Earlier this year I returned from a two-day meeting on the West Coast. The schedule was reasonable and the travel, this time, was easy.
Still, it took me an entire week to recover. It didn’t use to be like this. Maybe I’m getting old?
Although business travel can be exciting and even fun, it is a surprisingly profound stressor on the body, mind, emotions, and spirit.
We’re rushing to make flights, waiting in lines, suffering through flight delays, and subjected to surly flight attendants and annoyed fellow passengers. Then we have to sit still for hours, while flying through the air in a metal tube. On arrival, we need to adjust to time differences, hotel rooms, and disrupted routines. We’re separated from our families, friends, and the comforts of home.
Because of this increased stress and altered schedule, we tend to sleep less soundly and for fewer hours. We work out less, eat poorly, and often drink more alcohol than usual. All of which, of course, adds to our stress.
Offering smoking mothers-to-be a financial incentive to put down their cigarettes may not only be a successful approach but a cost-effective one as well. At least, that's the verdict handed down by a study published this November in the journal Addiction.
The study authors, after analyzing the results of a randomized trial of more than 600 Scottish pregnant smokers, found that the potential reward of a $600 voucher to quit smoking ultimately proved to be both a clinically and economically worthwhile treatment — accruing an incremental cost-effectiveness ratio (ICER) of $734 per quality-adjusted life year (QUALY). According to the authors, these costs are well below the recommended threshold of money that should be spent on a preventative treatment capable of providing a person with a healthy year of life — in the UK, that’s £20 000 ($30,000 US), a standard comparable with other high-income countries like the US.
Readers in Grenoble can now nibble fiction instead of vending machine snacks, after publisher Short Édition introduced eight short-story dispensers around the French city.
The free stories are available at the touch of a button, printing out on rolls of paper like a till receipt. Readers are able to choose one minute, three minutes or five minutes of fiction, and, just two weeks since launch, co-founder Quentin Pleplé says that more than 10,000 stories have already been printed.
“The feedback we got has been overwhelmingly positive [and] we are thrilled to see it working so well,” said Pleplé. “There are only eight dispensers in the city of Grenoble for now but we are planning to introduce way more. We are getting requests from all over the world – Australia, the US, Canada, Russia, Greece, Italy, Spain, Chile, Taiwan – that we are processing meticulously one by one.”
For the microbiologist Justin Sonnenburg, that career-defining moment—the discovery that changed the trajectory of his research, inspiring him to study how diet and native microbes shape our risk for disease—came from a village in the African hinterlands.
A group of Italian microbiologists had compared the intestinal microbes of young villagers in Burkina Faso with those of children in Florence, Italy. The villagers, who subsisted on a diet of mostly millet and sorghum, harbored far more microbial diversity than the Florentines, who ate a variant of the refined, Western diet. Where the Florentine microbial community was adapted to protein, fats, and simple sugars, the Burkina Faso microbiome was oriented toward degrading the complex plant carbohydrates we call fiber.
Scientists suspect our intestinal community of microbes, the human microbiota, calibrates our immune and metabolic function, and that its corruption or depletion can increase the risk of chronic diseases, ranging from asthma to obesity. One might think that if we coevolved with our microbes, they’d be more or less the same in healthy humans everywhere. But that’s not what the scientists observed.
Among the challenges facing research translation—the effort to move evidence into policy and practice—is that key questions chosen by investigators and funders may not always align with the information priorities of decision makers, nor are the findings always presented in a form that is useful for or relevant to the decisions at hand. This disconnect is a problem particularly for population health, where the change agents who can make the biggest difference in improving health behaviors and social and environmental conditions are generally nonscientists outside of the health professions. To persuade an audience that does not read scientific journals, strong science may not be enough to elicit change. Achieving influence in population health often requires four ingredients for success: research that is responsive to user needs, an understanding of the decision-making environment, effective stakeholder engagement, and strategic communication. This article reviews the principles and provides examples from a national and local initiative.
California Department of Public Health (CDPH) State Public Health Officer Dr. Karen Smith today announced that CDPH has received the first report of an influenza-associated fatality in a person under the age of one year for the 2015-2016 flu season. The death occurred in Stanislaus County and serves as another somber reminder that influenza can cause serious illness or death.
“As California’s public health officer, I am saddened when the flu turns into loss of life,” Dr. Smith said. “It is especially troubling when a baby, too young to be vaccinated, passes away. To protect babies who cannot yet be vaccinated, we should get our flu shots. Preventing the spread of this often deadly disease is why getting vaccinated is so important.”
Young children less than a year of age are at increased risk of severe influenza. While children cannot be vaccinated for the flu until they are six months old, there are several ways to protect them. Pregnant women should get vaccinated. This will protect the mother and the newborn baby. Also, anyone who is around a young child or other high-risk person should be vaccinated to reduce the risk of spreading influenza. Overall influenza activity in California remains sporadic, but Dr. Smith points out that influenza viruses circulate at their peak levels from December through April.
"I urge you to be vaccinated now before the flu really spreads widely to protect yourself and those around you," said Dr. Smith.
Conclusions and Relevance Long-term optimization of glycemic control is not achieved by a majority of individuals with diabetes. The addition of personalized education and risk assessment during retinal ophthalmologic visits did not result in a reduction in HbA1c level compared with usual care over 1 year. These data suggest that optimizing glycemic control remains a substantive challenge requiring interventional paradigms other than those examined in our study.
Past research shows that more than 85 percent of US adults who are dependent on alcohol are also dependent on nicotine, but why do the two go hand in hand?
Now, a new study with rats finds that nicotine cancels out the sleep-inducing effects of alcohol.
“We know that many people who drink alcohol also use nicotine, but we don’t know why exactly that is,” says Mahesh Thakkar, associate professor and director of research in the University of Missouri School of Medicine’s neurology department and lead author of the study.
“We have found that nicotine weakens the sleep-inducing effects of alcohol by stimulating a response in an area of the brain known as the basal forebrain. By identifying the reactions that take place when people smoke and drink, we may be able to use this knowledge to help curb alcohol and nicotine addiction.”
Dr Ekant Veer, Associate Professor of Marketing, School of Business and Economics In all likelihood, even if everyone knew what would guarantee a healthy life, would it really make any difference? There are many things that we know are extremely unhealthy, but still continue in our society: tobacco smokers likely know it is harmful to their health, but they continue to smoke, and binge drinkers probably know they will have a hangover in the morning, but they continue to drink excessively. Knowing something is healthy or unhealthy is only one part of the equation. Making people care about their health and care about making healthy choices is also needed to encourage a healthier life. Unfortunately, most public service campaigns focus heavily on education and not enough on making people care. This talk takes a consumer behaviourist perspective to first understand how people consume and engage in behaviours that may be deemed unhealthy; then use the same motivations to engage people to consume in a healthier manner. This talks draws heavily on research from Dr Veer and other consumer researchers engaged in initiatives to promote public health in New Zealand and internationally.
In May 2012, the US Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA)–based screening for prostate cancer, giving it a grade D and concluding, “there is moderate certainty that the benefits of PSA-based screening from prostate cancer do not outweigh the harms.”1Rather than put an end to this controversy over screening, this recommendation further fueled a contentious ongoing debate.
The Community Preventive Services Task Force recommends early childhood education programs based on strong evidence of effectiveness in improving educational outcomes that are associated with long-term health and sufficient evidence of effectiveness in improving social- and health-related outcomes.
No doubt can remain as to the growing importance of the patient’s voice in biomedical research and regulatory science after U.S. President Barack Obama clearly stated that people would not be treated as subjects in the Precision Medicine Initiative but would be partners in the process. He said, “… I’m proud we have so many patients’ rights advocates with us here today. They’re not going to be on the sidelines. It’s not going to be an afterthought. They’ll help us design this initiative from the ground up, making sure that we harness new technologies and opportunities in a responsible way” (1).
The latest bold commitment comes from the U.S. Food and Drug Administration’s (FDA’s) Center for Devices and Radiological Health (CDRH), which has opened an announcement in the Federal Regulations establishing a patient engagement advisory committee to advise the FDA commissioner (or designee) on complex issues related to the regulation of medical devices and their use by patients. CDRH’s acting associate center director of science and strategic partnerships, Kathryn O’Callaghan, specifically noted during her presentation on 6 October 2015 at the AdvaMed 2015 conference that patient input informs the total medical product life cycle by providing (i) patient-informed needs during discovery and ideation, (ii) patient-informed clinical trial design and patient-reported outcomes in the clinical phase, (iii) patient preference regarding benefit-risk information in regulatory decision-making, (iv) communication of benefit-risk information to patients during product launch, and (v) patient-centered outcomes as products are launched and transitioned to postmarket monitoring. CDRH has also been engaged in a project with the Medical Device Innovation Consortium (MDIC) (2) to develop a patient-centered benefit-risk assessment framework and catalog of methods to help patients and providers better understand patient preferences regarding clinical benefits versus risks of devices, including those related to the treatment of obesity (3).
The process of distilling and disseminating the best available evidence from research, context and experience, and using that evidence to inform and improve public health practice and policy.
Put simply, it means finding, using and sharing what works in public health.
STEPS in Evidence-Informed Public Health
Click on the diagram below for more information and helpful links to help you understand how to complete each step of the process. Find links to recommended methods and tools from our Registry that are applicable to each step.
Sorpresa, i tagli non fanno male alla sanità. A smentire studi e analisi è la nuova classifica delle Regioni sulla erogazione dei Lea, i livelli essenziali di assistenza. Al di là dal chi sale e chi scende e dal fatto che Sud più Lazio arrancano, i dati 2014 dicono che salvo Piemonte, Calabria, Veneto ed Umbria, in peggioramento rispetto all’anno precedente e l’Emilia Romagna stabile, tutte le altre migliorano le loro performance. Con passi avanti da gigante proprio per due regioni meridionali: Puglia e Basilicata, che ricoprono rispettivamente il 12° e l’8° posto in classifica.
Per il secondo anno consecutivo la medaglia d’oro va alla Toscana con 217 punti, mentre l’Emilia si conferma al secondo posto e il Piemonte mantiene un piede sul podio, ma con 194 punti anziché 201. In fondo alla classifica la Calabria con 131 punti, preceduta da Campania (139) e Molise (148).
The University of Colorado is returning $1 million from Coca-Cola for a group dedicated to ending obesity after criticism it tried to play down the role sugary drinks play in fueling weight gain.
The money was provided to establish the Global Energy Balance Network, which says it is working on an “evidence-based approach to ending obesity.” Since a New York Times story noted its funding from Coke in August, the group has been criticized for trying to play down the role sugary drinks play in fueling weight gain and instead playing up the importance for physical activity.
The group’s president, James Hill, is a professor at the university.
If the world were mapped according to how many scientific research papers each country produced, it would take on a rather bizarre, uneven appearance. The Northern hemisphere would balloon beyond recognition. The global south, including Africa, would effectively melt off the map.
This image makes a dramatic point about the complexities of global inequalities in knowledge production and exchange. So what is driving this inequality and how can it be corrected?
Importance In older adults with multiple serious comorbidities and functional limitations, the harms of intensive glycemic control likely exceed the benefits.
Objectives To examine glycemic control levels among older adults with diabetes mellitus by health status and to estimate the prevalence of potential overtreatment of diabetes.
Design, Setting, and Participants Cross-sectional analysis of the data on 1288 older adults (≥65 years) with diabetes from the National Health and Nutrition Examination Survey (NHANES) from 2001 through 2010 who had a hemoglobin A1c (HbA1c) measurement. All analyses incorporated complex survey design to produce nationally representative estimates.
Exposures Health status categories: very complex/poor, based on difficulty with 2 or more activities of daily living or dialysis dependence; complex/intermediate, based on difficulty with 2 or more instrumental activities of daily living or presence of 3 or more chronic conditions; and relatively healthy if none of these were present.
Main Outcomes and Measures Tight glycemic control (HbA1c level, <7%) and use of diabetes medications likely to result in hypoglycemia (insulin or sulfonylureas).
Results Of 1288 older adults with diabetes, 50.7% (95% CI, 46.6%-54.8%), representing 3.1 million (95% CI, 2.7-3.5), were relatively healthy, 28.1% (95% CI, 24.8%-31.5%), representing 1.7 million (95% CI, 1.4-2.0), had complex/intermediate health, and 21.2% (95% CI, 18.3%-24.4%), representing 1.3 million (95% CI, 1.1-1.5), had very complex/poor health. Overall, 61.5% (95% CI, 57.5%-65.3%), representing 3.8 million (95% CI, 3.4-4.2), had an HbA1c level of less than 7%; this proportion did not differ across health status categories (62.8% [95% CI, 56.9%-68.3%]) were relatively healthy, 63.0% (95% CI, 57.0%-68.6%) had complex/intermediate health, and 56.4% (95% CI, 49.7%-62.9%) had very complex/poor health (P = .26). Of the older adults with an HbA1c level of less than 7%, 54.9% (95% CI, 50.4%-59.3%) were treated with either insulin or sulfonylureas; this proportion was similar across health status categories. During the 10 study years, there were no significant changes in the proportion of older adults with an HbA1c level of less than 7% (P = .34), the proportion with an HbA1c level of less than 7% who had complex/intermediate or very complex/poor health (P = .27), or the proportion with an HbA1c level of less than 7% who were treated with insulin or sulfonylureas despite having complex/intermediate or very complex/poor health (P = .65).
Conclusions and Relevance Although the harms of intensive treatment likely exceed the benefits for older patients with complex/intermediate or very complex/poor health status, most of these adults reached tight glycemic targets between 2001 and 2010. Most of them were treated with insulin or sulfonylureas, which may lead to severe hypoglycemia. Our findings suggest that a substantial proportion of older adults with diabetes were potentially overtreated.
I cannot imagine not imagine a more tragic time to lose your life than in the very moment you are giving life to your child.
The chart shows how much rarer maternal mortality has become. Let’s look back a hundred years: Out of 100,000 child births about 500 to 1,000 ended with the death of the mother. This means every 100th to 200th birth lead to the mother’s death. Since women gave birth much more often than today the death of the mother was a common tragedy.
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