Romance, Revenge, and....Responsibility?

This can change people’s attitudes and behaviors. It has even been described as “a real catalyst for social change.” Nope, we’re not talking about politics or literature. We’re talking about soap operas. Yes, that cataclysmic romance between Felipe and Elena may actually be teaching you a thing or two about public health. With a viewership in the millions and characters that people can relate to, soap operas are an excellent medium for delivering education and social messages.

According to an article in the New York Times, the first soap opera that intentionally attempted education was a 1969 Peruvian telenovela called “Simplemente Maria,” in which a country girl moves to the city and learns to read and sew. After Maria marries her literacy teacher, enrollment in literacy classes in Peru skyrocketed. A similar pro-literacy telenovela in Mexico called “Ven Conmigo” had comparable effects.

But can soap operas influence behaviors such as safe sex and family planning? That seems to be the case. Regular viewers of “Soul City” in South Africa are significantly more likely to use condoms during sex, and soap opera viewers in Brazil have lower fertility rates than their counterparts.

The creators of socially conscious soap operas understand the importance of collaborating with local organizations to provide helplines and social services, and can even receive funding from the government or international donors (such as USAID) for their work.

Read the article (and watch a clip from Kenya’s “Makutanu Junction”) at:

http://opinionator.blogs.nytimes.com/2012/01/26/steamy-plots-with-a-social-message/

Public Health Headlines

A couple of public health headlines taken from the AMA Morning Rounds this week:

US obesity rates may be leveling off.

New data indicating that US obesity rates have stabilized generated extensive news coverage, including segments on two national television networks, with many sources contrasting the high prevalence of obesity with the fact that rates are not climbing. NBC Nightly News (1/17, story 6, 2:45, Williams) reported, "in new numbers just out, the CDC finds about one in three American adults and one in six kids and teenagers in this country are heavy enough to be considered obese." The CBS Evening News (1/17, story 8, 0:20, Pelley) reported that "these are about the same levels as in 2003."
The AP (1/18) reports that two "CDC reports summarize results of national health surveys in children and adults, which are conducted every two years." According to the AP, "The 2009-2010 reports involved nearly 6,000 adults and about 4,000 children, from infancy through age 19." The findings, divided into two reports (one on adults and one onchildren and adolescents ) "were released online in the Journal of the American Medical Association."
USA Today (1/18, Hellmich) reports in "Your Life" that, according to the data, "The average body mass index (BMI) of men rose to 28.7 in 2010 up from 27.7 in 2000," while "the average BMI" of women "remained unchanged at about 28.5."

Only 25% of kids use sunscreen regularly.

The Los Angeles Times (1/24, Roan) "Booster Shots" blog reports that "kids are really bad about using sunscreen consistently," according to a study published Jan. 23 online in Pediatrics. "Researchers studied fifth-grade children in Massachusetts in 2004 and then re-surveyed the same 360 children three years later. In the first survey, more than half of the kids said they had experienced at least one sunburn, and this rate did not change three years later."
"Despite numerous efforts to encourage people to wear sunscreen, a new study shows only 1 in 4 children regularly uses sunscreen," WebMD (1/24, Warner) reports. "The results showed that half of the children reported routinely wearing sunscreen in 2004, but only 25% did so in 2007." The article adds, "Researchers say the results show that the time between ages 11 and 14 is a critical time in developing attitudes about tanning and wearing sunscreen, especially among girls."
ABC News (1/24, Carollo) points out, "Most of the study participants said they liked the appearance of a tan, and the number of children who said they spent time in the sun to get a tan increased over the three-year period." Lead author Stephen Dusza, said, "At the same time, there was a signficant reduction in reported sunscreen use." Notably, "Dusza and dermatologists not involved in the research said the findings highlight the importance of finding effective ways to educate children of this impressionable age group about sun safety and the potential dangers of excessive exposure to ultraviolet light."

Let's pay more attention...

Once again, saw an interesting public health headline in the AMA Morning Rounds email this morning.

"Report notes increase in accidents of people wearing headphones while walking"

A slightly closer read sheds a little more light on what they're looking at.  This was a retrospective study of accidents over a 7 year period.  The accidents mentioned weren't simply stepping wrong off a side-walk or walking into a light-post.... we're dealing with people getting hit and killed by trains and the like!

In something along the lines of 30% of the cases, a warning sound was present before the victim was hit, but they did not respond (presumably because the music / sound from the headphones drowned out the warning sound).

This sure says a lot for a simpler and more attentive approach to life -- perhaps we don't always need to be plugged into our electronics (especially when around trains and fast moving cars).

For more info:  The ABC World News spot (16:42 into full broadcast from 1/16), an article in HealthDay , the study itself, and another article in MedPage Today.

Joint Commission Sentinel Event Alert -- Sleepiness

The Joint Commission published a short article last month on sleep deprivation and it's effects on patient (and provider) safety.  There are a lot of issues at play here and changing the culture of how we learn and practice medicine isn't quite as simple as saying, "Let's work fewer hours."  Though to guide our discussions, it is useful to understand what has been presented in the literature.

A selection (quoting from the Joint Commission article -- full sources can be found in the article) from a 2007 article in the Joint Commission Journal on Quality and Patient Safety:

"The article reports that residents who work traditional schedules with recurrent 24-hour shifts:

- make 36% more serious preventable adverse events than individuals who work no more than 16 consecutive hours
- make 5 times as many serious diagnostic errors
- have twice as many on-the-job attentional failures at night
- experience 61 % more needlestick and other sharp injuries after their 20th consecutive hour of work
- experience a 1.5 to 2 standard deviation deterioration in performance relative to baseline rested performance on both clinical and non-clinical tasks
- report making 300% more fatigue related preventable adverse events that led to a patient’s death"

Lockley SW, et al: Effects of health care provider work hours and sleep deprivation on safety and performance. The Joint Commission Journal on Quality and Patient Safety, November 2007;33(11)7-18, http://www.jointcommission.org/JQPS_11_07/

The 90%

While vacationing in New York last week, I visited an incredible exhibit at the United Nations visitor’s lobby showcasing innovative solutions to problems facing the world’s urban poor: safety, clean water, the spread of disease, and transportation.

The exhibit, called “Design With the Other 90 Percent: Cities,” focuses on the nearly one billion people (the 90%) living in informal settlements throughout the world. The recurrent themes of the exhibit were incremental design, the use of cheap and local materials for construction, and efficient use of waste.

The concept of incremental design was applied to everything from bicycles to buildings. There was a bicycle that could be re-assembled to make a cart. In Chile, architects designed basic houses (including bathrooms and kitchens) that could then be modified and tailored to the needs of future residents by those residents.

In Paraguay, loofah panels were used to build walls and elsewhere, sandbags were utilized for insulation.

There is a “biolatrine” in Kenya that converts human waste to fertilizer and gas for cooking and heating, a communal oven, also in Kenya, that uses trash as fuel, and various systems for recycling and water purification.

On the medicine front, there are public health campaigns waged through text message, HIV self-testing kits with instructions in both pictures and words, and “medikits” that include low-cost medical devices made from locally available inexpensive parts.

Some of the coolest work in my opinion is the drawing of informal settlement maps that identify locations for water and sanitation in addition to schools and clinics. These maps function both as a medium for sharing information between residents and a way to identify priorities for change in the community. It goes to show that data collection is an important first step in community improvement projects.

These projects were collaborations between NGOs, architects, engineers, community members, and sometimes local governments too.

Overall, it was a thoughtful and creative portrayal of ideas for sustainable change. The exhibit ends on January 9^th. Check it out if you’re in the area!