Welcome to another installment of the Get Ready Mailbag, when we take time to answer questions sent our way by readers like you. Have a question you want answered? Send an e-mail to getready@apha.org.
Q. This summer, my family and I will be going on vacation. Are there any steps I can take to make sure we're prepared while away from home?
A. Being prepared means making sure you are ready for potential health hazards — no matter where you are. And this includes while on vacation!
There are basic steps we can all take while on vacation to stay safe. These include packing a portable emergency preparedness kit and making sure everyone knows your family's emergency contact phone number.
However, it's also important to think about where you'll be vacationing to figure out how to get ready. For instance, the beach is a popular vacation destination for families during the summer months. If you're vacationing along the Atlantic, Gulf of Mexico or Caribbean between June and November, make sure you're prepared for hurricanes. Along with having a portable emergency kit ready to go, this includes mapping out an evacuation route and staying alert for warnings.
If you are traveling overseas, you should find out what sorts of natural disasters occur in your destination and prepare accordingly. Also, for many locations outside of North America, you should take steps to protect yourself from infectious diseases that might not ordinarily be a concern.
Furthermore, along with the location of your destination, it's a good idea to think about where you'll be staying and factor that into your preparedness. For instance, if you're renting a vacation home, you'll want to make sure the smoke detectors work, locate a first aid kit and fire extinguisher, and make sure you are familiar with the layout of the house in case you have to evacuate quickly. If you're staying in a high-rise hotel, take note of the nearest exits and be sure your family knows not to take the elevator in an emergency.
So just as you pack sunblock to protect yourself against harmful rays, take a few extra steps to keep you and your family safe from other possible threats while on vacation.
The Non-Accessible Grand Theatre in Kingston Ontario
The following video is of the make-shift ramp to allow wheelchair access onto the stage of the newly renovated Grand Theatre.
Note how I skid sideways on the second ramp because it was wet. Unlike the able-bodied, I had to go outside and dodge raindrops during intermission to get to the other end of the Theatre to use an accessible washroom. The rest of the choir had a choice of 2 change rooms on stage, complete with a washroom.
Prior to the city investing 17.1 million dollars into renovations of the Grand Theatre, I asked if the stage would be made accessible. I was told no because the building was land locked and there weren't enough people with disabilities who would be needing it.
My question is, why couldn't they add a porch lift to one of the back doors and a fold away wall at one corner of the stage to create a temporary accessible change room to use on demand? It wouldn't be perfect because full integration would be lacking, but at least there would have been a little accommodation for those who have a disability and want to take part in the performing arts.
Please read my other blogs:
Transit: http://wheelchairdemon-transit.blogspot.com
Health: http://wheelchairdemon-health.blogspot.com
Note how I skid sideways on the second ramp because it was wet. Unlike the able-bodied, I had to go outside and dodge raindrops during intermission to get to the other end of the Theatre to use an accessible washroom. The rest of the choir had a choice of 2 change rooms on stage, complete with a washroom.
Prior to the city investing 17.1 million dollars into renovations of the Grand Theatre, I asked if the stage would be made accessible. I was told no because the building was land locked and there weren't enough people with disabilities who would be needing it.
My question is, why couldn't they add a porch lift to one of the back doors and a fold away wall at one corner of the stage to create a temporary accessible change room to use on demand? It wouldn't be perfect because full integration would be lacking, but at least there would have been a little accommodation for those who have a disability and want to take part in the performing arts.
Please read my other blogs:
Transit: http://wheelchairdemon-transit.blogspot.com
Health: http://wheelchairdemon-health.blogspot.com
The Carved and the Directional Curl
(Click on the images to see larger versions.)
Source: American Hairdresser Beauty Shop Compendium 9th Edition.
Planning ahead is important for hurricane preparedness
If you could be any animal, wouldn't it be great to be a bird? You never have to wait in line for the restroom, you know the weather before it's on the news and if a storm approaches, it's pretty easy to evacuate. Unfortunately, as a human, preparing for a storm such as a hurricane requires more planning and information.
Hurricanes have the potential to cause flooding, destroy homes, spawn tornadoes, contaminate the water supply and cause other threats to health. During Hurricane Katrina on the Gulf Coast in 2005, many people were left stranded without food and water and more than 1800 people died. So it is very important to stay abreast of information as a hurricane develops.
Before a hurricane hits, make sure you know where high-risk areas are in your community, where to evacuate to and what to do in the aftermath. The better you stay updated and informed during hurricane season — which is during the months of May to November — the better you will be able to prepare.
Have an out-of-town evacuation place predetermined, and make sure your gas tank is full. Develop a hurricane supply kit and "go-bag" for you and your family, including pets. Your supplies should include non-perishable food items, identification, important documents, money and necessary medications. Because of flooding, the water supply could be contaminated, so you should enough water stored to last for three to seven days — at least one gallon per person per day.
If the weather looks like it is turning bad or there is a hurricane warning in effect, keep the TV or radio on and stay up on what's happening so you'll be ready to make like a bird and leave quickly. Listen for warning sirens as well.
Hurricanes, like anything natural, can be unpredictable. But if you stay informed, you'll know what you need to do to prepare for any hurricane, despite its severity. And that's not birdbrained at all.
Hurricanes have the potential to cause flooding, destroy homes, spawn tornadoes, contaminate the water supply and cause other threats to health. During Hurricane Katrina on the Gulf Coast in 2005, many people were left stranded without food and water and more than 1800 people died. So it is very important to stay abreast of information as a hurricane develops.
Before a hurricane hits, make sure you know where high-risk areas are in your community, where to evacuate to and what to do in the aftermath. The better you stay updated and informed during hurricane season — which is during the months of May to November — the better you will be able to prepare.
Have an out-of-town evacuation place predetermined, and make sure your gas tank is full. Develop a hurricane supply kit and "go-bag" for you and your family, including pets. Your supplies should include non-perishable food items, identification, important documents, money and necessary medications. Because of flooding, the water supply could be contaminated, so you should enough water stored to last for three to seven days — at least one gallon per person per day.
If the weather looks like it is turning bad or there is a hurricane warning in effect, keep the TV or radio on and stay up on what's happening so you'll be ready to make like a bird and leave quickly. Listen for warning sirens as well.
Hurricanes, like anything natural, can be unpredictable. But if you stay informed, you'll know what you need to do to prepare for any hurricane, despite its severity. And that's not birdbrained at all.
Sideburns
(Click on the image to enlarge.)Source: Practice and Science of Standard Barbering, ⓒ 1938-1958
Splendor Splendide
Yesterday the Archive had to shuffle along the shelves to allow in six of these beautiful little boxes. Complete with everything but the oily thumb print of a garagiste, each box contains a car lightbulb wrapped in a little piece of corrugated cardboard. Five of them have '24v 44w Prefocus' on the end, the last is in 'Cadmium Yellow' and obviously meant for a big winking indicator. It's the drawing of the car that attracted me of course, the result of a designer so obviously carried away by big 40s Americana, getting away with a Packard or Chrysler for an English made bulb. When he should perhaps of been thinking of the Morris Eights we were struggling to make in post-war Britain. But maybe they wouldn't have expressed 'Splendor' in quite the same way. Each bulb has a bayonet-style fitting, but without the little prongs, and one wonders how long these have been tucked away in the dimmer recesses of a workshop, a cheapo alternative perhaps to Lucas originals. Right, so all I've got to do now is find a car in a barn somewhere ('tis the season, we are told) with just these bulbs missing.
The Coronary Heart Disease Epidemic: Possible Culprits Part I
In the last post, I reviewed two studies that suggested heart attacks were rare in the U.K. until the 1920s -1930s. In this post, I'll be discussing some of the diet and lifestyle factors that preceded and associated with the coronary heart disease epidemic in the U.K and U.S. I've cherry picked factors that I believe could have played a causal role. Many things changed during that time period, and I don't want to give the impression that I have "the answer". I'm simply presenting ideas for thought and discussion.
First on the list: sugar. Here's a graph of refined sugar consumption in the U.K. from 1815 to 1955, from the book The Saccharine Disease, by Dr. T. L. Cleave. Sugar consumption increased dramatically in the U.K. over this time period, reaching near-modern levels by the turn of the century, and continuing to increase after that except during the wars:
Here's a graph of total sweetener consumption in the U.S. from 1909 to 2005 (source: USDA food supply database). Between 1909 and 1922, sweetener consumption increased by 40%:
If we assume a 10 to 20 year lag period, sugar is well placed to play a role in the CHD epidemic. Sugar is easy to pick on. Diets high in refined sugar tend to promote obesity due to overeating. An excess causes a number of detrimental changes in animal models and human subjects that are partially dependent on the development of obesity, including fatty liver, the metabolic syndrome, and small, oxidized low-density lipoprotein particles (LDL). Small and oxidized LDL associate strongly with cardiovascular disease risk and may be involved in causing it. These effects seem to be partly attributable to the fructose portion of sugar, which is 50% of table sugar (sucrose), about 50% of most naturally sweet foods, and 55% of the most common form of high-fructose corn syrup. That explains why starches, which break down into glucose (another type of sugar), don't have the same negative effects as table sugar and HFCS.
Hydrogenated fat is the next suspect. I don't have any graphs to present, because no one has systematically tracked hydrogenated fat consumption in the U.S. or U.K. to my knowledge. However, it was first marketed in the U.S. by Procter & Gamble under the brand name Crisco in 1911. Crisco stands for "crystallized cottonseed oil", and involves taking an industrial waste oil (from cotton seeds) and chemically treating it using high temperature, a nickel catalyst and hydrogen gas (see this post for more information). Hydrogenated fats for human consumption hit markets in the U.K. around 1920. Here's what Dr. Robert Finlayson had to say about margarine in his paper "Ischaemic Heart Disease, Aortic Aneurysms, and Atherosclerosis in the City of London, 1868-1982":
The rise of cigarettes was a major change that probably contributed massively to the CHD epidemic. They were introduced just after the turn of the century in the U.S. and U.K., and rapidly became fashionable (source):
If you look at the second to last graph from the previous post, you can see that there's a striking correspondence between cigarette consumption and CHD deaths in the U.K. In fact, if you moved the line representing cigarette consumption to the right by about 20 years, it would overlap almost perfectly with CHD deaths. The risk of heart attack is so strongly associated with smoking in observational studies that even I believe it probably represents a causal relationship. There's no doubt in my mind that smoking cigarettes contributes to the risk of heart attack and various other health problems.
Smoking is a powerful factor, but it doesn't explain everything. How is it that the Kitavans of Papua New Guinea, more than 3/4 of whom smoke cigarettes, have an undetectable incidence of heart attack and stroke? Why do the French and the Japanese, who smoke like chimneys (at least until recently), have the two lowest heart attack death rates of all the affluent nations? There's clearly another factor involved that trumps cigarette smoke.
First on the list: sugar. Here's a graph of refined sugar consumption in the U.K. from 1815 to 1955, from the book The Saccharine Disease, by Dr. T. L. Cleave. Sugar consumption increased dramatically in the U.K. over this time period, reaching near-modern levels by the turn of the century, and continuing to increase after that except during the wars:
Here's a graph of total sweetener consumption in the U.S. from 1909 to 2005 (source: USDA food supply database). Between 1909 and 1922, sweetener consumption increased by 40%:
If we assume a 10 to 20 year lag period, sugar is well placed to play a role in the CHD epidemic. Sugar is easy to pick on. Diets high in refined sugar tend to promote obesity due to overeating. An excess causes a number of detrimental changes in animal models and human subjects that are partially dependent on the development of obesity, including fatty liver, the metabolic syndrome, and small, oxidized low-density lipoprotein particles (LDL). Small and oxidized LDL associate strongly with cardiovascular disease risk and may be involved in causing it. These effects seem to be partly attributable to the fructose portion of sugar, which is 50% of table sugar (sucrose), about 50% of most naturally sweet foods, and 55% of the most common form of high-fructose corn syrup. That explains why starches, which break down into glucose (another type of sugar), don't have the same negative effects as table sugar and HFCS. Hydrogenated fat is the next suspect. I don't have any graphs to present, because no one has systematically tracked hydrogenated fat consumption in the U.S. or U.K. to my knowledge. However, it was first marketed in the U.S. by Procter & Gamble under the brand name Crisco in 1911. Crisco stands for "crystallized cottonseed oil", and involves taking an industrial waste oil (from cotton seeds) and chemically treating it using high temperature, a nickel catalyst and hydrogen gas (see this post for more information). Hydrogenated fats for human consumption hit markets in the U.K. around 1920. Here's what Dr. Robert Finlayson had to say about margarine in his paper "Ischaemic Heart Disease, Aortic Aneurysms, and Atherosclerosis in the City of London, 1868-1982":
...between 1909-13 and 1924-28, margarine consumption showed the highest percentage increase, whilst that of eggs only increased slightly and that of butter remained unchanged. Between 1928 and 1934, margarine consumption fell by one-third, while butter consumption increased by 57 percent: and increase that coincided with a fall of 48 percent in its price. Subsequently, margarine sales have burgeoned, and if one is correct in stating that the coronary heart disease epidemic started in the second decade of this century, then the concept of hydrogenated margarines as an important aetiological factor, so strongly advocated by Martin, may merit more consideration than hitherto.Partially hydrogenated oils contain trans fat, which is truly new to the human diet, with the exception of small amounts found in ruminant fats including butter. But for the most part, natural trans fats are not the same as industrial trans fats, and in fact some of them, such as conjugated linoleic acid (CLA), may be beneficial. To my knowledge, no one has discovered health benefits of industrial trans fats. To the contrary, compared to butter, they shrink LDL size. They also inhibit enzymes that the body uses to make a diverse class of signaling compounds known as eicosanoids. Trans fat consumption associates very strongly with the risk of heart attack in observational studies. Which is ironic, because hydrogenated fats were originally marketed as a healthier alternative to animal fats. In 2009, even the staunchest opponents of animal fats have to admit that they're healthier than hydrogenated fat.
The rise of cigarettes was a major change that probably contributed massively to the CHD epidemic. They were introduced just after the turn of the century in the U.S. and U.K., and rapidly became fashionable (source):
If you look at the second to last graph from the previous post, you can see that there's a striking correspondence between cigarette consumption and CHD deaths in the U.K. In fact, if you moved the line representing cigarette consumption to the right by about 20 years, it would overlap almost perfectly with CHD deaths. The risk of heart attack is so strongly associated with smoking in observational studies that even I believe it probably represents a causal relationship. There's no doubt in my mind that smoking cigarettes contributes to the risk of heart attack and various other health problems. Smoking is a powerful factor, but it doesn't explain everything. How is it that the Kitavans of Papua New Guinea, more than 3/4 of whom smoke cigarettes, have an undetectable incidence of heart attack and stroke? Why do the French and the Japanese, who smoke like chimneys (at least until recently), have the two lowest heart attack death rates of all the affluent nations? There's clearly another factor involved that trumps cigarette smoke.
Pin Curls
(Click on the images to get a better view.)
Source: Practice and Science of Standard Barbering, ⓒ 1938-1958
Play it safe outdoors this summer by being prepared
As the weather gets warmer and the days longer, we’re all drawn to the great outdoors. But exposure to the elements can lead to common injuries that may require first aid. Take some time this summer and get prepared so everyone stays happy and healthy in the warm weather.
If you are planning to be outside for a long time — whether it’s for a hike, fishing trip or family picnic — bring a first-aid kit stocked with gloves, bandages and other supplies. That way if something goes wrong, you’ll have the tools you need to provide basic medical attention, at least until the real experts arrive. You can assemble a kit yourself or purchase one at a store.
Greater time spent outside also increases the risk for exposure to threats such as poison ivy and insect bites. Learning to recognize dangerous plants (leaves of three, let it be!) can reduce the chance of skin contact and allergic reactions, but be prepared by sticking some calamine lotion in your kit. Bug repellant can prevent mosquito and tick bites. If you live in an area affected by Lyme disease, learn how to protect yourself and know the symptoms in case you get a tick bite. Most cases of Lyme disease can be cured, especially if detected and treated early.
Here are a few other tips:
* Brush up on first aid for common injuries
* Every so often, take a look at your first-aid kit to make sure you have everything you need, but remember that a well-stocked first-aid kit is no replacement for medical attention.
* Keep a list of emergency phone numbers with you at all times. Make sure to include a poison control center and the number of your family doctor. If the injury is severe, call 9-1-1 immediately.
Play it safe this summer by taking a few extra steps to prepare before setting foot outside.
If you are planning to be outside for a long time — whether it’s for a hike, fishing trip or family picnic — bring a first-aid kit stocked with gloves, bandages and other supplies. That way if something goes wrong, you’ll have the tools you need to provide basic medical attention, at least until the real experts arrive. You can assemble a kit yourself or purchase one at a store.
Greater time spent outside also increases the risk for exposure to threats such as poison ivy and insect bites. Learning to recognize dangerous plants (leaves of three, let it be!) can reduce the chance of skin contact and allergic reactions, but be prepared by sticking some calamine lotion in your kit. Bug repellant can prevent mosquito and tick bites. If you live in an area affected by Lyme disease, learn how to protect yourself and know the symptoms in case you get a tick bite. Most cases of Lyme disease can be cured, especially if detected and treated early. Here are a few other tips:
* Brush up on first aid for common injuries
* Every so often, take a look at your first-aid kit to make sure you have everything you need, but remember that a well-stocked first-aid kit is no replacement for medical attention.
* Keep a list of emergency phone numbers with you at all times. Make sure to include a poison control center and the number of your family doctor. If the injury is severe, call 9-1-1 immediately.
Play it safe this summer by taking a few extra steps to prepare before setting foot outside.
Old Walls
I recently went on about the appalling 'W' Wall's Ice Cream identity, but singularly failed to show you how their tin signs once fitted into the English landscape. One can only recoil in horror at the thought of their crass all-purpose heart symbol plastered on to this cottage in Ebrington. I found this photograph, by Noel Hapgood, in Garry Hogg's The Batsford Colour Book of The Cotswolds. Closer inspection will reveal the original Wall's sign, perfectly at home and in scale on this stone-built cottage tucked up in the furthest north east corner of Gloucestershire. Hapgood probably took his picture in the 1960s, and, like so many of the images in these souvenir guides to 'quainte olde Englande', over the years it slowly reveals the treasures of a lost country. The low signpost that Hogg says 'must be for the use of those not yet grown to maturity' and the back of the pre-Warboys road sign on the left that perhaps said 'bend' or 'crossroads' on it. But oh that Wall's sign. Positioned to catch not only the sun, but also the eye of the overheated traveller from Chipping Campden, Charingworth or Paxford.
The Coronary Heart Disease Epidemic
Few people alive today are old enough to remember the beginning of the coronary heart disease (CHD) epidemic in the 1920s and 1930s, when physicians in the U.S. and U.K. began sounding alarm bells that an uncommon disease was rapidly becoming the leading cause of death. By the 1950s, their predictions had come true. A decade later, a new generation of physicians replaced their predecessors and began to doubt that heart attacks had ever been uncommon. Gradually, the idea that the disease was once uncommon faded from the public consciousness, and heart attacks were seen as an eternal plague of humankind, avoided only by dying of something else first.
According to U.S. National Vital Statistics records beginning in 1900, CHD was rarely given as the cause of death by physicians until after 1930. The following graph is from The Great Cholesterol Con, by Anthony Colpo.
The relevant line for CHD deaths begins in the lower left-hand part of the graph. Other types of heart disease, such as heart failure due to cardiomyopathy, were fairly common and well recognized at the time. These data are highly susceptible to bias because they depend on the physician's perception of the cause of death, and are not adjusted for the mean age of the population. In other words, if a diagnosis of CHD wasn't "popular" in 1920, its prevalence could have been underestimated. The invention of new technologies such as the electrocardiogram facilitated diagnosis. Changes in diagnostic criteria also affected the data; you can see them as discontinuities in 1948, 1968 and 1979. For these reasons, the trend above isn't a serious challenge to the idea that CHD has always been a common cause of death in humans who reach a certain age.
This idea was weakened in 1951 with the publication of a paper in the Lancet medical journal titled "Recent History of Coronary Disease", by Dr. Jerry N. Morris. Dr. Morris sifted through the autopsy records of London Hospital and recorded the frequency of coronary thrombosis (artery blockage in the heart) and myocardial infarction (MI; loss of oxygen to the heart muscle) over the period 1907-1949. MI is the technical term for a heart attack, and it can be caused by coronary thrombosis. Europe has a long history of autopsy study, and London Hospital had a long-standing policy of routine autopsies during which they kept detailed records of the state of the heart and coronary arteries. Here's what he found:
The dashed line is the relevant one. This is a massive increase in the prevalence of CHD death that cannot be explained by changes in average lifespan. Although the average lifespan increased considerably over that time period, most of the increase was due to reduced infant mortality. The graph only includes autopsies performed on people 35-70 years old. Life expectancy at age 35 changed by less than 10 years over the same time period. The other possible source of bias is in the diagnosis. Physicians may have been less likely to search for signs of MI when the diagnosis was not "popular". Morris addresses this in the paper:
The solid line is MI mortality. Striking, isn't it? The other lines are tobacco and cigarette consumption. These data are not age-adjusted, but if you look at the raw data tables provided in the paper, some of which are grouped by age, it's clear that average lifespan doesn't explain much of the change. Heart attacks are largely an occurrence of the last 80 years.
What caused the epidemic? Both Drs. Morris and Finlayson also collected data on the prevalence of atherosclerosis (plaques in the arteries) over the same time period. Dr. Morris concluded that the prevalence of severe atherosclerosis had decreased by about 50% (although mild atherosclerosis such as fatty streaks had increased), while Dr. Finlayson found that it had remained approximately the same:
He found the same trend in females. This casts doubt on the idea that coronary atherosclerosis is sufficient in and of itself to cause heart attacks, although modern studies have found a strong association between advanced atherosclerosis and the risk of heart attack on an individual level. Heart attacks are caused by several factors, one of which is atherosclerosis.
What changes in diet and lifestyle associated with the explosion of MI in the U.K. and U.S. after 1920? Dr. Finlayson has given us a hint in the graph above: cigarette consumption increased dramatically over the same time period, and closely paralleled MI mortality. Smoking cigarettes is very strongly associated with heart attacks in observational studies. Animal studies also support the theory. While I believe cigarettes are an important factor, I do not believe they are the only cause of the MI epidemic. Dr. Finlayson touched on a few other factors in the text of the paper, and of course I have my own two cents to add. I'll discuss that next time.
According to U.S. National Vital Statistics records beginning in 1900, CHD was rarely given as the cause of death by physicians until after 1930. The following graph is from The Great Cholesterol Con, by Anthony Colpo.
The relevant line for CHD deaths begins in the lower left-hand part of the graph. Other types of heart disease, such as heart failure due to cardiomyopathy, were fairly common and well recognized at the time. These data are highly susceptible to bias because they depend on the physician's perception of the cause of death, and are not adjusted for the mean age of the population. In other words, if a diagnosis of CHD wasn't "popular" in 1920, its prevalence could have been underestimated. The invention of new technologies such as the electrocardiogram facilitated diagnosis. Changes in diagnostic criteria also affected the data; you can see them as discontinuities in 1948, 1968 and 1979. For these reasons, the trend above isn't a serious challenge to the idea that CHD has always been a common cause of death in humans who reach a certain age.
This idea was weakened in 1951 with the publication of a paper in the Lancet medical journal titled "Recent History of Coronary Disease", by Dr. Jerry N. Morris. Dr. Morris sifted through the autopsy records of London Hospital and recorded the frequency of coronary thrombosis (artery blockage in the heart) and myocardial infarction (MI; loss of oxygen to the heart muscle) over the period 1907-1949. MI is the technical term for a heart attack, and it can be caused by coronary thrombosis. Europe has a long history of autopsy study, and London Hospital had a long-standing policy of routine autopsies during which they kept detailed records of the state of the heart and coronary arteries. Here's what he found:
The dashed line is the relevant one. This is a massive increase in the prevalence of CHD death that cannot be explained by changes in average lifespan. Although the average lifespan increased considerably over that time period, most of the increase was due to reduced infant mortality. The graph only includes autopsies performed on people 35-70 years old. Life expectancy at age 35 changed by less than 10 years over the same time period. The other possible source of bias is in the diagnosis. Physicians may have been less likely to search for signs of MI when the diagnosis was not "popular". Morris addresses this in the paper:
The first possibility, of course, is that the increase is not real but merely reflects better post-mortem diagnosis. This is an unlikely explanation. There is abundant evidence throughout the forty years that the department was fully aware of the relation of infarction to thrombosis, of myocardial fibrosis to gradual occlusion, and of the topical pathology of ostial stenosis and infarction from embolism, as indeed were many pathologists last century... But what makes figures like these important is that, unlike other series of this kind, they are based on the routine examination at necropsy of the myocardium and of the coronary arteries over the whole period. Moreover Prof. H. M. Turnbull, director of the department, was making a special case of atheroma and arterial disease in general during 1907-1914 (Turnbull 1915). The possibility that cases were overlooked is therefore small, and the earlier material is as likely to be reliable as the later.Dr. Morris's study was followed by another similar one published in 1985 in the journal Medical History, titled "Ischaemic Heart Disease, Aortic Aneurysms, and Atherosclerosis in the City of London, 1868-1982", conducted by Dr. Robert Finlayson. This study, in my opinion, is the coup de grace. Finlayson systematically scrutinized autopsy reports from St. Bartholemew's hospital, which had conducted routine and detailed cardiac autopsies since 1868, and applied modern diagnostic criteria to the records. He also compared the records from St. Bartholemew's to those from the city mortuary. Here's what he found:
The solid line is MI mortality. Striking, isn't it? The other lines are tobacco and cigarette consumption. These data are not age-adjusted, but if you look at the raw data tables provided in the paper, some of which are grouped by age, it's clear that average lifespan doesn't explain much of the change. Heart attacks are largely an occurrence of the last 80 years.
What caused the epidemic? Both Drs. Morris and Finlayson also collected data on the prevalence of atherosclerosis (plaques in the arteries) over the same time period. Dr. Morris concluded that the prevalence of severe atherosclerosis had decreased by about 50% (although mild atherosclerosis such as fatty streaks had increased), while Dr. Finlayson found that it had remained approximately the same:
He found the same trend in females. This casts doubt on the idea that coronary atherosclerosis is sufficient in and of itself to cause heart attacks, although modern studies have found a strong association between advanced atherosclerosis and the risk of heart attack on an individual level. Heart attacks are caused by several factors, one of which is atherosclerosis.
What changes in diet and lifestyle associated with the explosion of MI in the U.K. and U.S. after 1920? Dr. Finlayson has given us a hint in the graph above: cigarette consumption increased dramatically over the same time period, and closely paralleled MI mortality. Smoking cigarettes is very strongly associated with heart attacks in observational studies. Animal studies also support the theory. While I believe cigarettes are an important factor, I do not believe they are the only cause of the MI epidemic. Dr. Finlayson touched on a few other factors in the text of the paper, and of course I have my own two cents to add. I'll discuss that next time.
Find The Fault No 12
I don't know about you, but I'm finding some of these puzzle pictures a bit tedious. Looking ahead in the pack of 20 I see far more interesting images, even if the 'fault' itself is obvious. I was summoned to a conference by Commentator Diplo last week where this point about tedium was high on the agenda, and I was left in no doubt that I had to address the issue. I think I said "Don't worry, there's some classics coming up", and then opened the archive box up this morning and found this. I should also be out there bringing you goodies from the leafy Highways & Byways of Unmitigated England, particularly as the weather is so now clement, instead of ferreting about indoors. So what if I skip the boring Fault Pics from now on, and just give you the more controversial interesting ones? Or do you mind waking up to find yourself staring at Uncertain Umbrellas?
Hold Your Nose
Funny how the smallest detail can act as an aide memoire to all things past. I took one of my boys on a tour of the sights of my own childhood- houses, workplaces, places I loved, places where I got to up to no good. I was born in the back bedroom of an 1899 house in Wigston Fields, just to the south of the city of Leicester. You'll find a picture of it on page 13 of The English Buildings Book - at long last in paperback. The back part of the house was once a remote Georgian cottage, but in late Victorian times large houses gathered around it in the fields and the old cottage was doubled in size. The original trackway became sealed-off as a cul-de-sac, and at the top there was a forbidding brick wall- I imagined heaven was on the other side- together with this lovely piece of cast ironwork forming the base of a tall tube that towered into the sky. We didn't think it special then, quite the reverse. For this, we were told, was a Stink Pole. Not understanding this meant a sewer ventilator I just assumed it was where 'Number Twos' were stored. Probably just mine. The lane is almost exactly as it was when I first propped my bike up against it- just more cars parked against the hedges. This was fascinating to my son, who stared at it and then at me and of course tried to climb up it. Something I never attempted, sadly. But I'm very pleased to see it still in service, 'doing the business' as it were.
Help the hungry, improve preparedness without leaving your doorstop on Stamp Out Hunger Day
On your way home from work today, take some time to stop at the grocery store and pick up a few extra items for those in need. You'll help improve preparedness in your community, and thanks to an upcoming national food drive, you only have to leave your contributions as far as your front door.
Tomorrow — Saturday, May 9 — is the annual Stamp Out Hunger Food Drive, the nation's largest single-day food collection event. To participate, leave bags of nonperishable, nonexpired foods next to your mailbox and your letter carrier will pick them up and deliver them to local food banks. How easy is that?
For the 15th year, the Stamp Out Hunger campaign, organized by the U.S. Postal Service, the National Association of Letter Carriers and the Campbell Soup Company, will help feed the nearly 35 million Americans who are hungry or living on the brink of hunger. Many of these people depend on food banks to ensure that they have enough to eat. In 2008, the event delivered over 73 million pounds of food.
Along with helping provide for those in need, food banks play an important part in community preparedness. If there are 35 million people who already don't have enough to eat, what will happen when a disaster such as a hurricane, a tornado or pandemic flu strikes? Demand on food banks will increase. That's why it is important to support our community food banks year-round.
Join Americans all around the country by contributing whatever you can on May 9. Whether you buy extra groceries the next time you shop or donate extra nonexpired canned goods you have in your pantry, every little bit helps and moves your local food banks one step closer to being prepared. Just leave them by your mailbox. No stamp required.
If you're not sure whether your letter carrier is participating in Stamp Out Hunger or if you live in an urban area, contact your local post office. Interested in other ways to help food banks? Read our tips and help your community prepare.
Get Ready Mailbag: Swine flu
Welcome to another installment of the Get Ready Mailbag, when we take time to answer questions sent our way by readers like you. Have a question you want answered? Send an e-mail to pandemicflu@apha.org.
Q. I read that CDC has decided that schools don't have to close anymore for swine flu. Why? And does that mean swine flu is over?
A. The recent change in guidance for schools from the Centers for Disease Control and Prevention is a result of the latest information on the H1N1 flu outbreak, which has also been called "swine flu." When the virus first appeared in the United States, outbreaks were frequently starting in schools. Also, early information from Mexico was that the virus was affecting previously healthy young adults and often resulting in respiratory failure and death.
Based on this initial information, CDC recommended that schools close when a student was infected as a way to reduce spread of a potentially severe disease. However, there are now more than 1,000 cases in 44 states, making school closure less effective. Additionally, most U.S. cases have not been any more severe than seasonal influenza. As a result, CDC has stopped recommending school closure and instead focuses on early identification of ill students and staff, staying home when sick, and good cough and hand hygiene.
Although this is good news, it's too early to say with certainty that the worst is over. Flu viruses are notoriously unstable and can change at any time to become either more harmless or more lethal. There is also a concern that this current outbreak will subside with warmer weather, only to come back in the fall and winter. Health officials are taking precautions to keep people safe while they continue to learn more.
If you have more questions about H1N1 flu, check out these FAQs from APHA.
Q. I read that CDC has decided that schools don't have to close anymore for swine flu. Why? And does that mean swine flu is over?
A. The recent change in guidance for schools from the Centers for Disease Control and Prevention is a result of the latest information on the H1N1 flu outbreak, which has also been called "swine flu." When the virus first appeared in the United States, outbreaks were frequently starting in schools. Also, early information from Mexico was that the virus was affecting previously healthy young adults and often resulting in respiratory failure and death.
Based on this initial information, CDC recommended that schools close when a student was infected as a way to reduce spread of a potentially severe disease. However, there are now more than 1,000 cases in 44 states, making school closure less effective. Additionally, most U.S. cases have not been any more severe than seasonal influenza. As a result, CDC has stopped recommending school closure and instead focuses on early identification of ill students and staff, staying home when sick, and good cough and hand hygiene.
Although this is good news, it's too early to say with certainty that the worst is over. Flu viruses are notoriously unstable and can change at any time to become either more harmless or more lethal. There is also a concern that this current outbreak will subside with warmer weather, only to come back in the fall and winter. Health officials are taking precautions to keep people safe while they continue to learn more.
If you have more questions about H1N1 flu, check out these FAQs from APHA.
Dihydro-Vitamin K1
Step right up ladies and gents; I have a new miracle vitamin for you. Totally unknown to our ignorant pre-industrial ancestors, it's called dihydro-vitamin K1. It's formed during the oil hydrogenation process, so the richest sources are hydrogenated fats like margarine, shortening and commercial deep fry oil. Some of its benefits may include:
This could be another mechanism by which industrially processed vegetable oils degrade health. It's also another example of why it's not a good idea to chemically alter food. We don't understand food, or our bodies, well enough to know the long-term consequences of foods that have been recently introduced to the human diet. I believe these foods should be avoided on principle.
- Inhibiting vitamin K2 metabolism
- Reducing bone mineral density
- Causing organ damage and inhibiting platelet formation in animal models
- Dramatically increasing the death rate of spontaneously hypertensive rats
This could be another mechanism by which industrially processed vegetable oils degrade health. It's also another example of why it's not a good idea to chemically alter food. We don't understand food, or our bodies, well enough to know the long-term consequences of foods that have been recently introduced to the human diet. I believe these foods should be avoided on principle.
Link: Retro Hairstyles for Dummies
Once again, another great link:
Retro Hairstyles for Dummies
I love that Sari has the updos from the Hairdo Handbook that we have here, but in German. (She has also translated them.)
(The English ones on this blog are here.)
Retro Hairstyles for Dummies
I love that Sari has the updos from the Hairdo Handbook that we have here, but in German. (She has also translated them.)
(The English ones on this blog are here.)
Clumber Lumber
Clumber Park is an ex-Ducal estate of 3,800 acres south east of Worksop in Nottinghamshire. The grand Palladian house, begun in 1760, has gone, leaving no sign of its passing other than that ethereal ghost that such places imprint on the mind. The substantial remains in the park include a two-and-a-half mile double avenue of limes leading down from the impressive Apleyhead Gate, the stables, a walled kitchen garden with the Long Range glasshouse and a Gothic Revival Chapel of 1889. The latter is one of the most impressive of its type. At least on the outside. I found inside deeply depressing, as dark sandstone interiors tend to be. So what captured my imagination most? Not difficult to guess, it's this pair of watering cans in a side room of the glasshouse. Unloved, unnoticed, I may have missed them altogether if a kindly sun hadn't decided to illuminate them just for a brief moment of time as I walked in. Only a few cans, I expect there were once many more. Up until the thirties there were twenty five gardeners toiling amongst the orchards and herbaceous borders or here in the glasshouse. And then it was all considered uneconomic. Pulling the house down in 1938 couldn't have helped. Find The Fault No 11
Apart from reminding me of that old joke that ends with a newspaper headline "Nut Screws Washers & Bolts", there's not a lot I can say about this. Although I'm slightly bothered by the name on the spanner- "Vanadium". What's that? Sounds like a cream you put on if you've got spots.
Pastured Eggs
Eggs are an exceptionally nutritious food. It's not surprising, considering they contain everything necessary to build a chick! But all eggs are not created equal. Anyone who has seen the tall, orange yolk, viscous white, and tough shell of a true pastured egg knows they're profoundly different. So has anyone who's tasted one. This has been vigorously denied by the American Egg Board and the Egg Nutrition Council, primarily representing conventional egg farmers, which assert that eggs from giant smelly barns are nutritionally equal to their pastured counterparts.
In 2007, the magazine Mother Earth News decided to test that claim. They sent for pastured eggs from 14 farms around the U.S., tested them for a number of nutrients, and compared them to the figures listed in the USDA Nutrient Database for conventional eggs. Here are the results per 100 grams for conventional eggs, the average of all the pastured eggs, and eggs from Skagit River Ranch, which sells at my farmer's market:
Vitamin A:
Looks like the American Egg Board and the Egg Nutrition Council have some egg on their faces...
Eggs also contain vitamin K2, with the amount varying substantially according to the hen's diet. Guess where the A, D, K2, beta-carotene and omega-3 fatty acids are? In the yolk of course. Throwing the yolk away turns this powerhouse into a bland, nutritionally unimpressive food.
It's important to note that "free range" supermarket eggs are nutritionally similar to conventional eggs. The reason pastured eggs are so nutritious is that the chickens get to supplement their diets with abundant fresh plants and insects. Having little doors on the side of a giant smelly barn just doesn't replicate that.
In 2007, the magazine Mother Earth News decided to test that claim. They sent for pastured eggs from 14 farms around the U.S., tested them for a number of nutrients, and compared them to the figures listed in the USDA Nutrient Database for conventional eggs. Here are the results per 100 grams for conventional eggs, the average of all the pastured eggs, and eggs from Skagit River Ranch, which sells at my farmer's market:
Vitamin A:
- Conventional: 487 IU
- Pastured avg: 792 IU
- Skagit Ranch: 1013 IU
- Conventional: 34 IU
- Pastured avg: 136 - 204 IU
- Skagit Ranch: not determined
- Conventional: 0.97 mg
- Pastured avg: 3.73 mg
- Skagit Ranch: 4.02 mg
- Conventional: 10 mcg
- Pastured avg: 79 mcg
- Skagit Ranch: 100 mcg
- Conventional: 0.22 g
- Pastured avg: 0.66 g
- Skagit Ranch: 0.74 g
Looks like the American Egg Board and the Egg Nutrition Council have some egg on their faces...
Eggs also contain vitamin K2, with the amount varying substantially according to the hen's diet. Guess where the A, D, K2, beta-carotene and omega-3 fatty acids are? In the yolk of course. Throwing the yolk away turns this powerhouse into a bland, nutritionally unimpressive food.
It's important to note that "free range" supermarket eggs are nutritionally similar to conventional eggs. The reason pastured eggs are so nutritious is that the chickens get to supplement their diets with abundant fresh plants and insects. Having little doors on the side of a giant smelly barn just doesn't replicate that.
Iodine
Iodine is an essential trace mineral. It's required for the formation of activated thyroid hormones T3 and T4. The amount of thyroid hormones in circulation, and the body's sensitivity to them, strongly influences metabolic rate. Iodine deficiency can lead to weight gain and low energy. In more severe cases, it can produce goiter, an enlargement of the thyroid gland.
Iodine deficiency is also the most common cause of preventable mental retardation worldwide. Iodine is required for the development of the nervous system, and also concentrates in a number of other tissues including the eyes, the salivary glands and the mammary glands.
There's a trend in the alternative health community to use unrefined sea salt rather than refined iodized salt. Personally, I use unrefined sea salt on principle, although I'm not convinced refined iodized salt is a problem. But the switch removes the main source of iodine in most peoples' diets, creating the potential for deficiency in some areas. Most notably, the soil in the midwestern United States is poor in iodine and deficiency was common before the introduction of iodized salt.
The natural solution? Sea vegetables. They're rich in iodine, other trace minerals, and flavor. I like to add a 2-inch strip of kombu to my beans. Kombu is a type of kelp. It adds minerals, and is commonly thought to speed the cooking and improve the digestion of beans and grains.
Dulse is a type of sea vegetable that's traditionally North American. It has a salty, savory flavor and a delicate texture. It's great in soups or by itself as a snack.
And then there's wakame, which is delicious in miso soup. Iodine is volatile so freshness matters. Store sea vegetables in a sealed container. It may be possible to overdo iodine, so it's best to eat sea vegetables regularly but in moderation like the Japanese.
Seafood such as fish and shellfish are rich in iodine, especially if fish heads are used to make soup stock. Dairy is a decent source in areas that have sufficient iodine in the soil.
Cod liver oil is another good source of iodine, or at least it was before the advent of modern refining techniques. I don't know if refined cod liver oil contains iodine. I suspect that fermented cod liver oil is still a good source of iodine because it isn't refined.
Iodine deficiency is also the most common cause of preventable mental retardation worldwide. Iodine is required for the development of the nervous system, and also concentrates in a number of other tissues including the eyes, the salivary glands and the mammary glands.
There's a trend in the alternative health community to use unrefined sea salt rather than refined iodized salt. Personally, I use unrefined sea salt on principle, although I'm not convinced refined iodized salt is a problem. But the switch removes the main source of iodine in most peoples' diets, creating the potential for deficiency in some areas. Most notably, the soil in the midwestern United States is poor in iodine and deficiency was common before the introduction of iodized salt.
The natural solution? Sea vegetables. They're rich in iodine, other trace minerals, and flavor. I like to add a 2-inch strip of kombu to my beans. Kombu is a type of kelp. It adds minerals, and is commonly thought to speed the cooking and improve the digestion of beans and grains.
Dulse is a type of sea vegetable that's traditionally North American. It has a salty, savory flavor and a delicate texture. It's great in soups or by itself as a snack.
And then there's wakame, which is delicious in miso soup. Iodine is volatile so freshness matters. Store sea vegetables in a sealed container. It may be possible to overdo iodine, so it's best to eat sea vegetables regularly but in moderation like the Japanese.
Seafood such as fish and shellfish are rich in iodine, especially if fish heads are used to make soup stock. Dairy is a decent source in areas that have sufficient iodine in the soil.
Cod liver oil is another good source of iodine, or at least it was before the advent of modern refining techniques. I don't know if refined cod liver oil contains iodine. I suspect that fermented cod liver oil is still a good source of iodine because it isn't refined.
Feather Halo
(Click on the image to open a larger version in a new window.)
Source: Modern Beauty Shop, June 1942
Loded
A signpost out on the fens east of Cambridge. Having a kind of horrible ring-of-truth for our times I thought 'What's all that about?'. As the River Cam winds across to its confluence with the Great Ouse, an offshoot goes off to the south east. This is Swaffham Bulbeck Lode, and it ends between the villages of Swaffham Bulbeck and Swaffham Prior (where two good-sized churches share the same churchyard), and just across the wide fields from Anglesey Abbey at Lode. The quay was dubbed Commercial End, and in the eighteenth century this was a very useful waterway, enabling local produce to be shipped straight off the fen and into either Cambridge or up towards Kings Lynn and the sea. The railways brought the water-born trade to an abrupt end when the Great Eastern put a branch through to Mildenhall and Bury St.Edmunds. You think everything's going to last forever; flowers in the church, God in His heaven, and suddenly 'pfff!' it's all gone in a puff of smoke.
Don’t let your tots miss their shots: Online tracker a handy helper
If you're a parent, you're no doubt familiar with the seemingly endless trips to the doctor to have your child vaccinated. Even if you can rattle off the alphabet soup of names of the vaccines your child has received — MMR! DTaP! Hib! — there is a good chance you can't remember which one is next, and when.
While vaccines have been able to keep disease rates low in the United States, missing childhood vaccinations is a bad idea. According to info released as part of National Infant Immunization Week— held April 25-May 2 — more than 20 percent of the nation's 2-year-olds are not fully immunized against infectious diseases they are at risk for.
"The unnecessary death of even one child from a vaccine-preventable disease is tragic," according to Anne Schuchat, director of the Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases.
One of the most common reasons parents miss shots for their kids is the frequent schedule. By the age of 2, children receive as many as 26 shots guarding against 14 diseases, and keeping track of all these appointments on top of everything else going on in your life can be tricky.
So how to keep track of all those shots? Cue CDC's online vaccination tracker, a nifty tool that helps parents plan ahead. Just enter your child's birth date to see which vaccines your child should have already received, and which she or he should receive in the near future.
The CDC tracker will also tell you what all those shots are for. Print out the schedule and keep it handy so that you can look at it when you make appointments and bring it along to your doctor visits. If you use an online calendar such as Outlook or Google, transfer the dates and set your calendar reminders to pop up before the vaccination dates do.
Still need help on vaccines? Contact your local health provider or physician, or read this helpful parents' guide from CDC. Don't let your tots miss their shots!
Image courtesy of the CDC
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