Awesome Infographic: Child Injury

This week's Awesome Infographic comes to us courtesy of CDC.

Infographic from CDC about child injury

There are so many upsetting statistics in this infographic. I find the disparities between states fascinating. The states with the highest child mortality are fairly rural--Alaska, Montana, Wyoming, Oklahoma, Louisiana, Mississippi, and South Carolina. The states with the lowest rates tend to be more urban--the Northeast corridor, the West Coast--with more rural states like Iowa and Minnesota and thrown into the mix. What are these states doing differently? Are the differences between the states a matter of the rates of life-threatening injuries or disparity in speed and access to medical care? While telemedicine has been rightly hailed as a groundbreaking innovation for improving rural health, it doesn't help much for emergency situations.

This CDC infographic is powerful. It takes complicated data and breaks it down visually so it is accessible to even the least data-inclined reader. It avoids cramming too much information and visual stimulation into one graphic, allowing the data be clearly explained by images and design. CDC does a great job with infographics--check them out!

Friday Five: sterilization, pain robot, brains, surgeons, Sharknado

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Rural women are more likely to be sterilized

Tubal ligation, also known as sterilization or “getting your tubes tied,” is far more common among rural women as compared to urban women. Of rural women, 23% said they had been sterilized; urban women, 13%. There is only speculation about why this difference exists. Some of the theories floating around are: less access to other forms of birth control; piggybacking tubal ligation onto post-partum Medicaid coverage; lower educational level. Importantly, 39% of those rural women regret their decision. We should be asking why they didn’t choose a long-term, reversible birth control such as an IUD or an implant (like Implanon) instead.

Somewhat cute robot helps reduce kids’ pain and suffering during injections

As a needle phobic myself, I was very excited to learn that there’s an innovation in helping kids’ distress during shots. The robot not only talks to the child in order to distract him or her from the scary needle, but encourages exhalation during the injection to help with muscle relaxation (video here). There are two reasons why reducing pain and anxiety for children receiving immunizations is important: excessive worry can make other parts of the exam difficult, and in the future, an adult who had a bad medical experience as a child may be more likely to avoid care. These both have significant health implications. If this robot can help, I say let’s get one in every pediatrician’s office—and maybe in internist’s offices too, for ‘fraidy cats like me.

Brain pathways involved with learning and changing behavior charted

This week the NIH published a study identifying neural pathways associated with learning and changing behavior in mice. The nerves associated with the switch from moderate to compulsive drinking were found to also have a role in learning and decision making. Researchers hope that their insights will be helpful in understanding alcoholism and addiction. Learning more about why some people can use substances in moderation while others become addicted is crucial to improving mental and physical health. Hopefully, these findings will also apply for humans.

Surgery residents operate less often under new rules

Medical residents (doctors who are done with medical school and are completing their practical training) work notoriously long shifts and even longer workweeks. Restrictions created in 2011 limited shifts to 16 hours for first-year residents and 28 hours for the more advanced doctors and everyone’s week is limited to 80 hours. Surgical residents have in turn participated in fewer hours of surgery because of the limits on working hours. Many doctors are concerned that this will put the budding surgeons at risk for not gaining enough experience. There has to be a balance between allowing doctors to get enough rest while also learning enough to practice on one’s own—the question is, how

Kathleen Sebelius may in fact have a sense of humor

Twitter blew up last night with references to Sharknado, a horribly wonderful movie about a tornado that blew sharks into a city. (I don’t know how that works, I didn’t watch it!) Buzzfeed immediately wrote an article claiming “There is no Obamacare coverage for pre-existing Sharknado injuries.” Kathleen Sebelius replied: https://twitter.com/Sebelius/status/355766513334108160 Hey, an ACA joke!

I leave you this weekend with an excellent infographic explaining pretty much everything you need to know about gender, sexual orientation, and the like…The Genderbread Person!

Genderbread-Person

Friday Five: Transplant ethics, Planned Parenthood, Hepatitis C, immigrants, Google

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Child in dire need of lung transplants starts a debate on ethics

Ten year old Sarah Murnaghan has been waiting for lung transplants for 18 months due to her cystic fibrosis and related lung failure. Doctors say she is not likely to live past the weekend without a transplant, so the severity of her illness placed her at the top of the pediatric list. However, Sarah is on very bottom of the adult list, meaning that any adults in need of lungs will be offered the organs before her, regardless of whether or not their need is as pressing as hers. Since 2005, organs are supposed to be distributed based on need, but that rule applies only to patients over age 12. Sarah’s parents have petitioned Kathleen Sebelius to change the rules to allow pediatric transplants of adult organs based not on age but on medical necessity. Hopefully, Sarah’s dire situation will ignite a conversation on organ donation and the ethics of treating children as if they are adults. (Okay, so this is six sentences but I think it’s worth it.)

Planned Parenthood case will not be heard by the Supreme Court

Indiana tried—and failed—to refuse Medicaid funding to Planned Parenthood. The Supreme Court refused to consider an appeal on behalf of the state to allow Indiana to withhold money from Planned Parenthood because it offers abortion services, even though federal law prohibits Medicaid dollars from being spent on abortion. Hopefully, this development will stall other attacks on low-income women’s right to choose their health care providers. However, the wily anti-choice movement is probably cooking up other ways to deny services to women—Indiana already has a law in place requiring facilities that offer non-surgical abortions to meet the same standards as facilities that perform surgical abortions. The Supreme Court’s choice not to hear the appeal is important, but as usual, fighting against restrictions on this legal medical procedure is a constant battle.

Is the “war on drugs” to blame for millions of Hepatitis C cases?

The Global Commission on Drug Policy called for an end on “the war on drugs,” in part because criminalization of injection drugs has lead to a quiet epidemic of Hepatitis C. The Commission estimates that of the 16 million injecting drug users (IDUs), 10 million are living with Hepatitis C; China, the Russian Federation, and the USA have the highest rates of Hepatitis C among IDUs. Arguing that harsh drug laws dissuade IDUs away from public health efforts such as needle exchanges, the Commission recommends reforming existing drug laws and focusing on health rather than incarceration and forced treatment. While I doubt many countries will decriminalize heroin and other injectable drugs, I’m pleased the Commission is drawing attention to the broader health concerns of IDUs. Regardless of drug use or dependence, a person has a right to access public health initiatives without fearing arrest and imprisonment.

Immigrants subsidize Medicare

A study published in June’s Health Affairs showed that in 2009 naturalized and non-citizen immigrants contributed $33 billion to the Medicare trust fund and received $19 billion in expenditures, creating a surplus of $14 billion. American-born citizens, on the other hand, contributed $192 billion and used $223 billion, creating a deficit of $31 billion. There are a few reasons why immigrants’ contributions lead to surplus: there are 6.5 working immigrants for every one retired immigrant and the cost of care for immigrants is less than the cost of care for the American-born. In a time when immigration and a path to citizenship are pressing issues, focusing on the positive contributions of new residents and citizens can only help decision makers to make choices to encourage new immigration. This study reminds us that immigration is crucial to the success and longevity of the United States, and treating all immigrants with respect and dignity is non-negotiable.

Google nutrition facts and get a clear answer

This coming week, Google is launching a new search feature: type a question about nutrition facts, and it provide you with a precise answer. The screen shots look much like the results when Googling conversions from cups to liters or the definition of a word. The feature is rolling out in the United States over the next ten days, but it shown up yet in Philadelphia so I haven’t been able to give it a try myself. Having the ability to ask direct questions about the nutrient content of food helps demystify some of the complicated information about healthy eating. This is health communication done right!

If you're looking to change up your workout routine this weekend, may I suggest Prancercise?

http://www.youtube.com/watch?v=o-50GjySwew

The Friday Five: Angelina, E. coli, Tetanus, Cloning, Sodium

This is the first week of my new feature: The Friday Five! Each Friday, I’ll use fewer than five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Here we go! Angelina Jolie’s preventative double mastectomy

The lovely actor-turned-humanitarian published an op-ed explaining her decision to undergo a preventive double mastectomy (and probably an oophorectomy in the future). Angelina even allowed—encouraged? Demanded?—her doctor to publish her pre- and post-op treatment plan. The Internet unsurprisingly buzzes with commentary: some support her, some worry her privilege sets an unattainable standard of care, and some are concerned she lopped off two of her most attractive assets. I’m impressed with her openness. While most of us do our best to keep medical information offline, Angelina willingly shared hers, hoping her candor would help other women.

Swimming pools teem with E. Coli

A study conducted last summer in Atlanta area pools showed swimmers were cooling off in more than just water.  E. coli was found in 59% of the pools, and as the CDC says, E. coli is a “fecal indicator.” Uh oh, seems like we need a refresher course in pool hygiene. The CDC gives a good finger wagging, reminding us all to take a soapy shower before swimming and to avoid the pool altogether if we’ve been suffering from diarrhea. Pool staff also should remain vigilant about chemical levels and health departments must enforce regulations.

Newborn tetanus mortality declines dramatically thanks to UNICEF

When women give birth in less than ideal conditions, and non-sterile instruments are used during delivery and to cut the umbilical cord, both the mother and child are at risk of contracting Maternal and Neonatal Tetanus if the mother has not been vaccinated. In the early 1990s, tetanus was identified as one of the most common causes of death for infants. In response, UNICEF partnered with national governments, The Gates Foundation, and many others in order to vaccinate 118 million women. The problem has been eliminated in 31 countries, but the programs in 28 countries are still vulnerable to financial cuts and shifts in political support.

Human embryonic stem cells successfully cloned

Researchers at the Oregon Health and Science University implanted donated eggs with a baby’s skin cells and for the first time, the resulting embryos lived long enough that researchers were able to extract usable stem cells. This development inspires hope that we are on the path toward creating genetically matched replacement organs for those in need and treating patients with rare diseases of the mitochondria. However, the usual suspects (mostly Catholic leaders) have moral objections and call for the elimination of all stem cell research, even though researchers are not creating viable embryos. The promise of healthy lives for children and adults will outweigh these concerns. To paraphrase Jurassic Park: science will find a way.

Questions surface about healthy sodium levels

Federal healthy eating guidelines and the American Heart Association have long encouraged us to keep sodium consumption under 2,300 mg/day and under 1,500 mg/day for anyone who is over 51, African American, or has diabetes, heart, or kidney disease. A new report questions this claim. The link between sodium, blood pressure, and heart disease may be more tenuous than most of us thought. A low sodium diet may have unintended health consequences and may not, in fact, reduce risk of heart attack or stroke. This challenge to nutritional orthodoxy shows that investing in nutrition research is vital to population health and reducing illness and death linked to diet.

I leave you with the song that plays in my head every Friday at 6:00 pm. Have a great weekend!

[youtube=http://www.youtube.com/watch?v=LOfgVKVulQk]

The HIV Breakthrough, Prenatal Care, and Hope for the Future

On Sunday, news quickly spread that a young child in Mississippi had been cured of HIV. As a newborn, the child tested positive for HIV and the specialist, Dr. Hanna Gay, administered a high dosage of drugs within hours of the child’s birth. After continuing on antiretrovirals for about a year, the child and mother stopped treatment. When they resurfaced months later, the mother stated she had continued the child’s treatment. Surprisingly, the child’s HIV test came back negative. A series of increasingly sensitive tests showed the virus was undetectable. This discovery could overhaul the way mother-to-child (also known as perinatal) transmission is treated. If the results are reproducible, the drug dosage and combination has the potential to stop the 300,000 cases of HIV in newborns reported annually worldwide. What’s unique about this case is that the mother received no prenatal care prior to entering the hospital in labor. Generally, pregnant women with HIV require special treatment considerations in order to prevent mother-to-child transmission. Doctors and expectant mothers weigh the costs and benefits of continuing treatment, keeping in mind that transmission does not usually occur until late in pregnancy or during delivery. This mother and child enjoyed none of the protections of drug treatment until after the birth of the child—and yet they are the center of one of the most promising HIV breakthroughs.

About 25% of infants born to mothers who do not take AZT and other drugs during pregnancy will be infected with HIV. But if the mother undergoes treatment while pregnant, only 2% of newborns will be test positive. Now, with the possibility of mega doses of drugs after birth reducing infection rates even more, we may be working toward eliminating mother-to-child transmission altogether.

Prenatal care is crucial. But in Mississippi, where the child was born, the Kaiser Family Foundation reports that women of color who give birth in the state are far less likely to receive prenatal care until late in their pregnancy or until they go into labor.

Lack of care until late in pregnancy or lack of prenatal care altogether is highest in American Indian (27.8%) and black mothers (22.8%), followed by Hispanic (23.0%) and Asian mothers (14.1%). Compared to the 9.1% of white women who go without care until their child is close to full-term, the inequity is disheartening. And the numbers are not unique to Mississippi. These prenatal care patterns are consistent with the patterns of the country at large. Paired with the CDC’s findings that black women have the highest rate of mother-to-child infection (9.9 per 100,000 births), ethnic and racial disparities in prenatal care matter.

This possible turning point in treatment means that even if an expectant HIV-positive mother receives no prenatal care and gives birth to an HIV-positive child, the child may have a fighting chance to live HIV free. We know that ethnic and racial minority women do not receive prenatal care at the same rates as white women. This potential new treatment option gives hope that HIV-positive women who do not receive prenatal care—women who are disproportionately from ethnic and racial minority groups—may be able see their children live HIV-free.