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Monday, 6 February 2012

Public Health hot topics

Certain tag words result in substantive increased activity on this site.  Poverty, Inequities and Fluoridation are examples.  Seems like Smart Meters also engender considerable interest within the blogosphere although no comments to explain why the surge of activity. 

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A few hot topics that have been building up as a set of short snappers:

Federal funding for important health improvement activities
The January 17th link spoke to a rare announcement by Minister Aglukkaq for a total of $300K Minister of health performance review and suicide release .  Looking at the issue of suicide which reaps some 4.5 Million potential years of life lost each year from the Canadian economy, that works out to some 6.7¢ per lost year of life invested in the future of Canada.   This week saw her involved in another announcement, this time for $67.5M to support personalized medicine.   The value of which on a potential year of life gained will be marginal.  Even if we are talking a few tens of thousand dollars for a potential year of life gained, it seems a bit odd.  Economist are often looking to that value number as one which represents a reasonable investment in improved health care.   Are we the only ones that see a bit of discrepancy in this inequity?

Motivational interviewing for obesity reduction:
It has been known for a long time that brief motivational interventions are reasonably effective in tobacco cessation.   The meta analysis estimated an effect size on BMI of 0.25 reduction.   Not much, but in the dearth of evidence of sustainable effects for obesity reduction, this is good news and a starting point. Motivational interviewing for obesity

Improving cancer screening rates:
Another synthesis analysis demonstrating value in client reminders, small media, and provider audit and feedback.   Insufficient quality research to provide judgement on mass media, client incentives, group education and provider incentives.   Of particular note is that provider incentives have been widely touted as a mechanism for improving rates, moreso that ensuring reminder systems are in place or undertaking “audits” of providers.   Improving cancer screening rates 

Alcohol interventions with youth
The persistent problems of youth behaviours associated with adoption of higher risk drinking practices makes the analysis of interventions worth staying current on.   While studies are of less than rigourous format (seems typical for interventions in real life where placebos are challenging), the consistent benefit of family based interventions shows promise.   Such efforts support alcohol and drug early intervention works in high schools – perhaps something that should be considered an integral part of the education system alcohol misuse in youth

Home visiting for alcohol and drug problems in pregnancy
The role of providing supports to new mothers is of considerable interest in many provinces.  This synthesis suggests that there is minimal value in home interventions where there are known high risk drug or alcohol problems.   Actually, if you read carefully most studies trended towards value, but not statistically significant – as such the authors conclude insufficient evidence and recommend further studying.   Given the importance of the service and the potential to save lives (RR 0.70 for infant death amongst program recipients, RR0.16 for foster care), seems like a logical area to invest a bit of money so that metaanalysis don’t misrepresent the findings because of the lack of statistical significance. home visiting for alcohol and drug problems in pregnancy

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