public health

RECENT POSTS

Why To Exercise Today: Because It’s Not Sitting

If you’re like me, this bout of November weather in June provides yet another excuse to ratchet back your exercise regime. And that means more sitting. Do not give in. Here, two more reports underscore the perils of sitting, one from the U.K. and one out of New York City.

In the U.K., sedentary behavior “now occupies around 60% of people’s total waking hours in the general population, and over 70% in those with a high risk of chronic disease. For those working in offices, 65–75% of their working hours are spent sitting,” according a new study published online in the British Journal of Sports Medicine.

cell105/flickr

cell105/flickr

To try to get workers off their bums, public health experts issued a consensus statement urging periodic stand-up breaks during the day.

According to the panel backing the new recommendations:

…for those occupations which are predominantly desk-based, workers should aim to initially progress towards accumulating 2 hours a day of standing and light activity (light walking) during working hours, eventually progressing to a total accumulation of 4 hours a day… To achieve this, seated-based work should be regularly broken up with standing-based work, the use of sit–stand desks, or the taking of short active standing breaks.

Along with other health promotion goals (improved nutrition, reducing alcohol, smoking and stress), companies should also promote among their staff that prolonged sitting, aggregated from work and in leisure time, may significantly and independently increase the risk of cardiometabolic diseases and premature mortality.

Even New Yorkers, who live in one of the best walking cities on the planet, are sitting far longer than what’s considered healthy, according to a new study by the U.S. Centers for Disease Control and Prevention and researchers at New York University, published in the journal Preventing Chronic Disease.

Researchers found great differences among various demographics — surprisingly, higher income folks spent more time sitting compared to those with lower incomes. Continue reading

Asthma, Lyme Disease, Salmonella: How Climate Change May Worsen Your Health

EPA Administrator Gina McCarthy speaks  in Washington in 2014. (Manuel Balce Ceneta/AP/File)

EPA Administrator Gina McCarthy speaks in Washington in 2014. (Manuel Balce Ceneta/AP/File)

The link between climate change and extreme weather is widely known. But as the planet warms, what about the risks to your own personal health?

I asked U.S. Environmental Protection Agency Administrator Gina McCarthy, a Boston native in town to deliver the commencement address at UMass Boston (her alma mater), to give some specific examples of how climate change can impact human health. Here, edited, is our conversation.

RZ: So, feel free to get scary here, what should people know about climate change and their own health?

GM: As temperatures rise, smog gets worse and allergy seasons get longer, which makes it harder for our kids to breathe. We know that increasing the ozone, the ground level smog, makes it difficult for kids — and also the elderly — to breathe, it impacts their lung function. So, you’re going to see a dramatic rise in the number of kids with asthma who experience bad air days.

So, the allergy season gets longer, and this is related to the warmer temperatures as well as the later fall frosts, which means plants produce pollen later in the year. The length of the ragweed pollen season has increased in 10 of 11 locations studied in the Central U.S. and Canada.

This season is awful: I have a little allergy this year for the first time. I found myself sneezing, my eyes watering. Even the dog went on some kind of antihistamine. I felt sorry for her.

You also mentioned ticks, what will happen in their world?

Warmer temperatures also bring increases in vector-borne diseases — Lyme disease, mosquito and tick-borne diseases, and expanded seasons. What we see is that the Lyme disease areas are expanding and the number of cases is increasing. Among the states where Lyme disease is most common [New Hampshire, Delaware, Maine, Vermont, and Massachusetts], on average, these five states now report 50 to 90 more cases per 100,000 people than they did in 1991.

You can clearly see the geographic region expand. Also, West Nile Virus is expanding. Our climate assessment tracks geography and seasons getting longer, expanding. As temperatures get higher, the entire ecosystem changes. I was in Aspen, the winters are getting shorter.

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Are there any other diseases we should brace for?

There are also water and food borne diseases: salmonella, that relates to food potentially sitting out, the higher the temperature the more salmonella outbreaks. The same with water — anything that’s a bacteria — it’s going to increase in warmer weather. Continue reading

What You Really Need To Know About Dense Breasts

From left: 1) a breast of normal density showing fat (white), fibrous tissue (pink) and glands within the rectangle, while a cancer is present (circle). This illustrates the fact that cancer can occur in breasts of any density; 2) an extremely dense benign breast without any fat, composed of pink fibrous tissue and minimal amounts of glands; 3) an extremely dense breast involved by cancer (infiltrating haphazard small glands), in contrast to Fig 2, but very similar in appearance, demonstrating the subtle similarities. (Courtesy Michael Misialek)

From left: 1) a breast of normal density showing fat (white), fibrous tissue (pink) and glands within the rectangle, while a cancer is present (circle). This illustrates the fact that cancer can occur in breasts of any density; 2) an extremely dense benign breast without any fat, composed of pink fibrous tissue and minimal amounts of glands; 3) an extremely dense breast involved by cancer (infiltrating haphazard small glands), in contrast to Fig 2, but very similar in appearance, demonstrating the subtle similarities. (Courtesy Michael Misialek)

By Michael Misialek, M.D.
Guest Contributor

Reading the pathology request on my next patient, I saw she was a 55-year-old with an abnormality on her mammogram. Upon further investigation I discovered she had dense breasts and a concerning “radiographic opacity.” The suspicion of cancer was high based on these findings and so, a breast biopsy had been recommended. As I placed the slide on my microscope and brought the tissues into focus, I immediately recognized the patterns of an invasive cancer. Unfortunately the suspicion had proven correct.

Just a few patients earlier, an almost identical history had prompted another breast biopsy. This time the results were far different, a benign finding and obviously a sense of relief for the woman. Every day these stories unfold; the never ending workup of abnormal mammogram findings. Both radiographically and microscopically, it can be challenging at times sorting out these diagnoses, particularly in the face of dense breasts.

But what, exactly, are dense breasts and why are they suddenly in the news?

Breast Tissue 101

Breast tissue is actually made up of three tissue types when viewed under the microscope. The percentage of each varies between patients. There is fat, fibrous tissue (the supporting framework) and glandular tissue (the functional component). This is what I actually see under the microscope. Cancer can occur in fatty or dense breasts. It can be toughest to assess when the background is dense.

Biopsy, considered the gold standard in diagnosis, may even prove difficult to interpret when in the background of dense breasts. Dense breasts can hide a cancer, making it more difficult to detect both by mammogram and under the microscope.

Breast density has taken a lot of heat recently. A new study published in the Annals of Internal Medicine found that not all women with dense breasts and a normal mammogram warranted additional screening, as was previously thought. Understandably this report has received much attention. The authors found nearly half of all women had dense breasts. This alone should not be the sole criterion by which additional imaging tests are ordered since these women do not all go on to have a cancer. Clearly other risk factors are at play.

Confusion All Around

This is confusing for patients and doctors alike, especially when it seems as if screening guidelines are a moving target. Recently, the American College of Physicians issued new cancer screening guidelines: among these was mammograms, being recommended every two years. This too is getting a lot of press.

The American College of Radiology, American Cancer Society, Society of Breast Imaging and American College of Obstetricians and Gynecologists recommend yearly mammograms beginning at age 40. Continue reading

Report: Judge Approves $200M Settlement Plan For New England Compounding Center Victims

A Massachusetts bankruptcy judge gave verbal approval for a $200 million settlement plan for victims of a national meningitis outbreak linked to the New England Compounding Center, the Boston Business Journal reports. Continue reading

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Study: Even After Depression Lifts, Sufferers Face Higher Stroke Risk

(mac keer/Flickr)

(mac keer/Flickr)

In case you missed this piece on NPR today, it’s worth a listen: Harvard researchers have found that long after the dark symptoms of depression have lifted, those of us who suffered from the disorder have an increased risk of stroke later in life.

Patti Neighmond reports on the new study, published in the Journal of the American Heart Association:

Medical researchers have known for several years that there is some sort of link between long-term depression and an increased risk of stroke. But now scientists are finding that even after such depression eases, the risk of stroke can remain high.

“We thought that once people’s depressive symptoms got better their stroke risk would go back down to the same as somebody who’d never been depressed,” says epidemiologist Maria Glymour, who led the study when she was at Harvard’s T.H. Chan School of Public Health. But that’s not what her team found.

Even two years after their chronic depression lifted, Glymour says, a person’s risk for stroke was 66 percent higher than it was for someone who had not experienced depression.

The study authors conclude that to mitigate this risk of stroke, depression should be identified and treated early:

This study, in conjunction with other work confirming that depressive symptoms are causally related to stroke risk, suggests that clinicians should seek to identify and treat depressive symptoms as early as possible relative to their onset, before adverse consequences begin to accumulate.

Continue reading

50 Years Of American Health Choices: Smoking Gains Offset By Getting Fatter

(Lucia Sofo via Wikimedia Commons)

(Lucia Sofo via Wikimedia Commons)

Feeling optimistic? Then you may see the moral of this story as, “Yay, public health efforts! They can wield amazing power and save many lives.”

In more of a glass-half-empty mood? Then your takeaway may be, “If it’s not one thing, it’s another.” Or perhaps, that public health must play an eternal game of Whack-a-Mole.

The story itself: The National Bureau of Economic Research just sent over word of a new working paper that looks at American health behaviors and their effects over 50 years, from 1960 to 2010. It examined six behaviors: obesity, smoking, heavy drinking, unsafe driving, firearms, and poison or overdoses. What most struck me: Though we’re generally living longer, our health gains from shunning cigarettes and safer driving are all but erased by the rise in obesity and drug overdoses. Sigh. From the summary:

(Source: NBER working paper 20631, “The Contribution of Behavior Change and Public Health to Improved U.S. Population Health”)

(Source: NBER working paper 20631, “The Contribution of Behavior Change and Public Health to Improved U.S. Population Health”)

…The authors find that the gains associated with declines in smoking, motor vehicle fatalities, and heavy drinking are essentially offset by the losses arising from rising obesity and misuse of firearms and poisonous substances. Valued in dollar terms, there is a near zero net gain in health from public health and behavioral changes over the past fifty years. However, the analysis includes a mix of some risk factors that have been aggressively addressed through public health and behavioral changes over a long period (smoking, unsafe driving), and others that are in the earlier stages of being addressed and have proven challenging (obesity, prescription drug addiction).

The authors conclude “our study demonstrates the enormous benefits of public health and behavioral change in improving population health, underscoring the importance of continued advances in these areas of research and practice.”

I asked Harvard health economist David Cutler, who co-authored the report, what he’d want the public’s takeaway to be (and included a plea to help me beat down my own cynicism.) His e-mailed response:

There are some who see this as ‘glass mostly empty’ – i.e., if it’s not one thing, it’s another. But remember how hard these changes are. Quitting smoking is very difficult, and yet millions of people have done it. Reducing caloric intake is very difficult, though weights finally seem to be stabilizing. The difficulty of these interventions makes the successes particularly notable.

Readers, your own thoughts? Read the full paper here and the summary here.

Elmo’s New Buddy, The Surgeon General, And Other Health Chiefs Urge Vaccines

 

Vivek H. Murthy, video star and Friend of Elmo. Who’d have thought, back when Dr. Murthy’s appointment to be the U.S. surgeon general was facing political fire, that this would be the sequel? But there he is in a popular new video, cavorting with Elmo. Okay, not cavorting, but rather working nicely together with Elmo to help promote vaccinations while the recent Disneyland measles outbreak is still fresh in memory.

And Dr. Murthy’s big-city colleagues are also going visual to promote vaccinations: Public health chiefs from Los Angeles County to Boston are just out with a series of videos in which they personally urge their residents to get their kids immunized. See the full collection here, including Boston’s Huy Nguyen (below). The videos, part of the Big Cities Health Coalition, are aimed at health districts with a combined population of 14 million.

Recent history: When President Obama proposed Dr. Murthy, then at Brigham and Women’s Hospital, as surgeon general in late 2013, colleagues showered him with praise and said they expected him to be a progressive and visible leader. Then, last year, opposition from gun groups — Murthy had expressed support for gun control in the wake of the Newtown shootings — held up and threatened to scuttle his confirmation. But in December, in a squeaker vote, he got the nod.

And now here he is, living up to predictions that he would be “visible” — and on “Sesame Street,” no less. After Elmo gets his vaccination in the video above, he (it?) says, “That was so easy! Why doesn’t everyone get a vaccination?” Dr. Murthy strokes his chin: “That’s a good question, Elmo, that’s a good question…”

Harvard Study: Better Police Reports On Bike Crashes Could Save Lives

A "ghost bike" is placed in memory of Marcia Deihl, who was killed in a crash in Cambridge, Massachusetts, on March 11. (Rachel Zimmerman/WBUR)

A “ghost bike” is placed in memory of Marcia Deihl, who was killed in a crash in Cambridge, Massachusetts, on March 11. (Rachel Zimmerman/WBUR)

Last month, Marcia Deihl, a songwriter and community activist out for a bike ride on the first warm day after a brutal winter, was struck and killed by a dump truck outside a Whole Foods in Cambridge, Massachusetts. A white “ghost bike” now memorializes her death.

Aspiring photojournalist Christopher Weigl, just 23, was also killed in a bike accident: Wearing a helmet, and traveling in the bike lane near Boston University, Weigl collided with a 16-wheel tractor trailer when the truck made a wide right turn in the winter of 2012.

And less than a year before that, MIT graduate student Phyo N. Kyaw sustained fatal injuries when his bike collided with a truck in a busy Cambridge intersection.

These deaths happened close to home: where I work, shop, ride with my kids. And they underscore two truths: There are more cyclists on the road, and more of them are getting hurt in accidents, some fatal. The number of commuters who bike to and from work rose about 62 percent nationwide from 2000 to 2013, one report found. With those numbers comes added risk: 726 bicyclists were killed and 49,000 bicyclists injured in 2012, according to the National Highway Traffic Safety Administration.

As a driver, you don’t need a research study to tell you that bikes are everywhere, whether you’re in Boston, New York or Seattle. But you do need research, and data, to help fix the problem — that is, reduce the number of accidents and deaths.

(Source: National Highway Traffic Safety Administration)

(Source: National Highway Traffic Safety Administration)

Cities, towns, planners and private businesses can’t move forward building safer cars and safer bike environments until they learn more precisely how bike accidents happen. Is a truck’s wide turn to blame? A taxi door opening at the wrong time? These seemingly small details of crashes are critical, says Anne Lusk, a research scientist in the Department of Nutrition at the Harvard School of Public Health.

That’s why Lusk and her colleagues have issued a blueprint of sorts for improving bike-vehicle crash reports produced by the police; their findings are published this week in the journal Injury Prevention.

After studying hundreds of hopelessly low-tech police reports used to record bike accidents, Lusk and her colleagues are making a nationwide plea: They’re calling on police in all states to step into the modern era and improve reports on crashes involving vehicles and bicycles. Currently, Lusk said in an interview, the details on crashes are handwritten and drawn by police on paper, with few bicycle-specific codes or diagrams.

Lusk offered one example: Currently, a crash report from Massachusetts shows “two vehicles” drawn. One of the “vehicles” is then coded as a “pedal cyclist” but there is no drawing on the template of a bicycle to show which side of the bike was hit.

Police have been recording bike crashes since the introduction of the bicycle in 1890, researchers note.

Now it’s time for a major upgrade. Lusk says police should “use electronic tablets with dropdown menus that have specific vehicle/bicycle codes, for instance, whether the bicyclist was riding inside a painted bike lane when hit, or whether the cyclist crashed into a driver’s open car door. The dropdown menu would also include other specific data like a coded vehicle picture and a coded bicycle picture. This information could then be automatically loaded onto spreadsheets for later analysis, Lusk said. Continue reading

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What To Expect When You’re Birthing At Home: A Hospital C-Section (Possibly)

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By Ananda Lowe
Guest Contributor

The term “homebirth cesarean” didn’t exist before 2011, when Oregon mother and student midwife Courtney Jarecki coined it. But now, a Google search returns almost 2,000 entries on the topic.

The term refers to a small but emerging community of mothers who have experienced the extremes of birth: They’d planned to have their babies at home, but ended up in a hospital, most often in the operating room having a cesarean section, major abdominal surgery. Needless to say, the effect of such a dramatic course change takes a toll, and can often be overwhelming.

(“Homebirth cesarean” can also refer to births that were planned to occur at a freestanding birth center outside of a hospital, but eventually were transferred to the hospital for a cesarean.)

How often does this happen?

Home births, though a small fraction of the approximately 3.9 million births a year in the U.S., are on the rise. Based on the most recent birth data from the National Center for Health Statistics, “the 36,080 home births in 2013 accounted for 0.92% of all U.S. births that year, an increase of 55% from the 2004 total.”

Eugene Declercq, a professor of community health sciences at Boston University School of Public Health, studies national birth trends. He said in an email that while there are no nationwide numbers on homebirth transfers to the hospital, “the studies that have been done usually report about a 12% intrapartum transfer rate.”

But beyond the numbers, what happens emotionally when your warm and fuzzy image of natural childbirth in the comfort of home suddenly morphs into the hard reality of a surgical birth under fluorescent lights?

A woman who'd planned a homebirth but ended up having a cesarean in the hospital. (Photo courtesy: Courtney Jarecki)

A woman who’d planned a homebirth but ended up having a cesarean in the hospital. (Photo courtesy: Courtney Jarecki)

Jarecki founded the homebirth cesarean movement to figure that out. She connected women who, like herself, shared the experience of giving birth through full surgical intervention, despite their original plans of having their babies at home or outside of the established medical system.

In Jarecki’s case, she labored at home for 50 hours until her midwives detected a rare complication known as a constriction ring, or a thickened band of tissue in her uterus that was impeding progress. Shortly after this, meconium appeared, and Jarecki knew it was time to go to the hospital. Her emotional response to the intensity of the situation, however irrational, was one of anger, shame and failure at her ability to give birth normally. A cesarean followed.

Over the next several years, Jarecki began helping other homebirth cesarean mothers emerge from the silence and shame they felt confronting their unexpected surgeries. Some of these women also report that their postpartum recovery was tougher because their unique needs were not adequately addressed by their home birth midwives or their hospitals.

Jarecki started by launching a (now busy) Facebook page as a support group for these mothers and their health care providers.

Childbirth Expectations vs. Reality

Rule number one in childbirth is that it rarely unfolds as you expect. Continue reading

Dementia As A Global Public Health ‘Tidal Wave’

We often think of dementia as a private, intimate hell. A mother no longer recognizes her daughter’s voice. A father rages incoherently at a family dinner.

But it’s worth remembering the global scope of dementia; it’s a looming, worldwide public health disaster, a ‘tidal wave,” as the head of the World Health Organization recently put it, that’s growing worse each year.

This week, the World Health Organization held the first-ever ministerial conference calling for global action against dementia, saying, essentially, enough already, this is something we really need to deal with now.

The WHO’s Director General, Dr. Margaret Chan, offered some sobering perspective in her opening remarks and noted that there are three specific reasons to act now: “Dementia has a large human cost. Dementia has a large financial cost. Both of these costs are increasing.”

According to remarks distributed by the WHO, Chan spoke of dementia, including Alzheimer’s, in dire terms:

“The world has plans for dealing with a nuclear accident, cleaning up chemical spills, managing natural disasters, responding to an influenza pandemic, and combatting antimicrobial resistance. But we do not have a comprehensive and affordable plan for coping with the tidal wave of dementia that is coming our way.”

And the numbers are staggering:

–Dementia currently affects more than 47 million people worldwide, with more than 75 million people estimated to be living with dementia by 2030. The number is expected to triple by 2050.

–Dementia leads to increased long-term care costs for governments, communities, families and individuals, and to productivity loss for economies. The global cost of dementia care in 2010 was estimated to be U.S. $604 billion – 1.0% of global gross domestic product. By 2030, the cost of caring for people with dementia worldwide could be an estimated US $1.2 trillion or more, which could undermine social and economic development throughout the world.

–Nearly 60% of people with dementia live in low- and middle-income countries, and this proportion is expected to increase rapidly during the next decade, which may contribute to increasing inequalities between countries and populations.

Continue reading