Welcome to DrPHealth

Please leave comments and stimulate dialogue. For those wanting a bit more privacy or information, email drphealth@gmail.com. Comments will be posted unless they promote specific products or services, or contain inappropriate material or wording. Twitter @drphealth.

Tuesday, 31 July 2012

Do the Olympics improve the general health of Canadians? A timely but odd question.

On one hand, we are being entertained by some of the world’s greatest athletic endeavours, engaged in by 0.0001% of the global population.  What is the value to the remaining 99.9999%.  For sure, each Olympian likely was the top say 1% of the elite athletes in their country.  That still leaves us 99.99% of the global population looking for the benefits of Olympic preparation.  

The average Olympic competitor is actually in their late 20’s.  Certainly very few sports offer entry opportunities for older athletes, so while there may be an argument for motivating some youth, the Olympics don’t seem to be a good incentive for the general population.

Yet, the distribution of support dollars for athletes continues to favour the elite and discourage recreational participation.  Canada spends about 200M on sport each year, one-third of which is spent on the handful of elite athletes, much of the rest on structures destined to filter to the elite level.     

There was one calculation that the success rate of high school basketball players making a career of longer than five years is about 1 in 100,000.  These are amongst the elite high school basketball players already.  Hence the odds of successfully becoming a world class athlete would appear to be sufficient to discourage more than encourage lifelong physical activity pursuits.  

Most likely the most engaging sport for the next few weeks will be couch surfing – not the healthiest of solutions in stimulating a population to engage in routine physical activity. 

There would be many questions that should be answered about our investment in physical activity for the general population.  At the moment, Canadian eyes, and those of other countries,  are watching the medal count as the measure of success of physical activity program. 

Monday, 30 July 2012

DrPHealth - what your feedback said.

A month ago, the future of DrPHealth was put out to the readership with some specific questions.

Should the site continue?  Eight votes were registered in favour of continuation.  One vote suggested it was time to wind up.

Three of the respondents recommended abandoning the anonymity guise.

Ten recommended marketing the site more and expanding its reach.

The bottom line is that only thirteen votes were received, and while those that voted were supportive, the underwhelming engagement is noted.

For the current time, DrPHealth will continue intermittently, responding to the very issues that need to be exposed in the Canadian public health realm.

There are numerous posts that reflect state of the science reviews and analysis of the Canadian system and continue to be referenced frequently enough to warrant the site remaining active.   The original target of 10,000 views will likely be reached later this year and a definitive decision made at that time.

In the meantime, DrPHealth would still like to hear from you as the reader about issues that are current in your community,  province or nationally that need comment and exposure.  Drphealth@gmail.com

Enjoy the summer, remember to stay safe.

Wednesday, 25 July 2012

Pertussis – whooping it up on the newswire

The past few weeks have seen resurgence in media reports related to the tragedy of pertussis and the numbers of outbreaks occurring in North America, something DrPHealth has addressed several times so far this year as the outbreak has been developing Pertussis need for adult vaccination February 7 and  Pertussis back in the news big time May 17 .

Andre Picard has synthesized and personalized the Canadian situation in the Globe and Mail  Pertussis by Andre Picard driving the issue to mainstream Canada at last. M. Picard’s poignant comments are worth reading on any good day, and his comments hack away at the non-immunizers.   For an enlightening education of balanced rhetoric, be sure to scan through the comments of fellow Canadians. 

South of the border, some 18,000 cases have been reported so far this year with at least nine deaths.  
If you are looking for more, try Googling “Pertussis outbreaks” or check out Twitter on the hash tag #pertussis.  More examples of using social media to monitor disease activity, it seems more effective than formal Canadian surveillance systems.    

NACI has not updated any adult immunization guidance to date, however recommends a single dose of acellular pertussis at some point on or after the school leaving age of 14-16.   NACI immunziation schedule

Tuesday, 24 July 2012

Some psychoactive drug tidbits to consume

Be sure to vote on the future of DrPHealth in the upper left side of page.  Both your vote and the number of votes are important in deciding whether the site makes a difference to Canadian public health. 

Early indications of the price of taking Oxycodone to slow release formulation and off the market Oxycodone losing funding  are showing up in increased heroin use.  Merely anecdotal reports currently, but a shift should be expected  and the failure to have good surveillance in place is a major oversight.  London report of increased heroin use.  US reports note that part of the shift reflects the discovery that heroin is cheaper than a dose of Oxycodone. 

This site is one of many that have supported a shift from the “War on Drugs” to using a rationale public health approach to the use of psychoactive substances intended to minimize the health consequences.  One of the potential unintended consequences of the shift would be an increase in secondary exposure to marijuana smoke.  Not surprisingly, smoke of any nature can be associated with health impacts.  Two Canadian articles in the journal Chemical Research in Toxocology scratch the surface on the potential downside for exposed persons Chemical toxicity of cannabis smoke  and Genotoxicity of cannabis secondary smoke .  Both studies should increase concern about secondary exposure, and in particular to women considering pregnancy.  It is an area for expanded concern.

Health Canada does try to post objective lay information on health effects of cannabis in various forms Cannabis health effects.  We would recommend the Ontario Centre for Addiction and Mental Health site as more comprehensive and current CAMH and cannabis.

As the AIDS 2012 conference progresses in Washington, more voices are speaking out loudly against the War on Drugs efforts because of its contribution to accelerating AIDS dissemination CBC story.   The comments are of themselves worth reading to reflect the diversity and sometimes very opinionated views  on HIV infection and drug use.   Check out the AIDS conference blog AIDS blog , in a year of political instability in the US, this conference is sure to carry many innuendos on both the disease and the linkage to drug use.  

Monday, 23 July 2012

Exciting news from the Injury Control field

While injury rates trend downwards over the long time period, the effectiveness of various interventions in preventing death from certain forms of injury has been mediocre at best.   The best efforts in motor vehicle collision deaths through engineering changes, merely modest success in reductions in falls, and suicide prevention programming has rarely shown any benefit and unlikely a major contributor to the recent reductions in suicide rates. 

In this disappointing field, there has been ample opportunity for the growth of various organizations invoking calls for injury prevention, engaging in high profile media events, and competing for limited resources.   Innumerable groups come to mind ranging from the Red Cross and Royal Lifesaving Society in water safety, Canadian Avalanche Centre for backwoods deaths to avalanches, and more recently Safe Communities, Safe Kids, SmartRisk and ThinkFirst.  All focusing on thematic variations in making safer choices.    Add to this the Brain Injury Association, Occupational Health and Safety groups, Agricultural safety groups, Hockey helmet groups and the list continues without end.  

Many provinces have invested in provincial injury control centres, BC, Alberta, Saskatchewan, Ontario, and Quebec.  Not to be left out, most of the remaining provinces have provincial strategies and functions integral to their Ministries of Health.  PHAC wanders into the field as well. 

One might almost be concerned that efforts are diluted and contributing to ineffectiveness.  Hence the very positive announcement that Safe Communities, Safe Kids, SmartRisk and ThinkFirst are amalgamating their organizations under the new banner of Parachute Canada.  press release on amalgamation of organziations.  In an era of decreasing government support and fiscal restrictions, such amalgamations are going to become an increasing necessity for financial reasons alone.  Amalgamating programming, resources, supports and infrastructure may help Parachute Canada also become more effective in protecting Canadians.   Kudos to the boards and administrations of the organizations for taking the bold leap, something public health workers should acknowledge and applaud. 

Many business mergers are destined to failure from the onset, hopefully the similar vision of these organizations can form an effective national coalition to bolster efforts nationally and provincially.  Would it not be shocking to see such collaboration and integration between the provincial injury control centres as well?  

As a total aside, an interesting injury prevention piece on the risks carried by the “one-size fits all” approach to engineered space in motor vehicles.  Evidence that obese persons carry a disproportionate risk for severe outcomes when involved in a crash Oottawacitizen Obseity and MVC  .  Innovative work that adds to the descriptive efforts of injury -  now to convert description into effective action.

Thursday, 19 July 2012

AIDS 2012: The Canadian role continues

Please vote for the future of DrPHealth - just on the upper left side of the home page.   

Next week the world will congregate together for the nineteenth world AIDS conference.  The first conference held in 1985 just as the outbreak was commencing, now the international spectacle meets every two years.  Three of those meetings have been held in Canada. 

The alignment of international public health efforts to control HIV infection is a model for other disease control international efforts, and the effect of international collaboration has demonstrated that we are stronger and more capable as a collective than working as 200 plus fiefdoms.  That so many countries continue to contribute and align their efforts behind the work done by the International AIDS Society is a tribute to it and its member country and organizational affiliates.  

As with many conferences, you can follow daily progress on line without attending AIDS 2012 home page. But, as with many conferences, the 10-20,000 expected attendees and multiple concurrent activities makes attendance and tracking activity a challenge.  That 3600 abstracts were accepted for the conference puts a whole new sense of the challenge of multitasking. 

What actually brought this issue to light was Canada released a self-congratulatory press release on its successful incorporation of Aboriginal issues into the 2012 conference agenda PHAC announcement.  That Canada should shout its accomplishments related to HIV and AIDS loudly was the focus of the year beginning posting HIV progress celebrating Canadian contributions, as such this is on the surface a welcomed announcement.

The announcement begged the first question of what does this actually look like and the program security is sufficiently daunting that it is unclear what this stream will entail but it is not inherently obvious from the information on the website.

Secondly, is what is the purpose behind the PHAC announcement?   PHAC has issued about a dozen press releases all year, half of them related to new HIV funding announcements in March.  So a press release is an unusually and somewhat unique event.   That Aboriginal issues will receive a greater presence in the main agenda is great, but the circumstances around the press release are suspect.  If it is a commitment to a new openness and efforts by PHAC to be transparent and to celebrate their good work – this has been a long time coming and we should welcome the change in operation.

It is disturbing that when PHAC issues a press released, the first question is why? What are they really up to?  Lets hope a change is in the winds. 

Tuesday, 17 July 2012

Disease eradication - find out which infection is set to disappear

Smallpox eradication was the pinnacle of public health efforts.  It demonstrated the capacity of the global community to unite for common cause that crossed political, religious and ideological boundaries.   Much was made of the effort and the success. The efforts started in 1958, were augmented in 1967, the last case recorded in 1977 and ultimately declared eradicated in 1980.

With much less pomp and publicity, a second disease is on the verge of eradication Scientific American report .  Yes efforts have targeted polio and measles, and at least for polio, the finish line may be just beyond the horizon – but the disease on the brink of extermination is dracunculiasis – or guinea worm infection.
Key to any disease eradication is that humans must be a required host.   The disease has predominately existed in Africa water consumption where the arthropod cycle of the parasite is hosted.  Eradiction is facilitated by improved sanitary conditions, filtering water supplies by even broad materials such as cloth, and appropriate education and management of cases.  

In 15 years the number of cases has dropped from 3.5 Million to just over a 1000 in 2011 and merely a handful reported so far in 2012.   Most cases are from the new autonomous country of South Sudan, where eradication efforts are slowed by poor water sources and political unrest of the past years.  The complex life cycle is a good example of typical parasitic diseases Wikipedia on Dracunculiasis.  

The interesting side story that seems to have gained some momentum is that the “snake” around the Rod of Aesculapius – the traditional symbol of medicine, was believe by some to have actually been a guinea worm, as the method of removal of the worm is to wrap the worm around a stick and extract sections at regular frequent intervals to extricate the worm which may ultimately be 2-3 meters in length.   This interpretation is not consistent with the use of snakes in ritualistic healing activites that followers of Aesculapian promoted and integrated into the Aesculapian symbol . 

However the analogy is worthy as it is a reasonable stylist depiction of the traditional method for guinea worm extraction. 

Polio remains the disease next on the brink of elimination.    

Monday, 16 July 2012

Rio +20: Sustainable development shifts from environmental sustainability to economic growth

Hopefully you didn’t miss it?   Rio +20 – the 2012 rendition of the global conference on sustainable development. 

Okay, perhaps you did miss it.  Understandable,  given the underwhelming coverage and the minor afterquake impacts of twenty years of rhetoric since the Rio Declaration stunned the world into actually believing that there was an urgency and imperative to do something globally.  

Well, most of the developed world was convinced.  
That the US never did buy in was one of the key failures.  
And that developing countries going through transitional economies were not included and now are major contributors to environmental degradation was another failure, 
and .......  there are more excuses than points of celebration. 

If you have not read the original declaration, it is a good time to view (or re-view) the 23 principles Rio Declaration. Contrast this with the recommitment statement of 2012 Rio plus 20 declaration  and its 283 prinicples over 50+ pages. 

Perhaps most telling is look for how the words derived from “econom-“ are used in the two statements.  In 1992 the impacts on the economy were secondary statements used four times, and in fact looked at issues to use the economy to bolster environmental protection.  The 2012 statement boldly addresses that economic sustainability is integral to its opening principle and follows this up with speaking to the economy and growth in a majority of the 283 principles. 

“Poverty” eradiction was mentioned once in the 1992 statement as a requirement to eliminate disparities between countries.   Poverty eradication becomes an end of itself and justification for economic growth in the 2012 statement. It even is the focus of a major section of recommendations for 2012. Promoting equity is perhaps buried within the tome, but not the focus that the second principle of 1992 was so clear about. 

"Health" gets three mentions in 1992, two related to human health.   Proportionately it maintains a similar status through 2012 albeit there is a specific section on human health principles.  

“Environment” as a word is integral to 18 of 23 principles in 1992.  While the word is still common in 2012, the proportion of principles that reference the environment has plummeted well below the economy to between ¼ and 1/3rd of the principles.

It would appear that fundamentally, global sustainability has shifted from the left led environmental movement, to what would appear to be a neo-right sustainable economic growth agenda.  While some may argue the two agendas can be aligned, economic growth to date has tended to occur at the expense of environmental sustainability, and the subtle innuendo that there must be ongoing economic growth for 'sustainability' to be achieved which is a fundamentally flawed assertion that has long term devastating consequences.  

Just as importantly is that the efforts of 1992 have been minimally effective in curtailing environmental and health degradation.  The efforts of 2012 go no further than generating a plethora of hot air and neatly composed words of immeasurable commitments. As we have noted before, health and the environment are inseparable companions Health and Environment Inseparable companions

Perhaps it was good that the conference did not get much attention. 

Thursday, 12 July 2012

This week in public health: Heat, Refugee health, parenting, injury prevention and colorectal cancer

DrP needed to take a short break.  Please be kind enough to fill out the survey on the future of the website.  The uinderwhelming response to date speaks loudly.

Summertime tends to be when either nothing happens, or important but potentially politically embarrassing information is discretely posted without fanfare in the hopes it flies under the radar.  Be sure to send any tidbits to drphealth@gmail.com 

A few quickies to get back on track:

With heat waves hitting, it is the earlier in the year heat that is most fatal as we struggle to acclimatize to the ever changing heat environment.   Heat kills up to 1000 Canadians each year – check out Weather that kills 

Apparently a slight budget on the refugee health issue, but realistically a political clarification.  Why would the government not provide health care to those that it sponsors?   Kudos to all the health care professionals that have and continue to apply the heat, this is one of Canada’s most disgraceful civil society moments.   Posting from Canadian Doctors for Refugee Care

 Parenting programs continue to garner considerable interest, with a good review on the impact on psychosocial wellbeing of parents to be found at Review article on psychosocial health of parents in parenting programs

How little we really know about preventing outdoor injuries to children comes across in this review Injury prevention for children.  It is one of those areas that there is a sense that we have to do something – but little sense of what is effective.

Colorectal cancers area  leading cause of both incident cancers and mortality.  The fecal occult blood test has had lots of proponents and opponents, but this review notes a 25% reduction in colorectal cancer mortality from its use.  Colorectal cancer screening.  Now that’s something we all should get behind. 

Expect postings over teh summer to be somewhat less frequent.  Ideas, suggestions and submissions are ever welcomed drphealth@gmail.com

Tuesday, 3 July 2012

Happy Birthday to DrP

DrPHealth celebrates one year since this experiment began by this writer.  Initially the purpose was about learning how to use social media.  It quickly became a form of self-education as there are it forces the writer to remain current with public health activities in Canada and more globally. Curiosity has driven its prolongation.  The dynamic shifting of audiences, the fascination with specific topics of controversy – whether Smart metres, fluoride, or Hookah and less interest in the the relatively mundane in public health like tobacco.  Wandering into the fringes of public health with telehealth, healthy built environments, and the use of social media have garnished much more interest than the exciting developments in work near the core like Hepatitis C, data management, influenza or screening. 

Topping the consistent list of views are topics directly linked to determinants of health. Topics related to food and nutrition have tended to garner the most engaging comments.    

What are the messages in this?   That these are the hot topics in public health, or merely a reflection of interest of the consistent readers? 

I am so appreciative of the core of readers who have the blog sent to them by email, for which I have no statistics on how many are recipients.  A small core of followers on both the Blog site, through Linked in, and the several dozen who follower Tweets @drphealth.   Increasing, more folks make passing verbal comments that reflect knowledge about the site, some of whom seem truly oblivious as to the sources. 

July 3rd will also see the 8000th visitor to the site - with an original horizon target of 10000.  

The time has come to begin to decide the future for the site.  At the top of the home page, there is a poll that asks the question about what should be the future for the DrPHealth blogsite?  For some reason the question was dropped and is added into the site description (I continue to learn).  Please vote, and you may choose multiple answers – they are in part based on feedback that has been received. Be sure to communicate with your colleagues and have them express their opinions too.   The poll results will be viewable, and will stay open until the end of July.   Comments of course are welcomed to be posted, or sent privately to drphealth@gmail.com.   Any and all feedback is encouraged and welcomed.  Anonymity has a value, but also a price when it comes to the interactive dialogue needed to ensure needs are being met.

In the meantime, please celebrate with me, this 185th posting, along with 175 Tweets, and some 85 followers between Twitter and Linked-in.   Happy Birthday to us, DrPHealth has become a small and sometimes vibrant community!!!. 

Sunday, 1 July 2012

Nationalism, Patriotism, Connectedness and social support as health determinants. Happy Canada Day

Socialization plays an important role as a social determinant of health, it is multifaceted word.

At the individual level, married persons are healthier than those not married. Moreover recent loss of a spouse significantly increases risk for a poor health  outcome.

Persons with fewer than 3 non-family friends they would call on in a crisis are more vulnerable to poor health than those with larger social networks

Several school studies have shown that students that feel connected to their school environment thrive compared to their aloof companions.

In current Aboriginal reform processes, culture is a consistent health theme.  Those who demonstrate closer connection to their culture being healthier, and many social reforms proposed and in implementation are based on rebuilding reconnection as a foundation to health improvement, or as more aptly stated “healing”

Sure enough, there is some evidence that those that demonstrate higher levels of patriotism at a civic or national level also profess better health Huff post on patriotismMens Health on patriotism.   Two studies, (in one of those elusive pay per view journals), one looked at 130,000 people in 128 countries, the other at 40,000 in 31 countries (and potentially some overlap?).   Both studies made some interesting comments on how nationalism based on connection to values and institution bring stronger benefit than tradition or economic prosperity.  

So Happy Canada Day, Happy Independence Day, and numerous other national celebrations also occur at this time of the year to be acknowledged.  Celebrate safely in style and be sure to wear your heart on your sleeve. It is good for your health. 

Cheer your Olympians over the upcoming weeks.  A question we posed and did not get an answer – does global health improve over the duration of the Olympics, theoretically it is a time of manifest patriotism and beneficial?  Anyone with  knowledge of work done on this one truly pan-global expression of national pride and linking it to health, please send information to drphealth@gmail.com