Medicine

Red Light Myopia Therapy Can Injure Your Retina

sb admin — Mon, 29 Jan 2024 19:18:47 +0000

Red Light Myopia Therapy Can Injure Your Retina

Over the last few years, low-level red light (LLRL) therapy has become popular to control myopia, or nearsightedness, especially in children. In LLRL therapy, children are instructed to look into a red light-emitting instrument for three minutes, twice a day, five days a week, for the duration of the treatment period, which could last years.

Studies reported the treatment as effective and responsible for significant reduction in myopia progression and it is already being used to address myopia in over 100,000 pediatric patients.

Despite passing clinical trials it's not safe in all cases, so stricter standards need to be created, according to University of Houston Professor Lisa Ostrin, who says the therapy can put the retina at risk of photochemical and thermal damage.

Photo courtesy of GETTY Images, provided by the University of Houston

Ostrin examined two different LLRL devices, and while both instruments were confirmed to be Class-1 laser products, as defined by International Electrotechnical Commission standards, according to Ostrin they are unsafe to view continuously for the required treatment duration of three minutes.

Class-1 lasers are low-powered devices that are considered safe from all potential hazards when viewed accidentally and briefly. Examples of Class-1 lasers are laser printers, CD players and digital video disc (DVD) devices. Class-1 lasers are not meant to be viewed directly for extended periods.

“We found that the red-light instruments for myopia exceed safety limits,” said Ostrin. “For both LLRL devices evaluated here, three minutes of continuous viewing approached or surpassed the luminance dose MPE, putting the retina at risk of photochemical damage.”

sb admin Mon, 01/29/2024 - 14:18

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Medicine

No, COVID-19 Vaccines Do Not Cause Infertility - Not Getting It Might

sb admin — Fri, 21 Jan 2022 01:17:23 +0000

No, COVID-19 Vaccines Do Not Cause Infertility - Not Getting It Might

Despite claims of anti-vaccine activists no different than groups that used to claim vaccines cause autism, COVID-19 vaccines do not impact fecundability—the probability of conception per menstrual cycle—in female or male partners who received the Pfizer-BioNTech, Moderna, or Johnson & Johnson vaccines.

The prospective study instead indicates that COVID-19 infection among males may temporarily reduce fertility— an outcome that could be avoidable through vaccination.

Lead author Dr. Amelia Wesselink, epidemiologist at Boston University School of Public Health, and colleagues analyzed survey data on COVID-19 vaccination and infection, and fecundability, among female and male participants in the BUSPH-based Pregnancy Study Online (PRESTO), an ongoing NIH-funded study that enrolls women trying to conceive, and follows them from preconception through six months after delivery. Participants included 2,126 women in the US and Canada who provided information on sociodemographics, lifestyle, medical factors, and characteristics of their partners from December 2020 to September 2021, and the participants were followed in the study through November 2021.

The researchers calculated the per menstrual cycle probability of conception using self-reported dates of participants’ last menstrual period, typical menstrual cycle length, and pregnancy status. Fertility rates among female participants who received at least one dose of a vaccine were nearly identical to unvaccinated female participants. Fecundability was also similar for male partners who had received at least one dose of a COVID-19 vaccine compared with unvaccinated male participants. Additional analyses that considered the number of vaccine doses, brand of vaccine, infertility history, occupation, and geographic region also indicated no effect of vaccination on fertility.

While COVID-19 infection was not strongly associated with fertility, men who tested positive for COVID within 60 days of a given cycle had reduced fertility compared to men who never tested positive, or men who tested positive at least 60 days prior. This data supports previous research that has linked COVID-19 infection in men with poor sperm quality and other reproductive dysfunction.

“These data provide reassuring evidence that COVID vaccination in either partner does not affect fertility among couples trying to conceive,” says study senior author Dr. Lauren Wise, professor of epidemiology at BUSPH. “The prospective study design, large sample size, and geographically heterogeneous study population are study strengths, as was our control for many variables such as age, socioeconomic status, preexisting health conditions, occupation, and stress levels.”

The new data also help quell concerns about COVID-19 vaccines and fertility that arose from anecdotal reports of females experiencing menstrual cycle changes following vaccination.

sb admin Thu, 01/20/2022 - 20:17

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Medicine

Should A Doctor Prescribe A Walk In The Park?

sb admin — Fri, 24 Jul 2020 19:39:42 +0000

Should A Doctor Prescribe A Walk In The Park?

Has your doctor recommended you go for regular jogs in the park, countryside walks, community food growing sessions, or some other nature-based activity? These so-called “green prescriptions” are typically given alongside conventional therapies and have existed in various forms for a number of years.

In recognition of the potential health benefits of green prescriptions, the UK government has just announced a £4 million investment in a two-year pilot as part of its post-COVID-19 recovery plan, with plans to scale up in the future.

There is increasing evidence of the benefits of contact with nature, and the World Health Organization has identified ten ways in which nature impacts positively on our physical and mental health. When parks and other greenspaces are accessible and inclusive they can promote physical activity, psychological relaxation and social cohesion.

There is even evidence to suggest that contact with microbes in the environment can “train” our immune systems and reinforce the microbial communities on our skin, and in our airways and guts. These “microbiomes” could play a role in how our bodies respond to infectious diseases such as COVID-19 and to secondary infections. Microbes from the environment could also potentially supplement our bodies with fatty acids such as butyrate, which are linked to reduced inflammation and may promote mental health.

Green prescriptions therefore have huge potential. But if they are to work, they need to be seen as the start of a much more holistic mode of health and social care delivery: part of a post-COVID “new normal”. This would chime strongly both with the renewed appreciation of nature and the surge in community mobilization and action we saw under the lockdown.

This needs to go beyond simply substituting green for conventional prescriptions. Instead we should provide greener, more natural settings and practices for health, social care, education, transport and active travel. A good example is the GoGoGreen project at a primary school we have worked with in Sheffield. There, greening a school playground not only created a barrier against air pollution from vehicle emissions but also provided multiple other benefits to the school community and started a conversation about cleaner modes of travel.

Green prescribing cannot be seen as a low-cost alternative to conventional treatments. To be effective it still demands investment and resources. The two year pilot is welcome, but if it is to be successful in the long-run the government must make a firm commitment to scaling-up while also addressing systemic issues such as social inequality. All this will take time, and if this holistic approach is not adopted then people in crisis with more immediate priorities will be less likely to go on that prescribed walk in the woods.

Our own research on improving wellbeing through urban nature in Sheffield confirms that people in more deprived communities, with poorer health and shorter life expectancies, don’t have the same levels of access to high quality, well-maintained greenspaces. These are the people that arguably most need green prescriptions, but if they don’t have the basic access then those prescriptions are unlikely to be effective. What’s more, many doctors are not aware of green prescribing, nor do they have a firm understanding of the benefits or know how to get involved.

Our research also reveals that context is critical and green prescriptions need to be rooted in their local area and closely related to the people and places who are going to use them. A wealthy white pensioner in a rural area is likely to have very different experience of and access to nature compared with a young working class person of color in an inner city. A formulaic top-down approach is unlikely to work for both these people.

Recommendations

To sum up, this is what we need to make green prescriptions a success.

They have to be part of a systemic approach to incorporating nature-based interventions and nature-based thinking in urban infrastructure and service provision.

The prescribing process needs to be made easy, for doctors, social care professionals and patients. GPs often lack time and resources, while patients may lack motivation and confidence, or have little previous positive experiences of nature.

Green prescribing also needs to be seen as one part of a holistic health-promotion strategy based on a planetary health perspective. In order to care for ourselves, we also need to care for our environments.

Finally, we need new ways of working with local organisations and communities to understand what’s needed in local contexts, and to build skills and capacity.

By Anna Jorgensen, Chair in Urban Natural Environments, Health and Wellbeing, University of Sheffield and Jake M. Robinson, PhD Researcher, Department of Landscape, University of Sheffield. Jorgensen receives funding from the British Academy and the European Commission. Robinson receives funding from the Economic and Social Research Council (ESRC). He is affiliated with inVIVO Planetary Health, the Healthy Urban Microbiome Initiative and Greener Practice. This article is republished from The Conversation under a Creative Commons license. Read the original article.

sb admin Fri, 07/24/2020 - 15:39

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Medicine

NVX-CoV2373: Here's How The Coronavirus Vaccine Based On A Flu Shot Works

sb admin — Wed, 27 May 2020 14:18:04 +0000

NVX-CoV2373: Here's How The Coronavirus Vaccine Based On A Flu Shot Works

A new trial has begun in Victoria this week to evaluate a potential vaccine against COVID-19.

The vaccine is called NVX-CoV2373 and is from a US biotech company, Novavax.

The trial will be carried out across Melbourne and Brisbane, and is the first human trial of a vaccine specifically for COVID-19 to take place in Australia.

This vaccine is actually based on a vaccine that was already in development for influenza. But how might it work against SARS-CoV-2, the coronavirus that causes COVID-19?

What’s in the mix?

Vaccines trigger an immune response by introducing the cells of our immune system to a virus in a safe way, without any exposure to the pathogen itself.

All vaccines have to do two things. The first is make our immune cells bind to and “eat up” the vaccine. The second is to activate these immune cells so they’re prepared to fight the current and any subsequent threats from the virus in question.

We often add molecules called adjuvants to vaccines to deliver a danger signal to the immune system, activate immune cells and trigger a strong immune response.

The Novavax vaccine is what we call a “subunit” vaccine because, instead of delivering the whole virus, it delivers only part of it. The element of SARS-CoV-2 in this vaccine is the spike protein, which is found on the surface of the virus.

By targeting a particular protein, a subunit vaccine is a great way to focus the immune response.

However, protein by itself is not very good at binding to and activating the cells of our immune system. Proteins are generally soluble, which doesn’t appeal to immune cells. They like something they can chew on.

So instead of soluble protein, Novavax has assembled the SARS-CoV-2 spike protein into very small particles, called nanoparticles. To immune cells, these nanoparticles look like little viruses, so immune cells can bind to these pre-packaged chunks of protein, rapidly engulfing them and becoming activated.

The Novavax vaccine also contains an adjuvant called Matrix-M. While the nanoparticles deliver a modest danger signal, Matrix-M can be added to deliver a much stronger danger signal and really wake up the immune system.

The spike protein is formed into nanoparticles to attract immune cells, and Matrix-M is added as an adjuvant to further activate immune cells. Author provided

Rethinking an influenza vaccine

The Novavax vaccine for SARS-CoV-2 is based on a vaccine the company was already developing for influenza, called NanoFlu.

The NanoFlu vaccine contains similar parts – nanoparticles with the Matrix-M adjuvant. But it uses a different protein in the nanoparticle (hemagglutinin, which is on the outside of the influenza virus).

In October last year, Novavax started testing NanoFlu in a phase III clinical trial, the last level of clinical testing before a vaccine can be licensed. This trial had 2,650 volunteers and researchers were comparing whether NanoFlu performed as well as Fluzone, a standard influenza vaccine.

An important feature of this trial is participants were over the age of 65. Older people tend to have poorer responses to vaccines, because immune cells become more difficult to activate as we age.

This trial is ongoing, with volunteers to be followed until the end of the year. However, early results suggest NanoFlu can generate significantly higher levels of antibodies than Fluzone – even given the older people in the trial.

Antibodies are small proteins made by our immune cells which bind strongly to viruses and can stop them from infecting cells in the nose and lungs. So increased antibodies with NanoFlu should result in lower rates of infection with influenza.

These results were similar to those released after the phase I trial of NanoFlu, and suggest NanoFlu would be the superior vaccine for influenza.

So the big question is – will the same strategy work for SARS-CoV-2?

The Novavax vaccine is one of several potential COVID-19 vaccines being trialed around the world. Shutterstock

The Australian clinical trial

The new phase I/II trial will enrol around 131 healthy volunteers aged between 18 and 59 to assess the vaccine’s safety and measure how it affects the body’s immune response.

Some volunteers will not receive the vaccine, as a placebo control. The rest will receive the vaccine, in a few different forms.

The trial will test two doses of protein nanoparticles – a low (5 microgram) or a high (25 microgram) dose. Both doses will be delivered with Matrix-M adjuvant but the higher dose will also be tested without Matrix-M.

All groups will receive two shots of the vaccine 21 days apart, except one group that will just get one shot.

This design enables researchers to ask four important questions:

can the vaccine induce an immune response?
if so, what dose of nanoparticle is best?
do you need adjuvant or are nanoparticles enough?
do you need two shots or is one enough?

While it’s not yet clear how the vaccine will perform for SARS-CoV-2, Novavax has reported it generated strong immune responses in animals.

And we know NanoFlu performed well and had a good safety profile for influenza. NanoFlu also seemed to work well in older adults, which would be essential for a vaccine for COVID-19.

We eagerly await the first set of results, expected in a couple of months – an impressive turnaround time for a clinical trial. If this initial study is successful, the phase II portion of the trial will begin, with more participants.

The Novavax vaccine joins at least nine other vaccine candidates for SARS-CoV-2 currently in clinical testing around the world.

By Kylie Quinn, Vice-Chancellor's Research Fellow, School of Health and Biomedical Sciences, RMIT University and Kirsty Wilson, Postdoctoral Research Fellow, RMIT University. This article is republished from The Conversation under a Creative Commons license. Read the original article.

sb admin Wed, 05/27/2020 - 10:18

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Medicine

COVID-19: The Downside To More Testing Could Be Overflowing Hospitals

The Conversation — Tue, 31 Mar 2020 02:25:10 +0000

COVID-19: The Downside To More Testing Could Be Overflowing Hospitals

"You can’t fight a virus if you don’t know where it is."

These were the words of Director General of the World Health Organisation (WHO), Dr Tedros Adhanom Ghebreyesus, at his briefing on the COVID-19 pandemic in mid-March.

He made the statement in a bid to underscore the need to test many more people as key to containing the spread of the disease.

Ordinarily, that makes sense and I would agree with it. It is the right thing to do in the face of a disease which would show mild to no symptoms in the majority of those that are infected but does not inhibit their ability to infect others.

Countries that follow the WHO view have sought to buy test kits and increase the number of tests conducted daily. Others have been more cautious and have set up guidelines to ensure that they only test people with significant history of risk for COVID-19 or symptoms of the disease.

An aerial view of a new isolation and treatment centre established by the Lagos State government at the main bowl of the state-owned Stadium. Pius Utomi Ekpei/AFP via Getty Images via The Conversation

Looking at the various models and the progression of the pandemic, I wish to offer some views on testing and the attendant issues and challenges.

I believe that there are a myriad of factors to consider and that, particularly in Africa, countries have to take them all on board when making their decisions to curtail the spread of the virus.

The factors include the dangers posed by false test results, the fact that testing data is being badly communicated leading to a rise in panic levels and the fact that testing capacity is limited in many countries.

The fear factor

It is quite clear that the world is now dealing with two pandemics instead of one. The first is the virus. The second is fear and, in many cases, outright panic. That is why landlords are kicking out health workers from their houses. That is why we get reports of chloroquine toxicity within 24 hours of US President Donald Trump saying that might be the treatment for COVID-19.

What has panic got to do with testing? Panic is being driven by the way in which the outcome of testing is being communicated. For example, most countries are releasing data about how many more cases there are. But they are not telling their citizens how many of these people have no symptoms at all, or have mild ones.

Knowing how many of those who tested positive were not considered to be in a critical state would be helpful.

The other area in which data is being badly handled, and adding to panic levels, is that countries are reporting new cases on a daily basis. These aren’t necessarily new infections but, rather, new detections. Most are people who already had it and (for whatever reason were able to get tested) were found to be positive. They are people who, just the day before, did not know they had the virus and therefore weren’t provoking fear in others. Also, the number of new confirmed cases alone may not be the best indicator for the challenge the disease poses in a country or community.

Knowing their status now should not cause panic. It should simply inform about the importance of the preventive measures, including testing, to prevent spread of the disease.

Limited resources

Countries are being urged to test as many people as possible in the face of limited test resources. The mainstay polymerase chain reaction test is quite limited and relatively slow. It is also expensive given the requirements even of staff and laboratories.

Enter rapid test kits to the rescue. But there aren’t enough. Even the US doesn’t have enough test kits to meet the demand.

In addition, not all the kits in use have been tested properly. For example, there are reports that thousands of test kits imported by the Spanish health authorities were found to be faulty.

The challenge of a test kit giving false negatives is that the people are told, erroneously, that they do not have the virus. They go away and continue to infect others freely. In the event that they have any symptoms, they are likely to ignore these, and some may become severely ill before seeking care. If they do seek care early, the health care workers may be exposed to COVID-19 thinking that this person had tested negative and could only have some other disease.

A false positive, on the other hand, means that the number of cases reported continues to rise along with the panic created and attendant socio-economic disruption.

The Jack Ma Foundation has donated 20,000 test kits to Nigeria. But what are these among so many? Consider two statistics alongside this number. The population of the country – about 200 million people. And the fact that with 65 confirmed cases (as at the time of writing this), Nigeria is tracking over 4,000 contacts already.

A further complication in Nigeria is that the allocation of available tests kits could become subject to social and political whims. Government officials are scrambling to get tested along with their families and wealthy friends. Unfortunately, the guidelines for determining who to test won’t apply to this category of people. This means that limited resources will be used up.

Overwhelming hospitals

The fatality rate for COVID-19 has not yet been definitively established. Nevertheless, the fatality rate – particularly among older people – has been one of the major factors stoking fear. It is also one of the reasons hospitals are overwhelmed with COVID-19 positive cases.

This is why the decision to increase testing needs to be made along with ensuring that the facilities are in place to manage the increase in numbers of people identified with COVID-19. Without additional measures, hospitals will simply become overwhelmed, as has happened in the US.

In China, for example, several new health facilities were built in just a few weeks along with the deployment of thousands of health workers to Wuhan, the epicentre of the outbreak in that country. For its part the UK recalled about 10,000 retired health workers and the US is offering visas to health workers who might want to come and work there.

In Nigeria, the approach being taken is similar to that of China. New facilities are being established and equipped to handle COVID-19 cases.

But the strain on the health system must not be underestimated. Admission of a case of a highly infectious disease, like COVID-19, stretches the health system many times over and increases the risk of health care workers being infected. Of course, as the numbers rise, the health care workers are soon overwhelmed and the fatalities could rise along.

What needs to be done

I would argue that we should not just follow the admonition of the WHO to “test, test, test” without examining it in the context of our local peculiarities. Testing is important but countries should adapt guidelines for testing that work for them, knowing also the dangers of having asymptomatic disease spreaders – that is those who have the virus but aren’t showing any symptoms.

They should also consider reporting confirmed cases along with their clinical status as well as recoveries and discharges (all to encourage reporting of possible cases). The bigger worry is the fatalities and that is what countries must work to avoid.

Lastly, lock downs must be considered – the socio-economic challenges weighed into it – as a means to minimise the spread in the face of limited facilities. This would allow those who might require hospital admissions to show up, while those who don’t will stop spreading the disease while they recover on their own.

By Doyin Odubanjo, Executive Secretary, Nigerian Academy of Science. This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Conversation Mon, 03/30/2020 - 22:25

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Medicine

Coronavirus Isn't a Pandemic, But That Doesn't Change Its Relative Risk

The Conversation — Fri, 14 Feb 2020 15:41:58 +0000

Coronavirus Isn't a Pandemic, But That Doesn't Change Its Relative Risk

Is the coronavirus a pandemic, and does that matter? 4 questions answered

The new coronavirus has now affected more than 20,000 people in China and claimed more lives as of Feb. 4 than the SARS epidemic from 2002 to 2004. Hong Kong has reported its first death. Some public health officials have said the outbreak is likely to soon be a pandemic, but the World Health Organization said Feb. 4 that it isn’t, yet.

Just what is a pandemic anyway? An epidemiologist and public health researcher explains.

1. What is a pandemic?

When a disease outbreak, or epidemic, crosses international boarders and spreads across a wide region, we public health professionals typically call it a pandemic. The term “pandemic” tells us that the outbreak is occurring in many places but says nothing about its severity.

Because of their wide geographic distribution, pandemics usually affect a large number of people. While we usually think of pandemics in relation to serious, life-threatening diseases, even outbreaks of mild diseases could cross borders and become pandemics.

2. Does it matter if it is or isn’t called a pandemic?

Calling an outbreak a pandemic is simply a reflection of where the disease is spreading. The terminology doesn’t change anything about the severity of the disease or how we are responding.

Since the day the outbreak was identified, health officials worldwide have been taking steps to isolate ill people to try and prevent any spread and quarantine people who have traveled to certain areas of China. The World Health Organization declared it to be a Public Health Emergency of International Concern Jan. 30, which improves information sharing and coordination throughout the world.

These actions will continue no matter what it is called.

Flight attendants check temperatures of passengers aboard an Air China flight from Melbourne to Beijing on Feb. 4, 2020. AP Photo/Andy Wong

3. Would it being a pandemic put me at greater risk?

Your risk wouldn’t changed simply because of a change in terminology. Though the virus has been identified in 23 countries as of Feb. 4, over 99% of the cases have occurred in China.

Local transmission outside of China has generally been limited to people who had direct contact with ill travelers from China. In a cluster reported from Germany, several employees of a company were infected by a co-worker who returned from travel to China, and one of the employees infected one of their children. This clearly shows that person-to-person spread is possible, but it doesn’t mean that the disease is spreading extensively in the community.

Even if an outbreak is spreading worldwide, how it is spreading locally and how people respond is what determines your risk.

4. So what happens next?

Public and global health experts and health care workers will continue to respond to this outbreak as they have for the last month. Doctors and nurses in the community will continue to quickly identify ill people and test them for the coronavirus. Sick people will be isolated so that they don’t spread their illness to their family, friends or co-workers. Public health officials will track the spread of this outbreak and will use that information to prevent the spread of the disease in the community.

The next move is up to the virus.

By Brian Labus, Assistant Professor of Epidemiology and Biostatistics, University of Nevada, Las Vegas. Labus received past funding from the Centers for Disease Control and Prevention for disease surveillance activities while working at the local health department. This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Conversation Fri, 02/14/2020 - 10:41

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Medicine

To Reduce Risk of Coronavirus and Flu, Wash Your Hands

sb admin — Wed, 12 Feb 2020 02:03:09 +0000

To Reduce Risk of Coronavirus and Flu, Wash Your Hands

A new study finds an easy way to reduce the spread of many infectious diseases, from coronavirus to influenza; washing hands more frequently in just 10 airports.

Though the findings were published in late December, just before the recent coronavirus outbreak in Wuhan, China, the study's authors say that its results would apply to any such disease and are relevant to the current outbreak. The methods included epidemiological and data-based simulations.

People can be surprisingly casual about washing their hands, even in crowded locations like airports where people from many different locations are touching surfaces such as chair armrests, check-in kiosks, security checkpoint trays, and restroom doorknobs and faucets. Based on data from previous research, the team estimates that on average, only about 20 percent of people in airports have clean hands -- meaning that they have been washed with soap and water, for at least 15 seconds, within the last hour or so. The other 80 percent are potentially contaminating everything they touch with whatever germs they may be carrying.

Use soap and water in airports. And everywhere else.

"Seventy percent of the people who go to the toilet wash their hands afterwards, and of those that do, only 50 percent use soap. Others just rinse briefly in some water. That figure, combined with estimates of exposure to the many potentially contaminated surfaces that people come into contact with in an airport, leads to the team's estimate that about 20 percent of travelers in an airport have clean hands.

Improving handwashing at all of the world's airports to triple that rate, so that 60 percent of travelers to have clean hands at any given time, would have the greatest impact, potentially slowing global disease spread by almost 70 percent, the researchers found. Deploying such measures at so many airports and reaching such a high level of compliance may be impractical, but the new study suggests that a significant reduction in disease spread could still be achieved by just picking the 10 most significant airports based on the initial location of a viral outbreak. Focusing handwashing messaging in those 10 airports could potentially slow the disease spread by as much as 37 percent, the researchers estimate.

They arrived at these estimates using detailed epidemiological computer models that involved data on worldwide flights including duration, distance, and interconnections; estimates of wait times at airports; and studies on typical rates of interactions of people with various elements of their surroundings and with other people.

Even small improvements in hygiene could make a noticeable dent. Increasing the prevalence of clean hands in all airports worldwide by just 10 percent, which the researchers think could potentially be accomplished through education, posters, public announcements, and perhaps improved access to handwashing facilities, could slow the global rate of the spread of a disease by about 24 percent, they found.

The researchers used data from previous studies on the effectiveness of handwashing in controlling transmission of disease, so these data would have to be calibrated in the field to obtain refined estimates of the slow-down in spreading of a specific outbreak.

sb admin Tue, 02/11/2020 - 21:03

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Medicine

Rural health report card - three reasons for higher mortality

sb admin — Wed, 05 Feb 2020 15:38:35 +0000

Rural health report card - three reasons for higher mortality

A recent paper, "Higher U.S. Rural Mortality Rates Linked To Socioeconomic Status, Physician Shortages, And Lack Of Health Insurance," published in Health Affairs Journal, seeks to explain differences in rural and urban people when it comes to mortality, but also rank states using county level data on outcomes and health care access.

The study focused on five explanatory variables within each county: socioeconomic (e.g., poverty status, access to housing and education, employment), uninsured rates, the supply of and access to primary care physicians, the percentage of racial or ethnic groups and the number of rural and urban residents.

However, after compiling all of the data, the researchers believed that only three of their explanatory variables were applicable: socioeconomic deprivation, percentage of uninsured and the primary care physician supply. Those three variables were linked to 81.8% of the total variance of mortality. Correlation is not necessarily causation but it is well known that people who claim their supplements and organic food and fitness crazes led to their better health often leave out that a lot of issues correlate with greater wealth. It isn't the special label on the food making people live longer, it is the other trappings of wealth. The percentage of racial and ethnic groups and the number of rural or urban residents were not significantly associated with mortality even though the percentage of African Americans was positively associated with mortality. After adjustments for socioeconomic deprivation, uninsured rates and supply-access to primary care physicians were factored in, the percentage of African Americans was no longer significantly associated with mortality. They used the rural-urban continuum codes put out by the USDA to break down and divide by counties, and because the health data tends to be by counties, they feel like the data are better matched.

"We're not saying that African Americans across the country don't have higher rates of mortality because they absolutely do," said Scott Phillips, editor in chief for theTexas Tech University Health Sciences Center Rural Health Quarterly magazine and a co-author to the study. "What we are saying, and what we discovered with this study, is that other disparities that African Americans face, particularly socioeconomic status and access to care, account for the higher African American mortality rates across the country."

The study also showed the percentage of Hispanic Americans is negatively associated with mortality, another facet of the "Hispanic paradox", an epidemiological confounder showing that Hispanic Americans tend to have health outcomes that are comparable to or better than whites even though Hispanic Americans on average tend to have lower socioeconomic status.

Rural residency does not negatively affect mortality but it does favor lower mortality - except in these western states

The results indicate that rural dwellers would have lived longer than their urban counterparts had their socioeconomic conditions and access to health care been similar.

Now the authors want to further analyze the three states that proved to be exceptions to those findings: Colorado, Montana and Wyoming. Those three contiguous states in the Mountain West have higher urban mortality than rural mortality.

sb admin Wed, 02/05/2020 - 10:38

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Medicine

Coronavirus: Less Hype, More Perspective, Worry About The Flu Instead

The Conversation — Tue, 04 Feb 2020 18:05:50 +0000

Coronavirus: Less Hype, More Perspective, Worry About The Flu Instead

With a new infectious disease outbreak on our doorstep, we might ask ourselves: are we reacting to the coronavirus in a way that is proportional to the threat?

The problem is that when it comes to infectious disease epidemics, we have a strong tendency to overreact emotionally and under-react behaviorally. The overreaction aspect may be attributable to the fact that we are primed to fear infectious diseases appearing suddenly within our population, in the same way that we are evolutionarily prepared to fear snakes and spiders.

Most of us fear snakes and spiders without ever having been harmed by them. Compare that with automobiles, which harm many more of us, yet are only feared by a small number who have been in accidents themselves. In the same way, we fear infectious disease outbreaks much more readily and intensely than we fear diabetes epidemics.

The amygdala (in red) is largely responsible for fear learning. (Shutterstock)

From the perspective of the brain, the amygdala is largely responsible for fear learning, a process by which fear responses become attached to formerly neutral cues that are now viewed as signifying something genuinely threatening.

This explains fearful emotional responses to a formerly innocuous sneezing sound in a crowded subway train. Such amygdala-driven learning more readily occurs when the threat in question is an infectious disease than, say, a chronic disease epidemic of a much larger scale that poses an authentic personal threat.

Déjà vu

In 2003, SARS infected more than 8,000 people worldwide and caused 774 deaths. In Canada, 438 people were infected and 44 died. Those figures yield about a 10 per cent death rate for SARS. To be sure, it was a lethal virus, and it spread at an alarming rate with tragic consequences, particularly in places where infection protocols were not enacted quickly and decisively.

Now, 17 years later, we are facing a very similar-looking threat from another coronavirus, again originating in China, and quickly spreading around the globe. The mortality rate is difficult to estimate so early, but signs so far suggest a mortality rate similar to or lower than SARS.

A man wearing a protective mask carries flowers at Women’s College Hospital in Toronto during the SARS outbreak in March 2003. THE CANADIAN PRESS/Kevin Frayer

In just over a week, mass travel restrictions are been enacted overseas, and governments (appropriately) are advising against travelling to the epicentre of the outbreak, the city of Wuhan, China.

Highly alarming stories and images are circulating on social media depicting an epidemic out of control, about to overtake North America. Netflix even just launched a (very) hastily prepared docu-series on the horrors of infectious disease epidemics (just like coronavirus). If that isn’t a sign of the coming apocalypse, I’m not sure what is.

Viral information

The world seems riveted to media content pertaining to the coronavirus outbreak. From many perspectives, this is not surprising.

We respond quickly and intensely to information about infectious disease threats, even in faraway places or if they’re unlikely to have an impact on us. A reader’s attention is captured by the topic even when the coverage itself is intentionally not sensationalistic. I would read a responsibly written Ebola article over an excitingly written heart disease article any day.

In this age of social media, sharing is an individual choice and one made almost reflexively. In our brains, this relatively unconscious level of processing is disproportionately in the domain of the amygdala and largely unimpeded by higher cortical centres known to be implicated in thoughtful deliberation.

Sensationalized news and misinformation about infectious diseases can spread quickly through social media. (Shutterstock)

The tendency to share emotionally evocative images and text is even more unchecked than in conventional media. This results in selective spread of highly sensationalistic content via social media, and motivation for media outlets to shape their offerings to be more sensational. An old dynamic on steroids.

There is also a trend evident in some media outlets to intentionally counter this. All of us, when we catch ourselves, can recognize and limit our indulgence of overly sensationalistic content and reactions, including when it comes to infectious disease outbreaks.

Word to the wise

What should we do while we wait for things to unfold? My advice, if I were a physician dispensing it, would be to encourage people to pay attention to official information as much as possible, the Public Health Agency of Canada, for example, or its provincial counterparts. It will be there, and will be up to date and accurate for the most part.

The behavioural advice is relatively straightforward: wash your hands often, cover your mouth (with your arm) when you cough, avoid touching your face (surprisingly difficult to do consistently) and, for now, avoid travelling to Wuhan.

The situation is more complicated in mainland China, where the state-controlled media is struggling to compete with social media sharing, in part because of lack of trust. One advantage that the Chinese government does enjoy, however, is the ability to quickly and decisively implement top-down actions to limit disease spread.

So really, there are very different challenges for capitalist and communist countries when attempting to stem the flow of infectious disease epidemics.

Food for thought

Long story short, don’t lose sight of the larger picture in terms of risks in everyday life.

Spending too much time watching television while snacking on potato chips is probably riskier than shaking hands. But maybe avoid both for now, just to be safe.

And to end where I began — recalling how SARS overtook our collective consciousness in 2003 — it’s important to also remember that five times more deaths are attributable to the seasonal flu every year. If there is an infection we should fear, could it be that one? Or should we stop fearing infections altogether?

By Peter Hall, Professor, School of Public Health and Health Systems, University of Waterloo. Hall receives funding from the Natural Sciences and Engineering Research Council of Canada (NSERC), the Canadian Institutes of Health Research (CIHR) and the Social Sciences and Humanities Research Council of Canada (SSHRC). This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Conversation Tue, 02/04/2020 - 13:05

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Medicine

“A gift to the construction industry”: catchy quotes from Court of Appeals argument on OSHA’s silica standard

cmonforton — Sat, 14 Oct 2017 15:19:29 +0000

“A gift to the construction industry”: catchy quotes from Court of Appeals argument on OSHA’s silica standard

OSHA took the long road to adopt a standard to address respirable crystalline silica. Although the final rule was issued in March 2016, it is being challenged by both industry and labor groups. The first says OSHA went too far, the other says OSHA didn’t go far enough.

The long road, however may be coming close to end. The U.S. Court of Appeals for the District of Columbia Circuit heard oral arguments last week from parties that are challenging the rule. Judges Merrick Garland, David Tatel and Karen LeCraft Henderson spent more than two hours listening to arguments from the National Stone, Sand and Gravel Association (NSSGA), the Brick Industry Association (BIA), the U.S Chamber of Commerce, the North America Building Trades, the United Steelworkers and others. Attorneys with the Department of Labor’s Office of the Solicitor were there, too, to defend the OSHA rule.

I enjoyed listening (and relistening) to the court’s audio of the oral argument. What made it particularly enjoyable was listening to the judges---they did their homework!

Judges Garland and Tatel, in particular, probed, cajoled, and challenged the attorneys to clarify their arguments. The judges pressed the attorneys on issues concerning economic feasibility, health risks, and the legal standard for substantial evidence. There were plenty of references to prior litigation on OSHA health standards. They mentioned significant previous court decision on OSHA standards, such as for asbestos, lead and formaldehyde. I felt a bit like an outsider, listening to the attorneys speak about those rulings. They described them as if they were old friends who remain relevant today. And like relationships with old friends, we don't always agree about what she said or remember events in the same way.

There were times during the oral arguments that the presenting attorney rose to a judge’s challenge for a cogent response. But I cringe a few times when I heard nervous laughter from an industry attorney who knew he was stumped by the judge’s question.

Below are just some of my favorite quotes and exchanges. The text doesn't capture the animation I heard in the audio from the courtroom or the commitment of the attorneys to their arguments. I've included a time stamp at each quote so you can listen for yourself. (I had difficulty distinguishing Judge Garland’s from Judge Tatel’s voice. If I incorrectly attribute the quotes, please leave a comment and I’ll correct it.)

NSSGA and BIA argue that OSHA overstates the risk of health harm caused by exposure to respirable crystalline silica. Their attorney, William L. Wehrum, said:

“We assert that OSHA had a thumb on the scale. We believe the record makes clear that OSHA came to this rulemaking with a determined goal of reducing the level of the standard. We believe it clouded OSHA’s judgement and caused it to lose objectivity, which we believe permeates the entire proceeding." [00:02:36]

Judge Tatel chimed in:

"You say that OSHA had its thumb on the scale, which is a curious statement given our standard of review. The question is: is there significant evidence in the record to support OSHA’s position for what it did? You can certainly point to contrary evidence, but OSHA has explained all that. ...You have to make your argument in terms of our specific standard of review, which is the substantial evidence question. Our case law is very specific about that."

Sounding like a law professor Tatel added:

"What’s your best argument regarding the substantial evidence test?" [00:04:19]

Wehrum had difficulty providing a short and sweet and precise answer.

Judge Garland addressed the problem for the court of dueling scientists. William Wehrum tried to describe the evidence from his side's experts, but Garland interrupted:

"We have scientists on both sides and the law here is quite clear. When there are scientists on both sides, OSHA is permitted to take the ones that are most likely to protect worker safety. There is supposed to be a thumb on the scale in terms of safety. ...That's what our own case says. It is perfectly appropriate for OSHA to weight in favor of worker safety. That's right, isn't it. [00:09:56]

William Wehrum: "Correct your honor to a point, but that dosen't insulate OSHA from review.

Soundly a bit frustrated, Garland said:

"That's what we doing here, but it is not enough to say there is a plausible mechanism. You have to be able to show that OSHA's studies are not themselves substantial evidence."

The attorney representing the U.S. Chamber of Commerce was also schooled by Judge Garland. This time it was a math problem.

Attorney Michael Connolly argued that there are so few deaths today is the U.S. from silicosis that OSHA has not met its burden of demonstrating that exposure to respirable silica poses a significant risk of harm to workers. Connolly pointed to the low number of silicosis deaths reported on death certificates and compared to the millions of workers in silica-related industries.

Judge Garland asked [00:18:50]:

"Is that the right division? Dividing the total number of deaths that are reported on the death certificates by the total number of workers in industry? Or is the right number the total number of deaths at a certain level of exposure? That is, in terms of the 1 in 1,000 test.

(The "1 in 1,000" comes from a 1980 Supreme Court ruling about OSHA's benzene standard. The Supreme Court justices did not offer a specific ratio but indicated that the threshold likely fell somewhere between 1 death per 1 billion (which would not be considered significant) to 1 death per 1,000 (which would be significant.))

Judge Garland continued:

"It's not supposed to be just 1 over the entire population of the United States, or 1 over everybody who works. It’s supposed to be 1 over 1,000 people who work at a certain exposure level, isn’t that right?"

Michael Connolly: "Sure. That’s correct."

Judge Garland:

"Isn't it exposed to silica at a certain exposure levels that matters? Not all people who may have been exposed to silica? [20:03]

Score one for the judge.

I wish I'd been in the courtroom for that exchange. I would have turned my head to see if Judge Garland's remark brought a smile to the attorneys who were defending OSHA's rule.

Labor Department attorney Kristen Lindberg was charged with responding to some of the arguments raised by the industry petitioners. Among her excellent synopsis was this:

[00:35:00] "It's worthwhile to step back a little bit and review the support OSHA had in the record for its findings. Their risk assessment findings were supported by nearly all of the occupational health and medical organizations that commented on the rule, including NIOSH, the American Cancer Society, the American College of Occupational and Environmental Medicine, the American Thoracic Society, the Association of Occupational and Environmental Clinics, and the American Public Health Association."

"... Industry petitioners want you to reject conclusions that have overwhelming support among scientists and that were supported by the independent peer reviewers who scrutinized OSHA’s risk assessment. They want you to reject this extensive body of scientific evidence on the flimsy basis that there are flaws in some of the studies that OSHA relied upon and that there is uncertainty in epidemiology. They want you to impose a legal burden on OSHA that the agency could never meet."

[00:36:53] "The broad support for OSHA’s conclusions within the scientific community should increase the court’s confidence that OSHA’s analysis is sound. The courts understand that OSHA, in marshalling scientific evidence to support a risk assessment, cannot ever reach perfection because the science those risk assessments are based on is not perfect. There will be flaws in studies, there will be stronger and weaker studies, there may be some uncertainty, but what OSHA has done here, its extensive analysis based on a huge body of evidence conforms fully with the OSH Act and with the requirements of courts that have interpreted the OSH Act."

Bradford Hammock argued the case on behalf of the National Association of Home Builders and other industry groups. He tried to convince the judges that OSHA's requirements for the construction industry are not technological feasible.

Victoria Bor, the counsel for North America’s Building Trades Unions dismissed Mr. Hammock's assertions. Her argument began with the following [00:67:40]

"By way of context, Table 1, which is the centerpiece of the construction standard, is a gift to the construction industry. Most OSHA standards set a permissible exposure limit and require employers to monitor their workplaces and devise their own strategies following the hierarchy of controls to bring exposures below the permissible exposure limit (PEL). The silica standard gives employers options. They can follow the traditional approach or they can follow Table 1, which is in effect is a manual that lists 19 of the 23 construction tasks that most commonly generate significant silica exposure, and specifies control strategies for each. Employers who fully and properly implement the controls listed on Table 1 are freed from monitoring their workplace and have a safe harbor for complying with the PEL.

"...OSHA assumes that most employers will follow table, which is a completely reason assumption because it tells employers exactly what they have to do, frees them from monitoring, and gives them a safe harbor for complying with the PEL."

"Now rather than accepting this gift, as Mr. Hammock already explained to you, the industry petitioners point to Table 1 and argue that to the extent it requires the use of respirators....OSHA is conceding that the standard isn't feasible. ...The petitioners’ argument completely ignores that Table 1 does not require employers to comply with the PEL. What it requires is for employers to implement the listed controls. So whether the PEL can be reached without the use of respirators---the question that the industry petitioners focus on--- is actually completely irrelevant."

Victoria Bor continued:

"What is relevant, as Ms. Goodman [of the Labor Department] said, is that the typical employer can comply with Table 1 most of the time. On this question, the petitioners argument on feasibility rests on vague assertions that in certain circumstances, certain employers may not be able to use certain of the wet methods listed in Table 1 at some time. …Petitioners point to no evidence that undermines OSHA’s conclusions that most employers will be able to comply with Table 1 by utilizing those controls most of the time."

There was dead silence after her rebuttal. None of the judges asked Victoria Bor to clarify or further defend her arguments. They seemed convinced.

The excerpts above are just some of memorable moments from the oral argument. Another was a lengthy argument by the unions and rebuttal by the Labor Department about OSHA's provisions for medical surveillance and medical removal protections. It was the one time that the Labor Department's case seemed on shaky ground.

If you listen to the audio for yourself you'll hear the word "grapple" used numerous times by attorneys for the unions. You'll hear the Labor Department attorneys repeat the phrase"de minimis benefit." You'll hear one judge say to an industry attorney "it's not your principle argument, it's your only argument" and another judge mention "a shopping list." You'll hear all the parties claim that OSHA's decisions are, or are not, "supported by the record." Finally you'll hear many references to previous Supreme Court and Appeals Court decisions on other OSHA standards.

It's been many years since OSHA started down the road toward a comprehensive silica standard. People will disagree on when the agency actually hit the road, but they know that last week's stop at the U.S. Court of Appeals means the road may soon be coming to an end.

Judges Garland, Henderson, and Tatel are now at the wheel. They will decide whether OSHA's rule will stand as is, or whether the agency needs to make a U-turn.

I relished listening to the oral arguments. I'll be eager to read the judge's opinion when it's issued.

cmonforton Sat, 10/14/2017 - 11:19

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Medicine