Entries for the ‘Public health’ Category

What did I miss in the message about Neti pots and brain-eating amoeba?

Monday, August 22nd, 2011

August 22, 2011

Perhaps you heard stories last week about a brain-eating amoeba and the use of Neti pots [http://www.wdsu.com/r/28921234/detail.html]. I heard a headline first about a young boy who died after being at a fishing camp and falling into water where he apparently had contact with the amoeba and it got into his body.

I heard about the Neti pot and exposure to the brain-eating amoeba from my husband who asked me to remind him to tell our daughter-in-law about it because she uses a Neti pot. And your sister, I added…

“What can you do about it?” I asked. My daughter-in-law suffers from allergies and sinus problems and the Neti pot provides relief. I didn’t want to just ‘scare’ her. After searching a few stories, I learned that you can use distilled water in the Neti pot to avoid any risk.   [http://abclocal.go.com/wpvi/story?section=news/health&id=8314285] Of course, I had to read to the very last line to glean that advice… 

How about this: Neti pot users can avoid risk from amoeba by using distilled water. Open the story this way or use this in a headline to state how to respond to the risk. Repeat it near the end to reinforce the response. But avoid telling a tale that arouses fear without a suggestion about how to reduce the risk near at hand… 

 

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What makes a good public health message–put your sheets in your freezer two hours before going to bed?

Thursday, July 21st, 2011

July 21, 2011

Yes, it is hot… And the weather affects our health…physically and mentally.

So, what are we to do about it?

I loved the message Dr. Besser gave on ABC News with Diane Sawyer tonight… ‘put your sheets in the freezer a couple of hours before going to bed…’

This is an example of a ‘good’ message. It is specific. It is doable. It is affordable…we mostly have sheets on our beds. We mostly have refrigerators in our homes and these appliances have freezers.

So, I am doing it. I will let your know tomorrow…did it work? That, of course, is one of the most important parts of a good public health message…

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…cell phones and cancer…why now?

Thursday, June 2nd, 2011

June 2, 2011

We have been hearing about the World Health organization’s conclusion that cell phones pose a health risk that is similar to lead exposure [http://www.latimes.com/health/la-he-who-cell-phones-20110601-1,0,3926296.story]. A summary of the report will appear in a medical journal in July. But advance news stories indicate that as with lead exposure, more exposure increases risk. Cell phone use rarely–less risk. Cell phone use for hours at a time and/or every day–greater risk.

Why has this report come out now? Last year, the U.S. National Cancer Institute reviewed research relating to cell phone use and cancer and posted a summary of their conclusions at http://www.cancer.gov/cancertopics/factsheet/Risk/cellphones. It is tricky to read through the findings. They sometimes suggest that the issue has been directly studied. The ‘gold standard’ for clinical trials is based on randomly assigning individuals to a condition in which the thing to be studied is ‘given’ to those participants and another condition for which the randomly assigned individuals do not have exposure to the thing being studied. Thus, when the NCI reports about studies that have compared individuals who subscribe to cell phone service with those who do not, it begins to sound like a randomized trial. I subscribe to a cell phone service and seldom use my cell phone. My daughter has a cell phone service, it is the only phone she has [no land line], and she uses the phone–talks on it–a lot. So if we were both included in the study mentioned by NCI based on being subscribers, the results might not be an accurate reflection of a relationship between cancer and cell phone use. Subscribers who seldom use their cell phones, if included in the denominator of an equation designed to inform about risk, may artificially reduce the overall risk.

For example, if there are 2 cases of cancer in people in the population that is not subscribed to cell phone service–let’s say that is 100 people–and there are 2 cases of cancer in people in the population that is subscribed to cell phone service–let’s say that is 200 people–it suddenly appears that  there are fewer cases in the latter…. But what if only 50 subscribers use the cell phone everyday….not even counting how long everyday–just everyday. 2 cases among 50 people is twice the risk of the poulation of nonsubscribers… Is that accurate?

So that has been the challenge for some years now. No one is going to conduct a randomized trial of cell phone use in which they randomly assign some people to be users and some to be nonusers, and then have some users use briefly everyday, and some users use for two hours, and some more…and track cancer incidence across yearssssss of the lives of the participants. So we have to rely on the research that makes comparisons such as the one described above. The WHO’s group of scientists apparently reached the conclusion that the nearly four dozen published studies reviewed with the thousands of particpants is sufficient evidence to classify cell phones as a possible risk for cancer. In view of how cell phones work, it seems a safe bet. And the ways to reduce risk by using the cell phone with a device that keeps the phone away from my brain is an easy and effective way to reduce that risk…

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What’s new under the sun?

Wednesday, April 20th, 2011
April 20, 2011   GUEST BLOG POST by Caroline Gilson 
 
Over the years, the desire to be tan led to use of tanning beds. Somehow, tanned skin is seen to be sexy and attractive. As many people have continuously begun to be “addicted” to tanning beds, their skin has been put in a dangerous environment.
 
Tanning beds have a different type of UV rays called UV-B rays. UV-B rays are more harmful to the skin than the sun’s UV rays.  
 
The dangers of tanning beds have caused the need for educational programs to educate the public about the health concerns involving tanning beds. Research studies have been done to find out the best way to communicate about the tanning beds. One study in particular looked at the use of narratives, and statistics. (http://www.springerlink.com.ezaccess.libraries.psu.edu/content/
457nhk7324q63501/fulltext.pdf)  
 
This particular study discovered that both statistics and narratives could be effective in educating individuals about the dangers of tanning beds. Specific stories about real life people seem to grab people’s attention. Statistics about tanning beds on top of narratives help with persuasion and education about tanning beds.
 
The research has been done and now it is time to effectively educate the public about the risks of tanning beds. Hopefully, through health communication, society will make better health decisions…  
 
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What do we say to youth about exercise?

Wednesday, April 13th, 2011

April 13, 2011 GUEST BLOG POST by Elliot Searer

In many previous studies, we have found out that a healthy balance of diet and exercise is the most efficient way of staying healthy.  I feel more emphasis needs to be put on children and how much physical activity they receive, and if they are even coming close to the recommended 60 minutes per day.  I feel that organizations, like YMCAs, should offer more opportunities for our youth to have a place to properly exercise. Questions I have are:

Do our youth have proper access to a clean, safe environment suitable for physical activity and play?  Do our youth understand the importance of physical activity from a health perspective?  Do our youth have access to information that answers their questions about different exercises or exercise equipment?  Do children understand the importance of nutrition in order to gain the most from their physical activity?  Are youth who lived in dirty, unsafe conditions permitted to exercise at facilities like YMCAs despite possibly not having the proper financial means?

In a study conducted by Bowman and Neal, particpants between 5 and 17 years of age were scheduled to attend nutrition classes only or nutrition classes and family YMCA membership. The primary outcome measure was change in BMI-for-age percentile.  Four participants in the control group and one in the treatment group achieved the target reduction of 2 BMI percentile points.  Within the treatment group overall, YMCA attendees had a mean increase of 0.30 BMI points compared with an increase of 0.60 BMI points in nonattendees.  Questions I have about the study in particular are:

1) In what type of shape, physically, were the eligible participants in before the experiment?  2) After? 3)  What type of guidance was received from YMCA workers or someone of a trainer’s capability?

Through my personal experiences as an athlete, I find it extremely surprising that better results weren’t seen.   The study states that some of the participants didn’t even go to the YMCA despite having a paid membership.  I would like to know what type of guidance they were getting.  For example, if they were doing proper exercises to promote weight loss or if they even knew how to properly operate the equipment and machines. 

I feel a lot more can be done by communities to stress getting the 60 minutes of daily physical activity.  Organizations should take a stronger stance and venture out in the community, and set up activities in parks or rec sites.  It wouldn’t be hard, and would be low cost.  Also, the organizations may not even have to use their facilities as host sites for the gatherings.  Getting our youth out in the community, learning how to properly take care of themselves through physical activity could possibly lead to more benefits.  Better eating habits, spreading nutrition information to other family members, and overall healthier communities may encourage children to pursue sports or other careers based on exercise/play as opposed to sitting at home…

M. A. Bowman and A. V. Neal;  Policy and Financing in Family Medicine and the Medical Home.  J Am Board Fam Med, May 1, 2010; 23(3): 277 – 279.

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Why is belly fat bad for your health?

Thursday, March 17th, 2011

March 17, 2011

I guess we would have to be living under a rock not to have heard health messages about belly fat. What I remember hearing the most is something like, “Belly fat is bad for you.” or “You want to concentrate on that belly fat.”  And what I really got out of the messages had to do more with how we look–that belly fat is not attractive–than how it relates to health. I had seen a number of programs addressing how to get rid of belly fat [ http://www.meandjorge.com/] but never really made a connection with why in terms of health. Until the other day…

I can’t even say what program was on as I was making a meal but I heard them say that belly fat is especially harmful for our health because it is fat that works it way between and around our organs. That it literally does harm by wrapping our kidneys, liver, and intestines in fat… that was a rather horrifying image. The program went on to say that one cannot have belly fat liposuctioned away…because it is wrapping and twisting its way through our insides. The fat that can be liposuctioned away is just beneath the skin… [see this for a discussion,   http://blog.healia.com/00488/belly-fat-damages-blood-vessels-could-cause-cardiovascular-problems]

To me, this is an example of one of those messages that needs to be clearer. I especially think that men are being shown as at risk for having belly fat…but the emphasis is too often placed on how the men look and not on what is really happening inside their bodies when the pounds add up around their middles…

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What’s politics got to do with how we talk about health care in the U.S.?

Saturday, October 16th, 2010

October 16, 2010

122_22282As I describe in the chapter, ‘What’s politics got to do with to do with it?’–more than we care to admit. Access to care is what we usually talk about.., but access to knowledge based on what research gets funded and access to treatment based on what drugs and products are approved relate to politics as well. And even access to information, as policy forms around labeling and package inserts and other ways to help us make informed decisions. All relate to politics… I was thinking about some of these issues while touring a Marcellus shale mining site and wondering about the health and welfare of workers and communities alike. 

A couple of days ago, I posted my thoughts about events leading to how we talk about the focus on politics and access to health care In the U.S. Here are a few other events worthy of note… The Great Depression led the government to identify access to health care as a political priority. Now it was unemployed workers who were unable to pay for their own health care that got the government involved. Because so many workers were unemployed, this led doctors’ incomes to fall. Middle class citizens began to rely on public hospitals and state and local health departments to receive health care. In turn, doctors began providing more services through these venues. Doctors charged the welfare departments, and State welfare departments in turn charged the federal government. This cost-shifting system was supported by political priorities established in debates at the federal level and then by passage of such policy as the Social Security Act in 1935. 149_0821

President Truman expanded Social Security and recommended national health insurance in 1949. He continued to work toward it–unsuccessfully–until 1953. A role for government support of health care shifted from keeping workers working based on commerce to a role for government based on those in need or underserved–with the initial stimulus being the unemployed.  

A role for government and politics in access to health care shows great expansion in the realm of the underserved and needy during the era of the Great Society, when Presidents Kennedy and Johnson expanded the social welfare and services system. The government’s role now extended well beyond keeping a work force healthy. The effort to provide health care included powerless groups, such as children and the elderly. 

The government’s role in protecting workers’ health also grew during this era. But the focus shifted with new initiatives such as the Occupational Safety and Health Administration (OSHA), which was inaugurated in 1971, aligning with efforts to assure health and reduce the need for health care. In OSHA’s first three decades, fatalities in the workplace were cut in half, while injuries were cut 40%.

122_2235A role for government in health care as a strategy to promote the economy began to threaten the economy as health care costs mounted in efforts to bridge the gaps associated with underserved groups. President Nixon reflected this reality in his attempt to decentralize decision-making about health care, reducing the federal government’s obligations in this realm. This was part of his policy of New Federalism, a doctrine designed to draw lines between issues for national versus state or local governments. Largely, this era focused on wresting control from the federal government and revenue-sharing with states, returning a portion of taxes collected back to state and local decision-making, policy from 1972 to 1986. President Reagan also used the term New Federalism in his block grant approach, shifting monies to state and local initiatives related to providing health care.

President Clinton came into office with health care reform established as a priority. The six principles stated in a health care reform speech in 1993 reveal that the nation was not yet ready to accept limits associated with access: [1] Security: Guaranteed, comprehensive benefits; [2] Savings: Controlling health care costs; [3] Quality: Making the world’s best care better; [4] Choice: Preserving and increasing what you have today; [5] Simplicity: Reducing paperwork and cutting red tape; and [6] Responsibility: Making everyone responsible for health care. The first, third, and fourth principles reveal an emphasis on access, while the second, fifth, and sixth were the guides to be used in controlling cost. The conflict in pursuit of these two divergent paths contributed to the plan never passing, which leaves the government’s obligation in access to health care in a costly dilemma…and that is how we talk about health care in the U.S.–as a costly dilemma relating to assuring the health of workers who will contribute to the economic well-being of the country and assuring the health of groups unable to access care on their own…  

 

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What is the message in ‘Jamie Oliver’s food revolution’?

Wednesday, April 7th, 2010

141_0767April 7, 2010

In the past couple of weeks, I have been watching the TV show that sparked some discussion on this blog a couple of weeks ago. After watching it so far [and with plans to continue to do so], I wanted to take note of a couple of points in his message that may be getting lost.

First, I heard Jamie say, “It is not about weight. …Thin people can be unhealthy, too.” This is a message about our health that gets lost in the clutter of messages about weight loss, dieting, obesity, and the fixation on what the scales say. Another time that I heard a similar message in a popular TV show was one year when the first dancer to be voted off ‘Dancing with the stars’ was a model. When she was rehearsing and then performing, she did not have the physical strength to pull herself up from some of the positions her partner placed her in. She was beautiful but as her expert dance partner said, “She is deceptively unfit.” So, yes, it is NOT about the weight. If we could follow more of the fitness model and less of the weight model, a healthy weight would likely be one of the outcomes. This is one of the great messages being communicated by Michelle Obama… to the kids of the U.S., get out and get up and get moving. To the rest of as adults who set role models for our youth and for our friends and family and coworkers, ditto… I talk about this in my book ‘Talking about health’ when I tell my own experience with sitting at the computer for too many hours over too many years and developing bone spurs in my neck–literally a stiff neck. I talk about how our generation of computer workers is not unlike the old factory and production line works in that we are in one position for too long and literally get stiff [and a little fat from it, too]. My physical therapist told me, ‘Never sit at the computer for more than 30 minutes without getting up and taking a stretching break for at least 2 minutes.’ He told me to set a timer and I do–at home and at the office. Get moving and make it fun!

A second message from Jamie Oliver’s show that we should hear and act on has to do with the how over processed our foods have become. We have given the food industry a profit motivation to come up with products for us to purchase that say on them such things as ‘fat free’ or ‘no sugar added.’ A long list of ingredients then includes a lot of long words that none of us recognize because they have mostly been created in food laboratories. I was shocked when Jamie showed a class of youngsters various vegetables and the kids could not name a ‘tomato’ or a ‘potato.’ They knew what french fries are but not what a potato looks like. Wow! A shout-out to those writing the ABC picture books. We need to put some vegetables in one. Perhaps an entire picture book devoted to vegetables. And then, of course, it would be great if we followed up by eating some of these vegetables. On this blog a couple of weeks ago when the Jamie Oliver show was brought up by a participant, it was noted that the cost of fresh vegetables is high. The cost of frozen vegetables may be a good substitute. One of the partipants in that discussion said that she could buy a bag of mixed frozen vegetables in the store brand for $1 and feed her family of four with it. I suspect that the store advertises that product with an emphasis on the cost rather than the nutrition. We need more communication about how to use frozen affordable vegetables when fresh ones are not an option.

Third, following on the heels of our food being over processed is a message about our foods containing too much salt. Most of us know that the ‘dead sea’ doesn’t support any life because the water is too salty. Well, when we get too much salt, our health doesn’t do well. That is one of the challenges of buying frozen vegetables. We still have to look at the product to see if anything has been added. Not all frozen vegetables are created ‘equal.’ Some of them have salt added. So it is not just the long scientific chemical names to watch out for when looking at nutrition labels and the ingredients of products, we need to watch out for ‘sodium’–salt that has been slipped into the ingredients. We can change the way products come to us. We change them with the votes of our dollars–our food purchasing dollars…

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What is Dr. Besser telling us when he says, “There is no ‘evidence’ that herbs work for a cold”?

Tuesday, March 30th, 2010

143_0779March 30, 2010

Spring is in the air and hopefully, you are not suffering from a spring cold. Or allergies. This morning on, “Good Morning America,” Dr. Besser talked about health information and social media–offering cautions about ‘advice’ that might appear on Facebook or other outlets, or health information sent via tweets.

After offering the general advice to be careful about what we believe, he focused on an example relating to the use of an herb to fight a cold. He made the statement I used in the title for this post: “There is no evidence that herbs work for a cold.” O.K. What’s wrong with that statement?

From a health communication perspective, this kind of comment is made often. If Dr. Besser or another source of the comment is someone we trust and believe to be an expert, we may accept the comment without further thought. We are usually not expert in health. Not surprisingly, we look to experts in health to guide our understanding.

But here is the problem I have with such statements. They do nothing to help us become more competent in making decisions for ourselves about health information. Dr. Besser could explain that there is no evidence and also explain what he means by evidence. For him, evidence = scientific data. Those numbers are usually the result of carefully conducted clinical trials. Those carefully conducted clinical trials cost — well a lot of money. And relatively few dollars are spent on research to study complementary and alternative medical practices–such as the use of herbs to fight colds.

The traditional approaches to health in the U.S. are prescription and over-the-counter drugs, and surgery, and the use of medical devices–many device relate to surgery and others that boost some of our ability to manage our own health. There are many expensive funded studies to evaluate the effects of these approaches. Based on the results, evidence is published and then disseminated to guide our doctors’ knowledge and our care.

We should realize that the research by pharmaceutical companies sometimes looks at herbs and works to understand how they might work to help or harm human health. Finding that an herb works may lead the drug company to produce synthetic versions of  the herb and conduct research to see how they work. After all, we and our doctors do not live in the era of Dr. Quinn, Medicine Woman and cannot go into nearby woods to pick herbs to make teas or other potions to heal us. Medicine generally needs products that can be sold in mass quantities.

So, what does a lack of evidence mean when it comes to Dr. Besser’s statement? It means that no scientific clinical trials have shown the use of the ‘natural’ herb to be effective in reducing the effects of a cold.

Dr. Besser’s statment is not considering that your friend, your neighbor, or a thousand friends and neighbors on a social media site have used the herb and tell their stories about how it worked for them. It is not addressing the fact that we often trust the stories of others as ‘evidence.’ But it is not the same kind of evidence as science would provide. That is something he did not say. From a health communication perspective, we want to know this to help us better understand health information.    

He also did not say whether the herb being promoted for a cold is one that drug companies may have or may be studying in some form. From a health communication perspective, we also want to know this to help us better understand health information…

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What can maps tell us about health?

Saturday, March 13th, 2010

115_04112

 

 

 March 13, 2010

 

A map is a wonderful example of a visual health communication tool that tells us so much with so little text. The notion that “one picture is worth a thousand words” more than applies. Mike Mackert discusses a new resource, a map, on his health communication research blog [http://blog.healthcommunicationresearch.com/2010/03/new-interactive-tobacco-map.html]. If you click on his link to the overall map resource, you can use a slide bar on the right side to display which states have passed which laws and policies relating to tobacco and smoking. A great example of giving citizens and elected representatives points for comparison. From a communication perspective, several thoughts come to mind.

First, this is a great way to illustrate a role for visual literacy as part of health literacy. In terms of our understanding, when we have a visual image to tell us something, it saves us a step in our thinking and understanding. We don’t “think” in words.  For example, when I say “snow,” you “think” an image — something likely related to your own experience with snow. You do not think “s”–“n”–“o”–“w” and try to get meaning from thinking and forming these letters in your head. When you see a picture of snow, there is an instant connection to your mental picture.

Second, this process I have just described assumes, of course, that you have experience with snow to draw on in forming a mental picture. I am reminded of a test that my daughter was given in order to start public school “early.’ Her birthday is September 14th. She thus missed the September 1 cutoff date. We requested that she be tested to  start, as we felt that she was more than ready. The test validated our opinion. It also showed that she could not give a name to a picture of a “snow shovel.” She was born in Tucson, Arizona, and she had never seen snow let alone a snow shovel. So, she could not make a match in memory between the picture and a name or label for it.

So, third, any visual form used to communicate–and there are many in health communication, ranging from photos to bar graphs to pie charts to maps and more–depends on a user’s ability to connect experience and skill to an intended meaning. In the case of the map Dr. Mackert identifies, it aids the user who moves a mouse over the geography by having the names of different states ‘pop-up’ to help a user who may not remember the name or location of any given state. It offers a series of folder options across the top for a user to click on, so that there is not too much information presented in any one map. It does rely on a number of colors in the maps that are somewhat close on a color wheel and might be difficult for some users to distinguish. It also identifies two sources of the information at the bottom of the map that are not easily navigated to gain insights about the method used to gather the information. It is, however, what policymakers often seek to help them wade through all the mounds of information related to decision-making.    

Maps can, therefore, tell us what is happening in one location as compared to another, giving us a location hypothesis or explanation for health and health care…

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