public health

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Crowdsourcing Food Poisoning; Yelping About Your Vomit

From the informatics experts at Children’s Hospital Boston who created Health Map to track local and global disease outbreaks comes another novel proposal: tracking food-borne illness through Yelp. Here’s their pitch to use social media for public health,  published on Vector, the hospital’s blog:

You just had a great meal at a restaurant. So you grab your phone and fire off a glowing review on Yelp.

Yelp Inc. /flickr

Yelp Inc. /flickr

Consider the opposite scenario: You just had a horrible meal at a restaurant. So you grab your phone and fire off a scathing review on Yelp.Now here’s one more: You had a great meal at a restaurant but woke up vomiting the next morning. Do you grab your phone and fire off a complaint on Yelp that your dinner made you sick… A report in Preventive Medicine, authored by John Brownstein, PhD, Elaine Nsoesie, PhD and Sheryl Kluberg, MSc, judges Yelp’s usefulness as a food poisoning surveillance tool. Their efforts are part of a growing trend among public health researchers of trying to supplement traditional foodborne illness reporting with what we, the people, say on social media. It’s estimated that some 48 million Americans get food poisoning every year, but that number is likely far off the mark. “Foodborne illness is under-reported, under-documented and hard to get at,” says Brownstein, who co-founded the HealthMap epidemic tracking tool and who also has a data grant from Twitter focused on foodborne illness. Continue reading

Leading Pediatrician: Sick Time Is Health Issue; Will Doctors Step Up?

(Mary MacTavish/Compfight)

(Mary MacTavish/Compfight)

Call me Sherlock Holmes, but when a ballot measure has “sick” in its title, I get a sneaking suspicion that it may involve an issue of health.

As in Question 4 on the Massachusetts ballots this November, which the secretary of state titles “Earned Sick Time For Employees” and summarizes as a proposed law that “would entitle employees in Massachusetts to earn and use sick time according to certain conditions.”

It would guarantee up to 40 hours of paid sick time if you work for a large employer and up to 40 hours unpaid if you work for a small employer. (More details here.)

This referendum — and measures like it in other states and at the federal level — tend to be portrayed as labor issues, pitting employers against employees. But Dr. Mark Schuster, Chief of General Pediatrics at Boston Children’s Hospital and Professor of Pediatrics at Harvard Medical School, argues that sick days are a health issue — and no one knows that better than doctors.

In the New England Journal of Medicine, he and Dr. Paul Chung of UCLA discuss the risks inherent in an economy where about 40 percent of employees get no paid sick leave, and many cannot even take unpaid sick days without risking their jobs.

They begin with the big-picture public health problem of the 2009 H1N1 flu pandemic, when health authorities were begging sick people to stay home and some workers were responding that they simply couldn’t.

And then there are the human difficulties that play out every day:

Consider a mother who knows both how to assess her son’s asthma symptoms and when he needs to see a clinician. If his medicine doesn’t seem to be working on a weekend or at night, they go straight to the clinic, he receives treatment, and they avoid a hospital admission. But when the boy has an asthma attack on a weekday morning, his mother sends him to school, fearing that missing work will mean losing her job. Three times in 18 months, when she waits until after work to bring him to the clinic, his asthma worsens, and he ends up hospitalized. Each time, what should have been three hours in the clinic becomes three days in the hospital.

Or consider a young girl with a fever and flulike symptoms who is given Tylenol and sent to school by her father because he can’t miss work. Two days later, the girl develops the rash characteristic of fifth disease on her cheeks. Her whole class has been exposed, and because the teacher is pregnant, her fetus is at risk.

About half of American workers get no paid sick days that they can use to care for family members, they note. And they end with a call to action directed at other health care professionals: “At the intersection between health and work, the health care community needs to provide a voice for patients and their families.”

Will it, though? Continue reading

Report: Fewer Infections Overall At Mass. Hospitals (But Problems Remain)

(UCI Irvine/flickr)

(UCI Irvine/flickr)

For the most part, patients are contracting fewer infections inside Massachusetts hospitals — but some problem spots remain, according to numbers from the state’s Department of Public Health.

WBUR’s Martha Bebinger reports:

It’s almost impossible to compare the quality of specific hospital procedures, but you can make a few hospital system comparisons.

For instance, the latest data show lower rates for three types of hospital infections — central line and surgical site infections for hysterectomies and colon operations. On the other hand, rates for urinary tract infections from catheters have increased.

Still, required reporting is spurring change, says Patricia Noga, VP for Clinical Affairs of the Massachusetts Hospital Association.

“When there is reporting and particularly when there is public reporting, people stand up and take notice of it,” Noga says. “Sometimes more than they would otherwise.”

Here are some specifics from the state Center for Health Information and Analysis:

•Central line-associated blood stream infections in Massachusetts have declined by 47%. In Massachusetts’ Intensive Care Units and neonatal ICUs, [such infections] declined by 57% and 49%, respectively.

•Surgical site infections related to abdominal hysterectomy declined by 23% in Massachusetts hospitals. While 8% of reporting hospitals had an observed to expected ratio greater (worse) than the national ratio, overall Massachusetts’ improvement is on track with positive national trends.

•Surgical site infections related to colon surgery declined by 19%. Massachusetts’ ratio of observed to expected infections is in line with the nation’s.

•Catheter-associated urinary tract infections have increased by 45% in the Commonwealth. In Massachusetts ICUs, [these types of infections] have increased by 64%. Among reporting hospitals, 15% had an observed to expected ratio greater (worse) than the nation’s. Massachusetts significantly lags national performance on this measure.

Continue reading

Poor Get Poorer But Babies Get Healthier, Thanks To Help For Moms

Patricia Wornum,right, is a 'home visitor' with Healthy Families. Every two weeks she check in with Keisha Harrison and her daughter, Cassidy, in their Dorchester home. (Gabrielle Emanuel/WBUR)

Patricia Wornum,right, is a ‘home visitor’ with Healthy Families. Every two weeks she check in with Keisha Harrison and her daughter, Cassidy, in their Dorchester home. (Gabrielle Emanuel/WBUR)

In elephant-print pajamas, 21-month-old Cassidy nuzzles her head into her mother’s lap and then pops up, grabs a ballpoint pen, and starts scribbling. Her squiggles decorate an important piece of paper; it contains a checklist of all the things her mother does for Cassidy, from getting her shots to daily reading aloud.

Cassidy and her mother, Keisha Harrison, are in their Dorchester living room with Patricia Wornum, a “home visitor” with Healthy Families Massachusetts. On the couch, Wornum glances at the decorated checklist and, in her perpetually upbeat manner, asks: “Any papers back from housing?”

Harrison shakes her head. She hasn’t heard anything about her various applications for subsidized public housing. She and Cassidy are staying with her mom — at age 20, she has aged out of a teen shelter — so Harrison is worried they’ve lost their spot on the housing waiting list. Wornum immediately makes a plan to figure out what’s going on. “You got this!” she says.

Wornum and over a hundred other home visitors in Massachusetts are trying to combat a known phenomenon: If you are born to a poor mother, that overwhelmingly raises the chances that you will grow up to be poor. The odds are stacked against you in several ways: Poverty can mean stress and anxiety, poor nutrition and environmental toxins, higher risks of obesity and heart disease. An entire issue of the journal Science on “The Science of Inequality” this month rounded up some of that bad news.

But it also shared what Janet Currie, an economics professor at Princeton, calls a “bright spot” — though inequality has been rising, the health of newborns born into the poorest families has been improving.  TWEET The conclusion: Public policies can make a difference and improve a child’s chance of success. The “Science” article she co-authored looks at which policies are most effective, and found many that work, from early education to family planning services. Home visiting programs like Wornum’s appear to work particularly well.

“You often just hear about how things are getting worse,” Currie says. “The unfortunate consequence of that is that people are left with the impression that nothing works. We wanted to point out that there are programs that work, that they do make a difference.”

What The Statistics Say

Keisha Harrison was in high school when she found out she was pregnant. She remembers it as a clarifying moment.

“Before I was pregnant I really didn’t think I was going to graduate,” says Harrison. “And then once I got pregnant, I just kicked everything into high gear.” Continue reading

Tick Season: Scary New Stats And Five Smart Tips (Spray Your Shoes)

A tiny nymphal deer tick among poppy seeds. Can you spot it? (TickEncounter Resource Center/ Brian Mullen)

A tiny nymphal (the most dangerous stage) deer tick on a poppy seed bagel. Can you spot it? (TickEncounter Resource Center/ Brian Mullen)

Fine. I’m a nag. I tell you the same thing over and over for your own good. But only once a year, and now is the time: Caution. Especially if you live in the Northeast, Midwest or mid-Atlantic. Watch out for the deer ticks that carry Lyme and other diseases.

This is the worst season, when the voracious adolescent “nymphal” ticks come out in force, plotting (I may be projecting a bit here) to creep under your clothes and drink your blood and give you their germs, knowing you’re unlikely to notice a dark speck the size of a poppy seed — check out the photo above — until it’s too late.

A bit of added incentive this year to take preventive measures: scary new statistics and some smart new tips. We cannot know whether this will be a particularly heavy tick year, but Dr. Catherine Brown, of the Massachusetts Department of Public Health, told WBUR, “We haven’t seen any weather in the last couple of years that is particularly bad for ticks, and so my suspicion is that there’s quite a few of them out there.”

That’s a suspicion already borne out by copious anecdotes along the lines of “I pulled a dozen of them off my dog this weekend on Cape Cod.” And tick spottings appear to be up around the country.

The scary new statistics come from the CDC: Last summer, it adjusted upward its estimate of Lyme disease prevalence by a factor of 10, to about 300,000 American cases a year. Most are easily resolved with prompt antibiotic treatment but some — an estimated 10 to 20 percent — are not, and once you’ve heard a few of the lingering Lyme horror stories, you resolve to do all you can to protect yourself and your loved ones.

‘May has definitely proven itself to be the tickiest month all across America.’
– Dr. Tom Mather

So what to do? The CDC offers its tips here, and I spoke with Dr. Tom Mather, director of the University of Rhode Island’s Center for Vector-Borne Disease and its TickEncounter Resource Center, a rich repository of evidence-based tick knowledge. He offered five fresh tips, and some new findings on how humidity affects the tick population:

1. Spray your shoes with repellent containing Permethrin. Dr. Mather: “Treating your shoes is a good idea because the nymphal-stage deer ticks are in leaf litter, and so as your shoes move through the leaf litter, that’s where those ticks take hold. They’re not going to to fall out of trees, they’re not going to fly and bite you or anything like that. They’re going to latch onto your shoes and crawl up, and they can crawl up pretty fast. And they’re going to crawl up generally inside your clothes.”

2. Pants. “And so the next place that you want to create a barrier would be your lower clothes, like pants legs. You should be treating the inside as well as the outside, or buy commercially treated clothes that are treated both inside and outside.”

3. The dryer: “Just strip your clothes off as soon as you come inside and throw them in the dryer for 10 minutes on high heat and that will pretty much desiccate any ticks you might carry in.”

4. But you can’t put your dog in the dryer: “So you want to make sure that your dog has effective quick kill product on it like Advantix II. Seresto collars are also very good.” Continue reading

CDC: Record-Breaking Year For Measles Due To Travel, Non-Vaccinated Residents

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

Measles, one of the most contagious diseases in the world, was officially eliminated from the U.S. in the year 2000.

Nevertheless, we’re in the midst of a record-breaking year for measles in this country, according to a new report from the Centers for Disease Control and Prevention, with 288 confirmed cases so far.

There are two main reasons for the spike, said Anne Schuchat, M.D. (RADM, USPHS) assistant surgeon general, United States Public Health Service and director of the CDC’s National Center for Immunization and Respiratory Diseases, speaking at a telebriefing for reporters today.

First, she said, travelers are importing measles into the U.S. from other parts of the world, including Europe, Asia, Africa and the Pacific, notably the Philippines, which has been experiencing a large measles outbreak. In addition, Schuchat said, the imported measles is spreading within communities of non-vaccinated people.

CDC: It's a record-breaking year for measles

CDC: It’s a record-breaking year for measles

From the agency’s weekly Morbidity and Mortality Report:

Most of the 288 measles cases reported this year have been in persons who were unvaccinated (69%) or who had an unknown vaccination status (20%); 30 (10%) were in persons who were vaccinated. Among the 195 U.S. residents who had measles and were unvaccinated, 165 (85%) declined vaccination because of religious, philosophical, or personal objections, 11 (6%) were missed opportunities for vaccination, and 10 (5%) were too young to receive vaccination.

When asked if the non-vaccinated U.S. residents who contracted measles had declined shots due to widely discredited information linking autism to the MMR vaccine, Schuchat said no, public health officials don’t believe that to be true.

Her bottom line message was clear, however: “This year we are breaking records for measles,” Schuchat said. “And it’s a wake up call. Measles may be forgotten but it’s not gone.” Continue reading

NIMBY Disease: Yes, U.S. Residents, You’re Vulnerable To Parasites Too

Photo by CDC/Jim Gathany: An adult triatomine, or kissing bug, with eggs. Triatomines transmit the parasite that causes Chagas disease.

Photo by CDC/Jim Gathany: An adult triatomine, or kissing bug, with eggs. Triatomines transmit the parasite that causes Chagas disease.

Just in time for outdoor-frolicking season, yet another thing to worry about: parasitic disease.

You may think this topic should be filed under: “no cause for concern;” indeed many people believe that illnesses transmitted by parasites are primarily a problem of the developing world, something you might pick up on an exotic trip, but never here at home.

Think again, says the CDC.

In a special supplement to the American Journal of Tropical Medicine and Hygiene, CDC scientists offer abundant detail on the health dangers of parasites.

Here’s the news release from the public health agency:

…parasitic infections also occur in the United States, and in some cases affect millions of people. Often they can go unnoticed, with few symptoms. But many times the infections cause serious illnesses, including seizures, blindness, pregnancy complications, heart failure, and even death. Anyone—regardless of race or economic status—can become infected.

CDC has targeted five neglected parasitic infections (NPIs) in the United States as priorities for public health action based on the numbers of people infected, the severity of the illnesses, or our ability to prevent and treat them. These NPIs include Chagas disease, cysticercosis, toxocariasis, toxoplasmosis, and trichomoniasis.

Parasitic infections affect millions around the world causing seizures, blindness, infertility, heart failure, and even death,” said CDC Director Tom Frieden, M.D., M.P.H. “They’re more common in the US than people realize and yet there is so much we don’t know about them. We need research to learn more about these infections and action to better prevent and treat them.” Continue reading

A Surprising New View Of Flu: Rethinking The 1918 Pandemic

Giving treatment to influenza patient at the U.S. Naval Hospital. New Orleans, Louisiana, Circa 1918. (Navy Medicine/Flickr)

Giving treatment to influenza patient at the U.S. Naval Hospital. New
Orleans, Louisiana, Circa 1918. (Navy Medicine/Flickr)

By Richard Knox
Guest Contributor

Ever since 1918, the world has wondered why a novel flu virus touched off an explosive pandemic that killed as many as 50 million people – most of them healthy young adults — and whether it could happen again.

Flu researchers today report some surprising news: They say the 1918 virus was no super-bug. Instead, its deadliness had to do with how very different it was from the flu viruses circulating 25 or 30 years before, when the young adults of 1918 were first exposed to the flu.

Indeed, the new study says it’s that first childhood exposure that determines how people will fight off – or fall prey to – every other flu virus they will encounter in a lifetime.

That’s a very different way of looking at flu, both pandemics and regular seasonal outbreaks.

Much of the current emphasis is on the virus itself. Scientists around the world are doing controversial “gain-of-function” experiments – adding and subtracting pieces of genes from flu strains to see what mutations make some viruses so virulent.

Instead of focusing on flu virus itself, authors of a paper published Monday in the Proceedings of the National Academy of Sciences say scientists and public health experts should pay attention to the vulnerabilities of different age groups to any new flu virus – and how those immune gaps might be filled in by targeted vaccine strategies.

“Childhood exposure seems to give kick-ass immunity to that kind of flu virus for many, many decades,” says evolutionary biologist Michael Worobey of the University of Arizona, the paper’s lead author. Continue reading

What Teens Say Teens Should Know About Sexually Transmitted Diseases

(Planned Parenthood)

(Planned Parenthood League of Massachusetts)

By Joey Boots-Ebenfield
Guest contributor

I’ve gotten used to hearing myths and misinformation when I talk about sex with fellow teens.

And I talk about sex often in my role as an 17-year-old peer educator with the Planned Parenthood Get Real Teen Council (GRTC) — a year-long high school sexual health program for 10th-12th graders who are trained to facilitate sex education workshops and serve as resources for peers, families and communities.

If teens are uncomfortable talking about topics related to sex and sexuality, or don’t have a trusted source of information about their health, it’s easy for all kinds of misinformation to spread. And of course, there’s the Internet, where bad information is often rampant, so it’s not always a reliable place to find accurate health information.

The subject of sexually transmitted diseases (STDs) is no exception. I’ve heard some pretty interesting misconceptions about what STDs are and what it’s like to get tested. One myth is that STDs have obvious symptoms, like localized pain or some other physical sign.

In fact, this is quite the opposite! STDs often show NO symptoms. This myth is especially dangerous because it means that someone can have an STD and not even know it. As a result, many STDs go untreated, which can cause cause some pretty nasty complications. Continue reading

CDC: Autism Rate Up To 1 in 68 Kids, But Still No Why

A new CDC analysis of autism prevalence shows a nearly 30 percent jump in cases between 2008 and 2010: that means 1 out of every 68 eight-year-olds in the U.S. is diagnosed with the disorder.

But health officials still don’t agree on what’s driving the increase. Debate continues to rage over whether the increase in cases is due to changing definitions and greater awareness of autism spectrum disorders, or if it’s due to some environmental or other factor.

Karen Weintraub reports for USA Today:

…virtually every grade in every elementary school has at least one child with autism – a seemingly astonishing rise for a condition that was nearly unheard of a generation ago.

What’s still unknown is the driver of that increase. Many experts believe the rise is largely due to better awareness and diagnosis rather than a true increase in the number of children with the condition.

(Jesse Costa/WBUR)

(Jesse Costa/WBUR)

“We don’t know the extent those factors explain in terms of the increase, but we clearly know they do play a role,” said Coleen Boyle, director of the National Center on Birth Defects and Developmental Disabilities at the CDC. “Our system tells us what’s going on. It (only) gives us clues as to the why.”

The aging of parents is also known to be a factor; the chances of autism increase with the age of parents at conception.

“But that’s not the whole story is it?” said Robert Ring, chief science officer for Autism Speaks, a research and advocacy group. Whether something in the environment could be causing the uptick remains “the million-dollar question,” Ring said.

Despite their concern, experts said they were not surprised by the increase, because other data had suggested the numbers would continue to climb. In New Jersey, for instance, autism rates were 50% higher than in the rest of the nation in 2000, and they remained that much higher in 2010 – suggesting the national rates will continue to rise to catch up, said Walter Zahorodny, a psychologist who directs the New Jersey Autism Study. “To me it seems like autism prevalence can only get higher,” Continue reading