public health

RECENT POSTS

New Moms Cite Lack Of Advice From Docs On Key Issues: Sleeping, Breastfeeding

A new study found that about 20 percent of mothers said they didn’t receive advice from their baby’s doctors about breastfeeding or the current thinking on safe placement for sleeping newborns. (Mark Humphrey/AP)

A new study found that about 20 percent of mothers said they didn’t receive advice from their baby’s doctors about breastfeeding or the current thinking on safe placement for sleeping newborns. (Mark Humphrey/AP)

After I gave birth to my kids, I was bombarded with advice from family, bestselling books and even strangers on topics ranging from how to lose the baby weight, when to have sex again and which infant toys boost IQ.

But according to a new, NIH-funded study, many sleep-deprived, hormone-addled new mothers may not be getting enough advice on critical issues from a most important source: doctors and other health care providers.

When it comes to breastfeeding, infant sleep position, immunization and pacifier use, many new moms report they get no advice at all from their children’s doctors — despite medical evidence on the benefits of certain practices, like breastfeeding and placing babies on their backs for sleep.

The new study — published in the journal Pediatrics and conducted by researchers at Boston Medical Center, Boston University and Yale University — found that about 20 percent of mothers said they didn’t receive advice from their baby’s doctors about breastfeeding or the current thinking on safe placement for sleeping newborns. And more than 50 percent of mothers told investigators that doctors did not offer guidance on where the babies should sleep.

(Of course the whole issue of where newborns should sleep is controversial. Official recommendations now say babies should “room share” with parents but not “bed share.”)

The study, part of a larger national effort called SAFE (Studies of Attitudes and Factors Effecting Infant Care Practices), surveyed more than 1,000 new mothers across the country, inquiring about infant care advice they received from different sources: doctors, nurses, family members and the media.

Dr. Staci Eisenberg, a pediatrician at Boston Medical Center and lead author of the new study, said in an interview that the number of moms who reported no advice from across the board is surprising.

“These findings say to me, ‘Hmm, this is a time to stop and think carefully about how we communicate, and are we communicating in a clear, specific enough way, and are we being heard, especially by new moms — new parents — who are often tired and likely overwhelmed?’ ” she said. “Amidst this sea of information, what are the messages that need to be highlighted and communicated clearly?” Continue reading

Happy 100 To You, And You — Centenarians Multiply, At Forefront Of Age Wave

Ethel Weiss, 100, dances with her daughter Anita Jamieson at the “Party Of The Century” at the Brookline Senior Center on Wednesday. (Jesse Costa/WBUR)

Ethel Weiss, 100, dances with her daughter Anita Jamieson at the “Party Of The Century” at the Brookline Senior Center on Wednesday. (Jesse Costa/WBUR)

It’s a rare milestone, to turn 100 — but not nearly as rare as it used to be.

This week in the town of Brookline, Massachusetts, the senior center hosted more than a dozen local centenarians for a “Party of the Century.” In the not-so-distant past — centenarian parties in 2002 and 2007 — party organizers had to reach out to centenarians from all of Greater Boston to gather a critical mass for a fete.

But now, the 99-and-over set has so grown that the party had to limit itself to just Brookline, says Ruthann Dobek, director of the Brookline Council on Aging. And if the numbers keep growing, she told the crowd, “we’re going to have to start it at 105 or 110 to be eligible.”

The centenarians are the leading edge of the fastest-growing sector of the population: people over 60. In this state, the population over 60 has grown 17 percent over just the last five years, and the over-60 cohort will soon outnumber people under 20 for the first time in history, says David Stevens, the executive director of the Massachusetts Association of Councils on Aging. Continue reading

It’s Not Just The Heat: How New England’s Sharp Shifts In Weather Affect Death Rates

(Zacharmstrong/Flickr)

(Zacharmstrong/Flickr)

You know the old saw: “If you don’t like the the weather in New England, just wait a minute.”

We tend to see our rapid shifts in weather as a benign local quirk, but there’s a darker side to them as well, and it may grow as the climate shifts: Heat waves and cold snaps are linked to little spikes in death rates, and those spikes add up to long-term effects, according to a paper just out in the journal Nature.

It charted temperature and death rates among the Medicare population for all of New England, ZIP code by ZIP code, from 2000 to 2008. Among its findings: It’s not just heat or cold that kills, it’s the sudden shifts in weather.

I asked Joel D. Schwartz, professor of environmental health at the Harvard Chan School of Public Health and senior author on the paper, how he would sum up its findings. Our conversation, lightly edited:

J.S.: There are hundreds of studies that have shown that when it gets hot, more people die, and when it gets cold, more people die, on that day or in the next couple of days. But these are all studies that look at what happens in a day or two; they’re not telling you anything about the long-term effects of temperature on people’s life expectancy. Maybe all the people who die when it gets hot would have died in the next month anyway — they’re sick and something is going to cause them to die in the near future.

“If the variation in temperature went up, more people died, and that was true for winter and summer.”

– Professor Joel Schwartz

What we did is a cohort study: We took all the people in New England who are on Medicare — about 2.9 million people — and we followed them over time. And we asked the question: Does their annual mortality rate change when weather changes?

This way, we avoid having to worry about whether these are really just the short-term effects, and we can address the question: Is there really an impact on life expectancy of temperature? This is the first study to do that in a general population study; we studied all of New England.

The second new thing is that all of the studies heretofore that have looked at the effects of temperature on the risk of dying have been done in cities, because a) that’s where the weather stations are, and b) in smaller towns there aren’t enough people to really be able to see anything. But we used satellite remote sensing and we calibrated it, and were able to get the temperature for every day for every square kilometer of New England — that’s about 6/10 of a mile on a side.

We had a separate measurement of temperature for every day for every ZIP code from 2000 to 2008. And so we could calculate, then, for each person, the mean temperature in the summer for each year and the mean temperature in the winter, over multiple years. And we could ask, “Well, if mean temperature is higher one summer than the previous year in a particular zip-code, were people in that zip-code more likely to die?” And the same for winter temperature.

What we found was that indeed, if the temperature in the summer was higher, the annual mortality rate went up. If the temperature in winter was higher, the annual mortality rate went down. The summer effect was bigger than the winter effect, so if it went up by the same number of degrees in the summer and the winter, then more people would die.

The next thing we did is we asked the question, “Well, since we have this fine geographic scale of temperature, did temperature differences across ZIP codes affect mortality rates?” And what we found was that there was lower mortality rates in ZIP codes that had warmer temperatures in the winter. Continue reading

Related:

CDC: Certain Antidepressants, But Not All, Taken During Pregnancy May Raise Birth Defect Risk

The debate over whether or not it’s safe to take antidepressants during pregnancy is heated, with extreme emotions — and conflicting research studies — on both sides.

But a broad new analysis led by researchers at the U.S. Centers for Disease Control and Prevention came to a fairly measured conclusion when comparing pregnant women who took SSRIs — a class of antidepressants — to women who did not take those medications during pregnancy.

The analysis suggests that certain serious birth defects occur 2 to 3.5 times more frequently among babies born to mothers taking the antidepressants Prozac or Paxil early in pregnancy. But the researchers also conclude that for pregnant women taking other SSRIs, such as Zoloft, the data “provide some reassuring evidence” that earlier studies linking the drug with specific birth defects could not be replicated.

The analysis of 17,952 mothers of infants with birth defects and 9,857 mothers of infants without birth defects was published in The BMJ.

“What our paper really adds, is that we can now offer women more options,” said Jennita Reefhuis, an epidemiologist with the CDC’s National Center on Birth Defects and Developmental Disabilities and the study’s lead author. Reefhuis said that since Zoloft (sertraline) was the most common SSRI taken among the women, “it was reassuring that we could not replicate the five earlier links with birth defects.”

In an interview, Reefhuis said: “The main message is that depression and other mental health conditions can be very serious and many women need to take medication to manage their symptoms. So women who are pregnant, or thinking of becoming pregnant, shouldn’t stop or start any antidepressants without speaking to a health care provider.”

The issue, she added, isn’t clear cut, but highly dependent on each individual woman and a very personal calculation of risks versus benefits. “We are trying to find the nuance here,” Reefhuis said. “It is really important that women get treated during pregnancy. Their illness doesn’t stop the moment they get pregnant. Women need options.”

It’s also important to retain perspective when evaluating risk, Reefhuis said, noting that in every pregnancy there is already a 3 percent risk of a birth defect. Continue reading

More Health Coverage, And Perhaps More Health, For Same-Sex Couples

A crowd waves rainbow flags during the Heritage Pride March in New York on Sunday, June 28. (AP)

A crowd waves rainbow flags during the Heritage Pride March in New York on Sunday, June 28. (AP)

You know how it goes: You have the great joy of the wedding — or of the gay pride celebrations that followed the Supreme Court’s marriage decision — and then the honeymoon’s over and it’s time to talk about the mundanities of stuff like (sigh) health insurance.

But still, it can be at least quietly pleasing to contemplate the many a newlywed who’ll now qualify for insurance offered by their new spouse’s employer. (And that on top of the several million people whose health insurance subsidies were just saved by the previous Supreme Court decision, on Obamacare.)

Not to rain on the weddings, but it’s also likely that many employers’ “domestic partner” benefits will go away. The picture is complex, but a study just out in JAMA finds that legalizing gay marriage does indeed increase employer-based health insurance coverage for same-sex partners. It looked at New York after gay marriage was legalized there in 2011, and more than 12,000 same-sex couples wed. From the press release:

Compared with men in opposite-sex relationships, same-sex marriage was associated with a 6.3 percentage point increase in ESI [employer-sponsored health insurance] and a 2.2 percentage point reduction in Medicaid coverage for men in same-sex relationships. Same-sex marriage was also associated with an 8.9 percentage point increase in ESI and a 3.9 percentage point reduction in Medicaid coverage for women in same-sex relationships vs women in opposite-sex relationships.

I asked the study’s author, Gilbert Gonzales of the University of Minnesota, whether anyone had done a similar study in Massachusetts after our own pioneering legalization of gay marriage more than a decade ago. He replied by email:

The only Massachusetts study I’m familiar with is an American Journal of Public Health study that found potential improvements in gay and bisexual men’s health after MA enacted same-sex marriage in 2003. There were significant reductions in mental health care visits and expenditures in the year after MA enacted same-sex marriage, which suggests broad public health benefits for LGBT people when states recognize same-sex marriage.

Another related study on health insurance coverage looked at the 2005 domestic partnership law in California, and found the law increased health insurance coverage among lesbian women relative to heterosexual women. There was no similar finding for gay men. The JAMA study suggests that legal same-sex marriage–rather than domestic partnerships–may improve coverage options for both men and women in same-sex relationships.

How many people in all may gain employer health insurance thanks to the Supreme Court ruling? Continue reading

Further Reading:

Why Your Doctor Might Want To Track Your Tweets

The little digital breadcrumbs you blithely leave in your wake — the tweets, the online searches, and communities you join, the wearables that account for every step and bite — are beginning to coalesce into what could ultimately become a critically important portrait of your true physical and mental state.

At least that’s what John Brownstein of Children’s Hospital Boston and his colleagues argue as they analyze and collect these “breadcrumbs” amassing a wide spectrum of data to support a broad new concept of personal and public health that they call the “digital phenotype.” It’s like a contemporary extension of the more traditional phenotype — one’s observable characteristics based on a mix of genetics and the environment.

(Medisoft via Compfight/Flickr)

(Medisoft via Compfight/Flickr)

In a sort of digital phenotype manifesto published earlier this year in the journal Nature Biotechnology, Brownstein, an epidemiologist and associate professor at Harvard Medical School and chief innovation officer of Children’s Informatics program, and others, explain the idea like this:

…there is a growing body of health-related data that can shape our assessment of human illness. Such data have substantial value above and beyond the physical exam, laboratory values and clinical imaging data — our traditional approaches to characterizing a disease phenotype. When gathered and analyzed appropriately, these data have the potential to fundamentally alter our notion of the manifestations of disease by providing a more comprehensive and nuanced view of the experience of illness. Through the lens of the digital phenotype, an individual’s interaction with digital technologies affects the full spectrum of human disease from diagnosis, to treatment, to chronic disease management.

Or, put another way: the digital phenotype adds a unique, more fine-grained look at the way people actually live each day.

Here’s one real-world example: Michael Docktor, a gastroenterologist and director of clinical innovation at Children’s Hospital Boston, treats many patients with Irritable Bowel Syndrome and one thing he usually requests is a detailed food diary. “Sometimes teenagers dump a 50-page food diary on me, and it’s hard for me as a human being to comb through that and, perhaps, find that milk, for instance, is a problem.” But, he says, “if we had that information digitally, tracked by software that used algorithms and machine learning to figure out the meaningful correlations and serve it up in an easily digestible format — that could be transformative.” Continue reading

Note From A Civilized City: Boston Parks To Offer Dispensers Of Free Sunscreen

Got sunscreen? A sunbather on the Boston Common, one of the city parks that will offer free dispensers of free sunscreen. (Alonso Javier Torres/ Flickr Creative Commons)

Got sunscreen? A sunbather on the Boston Common, one of the city parks that will offer dispensers of free sunscreen. (Alonso Javier Torres/ Flickr Creative Commons)

In winter, season of germs, we can turn for a squirt of protection to the multitudes of handy sanitizer dispensers that have cropped up everywhere over the last few years, from gyms to workplaces to public buildings.

And in summer, when the blue skies raise the risk of skin cancer, we here in the civilized city of Boston will now be able to turn to 30 dispensers of free sunscreen that are being installed in the central Boston Common and four other popular parks. They’re expected to be up by July 1.

“Skin cancer and melanoma are among the most prevalent cancers and they’re also among the most preventable,” says Matt O’Malley, the Boston city councilor who proposed the sunscreen initiative in April.

“So what we are doing in Boston is, we’re offering a service, we’re promoting public health and we’re reminding folks of the importance of sunscreen — at no cost to the taxpayer. It’s an incredibly wonderful initiative and I look forward to seeing it spreading across the country much like the way my freckles spread every summer.”

The dispensers being installed in Boston parks (Courtesy of the Melanoma Foundation of New England)

The dispensers being installed in Boston parks (Courtesy Melanoma Foundation of New England)

The idea for dispensers sprang, he says, from a medical student who argued that installing them was a growing practice, including at Hershey Park in Pennsylvania. But no major city has adopted it as a citywide initiative, O’Malley says — until now.

If the pilot project with 30 initial sunscreen dispensers works out well, he says, the plan is to extend the dispensers to all the city’s playgrounds and parks — more than 200 of them.

The dispensers cost between $100 and $200, O’Malley says, so the ultimate price tag could be close to $50,000 — but not to the taxpayers. The dispensers are a public-private partnership including the Melanoma Foundation of New England and Make Big Change, both organizations that fight skin cancer. The foundation is covering the cost of the dispensers, according to a press release, and Making Big Change provides the dispenser units; it has also been placing them in New Hampshire beaches and parks.

So how might Bostonians respond to the new dispensers? Continue reading

Related:

What The Supreme Court Ruling On Obamacare Means: A Student’s Perspective

By Marina Renton
CommonHealth Intern

As a public health major at Brown University, I’ll admit I’m biased: When the King v. Burwell decision was handed down this week, I was absolutely elated. The decision felt exactly right to me; people were not going to lose their health care coverage, and more might even have the chance to gain it.

But the case is complicated, so to really understand the take-home messages, I consulted a couple of health care policy experts.

One is Ira Wilson, professor of Health Services, Policy and Practice at Brown University, who taught my “Health Care in the United States” class last semester.

The other is Michael Doonan, assistant professor at the Heller School for Social Policy and Management at Brandeis and executive director of the Massachusetts Health Policy Forum

Their responses are lightly edited:

MR: What background do we need to understand the Supreme Court decision?

IW: One of the core tenets of health care reform is that people who can’t afford insurance get subsidies so that they can buy it.

The ACA:

• Reforms insurance by doing things like preventing denials due to pre-existing conditions. So it requires that insurance do certain things that it hasn’t always done in the past.

• Requires that everybody get insurance. That’s the individual mandate, and that was covered in the 2012 challenge and then upheld in the 2012 case.

• Requires that affordable insurance be available to everyone. And this King case threw into question that third leg of the stool, as it were. Or at least it brought it into question for the states that, rather than deciding to develop their own exchange, used a federal one. So without this, the entire framework for health care reform in those states that have a federal exchange begins to fall apart. And as we know because we’ve seen lots of articles about estimating how many people would lose insurance if those subsidies were taken away (estimates were in the six million range), it would have a devastating impact on people who are now insured who would lose it.

What does the ruling say about Obamacare?

MD: If the Supreme Court had ruled against the government and said that the subsidies could not be available in the 34 states that have federally run exchanges, it might not have been the death of Obamacare, but it certainly would have put it on life support. So this decision is really critical in helping root and solidify the Affordable Care Act. And the more it gets rooted in each of the states, the harder it’s going to be to repeal.

IW: So this actually was a 6-3 decision, not a 5-4 decision. And it does seem to me the fact that both Justice Roberts and Justice Kennedy — who were the two that one might have imagined might have been on the other side of this issue — came down on the side of upholding these subsidies is a bit of a statement.

What if the ruling had gone the other way?

MD: Think about Texas. Now, in Texas, there are about 1.1 million people who are enrolled in that exchange, that marketplace. Well, 90% of them — over 900,000 people — are receiving those subsidies, and they could have lost their insurance.

And it’s not only important that people lose their insurance, which is the most critical thing, but hospitals would see many, many more uninsured patients. So even people adamantly opposed — I think that even Republican governors who are opposed to this are secretly saying, “Oh my gosh; thank goodness.” This would have caused them a tremendous, tremendous burden, because they would have seen more uninsured.

Continue reading

New Normal In Age Of Hookup Apps? Rhode Island Rises In Syphilis, Gonorrhea, HIV

(Rhode Island Department of Health)

(Rhode Island Department of Health)

By Marina Renton
CommonHealth intern

The numbers are striking: Recent double-digit rises around the country in long-familiar sexually transmitted diseases — gonorrhea, HIV, even the old scourge of syphilis.

Perhaps even more striking is what Thomas Bertrand of the Rhode Island Department of Health said recently about the rising numbers on Here & Now: “I would not call it a crisis, I’d call it a new normal right now, and we need to push against it.”

Last month, the Rhode Island Department of Health put out a press release with its data from 2013 to 2014: Reported cases of infectious syphilis increased 79 percent, gonorrhea cases increased 30 percent, and newly diagnosed HIV cases increased 33 percent.

While these figures are dramatic, particularly the increase in syphilis, it’s important to remember that year-to-year changes aren’t always the best data to look at, said Bertrand, who is chief of the office of HIV, STDs, Viral Hepatitis, and Tuberculosis for the state Department of Health. It’s better to examine a period of five to 10 years, he says.

But those numbers don’t look good either: Since 2009, Rhode Island, along with the rest of the country, has seen increases in chlamydia, gonorrhea and syphilis, Bertrand said in a phone interview. “We mirror the national trends in general.”

“The acceleration or the increase may be a little bit steeper in Rhode Island than the rest of the country, but just a little bit,” he added.

Can swiping right lead to STDs?

The Rhode Island Department of Health’s statement mentions the use of hookup apps as a “high-risk behavior” that could be associated with the increase in STDs. However: “We don’t have data to say that the use of social media or the people who use it are more infectious or transmitting disease more than people who don’t,” Bertrand said.

But the apps do add to tracking problems: When people use social media such as Tinder and Grindr to arrange hookups, the encounter can be casual and brief, so people don’t share much information, Bertrand said. So, when someone is diagnosed with an STD, he or she might not be able to provide contact information for his or her sexual partners, making it harder to curb the spread of the disease.

Given the use of social media to arrange sexual encounters, there is opportunity for the health department to move online, Bertrand said. Continue reading

Just Sip It: More Than Half Of U.S. Kids Not Properly Hydrated

(sara_girl22/Flickr)

(sara_girl22/Flickr)

One statistic jumped out at me from this study by researchers at the Harvard School of Public Health about whether U.S. kids are drinking enough water: “Nearly a quarter of the children and adolescents in the study reported drinking no plain water at all.”

When you think about the kinds of serious health problems your kids might have, not drinking quite enough water may not top your list.

But it’s serious: beyond the physical problems related to insufficient water-drinking, there are cognitive implications as well, researchers report:

Inadequate hydration has implications for children’s health and school performance. Drinking water can improve children’s performance on cognitive tests. Two studies have found that children’s cognitive performance improved as their urine osmolality [a measure of urine concentration] decreased. Increasing drinking water access in schools may be a key strategy for reducing inadequate hydration and improving student health, because schools reach so many children and adolescents and that they typically provide free drinking water to students.

The study was published online in the American Journal of Public Health.

I asked Erica Kenney, a postdoctoral researcher and one of the study authors, a few questions about the work. Here, lightly edited, is what she said, via email.

RZ: What’s the takeaway here?

EK: We often take for granted that kids will keep themselves hydrated automatically and will drink when they’re thirsty, or that their schools, summer camps, afterschool programs, child care centers, etc. will be providing them with enough opportunities to drink water during the day. But our study indicates that this may not be the case — over half of all children and adolescents in the U.S. are estimated to be inadequately hydrated. We need to do a better job of getting safe, clean, appealing drinking water to kids (and by “we” I don’t just mean parents and families — I also mean the places where kids learn and play during the day) and keeping them hydrated so that they have the opportunity to be at their best in terms of well-being, cognitive functioning, and mood.

Where do we go from here? Continue reading