DiversityNursing Blog

Written by David McNamee

www.medicalnewstoday.com 

A new, first-of-its-kind infographic published in the Centers for Disease Control and Prevention's Preventing Chronic Disease journal maps the most 'distinctive' causes of deaths across all states in the US.

The map presents 2001-10 data on causes of death within individual states that were statistically more significant than the national averages, drawn from the Centers for Disease Control and Prevention's (CDC) own "Underlying Cause of Death" file, which is accessible through the WONDER (Wide-ranging Online Data for Epidemiologic Research) website.

The largest number of deaths in the map from a single condition were the 37,292 deaths from atherosclerotic cardiovascular disease in Michigan. The fewest were 11 deaths from "acute and rapidly progressive nephritic and nephrotic syndrome" in Montana.

The numbers of death from discrete illnesses varied across states. For example, 15,000 HIV-related deaths were recorded in Florida during the study period, 679 deaths from tuberculosis in Texas, and 22 people died from syphilis in Louisiana.

The most distinctive causes of death in New York were from gonorrhea and chlamydia, and the state also had the highest number of deaths from infection of female reproductive organs - mostly as a result of untreated sexually transmitted diseases.

According to the researchers behind the map, some of the findings make "intuitive sense," such as the high numbers of death from influenza in northern states, or pneumoconiosis (black lung disease) in states where coal is mined. However, some of the other findings are less easily explained, such as the deaths from septicemia in New Jersey.

What are the strengths and limitations of the map?

The map only presents one distinctive cause of death for each state, all of which were significantly higher than the national rate. However, many other causes of death that were also significantly higher than national rates were not mapped.

Another limitation of the map is that it has a predisposition toward exhibiting rare causes of death. For instance, in 22 of the states, the total number of deaths mapped was under 100. 

"These limitations are characteristic of maps generally and are why these maps are best regarded as snapshots and not comprehensive statistical summaries," explain the researchers, Francis P. Boscoe, of the New York State Cancer Registry, and Eva Pradhan, of the New York State Department of Health.

Boscoe and Pradhan say that the map has been "a robust conversation starter" - generating hypotheses that they consider would not have occurred had the data been formatted in "an equivalent tabular representation." They add:

"Although chronic disease prevention efforts should continue to emphasize the most common conditions, an outlier map such as this one should also be of interest to public health professionals, particularly insofar as it highlights nonstandard cause-of-death certification practices within and between states that can potentially be addressed through education and training."

By MELENA RYZIK

Artists, it’s fair to say, usually don’t know much about bacteria. Vik Muniz is an exception. Mr. Muniz, the Brazilian-born photographer known for his unorthodox materials, has been working with the M.I.T. bioengineer and designer Tal Danino on a series of trompe l’oeil images of microscopic organisms: cancer cells, healthy cells and bacteria.

At first glance, they look like ornate and colorful patterns. In reality, they represent teeming, living things. Among his latest: a pink print that could pass for floral wallpaper. But it’s made up of liver cells infected with the Vaccinia virus, which is used to make the smallpox vaccine.

“Normally, patterns are soothing structures,” Mr. Muniz said, “and all of a sudden, there’s a lot of drama.”

The work now has another meaning. It will be used in a new online campaign, The Art of Saving a Life, sponsored by the Bill & Melinda Gates Foundation. The intent is to promote vaccination just in time for an international effort to raise funds to inoculate millions, especially in poor nations.

The campaign, to be released online on Wednesday, is the first time that the foundation has commissioned artists in the service of a cause. The global roster includes photographers (Annie Leibovitz, Sebastião Salgado, Mary Ellen Mark); writers (Chimamanda Ngozi Adichie); filmmakers (Luc Jacquet, director of the documentary “March of the Penguins”); and bands (Playing for Change).

The intent is that their work will spread virally — in the digital sense — and be shared on social media with the hashtag #VaccinesWork to inspire a dialogue and donations.

“We want to get the buzz and the conversation going, because it’s easy to take these important lifesaving tools for granted,” said Dr. Christopher Elias, president of the global development program at the Gates Foundation. Art, the foundation hopes, will serve as a reminder to people “who aren’t going to read the editorial in Science,” Dr. Elias said. If the program is successful, he said, it could serve as a model for other Gates Foundation projects.

The idea came from Christine McNab, a consultant to the foundation. In brainstorming new ways to promote vaccines, she considered “what makes me cry, what makes me think,” she said. “It’s films, it’s books, it’s galleries.”

Ms. McNab and her team invited the artists in and suggested which diseases or issues to address. But they had no control over what was created. Some artists were paid a small fee to cover expenses; some retained their copyright, and others donated their work.

Ms. Leibovitz snapped a black-and-white portrait of people involved in vaccine development. Fatoumata Diabaté, a photographer from Mali, captured the last phase of trials for an Ebola vaccine. The German painter Thomas Ganter paid tribute to the little-sung medical aides who administer the shots, with his oil on canvas of “The Unknown Health Worker.”

The project is timed to lead up to a Jan. 27 meeting of Gavi, the Vaccine Alliance, an international public-private partnership in Berlin. Some images will be displayed at the conference, which aims to raise $ 7.5 billion from donors for Gavi’s next phase of development. Separately, the Gates Foundation has funded many immunization-related grants, at a cost of millions — far greater, a spokeswoman said, than the budget for the art initiative, which she would not disclose.

As the project developed in the last year, the anti-vaccination movement, in the United States and other Western countries, only gained steam. Though the programs that the Art of Saving a Life supports are targeted elsewhere, “in some ways what we’re hoping for is not just a broader debate about vaccination and immunization, but a more informed debate,” Dr. Elias said.

Countering the anti-vaccination rhetoric was part of the reason that Alexia Sinclair, a photographer from Australia, participated, she said. “I have a young daughter, and it’s quite a hot topic here,” she said, adding that she thought that producing a work of art “allows the conversation to happen in a clearer way.”

After learning that the Chinese characters for smallpox mean “heavenly flowers” — because the pustules bloom on the body, and the sufferers eventually die — Ms. Sinclair, who makes historically-inspired tableaus, created a scene of an 18th-century doctor administering a vaccination, surrounded by grass and blossoms. It brings a fashion-y aesthetic to an ugly disease. “I wanted to create something that looked at smallpox, but did it in a way that didn’t repulse people,” she said.

In an era when viewers are image-saturated, the campaign’s success, and how to measure it, are an open question. “We’ll look at the metrics,” Dr. Elias said. But, he added, the project has already proved valuable inside the Gates Foundation, as a new perspective on old problems.

“The phenomenal response” from artists, he said, “suggests that we have tapped a set of interests and voices that we perhaps should’ve been paying attention to sooner.”

Source: www.nytimes.com

By Sanjay Gupta

So, in no particular order, here's my take on the nine big health stories to watch for, and the questions they will likely raise, in 2015.

Doctor shortage. There aren't nearly enough of us to care for the U.S. population. By some estimates, the country is already short of tens of thousands of doctors, a problem that will only get worse as the demand for care increases with our aging population. That could mean longer wait times for you when you need to make an appointment. But that also means policy makers will have to consider questions like: Is there a way to increase the number of residency training slots? Are there other health care professionals who can reasonably fill in the gaps? Will the nation's quality of care go down? How can the country avoid a situation where only the wealthy will be able to afford quality care? 

Hospital errors and infections. Hospital mistakes and infections are still one of the leading causes of preventable death (indeed, some studies suggest "hospital-acquired conditions" kill more people than car accidents or diabetes). 

True, a recent study showed the rate did get better this year, saving tens of thousands of lives. But what else can hospitals do to prevent these mistakes and infections? Can technology like e-prescriptions and electronic health records prevent problems that most often occur: the mistakes caregivers make with a patient's drugs? 

Antibiotic resistance. It has been called public health's "ticking time bomb."The World Health Organization calls antibiotic resistant infections one of the biggest threats to global health today. Each year, at least 2 million peoplebecome infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year. Most of these deaths happen in health care settings and in nursing homes. How can we respond? Well, research teams around the world have already started searching for the next generation of infection-fighting drugs. But it remains to be seen if time will run out, sending us back to the beginning: a time before antibiotics, where even a cut that becomes infected could kill you. 

More do-it-yourself health care: apps and technology. Technology has made do-it-yourself patient care much easier. This goes beyond just a patient's ability to look up their symptoms online. There are apps to help with autism, apps that can simulate a check-up, apps that can monitor conditions. Wearables can motivate you to walk more or sleep more or check a diabetic's glucose level. But how does all this helping yourself make your health care better? How much is too much? And what does this mean for your privacy? After all, the health care industry accounted for 43% of all major data breaches in 2013. Meanwhile, although 93% of health care data requires protection by law, some surveys suggest only 57% of it is "somewhat protected." What could this mean for your privacy and personal information if security doesn't get better? 

Food deserts. While not everyone agrees with the term food desert, the USDA still estimates 23.5 million people live in these urban neighborhoods and rural towns with limited access to fresh, affordable, healthy food. Without grocery stores in these areas, residents often have to rely on fast food and convenience stores that don't stock fresh produce. It takes a real toll on their health. Families who live in these areas struggle more with obesity and chronic conditions, and they even die sooner than people who live in neighborhoods with easy access to healthy food. More farmers markets are now accepting food stamps and many nonprofits have stepped in to try to bring community gardens and healthy food trucks to these areas, but so far it's not enough. Will cities offer incentives to grocery store chains to relocate to these neighborhoods?  How else can this system be helped? 

Caregivers for the aging population. We are heading into a kind of caregiver crisis. The number of people 65 years and older is expected to rise 101%between 2000 and 2030, yet the number of family members who can provide care for these older adults is only expected to rise 25%. This raises a series of related questions, not least who is going to step up to fill the gaps? Will cities that don't traditionally have strong public transportation systems add to their routes? Will developers create more mixed-use buildings to make shopping and socializing easier to access? Could the government create a kind of caregiver corps that could check in on the isolated elderly? Who will pay for this expensive kind of safety net? 

The cost of Alzheimer's. Currently about 5.2 million Americans have Alzheimer's. That number is expected to double every 20 years. With a cure some way off, what can be done to ease the emotional and financial burden on families and communities affected by the disease? The Alzheimer's Association predicts that by 2050, U.S. costs for care will total $1.2 trillion, making it the most expensive condition in the nation. How will we be able to afford the costs of caring for this population? What can the country do to achieve the goal the White House set for preventing and effectively treating Alzheimer's by 2025?

Marijuana. With the growing acceptance of weed, we can expect that more laws will change to allow medical and recreational use of marijuana. How will the rest of the laws in this country adjust? For instance, Washington state is coming up with a Breathalyzer-type device to check if drivers are high. But it will be interesting to see how readily available these devices are going to be. Will legalization improve the scientific understanding of the long-term consequences of the drug? What other uses could this drug have to help those who may need pain relief most?

Missing work-life balance. Americans spend more time on the job than most other developed countries. We don't get as much vacation, we don't take what vacation we have, and we are prone to working nights and weekends. This stress has a negative impact on Americans' health. What are companies doing to help? What technology can change this phenomenon? Will millennials who say work-life balance is a bigger priority than other generations rub off on the rest of us? What can we personally do to find a better balance? 

We may not be able to answer all these questions in 2015, but we sure will try. And the health team and I look forward to exploring these issues with you in the coming New Year.

Source: www.cnn.com

By David McNamee

A new report finds that by 2100, there will be more people alive on the planet than has ever previously been predicted. We investigate what the consequences these extra bodies may have for maintaining public health.

The potentially catastrophic consequences of an exponentially growing global population is a favorite subject for writers of dystopian fiction.

The most recent example, Utopia - a forthcoming David Fincher-directed series for HBO - won critical acclaim in its original incarnation on UK television for its depiction of a conspiracy-laden modern world where the real threat to public health is not Ebola or other headline-friendly communicable viruses, but overpopulation.

Fears over the ever-expanding number of human bodies on our planet are not new and have been debated by researchers and policy makers for decades, if not centuries. However, recent research by University of Washington demographer Prof. Adrian Raftery - using modern statistical modeling and the latest data on population, fertility and mortality - has found that previous projections on population growth may have been conservative.

"Our new projections are probabilistic, and we find that there will probably be between 9.6 and 12.3 billion people in 2100," Prof. Raftery told Medical News Today. "This projection is based on a statistical model that uses all available past data on fertility and mortality from all countries in a systematic way, unlike previous projections that were based on expert assumptions."

Prof. Raftery's figure places up to an additional 5 billion people more on the Earth by 2100 than have been previously calculated.

A key finding of the study is that the fertility rate in Africa is declining much more slowly than has been previously estimated, which Prof. Raftery tells us "has major long-term implications for population."

Fertility rates declining more slowly in Africa than previously reported

A 2003 Centers for Disease Control and Prevention (CDC) report found that, in sub-Saharan Africa, both fertility and mortality rates were high, with the proportion of people aged over 65 expected to remain small, increasing from an estimated 2.9% in 2000 to 3.7% in 2030.

The CDC report notes that fertility rates declined in developing countries during the preceding 30 years, following a 20th century trend among developed countries. The pattern established by developed countries - and presumed to follow in developing countries - was that countries shift from high fertility and high mortality rates to low fertility and delayed mortality.

This transition starts with declining infant and childhood mortality as a result of improved public health measures. Improvements in infant and childhood mortality contribute to longer life expectancy and a younger population.

This trend of adults living longer, healthier lives is typically followed by a decline in fertility rates. The CDC report suggested that by 2030, there would be similar proportions of younger and older people in developing countries, by that point mirroring the age distribution in developed countries circa 1990.

Prof. Raftery's research, however, notes that in Nigeria - Africa's most populous country - each woman has an average of six children, and in the last 5 years, the child mortality rate has fallen from 136 per 1,000 live births to 117. This works out as a population increase of 20 people per square mile over the same timespan.

How will population growth affect developing countries?

But what does this mean for countries where the public health system is already stretched to breaking point - as has been demonstrated by the recent Ebola epidemic?

"Rapid population growth is likely to increase the burden on the public health service proportionally," answered Prof. Raftery.

"There are already big public health needs and challenges in high-fertility countries, and rapid population growth will make it even harder to meet them." However, if the fertility rate declines faster, Prof. Raftery suggests that high-fertility countries can reap "a demographic dividend."

He explained:

"This is a period of about a generation during which the number of dependents (children and old people) is small. This frees up resources for public health, education, infrastructure and environmental protection, and can make it easier for the economy to grow. This can happen even while the population is still increasing."

Does this suggest that an increasing population is not quite as much of a threat, but that it is more specifically the accelerations and decelerations in fertility rates that provide warning signs to future public health crises?

"Following a long run of an increasing human population growth rate, over the past half century the rate has been halved from about 2% to about 1%," Darryl Holman, professor of biological anthropology at the University of Washington, explained to MNT.

"The turnaround is quite remarkable," he said. "But as long as the growth rate remains positive, our species will eventually reach numbers and densities where technological solutions cannot ameliorate resource scarcity."

High population density leads to a much higher rate of contact between humans, which means that communicable diseases - ranging from the common cold to Dengue fever - can be much more easily transmitted.

And more people means greater efforts are needed to control waste management and provide clean water. If these needs cannot be adequately met, then diarrheal diseases become much more common, resulting in what Prof. Holman described to the University of Washington's news website The Daily UW as a "huge, huge, huge difference in mortality rates."

Taking a more general view, "the anticipated increase in the number of older persons will have dramatic consequences for public health, the health care financing and delivery systems, informal caregiving, and pension systems," wrote the authors of the CDC's 2003 report.

Overpopulation and the environment

"Can we assume that life on earth as we know it can continue no matter what the environmental conditions?," asked the authors of a 2001 Johns Hopkins School of Public Health report on the health consequences of population growth.

The Johns Hopkins report quoted figures demonstrating that unclean water and poor sanitation kill over 12 million people every year, while air pollution kills 3 million. In 64 of 105 developing countries, population has grown faster than food supplies.

By 2025, the report claimed, humankind could be using over 90% of all available freshwater, leaving just 10% for the world's plants and animals.

Prof. Holman summarizes the writings of experts Joel Cohen, E.O. Wilson, Paul Ehrlich and Ronald Lee, who have argued that the consequences of long-term environmental degradation - "specifically rising sea levels, disruption of agriculture and the increased frequency of extreme weather events resulting from anthropogenic climate change, exacerbated by resource scarcity" - create social problems that lead to social unrest.

With more people living together than ever before, it seems inevitable that this compounded social unrest would lead to increased warfare and fighting for resources.

According to the Johns Hopkins researchers, about half of the world's population currently occupies a coastal strip 200 kilometers wide - which means that 50% of us are squeezed together on just 10% of the world's land surface.

The projected flooding of these coastal regions as a result of global warming and rising sea levels could displace millions of people, result in widespread droughts and disrupt agriculture.

The Johns Hopkins team identified two main courses of action to divert these potential disasters.

Firstly - sustainable development. The report authors argued this should include:

• More efficient use of energy
• Managing cities better
• Phasing out subsidies that encourage waste
• Managing water resources and protecting freshwater sources
• Harvesting forest products rather than destroying forests
• Preserving arable land and increasing food production
• Managing coastal zones and ocean fisheries
• Protecting biodiversity hotspots.

The second vital area of action is the stabilization of population through good-quality family planning, which "would buy time to protect natural resources."

How to reduce fertility in a morally acceptable way?

Commenting on Prof. Raftery's finding that we may be welcoming an additional 5 billion individuals onto the planet by 2100 than had previously been estimated - a potential global population of 12.3 billion people - Prof. Holman admits that "it is difficult to know what the public health effects will be."

He explains:

"By then, we may see severe petroleum and fresh water resource shortages, climate changes that affect agriculture patterns that, in turn, affect food supplies. Reducing fertility in socially and morally acceptable ways seems like one public health strategy to avoid - or at least postpone - testing some of these limits."

In Utopia, a sinister governmental organization proposes to sterilize a large percentage of the population by rolling out a secretly modified vaccine in response to a manufactured flu pandemic. Obviously, that is not a socially or morally acceptable strategy for reducing fertility - but what is?

Experts consider boosting the education of girls in developing countries to be a prime solution.

As well as acquiring more control over their reproductive life, an educated female workforce should have more opportunities of employment and of earning a living wage. Studies report that the children of educated women also have better chances of survival and will become educated themselves. This pattern continuing across generations is associated with a decline in fertility rates.

A 2011 article by the Earth Policy Institute (EPI), analyzing data from the United Nations (UN), states that "countries in which more children are enrolled in school - even at the primary level - tend to have strikingly lower fertility rates."

In particular:

"Female education is especially important. Research consistently shows that women who are empowered through education tend to have fewer children and have them later. If and when they do become mothers, they tend to be healthier and raise healthier children, who then also stay in school longer. They earn more money with which to support their families, and contribute more to their communities' economic growth. Indeed, educating girls can transform whole communities."

The relationship between education, fertility and national poverty is a direct one. As the EPI authors add: "When mortality rates decline quickly but fertility rates fail to follow, countries can find it harder to reduce poverty."

The UN's 2012 Revision of the world population prospects report suggested if we make rapid reductions in family size, then it may still be possible to constrain the global population to 8 billion by 2045.

No projections are set in stone - all are contingent on what extent fertility rates will sway over the next century. And, as Prof. Holman pointed out to us, the nature of the threat posed by overpopulation has "been vigorously debated for over 200 years" with experts still not in complete accord.

For instance, in the 1980s, said Prof. Holman, the economist Julian Simon and ecologist Paul Ehrlich went on tour together, with a series of debates about the consequences of population growth.

"Ehrlich argued that continued population growth would lead to disaster for humans. Simon argued that population growth provided more people to invent new solutions to the problems confronting humans," said Prof. Holman, adding:

"Given the trends to this point, Simon has been 'more right.' One simple measure of this is mortality rates, which have decreased for most human groups. The flaw in Simon's argument may well be that we have never hit the limits of our finite earth. Positive population growth guarantees that we will, someday, hit some hard limits."

"So that," Prof. Holman concluded, "is the long term."

Source: www.medicalnewstoday.com