this is clearly an ethical issue.  In many others (equipment that can be re-sterilized or used without concern of degradation), this  is a great way to redistribute unused supplies to the benefit of the poor.

Take a look at the article and see some examples how this is taking place and helping deliver care in the real world.

U.S. medical 'trash' saving lives abroad

Published on CNN.com - Health | shared via feedly mobile

Third World hospitals are saving lives with medical materials discarded in the U.S.

Boosting Adherence to Antiretrovirals / UN AIDS reports AIDS epidemic may be reaching plateau

I already had HIV on the mind yesterday when I saw this news brief from the AMA (below). I had the privilege to hear a professor from Tufts speak about strategies to monitor and encourage adherence to antiretroviral therapy. There was an old thought that perhaps we shouldn't offer antiretrovirals to Africa because folks in resource limited settings wouldn't be able to adequately adhere to the regimen and would breed resistance. That's a scary proposition!

Well, the data flips that perspective upside down. Turns out, adherence studies in a half dozen or so cities in the US (think NYC, San Francisco, Hartford, and others) show Americans only reach 50-70% adherence rates while our counterparts in Africa frequently surpass 95%. Turns out they harness their social capital much more effectively and it boosts adherence. Imagine asking a friend or neighbor for money so you can get lifesaving drugs (or even so you could get the transportation needed to pick them up). To maintain the relationship, you're going to make darn sure you take those medications.

What about the issue of taking meds at the same time when you don't have a clock? You'd be amazed how creative folks can be - one gentleman had nearly perfect compliance over the course of a month (he timed his meds to a radio news broadcast at 7am and 7pm daily). He struggled a bit the next month, but that was because he fell in love and donated some pills to his HIV positive girlfriend who was running short on medications. So what turned out to be the best estimate of adherence? It was data from the pharmacy regarding prescription refills, this estimates the maximum possible adherence (and would miss the case of a patient sharing meds with others), but lined up very nicely with actual viral suppression rates.

In other news, this article below was published as part of the AMA Morning Rounds.

UN AIDS report suggests AIDS epidemic has plateaued. The New York Times (11/22, D5, McNeil, Subscription Publication) reports, "The world's AIDS epidemic has hit a plateau, with 2.7 million people becoming newly infected each year for the last five years, according to the annual report (pdf) released Monday by UNAIDS, the United Nations agency fighting the disease." The report also notes that "last year, 1.35 million got on treatment for the first time, meaning 200 people were newly infected for each 100 newly treated," compared with "two years ago, when 250 were infected for each 100 treated." However, "donor funds dropped about 10 percent last year as the worldwide economic crisis made some countries cut their donations." The report also compares a number of countries, pointing out that a large number of new cases are driven by "drug addicts, who are notoriously hard to reach, and also by groups like gay men and prostitutes who in conservative societies...have furtive, rapid sex -- a high-risk behavior."   

      The Washington Post (11/22, Brown) reports, "The biggest advances have occurred in sub-Saharan Africa, where a massive rollout of antiretroviral drugs, increasing acceptance of circumcision and changes in sexual behavior are driving new cases of infection to the lowest number in years." In contrast, "the big exception to the global trend is in the countries of the former Soviet Union and Central Asia, where there has been a 250 percent increase in people with HIV from 2001 to 2010.     

    Bloomberg News (11/22, Bennett) details, "A failure in Russia to implement harm-reduction programs such as offering drug users clean needles, or switching them to methadone tablets from heroin injections, is fueling the spread of the virus, said Paul De Lay, the deputy executive director of the Geneva-based agency." De Lay added that "five years ago they were really starting to see a turnaround," but now the progress has "pretty much fallen apart" and UNAIDS is pushing "for the surrounding countries not to follow the Russian Federation model."    

     The AP (11/22) reports that while "UNAIDS says it is working toward zero new HIV infections, zero discrimination and zero AIDS-related deaths," critics contend "that the body's aim of wiping out the disease is overly optimistic...considering there is no vaccine, millions remain untreated and donations have slumped amid the economic crisis."     

    CQ (11/22, Bristol, Subscription Publication) notes, "New infections reduced by 21 percent since they topped out in 1997. Deaths, which peaked in 2005, had also fallen by 21 percent by the end of last year. ... The report attributed progress in reducing the disease to changes in sexual behavior, especially among younger people who are reducing their number of sexual partners and using condoms more."         The UK's Telegraph (11/22) reports, "A significant expansion in access to treatment helped slash the number of Aids-related deaths in 2010, bringing the number of people living with HIV to a record 34 million," according to the United Nations. Also covering the story are Reuters (11/22, Kelland) and BBC News (11/22)"

All I need is a little help from my friends...

Although my roommate has thus far been unable to convince me to join her at bikram yoga, a couple of news items this week attest to the powers of peer pressure in changing one’s lifestyle.

The first is a study out of Stanford about the families of patients who underwent gastric bypass surgery. The investigators found that obese family members of bariatric patients lost an average of 3% of their total weight in the first year following the surgery – this is equivalent to the amount of weight loss achieved on the average diet plan such as the Atkins diet. So although the family member wasn’t officially on the post-op bariatric diet, it is as if they were.

The second is a program called the “Daniel Plan” created by Rick Warren (best known for “The Purpose Driven Life”) at his church in California. Warren has used what he calls “the healing power of the group” to motivate members of his church to lose weight; he effectively utilizes the existing foundation of church small groups not only for spiritual growth but also physical betterment. The first point of his six-point program is to “connect” or create partnerships that foster positive change. Fourteen thousand people signed up and 72% lost weight. A survey found that participants lost nearly 7 more pounds following the plan in a group than they following the plan on their own.

Both of the above examples involve groups – either natural or constructed. What is fascinating about the Stanford study is that the weight loss was unintentional – it was purely a product of environment. The other interesting thing is that there is really nothing inherently special about either diet plan. What is amazing is the difference the support of a group makes in adhering to that plan. Not surprisingly, this has great implications for global and public health. It is one of the reasons why Alcoholics Anonymous and Partners in Health have been so successful.

Message to my roommate: if exercise is anything like nutrition, the stats are on your side! Eventually, I may succumb to your good example.

(Arch. Surg. 2011;146:1185-90)

Practicing what we preach: Hospital Cafeterias

It's relatively common knowledge in the medical field and to many people that poor diet and physical inactivity is a leading "actual" cause of death. It is quickly catching up to tobacco and may soon overtake it to become the leading cause of death in America; no question, a leading public health threat.

So it may seem ironic when a cafeteria at a health care institution actively promotes a leading cause of death. While many institutions have taken the steps to a smoke free campus, saturated fat filled cheese pizza, fries, hamburgers, hot dogs, and macaroni and cheese still seems to be the rule, not the exception.

How would we feel if a hospital not only allowed tobacco on campus, but sold cigarrettes from vending machines? From a public health standpoint, these practices are equally harmful.

The cynical side of me recognizes that other than institutional philosophy, there has been little financial incentive for a hospital cafeteria to provide healthful food (and perhaps even has some incentive to keep their vascular surgeons and cardiac cath lab busy!). This may change if the new payment system under discussion, Accountable Care Organizations becomes the norm where the hospital or provider group stands to save money by promoting a healthy patient population.

So far, it is the rare hospital that has made health a priority. St Joseph Mercy Ann Arbor is one of those, employing a chef from Google and investing $1million to remodel their cafeteria in the name of health; reducing portion sizes, color coding options to help indicate nutritional value, and saying goodbye to their deep fryer.

By popular request, WooFood is actively working with the Cafeteria at UMass Memorial to promote change that will at least encourage healthful options. (Disclaimer; the author of this post is a founding member of WooFood). The need has been recognized by many people including the CEO of UMass Memorial who has stated that the healthcare community needs to practice what it preaches when it comes to healthful options.

What are your thoughts on hospital cafeteria food? How is the food at your school's or hospital's cafeteria? Does a hospital cafeteria have a responsibility to serve healthful foods because it is a healthcare institution?

Food for Thought - Comments on a Pediatrician's Reaction to the Haitian Earthquake

Last week, I had a chance to hear a pediatrician from Massachusetts (Dr. Dennis Rosen from Children's) talk about his experiences in Haiti in the months following the earthquake. Many of the experiences he described demonstrated the incredible ingenuity required to practice in such a resource poor and devastated setting. He told stories through pictures and the pictures spoke volumes about the condition health care in the country, both before and after the disaster.

When they could not find an incubator for preterm baby, one was fashioned from a cardboard box and a desk lamp. The baby in a box lived in soon they did this for many more. They saw many children who were malnourished and didn't quite know what to do. This was a condition the Haitian doctors and residents took great pride in knowing how to treat: " This we do very well."

Taking a photographic tour through the pediatric wards in Haiti - the small tents crammed with patients, parents sleeping underneath their children's cribs in streams of water flowing through the tents, parents taking children home with defects like omphaloceles - one found it difficult to not what to render assistance.  Stepping past the urges to offer assistance perhaps the most important lessons of the night were lessons of perspective.  There were numerous doctors in the audience who commented on a Haitian health care system that was largely in a similar condition when they visited 30 or 40 years ago.  Certainly the economy was no better at that time.  We discussed some of the disorganization that ensues when aid pours in from many sources.  When aid is given without regard to the specific needs on the ground, there tends to be a mismatch between what supplies are given and what is actually required. 


The take home? ... Perhaps aid is best rendered through established and organized groups instead of individual donations or traveling as part of a small contingent.

He reminded us of the Chinese proverb:

"Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime."

In some ways, rendering aid after the disaster works a bit like this.  There's an immediate need we need to help out with, but for a lasting change, aid needs to be delivered in a sustainable way that seeks to build up the infrastructure and the economy of the country in need.

Deadline for Photo Submission this Saturday!

The Committee on Global and Public Health is preparing a photographic newsletter featuring the public health and global health initiatives of medical students at various medical schools throughout the country. If you have photographs of members of your Chapter engaging in a global or community health project, working at a free clinic, teaching at a local school, etc. please send them along with a brief caption to Lauren.page.black@gmail.com by Saturday October 29th. Please note that in addition to this newsletter these photos may be used in other CGPH publications and programs.

Thanks,
Lauren Page Black
Vice-Chair, Committee on Global and Public Health

Soda, SNAP, and Policy

The Supplemental Nutrition Assistance Program (SNAP), formerly the food stamps program, was started in 1961 and was made permanent in 1964 with the goal of providing improved levels of nutrition to low-income households.  Almost 50 years later some 40 million individuals participate in the program but the nutritional state of this country is drastically different than it was in 1961.  While hunger still plagues individuals in the U.S., malnutrition due to overeating has been an increasingly larger problem.  This has led many, including Dr. Kelly Brownell, to question the role of SNAP in meeting its goals of improving levels of nutrition for all who participate. 

In August, the USDA denied a request from the state of New York to conduct a pilot program that would have allowed the elimination of sugar-sweetened beverages from SNAP in its state.  In a recent JAMA article, Dr. Brownell outlines the USDA's concerns for denying the proposal and argues that keeping sugar-sweetened beverages in the program only leads to an increase in obesity, diabetes, and heart disease.  If the USDA already denies non-essential items including those with adverse health effects (alcohol and tobacco) then it would seem logical to deny food items that offer no nutritional value to its participants.  Dr. Brownell also urges the USDA to fund research to generate the needed data to inform policy decisions when denying future pilot programs.

While the AMA does not have specific recommendations on the most recent decision denying the New York proposal, H-150.936 and H-150.937 from AMA policy clearly support the use of evidence based nutrition and reduced calorie-dense, nutrition-poor foods.  Dr. Brownell's article illustrates the need for the AMA and other professional healthcare organizations to become active in shaping nutrition policy by adopting a stance that supports optimal nutrition in government programs.  

Regarding Male Circumcision

Male circumcision is an issue discussed in the MSS house a couple of times in recent years (2000, 2009).  One resolution was a request for CEJA to investigate the implications of such a practice and the other asked for our section to oppose the practice.  Both were not adopted as policy, though I remember significant heated testimony on the issue.

It's not just the MSS that's been dealing with the issue.  The discussion has taken place in many states across the country and the AAP is readdressing their current policy (that circumcision may have some health benefits, but that data doesn't necessarily support routine circumcision).

This week, JAMA published an commentary no the issue with some interesting public health arguments.  In brief:  imagine a vaccine that would reduce the risk of HIV transmission by 60% (verified in 3 RCTs) and reduce the risk of herpes and high risk HPV transmission by roughly 30%.  That would be huge news!  The authors argue with these and several other points that male circumcision does in fact have a significant long-term pubic health benefits.  With the publication of new data to this end over the past few years, they encourage everyone to take a new look at the body of data before coming to conclusions on the practice.  Read the rest of the article here: http://jama.ama-assn.org/content/306/13/1479.extract

JAMA.2011;306(13):1479-1480. doi:10.1001/jama.2011.1431

Send us pictures of your Chapter!

The Committee on Global and Public Health is preparing a photographic newsletter featuring the public health and global health initiatives of medical students at various medical schools throughout the country. If you have photographs of members of your Chapter engaging in a global or community health project, working at a free clinic, teaching at a local school, etc. please send them along with a brief caption to Lauren.page.black@gmail.com. Please note that in addition to this newsletter these photos may be used in other CGPH publications and programs.

Thanks,
Lauren Page Black
Vice-Chair, Committee on Global and Public Health

Report: Local Strategies to Combat Obesity

Your Committee on Global and Public Health has just submitted a report to AMA Staff for review.  Titled  Physician Based Education to Combat Obesity on the Local Level, this report stems from a resolution referred for study at the Interim 2010 meeting in San Diego.  Keep your eyes peeled for the final publication of this report at Interim 2011!

Included in the report is a review of the current Supplemental Nutrition Assistance Program (SNAP -- the new generation of "food stamps") and a cursory review of many community based initiatives which have been successful at combating obesity and improving health in various communities.

World Suicide Prevention Day

It's National Suicide Prevention Week which corresponds with Sunday Sept 10th as World Suicide Prevention Day.

So why should you pay attention?

I just lost a friend to suicide.  He was a 24 year old Marine Sergeant who was home.  He shot himself.  Our soldiers are supposed to be out of harms way once we bring them state-side. It's heart wrenching to watch a college-aged friend have to bury her brother.   

Unfortunately, I know my experience isn't unique.  Just take a look at why are our adolescents and young adults dying.  It's accidents, homicides, and suicides.

Let me translate:  we do stupid things, we kill each other, and we kill ourselves.  That's preventable death.

Here's some statistics -- we're losing 12.7 young adults per 100,000 every year to suicide.  It's worse in the military -- active duty soldiers are committing suicide at a rate of 16.3 soldiers per 100,000 per year.  There's only old data for physicians -- but we're quoted as having a suicide rate of 28-40 doctors  per 100,000 in an AMA study.

Put another way, thats upwards of 400 physicians committing suicide a year.  Or one a day.  Or the entire medical school class from a large school (or 2 whole years at my school). ...Each year.

So take some time and consider the topic of suicide this week.  Pass this around. Discuss this with other medical students.  Check in on people who may be hurting. Let's work to reduce these numbers.  After al, these numbers aren't just numbers -- they're family and friends and co-workers.


Other sources: Pediatrics Vol. 120 No. 3 September 1, 2007 pp. 669 -676 (doi: 10.1542/peds.2007-1908)

NutritionFacts.org

Nutrition education has been a hot topic in the MSS of late.  There have been resolutions asking for nutrition education from middle school to med school at every meeting I've attended.  We know nutrition is a hit-or-miss topic in medical school education -- for those of you looking to supplement yout training, take a few moments to check out a new website titled NutritionFacts.org.  It's a heavily linked (read: sourced) site with daily snipets (in blog or video form) on nutrition topics. 
There are a couple of ways you can follow the content on the site:

Daily Videos: http://nutritionfacts.org/videos/feed
Facebook: https://www.facebook.com/NutritionFacts.org
Twitter: http://twitter.com/nutrition_facts

2010 Dengue Fever Epidemic - Lessons from Working with the CDC

Written by Tyler Sharp, reblogged from CDC (link below)

Paradise Has Its Risks

Given the choice I prefer my bones to remain unbroken. For that reason I began to worry when I found out that the disease I would be studying for the next two years in Puerto Rico was also referred to as “breakbone fever.”

In April of 2010, I accepted an assignment to study dengue fever as an Epidemic Intelligence Service Officer at the CDC Dengue Branch in San Juan, Puerto Rico.  While I was thrilled to be moving to “The Island of Enchantment,” reality began to sink in when I realized that I was running head first into an ongoing epidemic of a painful and deadly disease.

Earlier that year, CDC had issued an update on the status of dengue in the Caribbean, warning of impending epidemics.  From my time in graduate school I knew that the four viruses that cause dengue are transmitted by mosquitoes, but I didn’t know much about the illness itself. When I started reading up on dengue, I found out that the name “breakbone fever” comes from the intense bone and joint pain that accompanies the disease. Patients with severe forms of dengue can experience hemorrhage, shock, and even death.  I also discovered that the World Health Organization estimates that there are about 100 million cases of dengue each year, including 500,000 hospitalizations and more than 25,000 deaths.  This was serious business!  What had I gotten myself into?!


Keep Reading:  http://blogs.cdc.gov/publichealthmatters/2011/08/breakbone-fever/

Charity: Water --- Water Changes Everything

MSNBC Nightly News ran an awesome story last night about a girl named Rachel and her dream to give clean water to those in need.  She died tragically last month and it appears her cause has gone viral.  She gave up birthday presents for her 9th birthday in lieu of donations, with a goal of $300.  She's creeping in on $1.2 million at this point!

Check out the video story from MSNBC:  http://www.msnbc.msn.com/id/3032619//vp/43950745#43950745

Interestingly, the organization she was raising money for (charity: water) is a pretty cool NGO itself.  The financial model they have set up has separate donations for operations (private donors dedicated to supporting the infrastructure and meeting needs as they come up) and water projects (where 100% of the money from public donors is directed!). They have also made a commitment to being visibly and publicly accountable to their donors by posting photos of projects and placing them on maps using Google Earth.

Interesting model with HUGE public health implications!

We know that in many societies the duty of fetching water falls to the women and children.  Often, they walk for miles or for hours to collect water for the day -- water that frequently isn't even clean.  Imagine spending your day's work to bring home water that will likely make your family sick!  And in many cases, these outings are the most dangerous tasks for women as they are outside of the confines of their villages and are frequently assaulted or raped while searching for water.  On multiple fronts, water is the first step to improved health in these communities -- (1) by reducing the spread of water borne illness (when combined with sanitation programs -- i.e. changing community habits of open defecation -- providing a clean water source has an even larger impact (2) by keeping women and children out of some of the most dangerous places they must travel to, opportunities for physical and sexual abuse are diminished (3) the opportunity cost of gathering water is astounding -- once folks have a local source for water, they are able to pursue other pursuits with economic impact.

Check out their video: "Water Changes Everything"

And it you'd like, you can find more information by perusing charity: water's website (http://www.charitywater.org/)

Interesting Global Health Opportunities

Please see the announcement below from an organization (Child Family Health International) that offers opportunities for medical students to be involved with many global health initiatives.  There is a deadline for upcoming applications this Wednesday, August 10th.

---------------------------------------------------------------

CFHI Live Webinar- Socially Responsible Global Health Education Programs

Child Family Health International (CFHI) offers socially responsible Global Health Education Programs for health sciences students of all levels. Through CFHI participants go on 4-12 week placements in underserved communities. Participants rotate through local clinics and hospitals, attend medical lectures, and become immersed in the healthcare system of the community. CFHI is an NGO in Special Consultative Status with the ECOSOC of the United Nations.

CFHI Staff will be conducting a live CFHI Program Information Webinar on Wednesday August 10th at 5pm Pacific/ 8pm Eastern time.  All interested in learning more about participating in a CFHI Global Health Program are invited to call in and follow along online as staff and alumni talk and take questions about:

·         CFHI's 20+ programs in 5 countries

·         2012 Dates and Deadlines

·         How CFHI Supports Local Communities Abroad

·         Our newest Intensive Beginner Spanish Program

·         Effective CFHI Fundraising Tools

·         Upcoming CFHI Scholarship Opportunities

To participate, click here to register and to receive an email follow up with information on how to join the conversation.  Also view the online announcement.

From AMA Morning Rounds: Violence against women may damage long-term mental health

Violence against women may damage long-term mental health.

The Los Angeles Times (8/2, Kaplan) "Booster Shots" blog reported that according to a study published in the Aug. 3 issue of the Journal of the American Medical Association, "women who experience gender-based violence are more than twice as likely as their peers to have some kind of mental disorder." Researchers arrived at this conclusion after examining the results of "a nationwide survey of 4,451 Australian women conducted in 2007. Among them, 27% said they had been the victim of at least one instance of gender-based violence."
        "Fifty-seven percent of the women with a history of abuse also had a history of depression, bipolar disorder, post-traumatic stress, substance abuse, or anxiety (including panic disorder and obsessive-compulsive disorder), versus 28% of the women who had not experienced gender-based violence," CNN /Health.com (8/3, MacMillan) reports. And, among women who "had been exposed to at least three different types of violence, the rate of mental disorders or substance abuse rose to 89%."
        HealthDay (8/2, Gordon) reported, "Suicide rates were significantly higher for women who'd experienced gender-based violence." For example, the "average rate of attempted suicide was 1.6 percent for all women in the study, but it was 6.6 percent for women who'd experienced one form of violence, and 34.7 percent for women exposed to three or more types of violence." In addition, "rates of physical and mental disabilities were...much higher for women who had experienced gender-based violence."

How Should We Organize Global Health Interventions?

http://www.nejm.org/doi/full/10.1056/NEJMp1014255?query=public-health&

HHS to re-examine policy on blood donations from gay men.

The blurb below was taken from the AMA Morning Rounds email newsletter distributed this morning, July 27th.  This was a policy issue discussed by the MSS at a recent meeting.  See the article for an indication of progress by HHS on the issue of blood donations in MSM.

HHS to re-examine policy on blood donations from gay men.

The National Journal (7/27, Fox, Subscription Publication) reports, "A policy that bars gay men from donating blood for life is 'suboptimal,' advisers to the Health and Human Services Department said on Tuesday, and needs another look." The department had "asked a committee of experts on blood and tissue donations to reexamine the policy and see if there is a way to let at least some gays donate blood." As it stands, the FDA "has banned blood donation by any man who has had homosexual sex because of the risk of the AIDS virus," although "the Red Cross, always struggling with blood shortages, and other groups such as gay-rights organizations oppose the blanket policy."

        CQ (7/27, Bunis, Subscription Publication) reports that last year, Sen. John Kerry (D-MA) and Rep. Mike Quigley (D-IL) had asked HHS to re-examine the FDA policy on blood donations. In response to the announcement that HHS is taking steps to do that, Kerry said, "We've been working on this a long time in a serious way, and I'm glad Secretary [Kathleen] Sebelius responded with concrete steps to finally remove this policy from the books. ... HHS is doing their due diligence, and we plan to stay focused on the endgame: a safe blood supply and an end to this discriminatory ban." Meanwhile, HHS stated that it "is committed to continuously improving the safety and availability of the nation's blood supply, and" plans "to re-evaluate this policy as new scientific data emerges."

        The Boston Business Journal (7/27, Donnelly, Subscription Publication) says in "The Bottom Line" blog that HHS still has to conduct various tests before a decision can be made regarding the policy, and it is unclear at this point "what the timeline is for HHS to conduct these studies."

ABCNews.com: Magazine Photoshopping Linked to Eating Disorders

http://abcnews.go.com/WNT/video/magazine-photoshopping-linked-eating-disorders-13961966

Dr Lazarus, AMA President Elect was featured last night on ABC's World News Tonight discussing the photoshopping of images in the media. National publicity is one way our policies can take effect even before any legislative change occurs.  Kudos to the original authors of this resolution which cam from our very own Medical School Section! 

Annual Meeting -- Chicago

The recent MSS Annual Meeting included programming from the Committee on Global and Public Health. This event marked a new era of collaboration between MSS committees. Working together were the Committee on Global and Public Health (CGPH),  the Committee on Economics and Quality in Medicine (CEQM) and the Committee on Legislation and Advocacy (COLA).

40 to 50 students showed up to participate in a game designed to teach the importance of understanding the interests of involved stakeholders, to practice working together towards win-win solutions, and underscore the benefits of investing in sustainable programs in the short-term will yield valuable outcomes in the long-run.  Students were divided into several groups and given a set of resources with which to address a public health problem such as childhood obesity, smoking, or texting while driving.  The CEQM provided background on the cost-effectiveness of interventions.  A friendly competition developed as groups looked to see who chose the most effective interventions.

Thank you to all who were involved in planning and participating in the event!

Note that standing committee applications are currently open with an extended deadline of July 5. Check out the AMA-MSS website for details

AMA Annual Meeting

It's time - once again - for our annual meeting of the American Medical Association in Chicago.  Public Health team will be running a collaborative presentation tomorrow (Friday 6/17) on learning to negotiate with other stakeholders and allocate scarce resources.  Stay tuned for updates on policy pertaining to global and public health in the Medical Student Section.

Obesity and Stillbirths

Reporting on Obesity

As part of a series of studies published online April 14 in The Lancet, researchers report that a leading cause of stillbirth in the United States may be obesity, which can raise the risk for fetal loss.

Global Health Immersion Programs The Chronicling Of One NGO’s Attempt To Make A Difference In Health For All

http://globalhealthimmersionprograms.org/global-health/making-global-health-knowledge-requirement-md-students/

AIDS Activism

From one of our own - a fellow medical student at the University of Colorado and former Fulbright scholar - here is a personal take on the state of the conflict over the distribution of federal dollars for health initiatives abroad.

http://www.huffingtonpost.com/anand-reddi/aids-activism-confusing-a_b_831712.html

Would you prescribe alcohol to your patients?

Identified in 2005 as the most highly cited researcher in clinical medicine, Meir Stampfer, MD D.Ph., Professor of Nutrition and Epidemiology at Harvard School of Public Health is a leading expert in the etiology of chronic disease - particularly Cancer and Cardiovascular disease. He's also an expert in one other thing: Alcohol's protective effects on the heart.

I invited Meir Stampfer to speak at UMass about The Role of Alcohol in a Healthy Diet after an interesting question was proposed in one of our classes at UMass - would you give the OK to a middle aged man with significant cardiac risk and no history of alcohol abuse the green light to knock back a beer or two? (The patient was asking because he heard it was good for his heart).

To my surprise only 2 people in the group (out of 16 or so) said they would give the green light.

No one is arguing the harms of excessive drinking. Granted, the stakes can be high if a patient is instructed by their physician to drink alcohol and develops dependence - but balancing the risks and benefits, to me it seems like more times than not, the risk is actually higher to not recommend moderate alcohol for the patients in our cardiovascular disease prone society. This point was driven home when Dr. Stampfer showed a slide framing not drinking versus being a cardiovascular risk factor (You have a relative risk of about 1.6 if you are an abstainer of developing a cardiac endpoint versus moderate drinkers)

Here are some of the points from the talk (much of this is available at http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/alcohol-full-story/index.html#possible_health_benefits):

• Although there is always a risk of developing dependence, alcoholism usually presents at a relatively young age, so the likelihood of precipitating abuse in a middle aged person is not very likely.
• Over 100 prospective studies show an inverse association between moderate drinking and CVD (including MI, Ischemic stroke, PVD, Sudden Cardiac Death, and death from all cardiovascular causes)
• This reduction has been found in both men and women, in those who do not have clinically evident heart disease, in those at high risk for dying of heart disease including people with Type II diabetes, high blood pressure, and existing cardiovascular disease
• It doesn't matter what type of alcohol you drink (Red Wine, White Wine, Sake, Martinis) - all had equal benefit. (Resveratrol found in Red Wine has been found to be beneficial in mice studies, but you would have to drink 1.5 gallons of wine in order to get this experimental amount.
• Cause and effect, while not proven in a double blind study - is essentially proven. Many studies have adjusted for confounding variables, and the measurable effects of moderate alcohol consumption (increased HDL levels, decreased hemoglobin A1c, effects on plasminogen activator, fibringen, Factor VII, and von Willebrand) can essentially account for the cardiovascular benefits alone
• The best correlation with benefits is actually in the number of days one drinks per week, not number one drinks per day. (eg. 1, 2 or even 3 drinks/day on > or = 5 days/week has better outcomes than drinking this many per day for less than 5 days/week
• The negative effects of alcohol at moderate doses include a modestly increased risk for breast CA, a modestly increased risk in blood pressure. This is a consideration, but studies have shown that all cause mortality is still decreased.
• A cohort from Harvard School of Public Health was stratified in to a "healthy group" who were nonsmokers, have a healthy diet, are physically active, and have a low BMI. The benefits of Alcohol were still found even among this group.

Despite this, over 65% of men, and an even greater percentage of women report never drinking at all. (I am working on specifics of this statistic- I believe it is from one of the HSPH cohorts)

Harvard's Health Eating Pyramid actually includes alcohol (red wine) in the pyramid. (1 or less/day for women, 2 or less/day for men) The USDA's pyramid is next to it for comparison.

So.... would you ever consider giving the green light to a patient to drink alcohol? How about recommending or prescribing it? What if Pfizer marketed it? Leave your comments below!

U.S.D.A's "Food" Pyramid vs HSPH's "Healthy Eating Pyramid"

MA Medical Society Tackles Inappropriate Antibiotic Use

The Massachusetts Medical Society in conjunction with the MA Department of Public Health and several other agencies is trying to educate the public regarding appropriate and inappropriate uses of antibiotics. The advertising campaign includes messages on billboards around the Boston area and on local TV stations. Much of this initiative is quite consistent with the CDC's Get Smart campaign. More resources can be found on the society's website. Check out the video and resources and consider how you might publicize similar information in your area.

Lower Costs and Better Care for Neediest Patients : The New Yorker

Lower Costs and Better Care for Neediest Patients : The New Yorker: "Online version of the weekly magazine, with current articles, cartoons, blogs, audio, video, slide shows, an archive of articles and abstracts back to 1925"

If you’re in medicine, you’re in politics

If you’re in medicine, you’re in politics: "

by Nicholas J. Rohrhoff

Each generation of physicians has no choice but to take on the responsibility of learning the science of medicine – how best to care for patients. But current circumstances dictate that we must also bear the burden of developing policy that creates the best system in which to provide that care.

Creation of a 21st century American healthcare system will require engagement and effort from everyone. In this endeavor, the role of physicians is special. We are, first and foremost, the chief advocates for patients. Far too often, this role absconds when we leave the exam room, hospital or clinic.

No more.

(...)
Read the rest of If you’re in medicine, you’re in politics

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4 comments | Tags: Health reform, Medical school | Category: Medical education

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Publicly Speaking - Winter Edition 2010-2011

Publicly Speaking - Newsletter from the AMA-MSS Committee on Global and Public Health