Episurveillance
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21st century Epidemiological Surveillance. New maps, new formulas, new techniques.
Curated by Brian Altonen
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History and Public Health - Polio Vaccines finally approved 60 years ago today

History and Public Health - Polio Vaccines finally approved 60 years ago today | Episurveillance | Scoop.it

Today, April 26, 2014, marks the 60th Anniversary of the initiation of the polio vaccine!

 

Invented by Jonas Salk, experimental trails of this vaccine were initiated on April 26, 1954.  The first vaccines were provided to children at Franklin Sherman Elementary School, McLean, Virginia. Ultimately, 1.8 million children would be vaccinated for this trial.  

 

Albert Savin developed an attenuated form of this organism that could be administered orally several years later (ca. 1957).  This method was later licensed for its first clinical trials by 1962.  

 

The important lesson here:  progress came about quickly due the creation of an oral vaccine; it took just a half century to nearly wipe out polio disease worldwide, whereas certain pox, measles and other infectious diseases requiring injections continue to produce outbreaks.

 

 

Brian Altonens insight:

The pictures provided here (minus the descriptive text) are from the AMA's "family health magazine" Hygeia, published in 1944.
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The problem as it existed at this time is discussed in detail in Mark Graczyk's "HIDDEN HISTORY: Polio outbreaks hit area, 1939 & 1944."
http://thedailynewsonline.com/blogs/mark_my_words/article_03cf064a-e8ce-11e2-8327-001a4bcf887a.html 
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The magazine Hygeia was devoted to health and targeted the average American households (not to be confused with a contemporary journal bearing the same name, published in India). The title Hygeia was in use from 1923 to 1949, after which it was renamed Today's Health (1950-1976).
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More on the Polio vaccine and its history can be found at the History Channel: http://www.history.com/this-day-in-history/polio-vaccine-trials-begin
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"The Charbor Chronicles". Saturday, April 26, 2014. "On This Day in History - April 26 Polio Vaccine Trials Begin" at http://charbor74.blogspot.com/2014/04/on-this-day-in-history-april-26-polio.html
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Smithsonian National Museum of American History wepage. "Whatever Happened to Polio? " http://amhistory.si.edu/polio/virusvaccine/clinical.htm
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Polio Eradication - Global Status and Progress. UNICEF. at http://www.unicef.org/media/media_18981.html

Brian Altonen's curator insight, April 26, 2014 6:09 PM

The pictures provided here (minus the descriptive text) are from the AMA's "family health magazine" Hygeia, published in 1944.    

 

The problem as it existed at this time is discussed in detail in Mark Graczyk's "HIDDEN HISTORY: Polio outbreaks hit area, 1939 & 1944."  

 http://thedailynewsonline.com/blogs/mark_my_words/article_03cf064a-e8ce-11e2-8327-001a4bcf887a.html 

 

The magazine Hygeia was devoted to health and targeted the average American households (not to be confused with a contemporary journal bearing the same name, published in India).  The title Hygeia was in use from 1923 to 1949, after which it was renamed  Today's Health (1950-1976).  

 

More on the Polio vaccine and its history can be found at the History Channel: http://www.history.com/this-day-in-history/polio-vaccine-trials-begin

 

"The Charbor Chronicles".  Saturday, April 26, 2014. "On This Day in History - April 26 Polio Vaccine Trials Begin" at http://charbor74.blogspot.com/2014/04/on-this-day-in-history-april-26-polio.html

 

Smithsonian National Museum of American History wepage. "Whatever Happened to Polio? "   http://amhistory.si.edu/polio/virusvaccine/clinical.htm

 

Polio Eradication - Global Status and Progress.  UNICEF.  at http://www.unicef.org/media/media_18981.html

 

 

 

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From where cometh the Bearded Dragon my Lady?

From where cometh the Bearded Dragon my Lady? | Episurveillance | Scoop.it

One more pet for the household, one more source of yet another zoonotic disease . . . an increasingly popular pet, the Bearded Dragon, is linked to Salmonella outbreaks in the US.  Like many pet-borne diseases, this foreign animal disease source (host or carrier) enters this country through just a few ports along eastern and western shores.

Brian Altonens insight:

When it comes to variety, there are enough zoonotic diseases to go around.    We have a number of zoonotic diseases we can call our own, some that make their way regularly into the U.S. from Canada and Mexico, and others that sneak past the borders we set up in airports and shipping ports.  Tracing zoonotic disease migration is a primary objective for WHO and anti-bioterrorism global epidemiologic surveillance programs.  Zoonotic diseases are the most understandable disease ecology patterns due to their natural ecology.  What is not so well understood is the human ecology of zoonotic diseases that become capable of causing human infections.  

The hybridized anthropozoonotic disease theories, which were used to explain why some diseases were capable of infecting man and animal alike, made Russia the global expert in zoonosis (the study of animal born diseases) back in the 1940s.  This tradition remains Russia's major advantage over most other countries when it comes to environmental disease research.  But this certainly is nothing to brag about.  

 

In recent years diseases that were once found mostly or only in Eurasia have penetrated our borders.  Some accomplished this naturally, others due to commercial trade practices, and a few due mostly to human migration and transportation patterns..

 

Current anti-bioterrorism programs specialize in understanding the natural and human ecology of foreign born infectious zoonotic diseases.  There are dozens of domestic zoonotic diseases that may also be researched and monitored as a regular part of any managed care epidemiologic surveillance program.

 

So how does the bearded dragon make its way from its carrier's native country, Australia, into this country?  

 

Indirect passage has been documented for Salmonella enterica out of Germany and Austria (L. Geue, U. Loscher. Veterinary Microbiology, 84(1):79-91.  2002).  Iguanas in general and Salmonella marina tend to recur in the U.S. with children (J. Mermin, B. Hoar, F. J. Angulo.  Pediatrics 99(3), 399-402. 1997).  But the climate and topography of lizard-bearing regions in Australia, due to similar regions found in the U.S., may be the reason why this disease behaves the way that it does, and may be used to predict if and how it could become a natural part of the local ecology in some parts of the U.S..  

 

A basic online summary of zoonotic disease patterns (an extensive list with explanations) was penned by Veterinary physician Ron Hines, at "Diseases we catch from our Pets," at http://www.2ndchance.info/zoonoses.htm

 

CDC information on this topic begins at http://www.cdc.gov/ncidod/diseases/pets/

 

For a controversial review on how natural ecology supercedes all of the most basic basic epidemiological intellectualism on how and why countries become "healthier" as they advance, see  http://www.columbia.edu/itc/hs/pubhealth/rosner/g8965/client_edit/readings/week_2/mckinlay.pdf

 

For more on zoonotic GIS and spatial epidemiology, its history and theory, go to the review at  http://brianaltonenmph.com/gis/historical-disease-maps/zoonoses/


To see where they are most likely to enter--go to my video on the majority of zoonotic disease patterns, combined into one metric, at https://www.youtube.com/watch?v=NWYslHBLzeI

 

The anti-bioterrorism, anti-agriterrorism concerns about Emerging Disease patterns are reviewed at https://www.youtube.com/playlist?list=PLWrApErk5byYvO6ZHvDzgzmPqOGs1WI9B

 

Finally, for something simple, see Robert Roy Britt's 'Ten Deadly Diseases that Hopped Across Species'.  At   http://www.livescience.com/12951-10-infectious-diseases-ebola-plague-influenza.html

 

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Into population health statistics? What is your goal for 2014?

Into population health statistics?   What is your goal for 2014? | Episurveillance | Scoop.it

The untapped potential of NPHG and mapping US population statistics--a most important example: childhood health statistics and their importance in light of the Columbine tragedy. 

Brian Altonens insight:

Sunday, April 20th, 2014, marks the 15th year since the Columbine event.  How much have we progressed since then in the population health public health surveillance fields?

Several hundred indicators can be measured to monitor the physical and mental health in children and young adults, to determine how it might potentially impact the safety and health of the children in our schools.  We can evaluate this population health behavior by monitoring specific ICDs, V-codes and E-codes, relying heavily upon EMR and digitized medical records information.

By the end of 2014 such a method of monitoring health in this country could be (and should be) fully implemented, for use in producing monthly, daily or even weekly reviews.  This is one of the major accomplishments of the NPHG activities engaged in over the past several years.

By adding age-gender differences to this surveillance method, more than a thousand indicators can be identified that help in determining the most reliable metrics for future monitoring.  No ICD, E-code, V-code, or demographic history detail should be left untouched by using this method.

Several years ago, using NPHG methods, age distributions for diagnoses related to the Columbine event were evaluated for nearly all of the ICDs, ranging from group evaluations to ICDs differentiated by as many as 6 characters.  Multiple gender and 1-year age to age range groups were then added for thoroughness and completeness.   Three methods for evaluation spatial distributions were then developed (grid and non-grid, none using GIS) and tested.

A number of ICDs could be identified that were very specific to events like those that occurred in Columbine, Colorado, Pine Plains, NY, and Newtown, Connecticut.

As a result, indicators for evaluating bullying, cyberbullying, racism, and school violence in EMRs can be identified, and have important applications to future use in this important public health surveillance activity.  

Unlike many of the other methods, NPHG enables the U.S. to be evaluated down to the small area level, nationally, regionally, and even locally.  Due to its processing speed, it is the fasted way to evaluate results and produce figures (map images and videos) depicting your results.

 

For more on the Columbine event and the local recovery, begin with: http://kfor.com/2014/04/20/15th-anniversary-of-tragic-columbine-high-school-shooting-heres-the-background/ ;

To support the most important Columbine Memorial, go to:  http://www.columbinememorial.org/

In USA Today—coverage of the Survivors, 15 years later, can be found at: http://www.usatoday.com/story/news/nation/2014/04/20/columbine-15-years-later/7914447/

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CDC - Occupational Respiratory Disease Surveillance - NIOSH Workplace Safety and Health Topic

CDC - Occupational Respiratory Disease Surveillance - NIOSH Workplace Safety and Health Topic | Episurveillance | Scoop.it

Traditionally, occupational respiratory disease surveillance has been a special topic covered by a very elite workforce in public health.  It is now possible to make this a part of the normal surveillance routine for managed care programs and large hospital settings with well established EMR/HIT programs.  Next the dander, lead paint exposure and second hand smoke exposure we can now monitor the health of people at work, at home, in school or during play.  Automated disease mapping processes make this possible.

Brian Altonens insight:

Occupational and Environmental Respiratory Diseases can be easily evaluated in a managed care community.  We most often engage in this as a part of the required childhood asthma prevention programs, surveillance of second hand exposure to smoke from smokers, and preventing  exposure to lead from paint found in older buildings.

The technology now exists to monitor dozens to hundreds of occupational and environmental diseases for each managed care region.  It is due to EMRs that this is now possible.

The above maps and plenty of others I produce to demonstrate this technology are at:

https://www.youtube.com/watch?v=ugyETx1646w&list=UUN1qTQzREkH6ratg-pg2_fg

 

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A Doctor Provides Medical Treatment To Homeless People Living On The Streets.

A Doctor Provides Medical Treatment To Homeless People Living On The Streets. | Episurveillance | Scoop.it
Dr. Jim Withers and his partner take to the streets to provide much needed medical attention to homeless individuals. This practice has been called "Street Medicine", and has been a growing trend in the United States since the early 90's.
Brian Altonens insight:

See also my pages:

 

 

Homelessness in the Pacific Northwest -- 

 

http://brianaltonenmph.com/gis/population-health-surveillance/production-examples/regions-and-health/part-v/

 

Videos on the distribution of the homeless, divided into 10-15 year age groups (including where the peaks in homeless children are in this country).

 

https://www.youtube.com/watch?v=qzBvG-jPU9o&list=PLWrApErk5byYk0dUG4wr84OH7xo8pTKZ3

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Deadly Ebola virus on the move in Africa

Deadly Ebola virus on the move in Africa | Episurveillance | Scoop.it
A deadly Ebola outbreak in urban Guinea, where it had not been seen before, has reportedly killed more than 100 people there and in neighboring Liberia and Sierra Leone. The virus causes severe bleeding and has killed up to 90 percent of the people infected in some past outbreaks. Authorities suspect it was transmitted to humans in Guinea through contaminated bat meat and is now being passed from person to person.
Brian Altonens insight:

How might this relate to US surveillance?

When we look at a history of Ebola related claims, we first might be surprised.  

We would know it if this disease had reached the U.S. and caused serious cases, right?

These "peaks" are possibly due to some common errors in claims based EMR data.

The first "rule-out" is entry of diagnosis as an actual "Rule-Out Diagnosis for" event.

The second is a patient claim that is transferred to the EMR without much confirmation.

The third is a suspicion of history due to foreign travel history, again overentered.

The fourth is an actual case history or diagnosis, or possibility thereof, in particular in the past.

A fifth reason for the peaking noted here is rule-out based on a higher likelihood of exposure for a setting, with imperative need to rule out should such a concern arise (working in association with potential vectors or animals that have the likelihood of being vectors.

A sixth is the same, but with likelihood of other cultural phenomena resulting in overrecording of suspected cases in the local patient population.

Whatever the reasons for the peaks on this map, we can come up with ecological reasons for potential "Ebola peak", but also reasons for probable mistaken ICD entry into the EMRs.

The mechanisms for entry of Ebola are human transportation/population density related, and/or with zoonotic carrier impacts as addition complications for these diffusion behaviors.  The peaks on this map point to suspicious potential points of entry, but of low probability.  

We can look at how other foreign born illnesses like Altitude Sickness come into this country, forming peaks, due to travel, or a host of zoonotic (West Nile) and human born cultural-behavior, infectious, bacterial and viral diagnoses (Kuru) to define the most likely points of entry for a new foreign born event like Ebola.  

Brian Altonen's curator insight, December 29, 2014 11:19 AM

Restating my insights back on April 10th regarding the Ebola re-eruption:     

 

How might this relate to US surveillance?    --      
When we look at a history of Ebola related claims, we first might be surprised.      --  
We would know it if this disease had reached the U.S. and caused serious cases, right?    --  
These "peaks" [in US data] are possibly due to some common errors in claims based EMR data.    
1)  The first "rule-out" is entry of diagnosis as an actual "Rule-Out Diagnosis for" event.    
2)  The second is a patient claim that is transferred to the EMR without much confirmation.    
3)  The third is a suspicion of history due to foreign travel history, again overentered.   
4)  The fourth is an actual case history or diagnosis, or possibility thereof, in particular in the past.     
5)   A fifth reason for the peaking noted here is rule-out based on a higher likelihood of exposure for a setting, with imperative need to rule out should such a concern arise (working in association with potential vectors or animals that have the likelihood of being vectors.   
6)   A sixth is the same, but with likelihood of other cultural phenomena resulting in overrecording of suspected cases in the local patient population.      
Whatever the reasons for the peaks on this map, we can come up with ecological reasons for potential "Ebola peak", but also reasons for probable mistaken ICD entry into the EMRs.     

 


*** The mechanisms for entry of Ebola are human transportation/population density related, and/or with zoonotic carrier impacts as addition complications for these diffusion behaviors. The peaks on this map point to suspicious potential points of entry, but of low probability.      


*** We can look at how other foreign born illnesses like Altitude Sickness come into this country, forming peaks, due to travel, or a host of zoonotic (West Nile) and human born cultural-behavior, infectious, bacterial and viral diagnoses (Kuru) to define the most likely points of entry for a new foreign born event like Ebola.

 

************************************************

 

12/29/14 added notes:

 

The past few months have demonstrated a human ecological method of diffusion for Ebola, which makes sense since human related diffusion is much faster than many natural ecological behaviors.  The ecological diffusion of Ebola will follow the tropical-subtropical equatorial regions, both north and south of the equator.  

 

The possibility of a Caribbean route exists, due to frugivore (fruit eating) bat ecology.  This entry could proceed into Middle America and then head southward, or into Mexico and remain there ecologically or move northward slightly.   A southward move would be the hardest migration pattern to deal with.  A direct migration into the US (such as from Cuba) has also been proposed.

 

Migration of the bat to Mexico is also possible, with a propensity for it to reside in the moist forests of Yucatan.  Travelling slightly northward along both sides of the mountain range in Mexico where there are numerous fruit trees is possible.  

 

A Central American-Mexico route into the U.S. seems unlikely due to combined animal ecology and climate-regional weather patterns; western borders of Texas are not conducive to supporting a frugivore migration across the border; but there are other animal carriers and carcass species to consider (a joke was made about armadillos at one point).  

 

If there was a border crossing, I'd expect it to be close to the Gulf, and trend northeast-eastnortheast-east, and maybe head north across the Great Plains along its primary travel routes, combined with population density, frugivore-phytoecology, and urban settings.  The natural ecological migration process is slower;  if it happens, it would not be noticed clinically probably until next summer/early Fall, or even the following year.  Tradition for Caribbean diseases shows that our most susceptible weeks are mid-August to early October.

 

Current diffusion by international air travel is following expected routes.  

 

It also helps to note that the Caribbean is considered a neotropical zone, the US borders, except for the tip of Florida are termed warm temperate.  Not that this line is absolute.  The flora of the Gulf Shore and the nearby ecology are often neotropical escapees.  The Jamaican Bat that is the host carrying Ebola is dependents mostly on just 5 or 6 fruit producers (even when abundant and varied, it usually prefers just two).  Some of the neotropical Island Solanaceae fruits (i.e. Lulu) that is favors grow wild occasionally on the Gulf Shore.   The Jamaican or Mexican fruit bat (Artibeus jamaicensis) also lives on wild figs, cecropia, guava, papaya, and banana.  I've seen reference to larger Mexican fruit like sapota and sapadilla, mammea and the like referred to as well.

 

 

 

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Does our reliance on the "Herd Immunity" theory make us too complacent about community health and safety? The NYC measles outbreak continues to grow in April 2014.

Does our reliance on the "Herd Immunity" theory make us too complacent about community health and safety?   The NYC measles outbreak continues to grow in April 2014. | Episurveillance | Scoop.it
New York City's Health Department announced four new cases of measles -- two pediatric and two adults in the past week. That brings the total number of measles cases to 25 in Manhattan, the Bronx, and Brooklyn. Most of these new cases of the measles are from a new area of the city. Three cases on the Lower East Side and one from the main epicenter of the measles outbreak, northern Manhattan.
Brian Altonens insight:

For a while now, I've been claiming that we sometimes rely too much upon what are really just beliefs or opinions.  We call them theories and hypotheses, but they are far from being final "truths."  
Every now and then, things change, and so we rewrite our arguments to make them seem more truthful.  
As an example, 25 years ago we considered Vibrio cholerae, the cause for Asiatic cholera, to be primarily of Asian birth and origin each time it struck this country.  Then, in the 1980s, it was discovered that vibrio could exist ecologically in the Mississippi Delta, waiting for the next opportunity to find more hosts and produce human cases.
The ongoing measles problem in NY is very much an example of what happens whenever we let our guard down due to unwillingness to change.  
In theory, we can map these minor outbreaks, and use our surveillance information to determine what factors are responsible for each phase of this public health problem--accepting or ruling out things like SES, population density, public travel and events, household density, socialization patterns, culture, poverty, sanitation, streetlife activity, animal/vermin behavior.
 What prevented us from developing this technology this last time through was the unwillingness of health care professions in general to share medical data due to HIPAA concerns, and insurance companies (where data pile up and are never fully evaluated) unwilling or unable to make the best use of their human resources and EMR potentials.  
Lack of EMR compliance and unwillingness to change or catch-up with technology are the dilemmas we now face due to resistance to change.
Could the recent outbreaks have been prevented? Probably not. But the resilience of this measles following this recent re-emergence could have been better predicted, were adequate HIT changes already completed.

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Omsk Fever - YouTube

http://youtu.be/nk2HMqICMd8 IMG 0724 OmskFever
Brian Altonens insight:

In 2006, I was asked by two companies in Atlanta, Georgia to develop a model for surveilling in-migrating disease patterns.  

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This is why I re-developed my algorithm used to map cholera outbreaks back in the late 1990s.

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I then tested this technique on dozens of very unusual foreign-born diseases migrating into this country and resulting in cases being documented in a national EMR database.

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After producing more than one hundred maps of international disease patterns, I merged these into disease patterns for combinations of ICDs linked to certain parts of the world.  By merging so many ICDs together, patterns emerged enabling you to tell if diseases are spread across land based international borders with the U.S., by air-water travel Pacific Rim routes, or via traditional commercial air-water routes involving the East Coast, Saint Lawrence and the Great Lakes, or the Mississippi River.
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The Omsk Hemorrhagic Fever, named for its first descriptions published for Omsk, U.S.S.R. in the 1940s and 1950s, is an example of a disease pattern that can take either the east coast or west coast route.  

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Contaminated water, ticks and an animal host like the muskrat are important natural ecological requirements for its distribution. Human population density and cultural demographic patterns define its human ecological distribution patterns.

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This video map depicts numerous isolated cases in EMRs which are probably the result of in-migrating people with a history of exposure or need for "rule-outs" for this diagnosis. (Rule-outs typically include the ICD for a specific case the lab is asked to remove from a list of possible diagnoses, and so these appear in the EMRs, but as single hits.)
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The loner peak in the Southwestern U.S. is an exceptionally high number of cases, suggesting (but not at all proving): i) possible Pacific Rim in-migration behavior and therefore ecological origin , and ii) a probable rule out of human ecology and population density as the sole explanations for this particular outbreak.
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One role of the spatial epidemiologist in disease surveillance is to locate potential niduses, so they can be ruled out where appropriate or added to local surveillance programs.

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John Lea and the Geology of Cholera (1850)

John Lea and the Geology of Cholera (1850) | Episurveillance | Scoop.it

A number of ways to map cholera were use during the mid-19th century epidemic.  Most of these methods were completely correct.  Yet only one was accepted as the most important at the time--that of London epidemiologist John Snow.  Of the remaining four disease mappers, one other was equally accurate and another from the United States very valuable due to the association its author made between alkalinity and the disease.  

Brian Altonens insight:
Brian Altonen's insight:

What do the accomplishments of past disease cartographers and medical geographers teach us?

 

 

For more on this increasingly popular epidemiological topic and its history, begin with my review of a classic published in International Journal of Epidemiology . . . 

 

Brian Altonen.  Commentary: John Lea’s Cholera with Reference to Geological Theory, April 1850 .  International Journal of Epidemiology 2013 42: 58-61.   

 

Available for viewing at :

 

https://www.researchgate.net/publication/233965944_Commentary_John_Lea's_Cholera_with_Reference_to_the_Geologic_Theory_April_1850

 

 

And also see: 

 

http://brianaltonenmph.com/gis/historical-disease-maps/john-leas-geology-and-cholera-1851/

 

http://brianaltonenmph.com/gis/historical-disease-maps/henry-wentworth-dyke-acland/

 

the infamous William Farr's paper on elevation and cholera at 

http://brianaltonenmph.com/gis/historical-medical-geography/1852-william-farr-elevation-and-cholera/

Brian Altonen's curator insight, December 10, 2013 10:43 PM

What do the accomplishments of past disease cartographers and medical geographers teach us?

 

If we spend the time reviewing their methods, logic, and in some cases, important findings about the spatial distribution of people, communities, organisms and disease, we are provided with important insights into the more modern uses for medical GIS.

 

Recently, a considerable amount of celebration in England focused the 160th anniversary of John Snow and his famous map of cholera. Snow used this map to prove and prevent the transmission of this disease throughout a part of London.  He also used it to demonstrate the value of hygienic living practices and the importance of a clean water supply.  

 

Today, we are still very much concerned about the cleanliness of our drinking water, and our risk of exposure to toxic chemicals, bacteria and other environmental health hazards.  


For this reason, another map produced before Snow's 1854 map deserves recognition.  In 1850, John Lea of Cincinnati, Ohio published a map and pamphlet on the local cholera epidemic, claiming the cases he observed were due to the use of well water contaminated by non-alkaline (non-calcareous) soils.  He recommended rainwater be used instead.  Much of the public agreed, and a number of businesses were established to produce rainwater barrels.  


John Lea's map is more detailed than Snow's and yet was completely forgotten.  Lea correctly associated the relationship between cholera and alkaline wells.  John Snow never supported his theory, and claimed that Lea's observations were correct but his reasoning was somehow wrong (see my International Journal of Epidemiology article on this--link below).


Over the next several years, John Lea fought many of the arguments against his alkaline theory, and never won the support of the profession.  (A lot of his other lines of reasoning were wrong.)  


As a result of this forgotten discovery, a Japanese epidemiologist received recognition for the same decades later, demonstrating that pH and alkalinity determined whether or not the bacteria that caused cholera could survive.

 

Other maps depicting the mid-19th century cholera epidemic in the illustration include one published by Hector Gavin of London (ca. 1848), which made use of miasma theory to explain how the undernourished poor could become so sick.

 

In 1850, the American Medical Association (AMA) published a map depicting the cases near Philadelphia, but unlike Lea's map was very difficult to interpret.

 

Also important to note is the cholera map published the same year as Snow's famous map by British epidemiologist Henry W. Acland.  He produced a map of equal caliber to Snow's, one that was more colorful.  

 

For more on this see 


my article published in International Journal of Epidemiology . . . 

 

Brian Altonen.  Commentary: John Lea’s Cholera with Reference to Geological Theory, April 1850 .  International Journal of Epidemiology 2013 42: 58-61.   Link:  JohnLea-Cholera_IJE-Article

 

or . . . 

 

http://brianaltonenmph.com/gis/historical-disease-maps/henry-wentworth-dyke-acland/

 

http://brianaltonenmph.com/gis/historical-disease-maps/john-leas-geology-and-cholera-1851/

 

and William Farr's elevation and cholera paper at 

http://brianaltonenmph.com/gis/historical-medical-geography/1852-william-farr-elevation-and-cholera/

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Has polio-like virus spread outside California? | wtsp.com

Has polio-like virus spread outside California? | wtsp.com | Episurveillance | Scoop.it
Brian Altonens insight:

Take your pick . . .

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Three interpretations of a new disease pattern, be it emerging, re-emerging, neither, or because we simply do not know:

 

“These five new cases highlight the possibility of an emerging infectious polio-like syndrome in California,” author Emanuelle Waubant, MD at UCSF.

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“We would like to stress that this syndrome appears to be very, very rare . . .Any time a parent sees symptoms of paralysis in a child, the child should be seen by a doctor right away.”  Stanford's Keith Van Haren, MD 

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“At this time, CDC does not think the situation in California is a cause for public concern,” Jamila H. Jones,  CDC public health educator, to the AP.

 

Three newer stories on this growing concern:

 

Reuters news:  http://rt.com/usa/polio-paralysis-california-children-692/

 

Boston globe:  https://www.bostonglobe.com/lifestyle/health-wellness/2014/03/03/how-worried-should-about-new-polio-like-virus/D44YZgt3mKHSLgQLdvXYnN/story.html

 

Stanford:  http://med.stanford.edu/ism/2014/march/polio-0310.html

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NPHG + the News on Pinterest

NPHG + the News on Pinterest | Episurveillance | Scoop.it

This is a description of the visitors of my NPHG sites over the past year.  This site has been in operation now for more than 5 years and receives anywhere from 5,000 to 10,000 visitors per month depending on the academic period, with peaks on primary lecture and/or regional and national spatial health conference and seminar dates.   As expected, the usual countries to visit my site on a daily basis are US, Canada, India, Australia, China, and parts of South America.

Brian Altonens insight:

 My major inspirations for the topics I cover at this site come from real experiences mapping costs, claims, billing and fraud, prescription drug patterns, age-gender-ethnicity relationships, and most ICDs, V-codes and E-codes considered hot topics or linked to important social issues in today's day and age.  Like always, I make it a point to focus on the less obvious, metrics that are normally underrepresented but important to understanding the US health care system.  I developed this unique mapping technique more than ten years ago.

 

My NPHG spatial mapping site is at http://www.pinterest.com/altonenb/nphg-the-news/

 

My more frequently visited educational site is http://brianaltonenmph.com

 

My videos of the rotating 3D US maps of epidemiology are being posted at https://www.youtube.com/user/altonenb/playlists

 

 

These are the only sites where hundreds of examples of my NPHG 3D disease mapping algorithms are demonstrated, nationally and at the small area level.  

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Population Density + Immunization Refusal = Potential Outbreak

Population Density + Immunization Refusal =  Potential Outbreak | Episurveillance | Scoop.it
Brian Altonens insight:

The recent exposure of a shopping mall to measles in Rockland, NY is a reminder of how important childhood immunization programs are and the need for ongoing surveillance of infectious disease patterns.

Three spatial behaviors define how outbreaks occur and the patterns by which they are likely to spread.  

1) Population density is important to understanding these patterns due to likelihood of contact and the development of new victims.

2) Transportation and communication patterns define where people travel and aggregate, and the most likely routes to be taken by diseases or health problems imported from other locations.

3) In some cases, local land use patterns, and socioeconomics and human behavioral patterns help to define those parts of the country that are more susceptible to certain diagnoses and new cases than others.

 

The review of several immunizable diseases and their varying spatial patterns for outbreaks over the past decades, at the small area level, is at https://www.youtube.com/playlist?list=PLWrApErk5byY6emyCz0_ROOXw9FdsfCfY

 

 

A review of immunization refusal patterns in this country for childhood immunization programs is at https://www.youtube.com/watch?v=9TYCqtIg2Xs&list=PLWrApErk5byaJjbbjS6TEAAChZ7apmbzg

 

The Pacific Northwest, the nidus or nest for this behavior of refusing to immunize your child, is displayed spatially in detail and 3D at  https://www.youtube.com/watch?v=YHH32Oq_obs&list=PLWrApErk5byaJjbbjS6TEAAChZ7apmbzg

 

According to the 2D krigged data map, the New York City region and urban settings in the Pacific Northwest are the epicenters for these outbreaks.

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Community Health Mapping and Wellness Center Project for Boyle Heights in Los Angeles

Community Health Mapping and Wellness Center Project for Boyle Heights in Los Angeles | Episurveillance | Scoop.it

Faculty Project:  2013-2014

PI: Andrew Curtis
Collaborators: Wei-An Andy Lee, Kreck Medical Center of the University of Southern California

Brian Altonens insight:

Abstract

This project is designed to understand the diabetes landscape of vulnerable populations in the Boyle Heights area of Los Angeles and to help facilitate intervention and management strategies for a participating diabetes clinic. The objective of this work is to develop a geospatial tool and/or approach that is easy to implement and is transferable amongst other resource challenged clinics serving vulnerable populations. To achieve this, the GIS Health & Hazards Lab is currently (1) Providing a comprehensive summary review of health, social science and planning research previously conducted in Los Angeles, (2) Evaluating the feasibility of using spatial analysis of health and census data for the targeted neighborhood of Boyle Heights, and (3) Piloting the use of mobile mapping to capture the fine scale built environment of patients in Boyle Heights.

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History and Public Health - Polio Vaccines finally approved 60 years ago today

History and Public Health - Polio Vaccines finally approved 60 years ago today | Episurveillance | Scoop.it

Today, April 26, 2014, marks the 60th Anniversary of the initiation of the polio vaccine!

 

Invented by Jonas Salk, experimental trails of this vaccine were initiated on April 26, 1954.  The first vaccines were provided to children at Franklin Sherman Elementary School, McLean, Virginia. Ultimately, 1.8 million children would be vaccinated for this trial.  

 

Albert Savin developed an attenuated form of this organism that could be administered orally.  This method was licensed for its first clinical trials and use in 1962.

 

 

Brian Altonens insight:

The pictures provided here (minus the descriptive text) are from the AMA's "family health magazine" Hygeia, published in 1944.    

 

The problem as it existed at this time is discussed in detail in Mark Graczyk's "HIDDEN HISTORY: Polio outbreaks hit area, 1939 & 1944."  

 http://thedailynewsonline.com/blogs/mark_my_words/article_03cf064a-e8ce-11e2-8327-001a4bcf887a.html 

 

The magazine Hygeia was devoted to health and targeted the average American households (not to be confused with a contemporary journal bearing the same name, published in India).  The title Hygeia was in use from 1923 to 1949, after which it was renamed  Today's Health (1950-1976).  

 

More on the Polio vaccine and its history can be found at the History Channel: http://www.history.com/this-day-in-history/polio-vaccine-trials-begin

 

"The Charbor Chronicles".  Saturday, April 26, 2014. "On This Day in History - April 26 Polio Vaccine Trials Begin" at http://charbor74.blogspot.com/2014/04/on-this-day-in-history-april-26-polio.html

 

Smithsonian National Museum of American History wepage. "Whatever Happened to Polio? "   http://amhistory.si.edu/polio/virusvaccine/clinical.htm

 

Polio Eradication - Global Status and Progress.  UNICEF.  at http://www.unicef.org/media/media_18981.html

 

 

 

Brian Altonen's curator insight, April 26, 2014 8:53 PM

The pictures provided here (minus the descriptive text) are from the AMA's "family health magazine" Hygeia, published in 1944.
.   
The problem as it existed at this time is discussed in detail in Mark Graczyk's "HIDDEN HISTORY: Polio outbreaks hit area, 1939 & 1944."
http://thedailynewsonline.com/blogs/mark_my_words/article_03cf064a-e8ce-11e2-8327-001a4bcf887a.html 
.   
The magazine Hygeia was devoted to health and targeted the average American households (not to be confused with a contemporary journal bearing the same name, published in India). The title Hygeia was in use from 1923 to 1949, after which it was renamed Today's Health (1950-1976).
.   
More on the Polio vaccine and its history can be found at the History Channel: http://www.history.com/this-day-in-history/polio-vaccine-trials-begin
.   
"The Charbor Chronicles". Saturday, April 26, 2014. "On This Day in History - April 26 Polio Vaccine Trials Begin" at http://charbor74.blogspot.com/2014/04/on-this-day-in-history-april-26-polio.html
.   
Smithsonian National Museum of American History wepage. "Whatever Happened to Polio? " http://amhistory.si.edu/polio/virusvaccine/clinical.htm
.   
Polio Eradication - Global Status and Progress. UNICEF. at http://www.unicef.org/media/media_18981.html

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Is there anything wrong with a $1,000 per day prescription drug?

Is there anything wrong with a $1,000 per day prescription drug? | Episurveillance | Scoop.it

Don't blame the pharmaceutical company.  Insurance companies share  equal blame for this problem, according to news staff in a video at this site.  

 

What do we as healthcare providers and MC managers/leaders think?  

 

How much are we to blame for this expensive drug ($84K in the US, just $2K in developing countries).

Brian Altonens insight:

Sovalid is designed to treat a common disease, not a rare disease like some forms of hemophilia, for which so few patients serve as sources "reimbursement" of research costs.

 

It takes at least insurance and pharmaceutical companies to develop the contracts that approve these costs, and a complacency expressed on behalf of federal agencies overseeing and approving these "cost control" and sophisticated management plans. 

 

In ten or fifteen years, its worth in the marketplace will drop to less than 1% of its current value, making it the next "generic" for treating Hepatis C cases.   This implies a marketing logic, not a scientific logic that is primarily resource-based.  

 

The potential for worldwide distribution of this product implies that its is us, and the US insured companies, that are the chief source of revenues for drugs like sofosbuvir that will become commonplace  for the world healthcare market.  This implies that insurance agencies and pharmaceutical companies (some international or most foreign based) view the U.S. as their chief source for revenues needed to subsidize world health care in the future.  

 

Governmental actions and legal decisions, and the U.S. pharma patent laws that our products and companies abide by, are the primary reasons this unique relationship we have with the world enables us to provide other countries with "affordable care" in the future, that we cannot provide to ourselves during these initial years of marketing this medication. 

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Social or Societal Disease Patterns

Social or Societal Disease Patterns | Episurveillance | Scoop.it

The Pine Plains legal case is over in the news, but not in day to day life. Today I took a stroll across the school grounds, and lo' and behold, on some large pieces of concrete lying out on the grass, was this epitaph. 

Brian Altonens insight:

When I first saw this writing scribbled onto the surface I thought nothing of it, but the swastika image made me wonder.  

So I queried this on my cell phone, typing in "N.B." and the word 'swastika', and was surprised at what I found.

This was in reference to a case in New Brunswick, Canada, in which graffiti in the form of a swastika covered a number of war memorials.

This still didn't seem to fit, until I queried for "2012 racism Pine Plains".  (I had other ideas for "N.B.", but didn't want to stretch it that far yet.)

The list of links I had to choose from  seemed endless, most of them news about the legal case involving the Zeno family versus the Pine Plains Central School District.

In December 2012, the appeals court decided in favor of the Zeno Family for the harassment and bullying the son Anthony received due to his Hispanic-African American background.  The court then reinstated  the award to his family, amounting to a record breaking one million dollars!

What is most unusual about this case however is the ruralness of this region, and the persistence of these racist attitudes within this rural township, with less than 2500 residents in a 31 sq mile township.    

To many of us, Pine Plains did not represent the kind of community where racism seemed most likely to happen.  We tend to relate racism problems to lower income community settings and sizeable urban and suburban settings.  

The truth is, racism happens anywhere and everywhere, even within very small, rural tight-knit community settings.  It is only the ways in which racism is expressed that tend to differ between regions.  

In some places, racism happens as a part of everyday rural living.  In other places, it happens as a part of everyday urban life.  So how exactly do the two differ?  Only by how we categorize and define them.

There are some regionalism aspects to racism in need of exploration, as demonstrated by some spatial studies I and others have done of extremist groups (reviewed elsewhere).  Anti-African racism to the south is rich in KKK group teachings and lingo.  To the north, it is more the sociocultural issues that exist for the time, such as drug abuse or crime, that become the excuse.  

In other cases, where discrimination is based upon religion not color, we have anti-Muslim attitudes being the cause.  And we haven't even begun to ponder the anti-Semitic, anti-Asian, and anti-LGBT forms of behavior that exist. 

But back to the Pine Plains case--the 'N.B. [swastika] 2012' graffiti that I came upon tells us how much this issue remains in our kids' minds, today, not as a part of the past.  The kids who see this graffiti today (and it is fairly recent) are a different generation than the first who demonstrated this social practice between 2005 and 2008.   How much parents, teachers, and society pay heed to these warning signs remains to be told.  

However, the presence of this epitaph on school grounds, out of site of everyone but groundkeepers, implies more about its persistence to this day than we are willing to admit.

 

For more on this case (and the victims portrayed in the two photos above), go to:

 

The Legal Case: http://www.wrightslaw.com/law/caselaw/2012/2d.zeno.pine.sch.damage.harrass.pdf

 

Anthony Zeno v. Pine Plains Central School District

Posted by Justin W. Patchin on December 20, 2012  Cyberbullying Research Center. 

http://cyberbullying.us/anthony-zeno-v-pine-plains-central-school-district/

 

Paula Ann Mitchell. For Pine Plains high schooler Anthony Zeno, racial harassment turned life upside down (video)

http://www.dailyfreeman.com/general-news/20130303/for-pine-plains-high-schooler-anthony-zeno-racial-harassment-turned-life-upside-down-video

 

The swastika case: 

http://www.thewesternstar.com/People/2008-07-10/article-1468273/NB-RCMP-investigating-spraypainted-messages-including-swastikas/1

http://www.cbc.ca/news/canada/new-brunswick/n-b-monument-graffiti-includes-swastika-1.842620

http://news.ca.msn.com/local/newbrunswick/article.aspx?cp-documentid=22713346

 

Pine Plains on a map: https://maps.google.com/maps/ms?msa=0&msid=205174362242775615569.00047806ec902929b390f

 

 

 

 

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Is the "Herding Effect" an out of date theory?

Is the "Herding Effect" an out of date theory? | Episurveillance | Scoop.it

The recent measles problem in NY is proving that this old adage, "the Herding Effect", is out of date.  This "theory" (and that is all it is--is a construct or belief system) has seen its time.  It needs to be either reconceptualized or replaced by a more balanced and truthful ecological rendering of infectious disease theory. 

Brian Altonens insight:

This "theory" (and that is all it is--a construct or belief system) has seen its time.  It needs to be either reconceptualized or completely replaced by a more balanced and truthful ecological rendering of infectious disease theory.  

In a recent review of the vaccine by Oregon Health Sciences University (OHSU) researchers, it was demonstrated that there was a 5% failure rate for vaccinations, thus the reason for repeated vaccinations found in some studies.  

For those who are engaged in HEDIS Quality Improvement activities for managed care, we have all seen those cases where a child received two or three extra immunizations--interpreting these as a waste of resources and money.  Instead, this study by OHSU could mean that too many vaccinations are in fact be better for overall population health, than not reaching the bare minimum requirements for prevention.  

This doesn't mean we change our current guidelines, only that we re-evaluate the childhood immunizations problem with respect to the re-emerging infectious disease issue we now face.  At least in this case, 'too many' is better than 'too few'.

OHSU should know by the way, the Pacific Northwest is the center of immunization refusal practices over time and space.

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Media Kit - Bullying Statistics - National Bullying Prevention Center

Media Kit - Bullying Statistics - National Bullying Prevention Center | Episurveillance | Scoop.it

Child Abuse of kids upon kids, or bullying, is one of those things we can monitor in any managed care system.

Brian Altonens insight:

The current technology exists to monitor child abuse, bullying, adult abuse, or any form of abuse and mistreatment using a basic statistical program.  We do not need a GIS to map many of the conditions that should be monitored by a managed care system, just the right knowledge and manpower.  

Unfortunately, many companies choose to not engage in this very detailed review of the healthcare that our population receives.  This is either because we lack the desire to engage in this work, think we lack the software to accomplish such a brutal endeavour, or believe we haven't got the manpower we need to accomplish it.  

All of these limits we place upon our self in managed care.  Either we place them upon ourselves, or higher up decisions limit us from reaching these potentials.  Some of the most important social issues in medicine and public health are poorly managed due to this lack of engagement.

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Is Religion Why Parents are Refusing Immunization for their Children?

Is Religion Why Parents are Refusing Immunization for their Children? | Episurveillance | Scoop.it

CDC images are mostly from:  Measles — United States, January 1–August 24, 2013.  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6236a2.htm

 

Peach-toned 3D map imags are from NPHG, Nationalpopulationhealthgrid.com.

Brian Altonens insight:

For some reason, religious is a common reason given for immunization refusals.  This argument bears its best evidence only on the east coast.

In the Pacific Northwest, immunizations are refused due to ADHD concerns.  However, this argument also is not solely the reason for so many refusals.

The healthcare culture of the Pacific NW is mostly the reason for this refusal.  In fact, this explains why it is seen with nearly all immunizations that are possible, in children or adults.

A number of peak urban areas for religious based refusal of care are noted in two of the top four maps in this series.  The bottom maps depict immunization refusals.  

The advantage to grid mapping is these two can also be overlain quite easily to demonstrate the Pacific NW peaks far outweigh the NY peaks in terms of immunization refusal, but vice versa for religious based refusals for care.

With medical GIS, we needn't be as much concerned about knowing the reason these east-west differences exist, only that they do exist, and that simple solutions are not always possible for the same kind of public health concern in different regions, different cultures of the United States.

Intervention programs have to assess and meet the specific needs of local populations.  At the national level, it is unusual for the same interventions to fail for the exact same reasons.  This use of Medical GIS allows you to be more precise at the small area level.

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Legislation to let kids with epilepsy use medical marijuana advances - Chicago Sun-Times

Legislation to let kids with epilepsy use medical marijuana advances - Chicago Sun-Times | Episurveillance | Scoop.it

SPRINGFIELD — Legislation to expand the use of medicinal marijuana to severely epileptic children and to lower the penalties for possession of pot for recreational purposes advanced Tuesday at the Illinois Statehouse.   

Brian Altonens insight:

The history of treating epilepsy is a great example of how much healthcare relies upon paradigms or belief systems for treating disorders or medical problems which we know little about.  It also serves as an example of why mapping culture and medicine is important to understanding the healthcare profession in general.

About the turn of the 19th century when Bernarr MacFadden, healthy diet, and fitness became popular it was "discovered" that fasting reduced seizures in some cases.  Twenty years later the osteopaths, a medical profession with a different philosophy of care, recommended fasting as a way to reduce or eliminate a seizure problem.  

This recommendation was scoffed of course by the best trained allopaths and specialists in neurophysiology and neurology, that is until 1994 when the case of Charlie Abrahams was aired by NBC's Dateline.  His story was retold three years later as part of the movie 'First Do No Harm' starring Meryl Streep, and ultimately, over the next several years,  the long process of demonstrating validity of these claims came to be--this form of treatment took on the name ketogenic diet.   Only in the past few years has this form of treatment come to be accepted, mostly conditions with epilepsy such as Dravet syndrome, infantile spasms, myoclonic-astatic epilepsy and tuberous sclerosis complex.

The use of Cannabis or cannabinol for treating certain forms of epilepsy is currently undergoing the same scrutiny as the ketogenic diet   It took more than a century for medicine to accept the validity of this early discovery described in a 1922 New York Times article by osteopaths (http://query.nytimes.com/mem/archive-free/pdf?res=9E02E6DB1539EF3ABC4E53DFB1668389639EDE ).  

This time a number of allopaths are promoting the use of cannabinol or the like for preventing chronic seizures suffered by individuals diagnosed with Dravet syndrome, Doose syndrome, Lennox-Gastaut syndrome and even idiopathic epilepsy.

The wikipedia map provided here illustrates where the resistance to cannabinol use as a medicine continues, in spite of recent evidence demonstrating success in certain critical cases.  

It is maternal instinct and popular opinion that state and federal law givers are up against this time.  

The number of cases providing evidence-based proof of a value of this therapy in some cases, even when few in number, is difficult to argue.   Since epilepsy cannot be fully and completely managed by standard healthcare givers, alternative routes for therapy need to be addressed.  

Practitioners who don't support these changes in epilepsy care, are essentially telling us they still believe that statement first aired on television in the 1960s about epilepsy--"There is no cure for epilepsy"  [a Parke-Davis TV ad].  They probably shouldn't be active  in their profession, at least for treating people with epilepsy, for they serve as a bad example for kids with epilepsy, and the parents who believe in their foreclusions (pun intended).  

The position taken by Epilepsy Foundation for this new treatment is perhaps best expressed by Orrin Devinsky:  

" Humility is essential in trying to understand something for which we lack solid evidence. Both doctors and patients are equally biased and the greater the expectation, the greater the potential for bias. " (http://www.epilepsy.com/article/2014/2/epilepsy-foundation-calls-increased-medical-marijuana-access-and-research )

 

MAP courtesy of wikipedia, at:   http://en.wikipedia.org/wiki/Medical_cannabis_in_the_United_States  ;

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VIDEO: Kristin Cavallari Defends Her Decision to Not Vaccinate Her Kids | TIME

VIDEO: Kristin Cavallari Defends Her Decision to Not Vaccinate Her Kids | TIME | Episurveillance | Scoop.it
Jenny McCarthy's not the only one ignoring science
Brian Altonens insight:

Recommended video--famous actress Kristin Cavallari defends her practice of not immunizing her children -- http://ti.me/1pc25CA

 

 

Measles outbreaks in general -- http://www.cdc.gov/measles/outbreaks.html

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The NYC outbreak - - http://www.nytimes.com/2014/03/19/nyregion/measles-outbreak-in-new-york-may-have-spread-in-medical-facilities.html?hpw&rref=nyregion&_r=1

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Information about Thimerosal, by CDC --  http://www.cdc.gov/vaccinesafety/Concerns/thimerosal/index.html

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The story in press -- http://shine.yahoo.com/fashion/vaccine-celebrities-measles-anti-vaccination-jenny-mccarthy-184750111.html

 

 
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Mumps Outbreak at Ohio State Widens

Mumps Outbreak at Ohio State Widens | Episurveillance | Scoop.it

U.S. vaccination refusals demonstrate peaks in the Pacific Northwest and the region just north of New York City.

Brian Altonens insight:

March 17th 2014, 7:12 pm

.

Mumps Outbreak at Ohio State Widens

.

COLUMBUS, Ohio — Health officials say 23 cases of mumps are confirmed in an outbreak at Ohio State University. Eighteen students and a staff member are among those infected.

University and public health officials warned Ohio State students, faculty and staff to take precautions to keep themselves healthy as they headed back to class Monday after spring break.

A Columbus Public Health spokesman says authorities are mapping cases to determine how people became infected and any links between them. He says three people have been hospitalized for at least one day.

The confirmed cases involve 11 women and 12 men. They range in age from 18 to 48.

The spokesman says they include a relative of a student and three people who don't study or work at Ohio State but have links to the university community.

.

— The Associated Press

 

See video at  http://www.10tv.com/content/sections/video/index.html?ooid=BpeGYxbDpBhyQajV5Omm4f9Rif2uF-VW&cmpid=share

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Population Health and Meaningful Use measures

Population Health and Meaningful Use measures | Episurveillance | Scoop.it

Why focus on mapping events by age and gender in one year brackets rather than five year brackets? The innovative nature of such work stems from how much more detail it provides quantifying differences between two different groups by one year periods. This way of analyzing population tells you exactly where differences in age gender distribution are statistically significant. Which diagnosis presented here does the woman best represent?  The traditional broad age group methods for past analyses worked well with researching in epidemiology, but not for tending to your managed care program and engaging in Meaningful Use programs.

Brian Altonens insight:

The only way we can fully understand an ICD, V-code, E-Code, or any other statistic analyzed, is by engaging in detailed reviews and presentations of our data.  The standard way of presenting age-related health measures in 5 year age brackets is outdated for most Big Data programs focused of managed care populations.  There is a difference between populations made completely of people in one age band versus two populations with two age bands at opposing ends of the age and gender spectrum, but with the same average age result. 

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Even more importantly, the causes for certain public health concerns may be completely different for two similar groups are just a few years apart in terms of average age and gender.  Why risk spending all of your money on an intervention program or task that wasn't designed with specific target populations in mind?  

.

In managed care, true age, gender, ethicity, socioeconomic status and place are important.  The only way to be successful in managed care special studies (QIAs and PIPs) is to focus on these attributes when interpreting your population and defining preventive care goals.

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The best way to meet your Meaningful Use [MU] requirements in 2014 is to take this more detailed approach to reviewing your population.  You need to know your members down to their smallest communities and cultural, socioeconomic subgroups, and the bulk of these MU processes should be automated.

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Are There Geographic "Hotspots" for Shaking Babies? Shaken Baby Syndrome.

Are There Geographic "Hotspots" for Shaking Babies?  Shaken Baby Syndrome. | Episurveillance | Scoop.it

The Medill Justice Project, in its now year-long effort to build a database of SBS cases, has published a portion of that data relating to the geographic occurrence of SBS . . . .  http://www.medill.northwestern.edu/experience/bsj/exclusives/medill-justice-project.html

Brian Altonens insight:

Phil Locke's article "Are there geographic "hotspots" for shaking babies?" (http://wrongfulconvictionsblog.org/2013/12/15/are-there-geographic-hotspots-for-shaking-babies-shaken-baby-syndrome/) provides us with important insight into this growing national public health problem. 

 

The above map in this figure is the nationalpopulationhealthgrid (NPHG) mapping technique developed for mapping any medical statistic or number down to the small area level.  Beneath the NPHG map is the US map by states produced by Lauryn Schroeder of The Medill Justice Project at Northwestern University (http://www.medill.northwestern.edu/experience/bsj/exclusives/medill-justice-project.html).

 

NPHG allows us to identify small areas of high incidence for any medical diagnoses, episode or event.   Exact locations within each of the states noted as high risk were reassessed down to the town/city level using this innovative mapping technique. 

 

Important to note here is that NPHG displays its results in 3D, and can also be used to generate rotating videos of your results, impressive for any public speaking or upper level management presentation.

 

Minus the videos, NPHG can produce hundreds to thousands of maps per day, depending upon your study.  The rotational 3D images used to make the videos could be produced at a rate of 15,000 to 20,000 (15-20 videos) per day.   At this speed, we can now report on dozens to hundreds of metrics per week spatially, either locally or at the national level, and at any pre-determined subpopulation level (age, gender, SES, etc.).  


There are no limits to the use for this spatial modeling tool.

Brian Altonen's curator insight, February 21, 2014 1:02 PM

Comparing the highly detailed spatial results (above figure) to other undergoing programs (below figure), demonstrates two different applications for Medical GIS.  

 

Regional programs provide the impetus needed for better preventive care practices and the development of effective surveillance and health education programs.  Programs that monitor small service areas are capable of finding the exact cause for a health problem and define the barriers  that may exist.  

 

The best programs  utilize both of these research, intervention and public health education methods.  

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Yahoo! Another Olympics.

Yahoo!  Another Olympics. | Episurveillance | Scoop.it

Rabies may be the reason for the ordered slaughter of stray dogs.

Brian Altonens insight:

See my 3D NPHG map video on the distribution of Rabies in the U.S. at https://www.youtube.com/watch?v=WFdWszKEYJ4.  

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