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?