How to Add the Gentle Look of Wings



(Click on images to enlarge.)
Source: Dell 1000 Hints - Your Hairdo, January 1958

Malocclusion: Disease of Civilization

In his epic work Nutrition and Physical Degeneration, Dr. Weston Price documented the abnormal dental development and susceptibility to tooth decay that accompanied the adoption of modern foods in a number of different cultures throughout the world. Although he quantified changes in cavity prevalence (sometimes finding increases as large as 1,000-fold), all we have are Price's anecdotes describing the crooked teeth, narrow arches and "dished" faces these cultures developed as they modernized.

Price published the first edition of his book in 1939. Fortunately,
Nutrition and Physical Degeneration wasn't the last word on the matter. Anthropologists and archaeologists have been extending Price's findings throughout the 20th century. My favorite is Dr. Robert S. Corruccini, currently a professor of anthropology at Southern Illinois University. He published a landmark paper in 1984 titled "An Epidemiologic Transition in Dental Occlusion in World Populations" that will be our starting point for a discussion of how diet and lifestyle factors affect the development of the teeth, skull and jaw (Am J. Orthod. 86(5):419)*.

First, some background. The word
occlusion refers to the manner in which the top and bottom sets of teeth come together, determined in part by the alignment between the upper jaw (maxilla) and lower jaw (mandible). There are three general categories:
  • Class I occlusion: considered "ideal". The bottom incisors (front teeth) fit just behind the top incisors.
  • Class II occlusion: "overbite." The bottom incisors are too far behind the top incisors. The mandible may appear small.
  • Class III occlusion: "underbite." The bottom incisors are beyond the top incisors. The mandible protrudes.
Malocclusion means the teeth do not come together in a way that's considered ideal. The term "class I malocclusion" is sometimes used to describe crowded incisors when the jaws are aligning properly.

Over the course of the next several posts, I'll give an overview of the extensive literature showing that hunter-gatherers past and present have excellent occlusion, subsistence agriculturalists generally have good occlusion, and the adoption of modern foodways directly causes the crooked teeth, narrow arches and/or crowded third molars (wisdom teeth) that affect the majority of people in industrialized nations. I believe this process also affects the development of the rest of the skull, including the face and sinuses.


In his 1984 paper, Dr. Corruccini reviewed data from a number of cultures whose occlusion has been studied in detail. Most of these cultures were observed by Dr. Corruccini personally. He compared two sets of cultures: those that adhere to a traditional style of life and those that have adopted industrial foodways. For several of the cultures he studied, he compared it to another that was genetically similar. For example, the older generation of Pima indians vs. the younger generation, and rural vs. urban Punjabis. He also included data from archaeological sites and nonhuman primates. Wild animals, including nonhuman primates, almost invariably show perfect occlusion.

The last graph in the paper is the most telling. He compiled all the occlusion data into a single number called the "treatment priority index" (TPI). This is a number that represents the overall need for orthodontic treatment. A TPI of 4 or greater indicates malocclusion (the cutoff point is subjective and depends somewhat on aesthetic considerations). Here's the graph: Every single urban/industrial culture has an average TPI of greater than 4, while all the non-industrial or less industrial cultures have an average TPI below 4. This means that in industrial cultures, the average person requires orthodontic treatment to achieve good occlusion, whereas most people in more traditionally-living cultures naturally have good occlusion.

The best occlusion was in the New Britain sample, a precontact Melanesian hunter-gatherer group studied from archaeological remains. The next best occlusion was in the Libben and Dickson groups, who were early Native American agriculturalists. The Pima represent the older generation of Native Americans that was raised on a somewhat traditional agricultural diet, vs. the younger generation raised on processed reservation foods. The Chinese samples are immigrants and their descendants in Liverpool. The Punjabis represent urban vs. rural youths in Northern India. The Kentucky samples represent a traditionally-living Appalachian community, older generation vs. processed food-eating offspring. The "early black" and "black youths" samples represent older and younger generations of African-Americans in the Cleveland and St. Louis area. The "white parents/youths" sample represents different generations of American Caucasians.


The point is clear: there's something about industrialization that causes malocclusion. It's not genetic; it's a result of changes in diet and/or lifestyle. A "disease of civilization". I use that phrase loosely, because malocclusion isn't really a disease, and some cultures that qualify as civilizations retain traditional foodways and relatively good teeth. Nevertheless, it's a time-honored phrase that encompasses the wide array of health problems that occur when humans stray too far from their ecological niche.
I'm going to let Dr. Corruccini wrap this post up for me:
I assert that these results serve to modify two widespread generalizations: that imperfect occlusion is not necessarily abnormal, and that prevalence of malocclusion is genetically controlled so that preventive therapy in the strict sense is not possible. Cross-cultural data dispel the notion that considerable occlusal variation [malocclusion] is inevitable or normal. Rather, it is an aberrancy of modern urbanized populations. Furthermore, the transition from predominantly good to predominantly bad occlusion repeatedly occurs within one or two generations' time in these (and other) populations, weakening arguments that explain high malocclusion prevalence genetically.

* This paper is worth reading if you get the chance. It should have been a seminal paper in the field of preventive orthodontics, which could have largely replaced conventional orthodontics by now. Dr. Corruccini is the clearest thinker on this subject I've encountered so far.

England. Enjoy.

Those nice people at the Guardian have asked me to blog about three things I do to enjoy England. Well, they came to the right place, obviously. But where on earth, or England, to start? The thing is I’m usually out there most of the time, enjoying it all. The sheer variety of landscape, buildings and infinite detail. Here’s a trio of tasters:

If I’m close to home then I’m invariably drawn to Kirby Hall, over the border in Northamptonshire from my home in neighbouring Leicestershire. Originally built in the 1570s-80s, this is a superb example of a ‘prodigy house’. Prodigious in scale, intimate in detail. The Hall sits alone in its park and gardens, found at the end of an avenue of chestnuts alive with the raucous calls of rooks. Part of the house is open to the skies, much more is a succession of echoing rooms- four with tall rounded bay windows that look like the sterns of a pair of galleons. My young boys simply love it, backdrop scenery to their rumbustious adventures.

Pubs figure largely in my wandering itineraries. In London this could mean the Windsor Castle in Notting Hill or the Jerusalem Tavern in Clerkenwell. But if I find myself near the Law Courts on the Strand (increasingly likely) then I can’t resist the Seven Stars in Carey Street. A pedigree going back to 1663, well- kept Adnams from the Suffolk coast, posters on the walls for films like Action for Slander, a cat on the bar called Tom Paine. And a redoubtable landlady, Roxy Beaujolais, who keeps it all how I like pubs to be. There’s the inevitable Dickens connection, precipitous stairs to the lavatory, and it survived the Great Fire of London. With the blighting of so many pubs by overt commercial concerns, this a true survivor in anyone’s book.

What else? Well, undeterred by jaded music hall gags- “It’s like a mortuary with the lights on”- we recently spent a week in Barrow-in-Furness. The town was curiously of great interest, but once we’d got beyond submarine buildings (prodigious, but not like Kirby Hall) and Victorian red-brick tenements, we discovered a long walk along the sands to the north. So lonely, so breathtakingly beautiful. The cloud-capped fells of the Lake District rose up over the Duddon estuary, a strange hinterland of alarming sand dunes spread out to the south. We didn’t really see anybody until a bloke in a tracksuit gave us unfathomable directions, but nevertheless we made it back to the car park and welcoming large 99 Flakes from a green-painted hut.
So enjoyable, so England.

Find The Fault No 41

We've all known garages like this I'm sure. The family car didn't start losing oil until the 1920's, so houses didn't come complete with a purpose-built addition to park the Austin in. We had one on the side of the Victorian house I was lucky enough to have been born in, a lean-to affair with a corrugated iron roof (yess!) that my elder brother once fell through with such force that the sound of collapsing metal still reverberates in me now. We didn't have a car until much later, so our neighbour kept his little Morris in there. Dark and somehow comforting, another memorable day in my fourth year saw me climb into its leathery interior and take the handbrake off. It very slowly rolled forward and firmly wedged itself into my father's workbench. I remember clambering out, shaking with fear and running crying round to the kitchen where my mother was boiling up tripe (I would imagine). "What's on earth's the matter now?" she asked, probably waving wooden laundry tongs at me. "I've crashed next door's car", I spluttered through my tears. Anyway, quite apart from the obvious, I think the FTF artist could have taken a bit more trouble with the decoration on the gable of this improbable garage. A nice sunrise motif would've been nice.

Diabetics on a Low-carbohydrate Diet, Part II

I just found another very interesting study performed in Japan by Dr. Hajime Haimoto and colleagues (free full text). They took severe diabetics with an HbA1c of 10.9% and put them on a low-carbohydrate diet:
The main principle of the CRD [carbohydrate-restricted diet] was to eliminate carbohydrate-rich food twice a day at breakfast and dinner, or eliminate it three times a day at breakfast, lunch and dinner... There were no other restrictions. Patients on the CRD were permitted to eat as much protein and fat as they wanted, including saturated fat.
What happened to their blood lipids after eating all that fat for 6 months, and increasing their saturated fat intake to that of the average American? LDL decreased and HDL increased, both statistically significant. Oops. But that's water under the bridge. What we really care about here is glucose control. The patients' HbA1c (glycated hemoglobin; a measure of average blood glucose over the past several weeks) declined from 10.9 to 7.4%.

Here's a graph showing the improvement in HbA1c. Each line represents one individual:

Every single patient improved, except the "dropout" who stopped following the diet advice after 3 months (the one line that shoots back up at 6 months). And now, an inspirational anecdote from the paper:
One female patient had an increased physical activity level during the study period in spite of our instructions. However, her increase in physical activity was no more than one hour of walking per day, four days a week. She had implemented an 11% carbohydrate diet without any antidiabetic drug, and her HbA1c level decreased from 14.4% at baseline to 6.1% after 3 months and had been maintained at 5.5% after 6 months.
That patient began with the highest HbA1c and ended with the lowest. Complete glucose control using only diet and exercise. It may not work for everyone, but it's effective in some cases. The study's conclusion:
...the 30%-carbohydrate diet over 6 months led to a remarkable reduction in HbA1c levels, even among outpatients with severe type 2 diabetes, without any insulin therapy, hospital care or increase in sulfonylureas. The effectiveness of the diet may be comparable to that of insulin therapy.

Diabetics on a Low-carbohydrate Diet
The Tokelau Island Migrant Study: Diabetes

Shirtwaist Girl... 1943!



(Click on the images to enlarge.)
Source: Modern Beauty Shop, April 1943

Back to 1662

Today is apparently 'Back to Church Sunday'. There's been some radio commercials, a website and the Bishop of Reading has come out to say, in response to the dramatic falling-off of attendance: "How did it come to this, that we have become the Marks & Spencer's option when in our heart of hearts we know that Jesus would just as likely be in the queue at Aldi or Lidl?". I think he's summed it all up in just that one crass statement. The Church of England has for far too long tried to re-invent itself, to appeal to a culture far more interested in being in B&Q on a Sunday. It started with the New English Bible (sic), the attempt to subvert and alter the Book of Common Prayer, ripping out pews, hiding the altar behind an Ikea table, sacking the organist and putting pimply youths in front of guitar stands on the chancel steps. The CofE had a simply irreplaceable heritage that has been squandered and vandalised. Toilet block additions, solar panels instead of lead (if it's not already been nicked) and leasing out the nave to Halfords. Listen bishops. Kick out the moneychangers like Our Lord did before he went down to Aldi, stick some decent flowers round the pulpit, re-install the organ, dust off the 1662 Prayer Books, bring back Hymns Ancient and Modern and preach proper sermons that are both intelligent and inspirational. Stop everyone embarrassingly having to hug each other and just instil calm, simple faith in people. Of course there's much more you've got to do, and Norman architecture and chucking canteen chairs out of cathedrals won't do it on its own. God help us. The church pictured is Kings Norton in Leicestershire.

Insurance doesn't cover cancer pills!




Today, this New York Times article entitled: Insurance Lags as Cancer Care comes in a Pill revealed the communication gap between patients, doctors, technology and insurance companies.
With oral cancer drugs, “the technology has outstripped the ability of society to integrate it into the mainstream in a smooth fashion,” said Carlton Sedberry, a pharmacy expert at Medical Marketing Economics, a consulting firm.
Cancer pills provide a convenient alternative to IV chemotherapy since it reduces the number of visits that patients need to make to the hospital. However, most insurance companies do not cover these pills even though alternative therapies are covered. This makes the cost of this treatment weigh heavily in the pockets of the patients. Additionally, there may be problems with controlling dosage quantities and interpreting side effects. This new wave of cancer therapy still has a long way to go before becoming mainstream as doctors, patients and society learn to deal with the challenges that arise.

Keeping kids and child care centers flu-free

Ask any parent — little kids have a tendency to touch everything in sight. Their hands glide blissfully from doorknob to toy to nose to shoe to dog to mouth. So imagine the biological brew stirred up and shared when dozens of germy toddlers gather together. Ick!

That’s why the H1N1 flu virus, also known as swine flu, is such a concern for child care facilities. And, according to the Centers for Disease Control and Prevention, children under 5 are more vulnerable to the virus.

If you’re a parent, guardian or day care provider, don’t despair. There are steps you can take to reduce the spread of H1N1 and keep kids healthy and happy.

• After kids have left child care, they often leave their germs behind. Staff should disinfect as they normally would, according to CDC guidelines , paying special attention to things kids touch or put in their mouths, such as toys and play areas.

• The H1N1 virus is likely to spread more quickly at child care facilities because kids share toys and eat meals together. However, before young children even enter a child care center, teachers can do a very quick health check, which helps identify sick children and prevent any infected young ones from spreading the virus.

• Very young children have not yet acquired good handwashing skills. Child care workers should monitor children carefully while they wash their hands and distribute hand sanitizer often.

• On the home front, parents should not send their children to day care if they have symptoms of flu, which include sore throat, fever, runny nose, and cough. If sick, CDC recommends kids and staff stay at home until they are fever-free for 24 hours without the use of medicine.

Follow the tips for keeping your tot and child care facilities flu-free and staying healthy this season will be as easy as learning your ABCs.


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Weekly Update on H1N1 in Maine 9/24/09

Maine CDC/DHHS Update on Novel Influenza A (H1N1) Virus
September 24, 2009

Overview

US CDC reports that key indicators show that flu activity continued to increase in the US during the week of Sept. 6-12. Visits to doctors for influenza-like illness are higher than what is expected during this time of year and have increased for five consecutive weeks. Total flu hospitalization rates are higher than expected for this time of year. As of Sept. 13, the World Health Organization reported at least 3,486 deaths from H1N1.

Maine has identified 388 cases of H1N1, which include 19 individuals requiring hospitalization and one individual who has died. The number of cases is only a barometer of community transmission, not of actual case counts, because not all people with infection are tested. Of Maine residents with confirmed H1N1, 64 percent have been under 25 years of age.

The outbreak at Bowdoin College appears to be subsiding. In addition, Maine saw two apparent outbreaks of influenza-like illness in Central Maine schools seeing absentee rates above 15%.

Seasonal influenza vaccine:

Maine CDC has distributed about 114,000 doses of seasonal flu vaccine, with most of this being distributed to schools or pediatric providers. About 14 schools or school districts have held vaccine clinics. Due to nationwide delays in shipping of seasonal flu vaccine, Maine CDC recommended this week that large public clinics and school-located clinics be rescheduled if vaccine for those clinics had not already arrived. Clinic planners were advised to reschedule for mid- to late-October or into November, and to consider offering both seasonal flu vaccine and H1N1 flu vaccine at the same time.

H1N1 influenza vaccine:

It appears from preliminary clinical studies that children 10 – 18 may only need one dose of the H1N1 vaccine. Previous results in adults ages 18 – 65 indicate this population will also only need one dose. Dosage results for younger children are pending. (http://www.nih.gov/news/health/sep2009/niaid-21.htm)

US CDC issued a Q&A for clinicians related to H1N1 vaccination: http://www.cdc.gov/h1n1flu/vaccination/clinicians_qa.htm


Updates by Priority Population

The following groups are prioritized to be offered the first available doses of H1N1 vaccine, because they are at higher risk of complications from H1N1 infection or are more likely to pass the flu on to others who may be at higher risk of complications:
Pregnant women;
Household members and caregivers for children under 6 months old;
Health care and emergency medical services personnel;
All people ages 6 months through 24 years of age;
People ages 25 through 64 who have health conditions.

Minority Populations:
Maine CDC’s Office of Minority Health, under the leadership of Lisa Sockabasin, has been working since April on outreach and communications with Maine’s minority populations related to H1N1, making sure appropriate materials are translated and communities are engaged. This office is working now on assuring such efforts are in place to address the H1N1 influenza vaccine. They can be reached at 287-4844 for further questions or concerns.


Pregnant Women:

US CDC updated its Interim Recommendations for Obstetric Health Care Providers: http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm

A conference call for clinicians who care for pregnant women was held Sept. 17. Following are the questions and answers from the call:

Q. Is it safe to get the vaccine during the first trimester?
A. Yes.

Q. Will the screening questions be the same for seasonal and H1N1?
A. The Vaccine Information Statement (VIS) will determine that. CDC will be releasing the VIS for the licensed H1N1 vaccine soon.

Q. If a patient already has had H1N1 should they be vaccinated?
A. Generally yes, since the very vast majority of those with H1N1 never got tested, and there is no increased risk of getting the vaccine if you had the disease.

Q. How many shots are needed for H1N1?
A. Preliminary results of clinical studies show that people 10 and older only need one dose of H1N1 vaccine. Clinical studies in pregnant women are underway and results should be available soon.

Q. Is the vaccine diminished by antivirals?
A. Intranasal vaccine should not be administered until 48 hours after cessation of antiviral therapy, and influenza antiviral medications should not be administered for two weeks after receipt of intranasal vaccine.

Q. When will medical practices receive H1N1 vaccine if schools are a priority?
A. We have not yet received specific dates from US CDC for vaccine shipment. We anticipate that the first doses to arrive will be prioritized to medical providers for pregnant women and high-risk children, especially pre-school aged children.

Q. What are the storage and handling requirements for H1N1 vaccine?
A. Please see http://www.maine.gov/dhhs/boh/maineflu/h1n1-vaccine.shtml for information. H1N1 vaccine must be handled in accordance with the package insert, in a vaccine refrigerator.

Health Care and Emergency Medical Services Personnel:

Maine CDC is working with the Regional Resource Centers at Eastern Maine Medical Center, Central Maine Medical Center, and Maine Medical Center, to assure that all health care providers and Emergency Medical Services personnel (EMS) are offered H1N1 vaccine during the first few weeks of its arrival.

A health care provider tool kit for H1N1 vaccine clinics has been posted at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/hc-providers/index.shtml

Health care workers and EMS who would like to volunteer to vaccinate children as part of the school-based clinic initiative should register at www.maineresponds.org. Maine Responds will verify the credentials of volunteers, and they will be added to a list at http://www.maine.gov/mema/mema_news_display.shtml?id=79232.

Child Care Providers:

A conference call for child care providers was held Sept. 21. Following are the questions and answers from the call:

Q. Will the 2009 H1N1 influenza vaccines be safe?A. We expect the 2009 H1N1 influenza vaccine to have a similar safety profile as seasonal flu vaccines, which have a very good safety track record. Over the years, hundreds of millions of Americans have received seasonal flu vaccines. The most common side effects following flu vaccinations are mild, such as soreness, redness, tenderness or swelling where the shot was given. The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) will be closely monitoring for any signs that the vaccine is causing unexpected adverse events and we will work with state and local health officials to investigate any unusual events.

Q. Will there be a possibility of Guillain-Barré Syndrome (GBS) cases following the 2009 H1N1 vaccine?A. Guillain-Barré syndrome (GBS) is a rare disease in which the body damages its own nerve cells, causing muscle weakness and sometimes paralysis. It is not fully understood why some people develop GBS, but it is believed that stimulation of the body’s immune system may play a role in its development. People can also develop GBS after having the flu or other infections (such as cytomegalovirus and Epstein Barr virus). On very rare occasions, they may develop GBS in the days or weeks following receiving a vaccination.

Q. Should someone with Guillain-Barré Syndrome get vaccinated against the flu?
A. If you have Guillain-Barré Syndrome, you should contact your health care provider to find out if you should receive the flu vaccine or not.

Q. If you have an autoimmune disorder, asthma, or other chronic illness, should you avoid getting vaccinated?
A. People who have a severe (life-threatening) allergy to chicken eggs or to any other substance in the vaccine should not be vaccinated. People with asthma, chronic respiratory illnesses, or neurodevelopmental disorders or delays are prioritized to be vaccinated early due to their risk of complications from the flu.

Q. If you get H1N1, can you get it again?
A. We do not know yet. H1N1 is a new flu virus, and it is possible that it will evolve.

Q. Can you get seasonal and H1N1 vaccinations at the same time?
A. It is anticipated that seasonal flu vaccine and H1N1 vaccine may be administered on the same day. However, if you receive the intranasal (“FluMist”) form of vaccine, these should be separated by 1 month. You can get an intranasal vaccine and an injectable vaccine at the same time.

Q. Will the H1N1 vaccine have thimerosal?
A. As with the seasonal influenza vaccines, the 2009 H1N1 vaccines are being produced in formulations that contain thimerosal, a mercury-containing preservative, and in formulations that do not contain thimerosal. We expect to have some thimerosal-free H1N1 vaccine available for pregnant women and very young children.

For more facts about thimerosal see our Fact Sheet (http://www.maine.gov/dhhs/boh/Thimerosal%20Fact%20Sheet%20Final%20Version10%200521.pdf) and Dr. Mills’s presentation: (http://www.maine.gov/dhhs/boh/thimerosal_presentation.pdf).

Q. Will schools have the intranasal vaccine, or will it be available in pediatrician offices only?
A. Distribution plans are currently being determined.

Q. Are there advantages of the intranasal vaccine instead of the injectable?
A. The intranasal vaccine does not require a needle stick; however, it is only recommended for healthy people ages 2-49 who are not pregnant. The intranasal vaccine is as effective as the injected vaccine.

Q. How many shots are required for H1N1?
A. The US Food and Drug Administration (FDA) has approved the use of one dose of 2009 H1N1 flu vaccine for people 10 to 65 years of age. Data from trials among children indicate those 6 months to 10 years of age will need 2 doses, a month apart.

Q. What will be the recommended interval between the first and second dose for children 9 years of age and under?
A. This will not be known until clinical trials are complete. For planning purposes, planners should assume 21-28 days between the first and second vaccination.

Q. What kind of thermometer is best for monitoring fevers?
A. This web site has additional information about fevers: http://www.mayoclinic.com/health/first-aid-fever/FA00063

This Consumer Reports article may give you helpful information in determining what type of thermometer to use:
http://www.consumerreports.org/cro/babies-kids/childrens-health/health-issues/thermometers/thermometers-4-07/overview/thermometers-ov.htm?loginMethod=auto

Q. If the severity increases and day care are asked to close, is there funding available to help make up for lost business?
A. In cases of increased severity, current guidance is to close for 10 days and reassess. Maine CDC would close a business as a last resort. We are unaware of funds to help businesses that have to close due to a disease outbreak.

Q. What precautions should be taken for infants under six months?
A. Infants younger than six months cannot be vaccinated against influenza. Household members and caregivers of these infants are prioritized to receive vaccine in an effort to protect these infants. Other general hygiene protection measures, such as frequent washing of toys, especially during a flu outbreak, are warranted.

Other New or Recently Updated H1N1 Guidance or News

US CDC posted the following materials on its web site:
Preparedness tools for professionals: http://www.cdc.gov/h1n1flu/tools/
Q&A about antiviral drugs: http://www.cdc.gov/h1n1flu/antiviral.htm
Brochure, “H1N1 Flu and You”: http://www.cdc.gov/h1n1flu/flyers.htm
Information for pharmacists: http://www.cdc.gov/H1N1flu/pharmacist/pharmacist_info.htm

How to Stay Updated

Weekly Updates: Check the Thursday morning updates on H1N1 in Maine on Maine CDC’s H1N1 website. Now available as an RSS feed (midway down the center of the homepage): http://www.maineflu.gov/

Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at www.mainepublichealth.gov (midway down the center of the homepage).

Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
MySpace (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com)

H1N1 Conference Calls: Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks. Upcoming calls:

Monday, Sept. 28
Noon to 1 p.m.
conference call for interested stakeholders on H1N1 vaccine efforts and update
1-800-914-3396
pass code: 473623

Monday, Oct. 5
Noon to 1 p.m.
conference call for interested stakeholders on H1N1 vaccine efforts and update
1-800-914-3396
pass code: 473623

Consider Calling or Emailing Us:
For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
General Public Call-in Number for Questions: 1-888-257-0990NextTalk (deaf/hard of hearing) - (207) 629-5751Monday - Friday 9 a.m. – 5 p.m.
Email your questions to: flu.questions@maine.gov

U.S. CDC H1N1 Recommendations and Guidance:
http://www.cdc.gov/h1n1flu/ and http://www.flu.gov/

Find The Fault No 40

Quite a lot going on here. Looks like my dad in the trilby on the bus. Could that green van be a Trojan? And is that a miniature Dick Tracy outside Harris's? Anyway, off you go...

Styling Hair for Permanent Wave


(Click on the image to enlarge.)
Source: The Journeyman Barber, September 1940

What's New in Hair-Dos





(Click on images to enlarge.)
Source: Dell 1000 Hints - Your Hairdo, January 1958

Flu U: Keeping campuses safe from H1N1 influenza

Heading back to college means more this fall than sorority rush, new roommates and visits to the campus bookstore. The threat of H1N1 flu — also called swine flu — has added a new concern for students, administrators and parents alike — and it’s one that’s potentially worse than a final exam.

To help colleges prepare for the H1N1 flu virus, the Centers for Disease Control and Prevention has released recommendations for colleges and universities.

For college students, protecting yourself starts with good hygiene and prevention. Wash your hands often (PDF), cover your nose and mouth when you cough or sneeze, and avoid people who are sick. A new vaccine will also soon be available to help protect against H1N1 flu. Be sure to get your shot when the vaccine is available. (But CDC and other public health professionals remind you to make sure to get your seasonal flu vaccine too.)

If the virus does begin to infect people on campus, students and faculty should stick to a policy of “self-isolation.” That means students who show symptoms of H1N1 flu should stay out of contact with others and remain in their rooms until they are free of fever for 24 hours without use of medication. While this may be difficult for the overly social bunch on campus, it will help prevent the virus from spreading. Isolated students won’t be attending class, so CDC has encouraged colleges to adopt new absentee policies to enable students to remain in their rooms when they are sick.

CDC also recommends students adopt a “flu buddy” system, which essentially means people who have symptoms should help care for and check in with each other throughout the day. University staff should call, text or e-mail isolated students to check on them each day.

If handwashing and self-isolation are not enough and the spread of flu worsens, schools may take more drastic measures such as cutting down on campus-run social events and using online education as an alternative to class time.

Protect yourself on campus this fall. Follow the tips to stay healthy and you’ll be receiving that diploma before you can say “ah-choo!”


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Weekly Update on H1N1 in Maine 9/17/09

Overview

US CDC reported 1,380 hospitalizations and 196 deaths nationwide between August 30, and September 5, 2009. As of Sept. 6, the World Health Organization reported at least 3,205 deaths from H1N1 and reports of H1N1 from more than 200 countries.

Maine has identified 381 cases of H1N1, which include 19 individuals requiring hospitalization and one individual who has died. There have been no new outbreaks or institutions since the last update. The outbreak at Bowdoin College is ongoing. Of Maine residents with H1N1, 63 percent have been under 25 years of age. The number of cases is only a barometer of community transmission, not of actual case counts, because not all people with infection are tested.

H1N1 influenza vaccine: Licensed health care providers may now register to receive H1N1 vaccine. Information can be found at http://www.maineflu.gov/. H1N1 vaccine is expected to arrive in Maine in mid-October, with a possible small shipment in early October. The distribution of the first few shipments of H1N1 vaccine will be focused on settings where pregnant women are cared for, schools, and hospitals. Eventually sufficient vaccine is expected for everyone.

Seasonal influenza vaccine: Maine CDC has distributed about 49,000 seasonal flu vaccine for children and 55,000 for adults. 11 schools have conducted seasonal flu vaccine clinics this week, and about 116 school districts or schools have registered to offer seasonal flu vaccine clinics.

Maine CDC has posted an updated FAQ for the general public at http://www.maine.gov/dhhs/boh/maineflu/swine-flu-public-faq.shtml.

US CDC released several question and answer documents, including the following topics:
Guillain-Barré syndrome: http://www.cdc.gov/h1n1flu/vaccination/gbs_qa.htm
H1N1 vaccine safety: http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety_qa.htm
Thimerosal: http://www.cdc.gov/h1n1flu/vaccination/thimerosal_qa.htm

Updates by Priority Population

The following groups are prioritized to be offered the first available doses of H1N1 vaccine, because they are at higher risk of complications from H1N1 infection or are more likely to pass the flu on to others who may be at higher risk of complications:
Pregnant women;
Household members and caregivers for children under 6 months old;
Health care and emergency medical services personnel;
All people ages 6 months through 24 years of age;
People ages 25 through 64 who have health conditions.

Pregnant Women:

An increased risk during pregnancy – especially in the second and third trimesters – has been consistently well-documented across several countries. Pregnant women are prioritized for H1N1 vaccine because of this risk, and because they can potentially provide protection to infants who cannot be vaccinated.

Maine CDC is working with clinicians who provide health care for pregnant women to assure they have H1N1 vaccine for their patients and themselves as soon as it arrives in Maine. A conference call for clinicians who care for pregnant women washeld from noon to 1 p.m. Thursday, Sept. 17. Q&As from the call will be posted at http://www.maineflu.gov/ soon.

The National Institute of Allergy and Infectious Diseases (NIAID) has begun H1N1 vaccine trials in pregnant women: http://www.nih.gov/news/health/sep2009/niaid-09.htm

Health Care and Emergency Medical Services Personnel:

Maine CDC is working with the Regional Resource Centers at Eastern Maine Medical Center, Central Maine Medical Center, and Maine Medical Center, to assure that all health care providers and Emergency Medical Services personnel (EMS) are offered H1N1 vaccine during the first few weeks of its arrival.

Updated frequently asked questions for health care providers, clinicians, and EMS have been posted at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/provider-faq.shtml

Health care workers and EMS who would like to volunteer to vaccinate children as part of the school-based clinic initiative should register at http://www.maineresponds.org/. Maine Responds will verify the credentials of volunteers, and they will be added to a list at http://www.maine.gov/mema/mema_news_display.shtml?id=79232.

The Institute of Medicine issued its report to US CDC and OSHA with their recommendations for the use of protective personal equipment (PPE) in clinical settings. Their recommendations confirmed the current US CDC guidance issued in May (http://www.cdc.gov/h1n1flu/guidance/) that N95 respirators be used in clinical settings by health care workers in close contact with those with H1N1 or influenza-like illness. (http://www.iom.edu/CMS/3740/71769/72967.aspx) CDC anticipates that their updated recommendations should be available by or in October. Maine CDC is not planning to issue guidance until after US CDC issues their updated recommendations.

Child Care Providers:

Maine CDC will be holding a conference call for child care providers from noon to 1 p.m., Monday, Sept. 21. The call-in number is 1-800-914-3396, pass code is 473623. Maine CDC has mailed information on H1N1 to all 3,000 licensed early childhood programs in Maine.

School-age Children:

Maine CDC is working with Maine Department of Education (DOE) to assure that all Maine children are offered seasonal (regular) and H1N1 vaccine in local schools.

US CDC released school-located vaccination planning materials and templates (http://www.cdc.gov/h1n1flu/vaccination/slv/). Maine-specific information can be found in our school-based vaccine clinic tool kit: http://www.maine.gov/dhhs/boh/maineflu/schools/index.shtml

A conference call for school personnel and health care providers working on this initiative was held Monday, Sept. 14. The questions and answers from this call, as well as other frequently asked questions, can be found at: http://www.maine.gov/dhhs/boh/maineflu/schools/index.shtml#faq

A list of schools and schools units that have signed up with the Maine Immunization Program to offer vaccine to their students (as of Monday, Sept. 14) is posted at http://www.maine.gov/dhhs/boh/maineflu/schools/index.shtml.

People with Health Conditions:

Anyone with asthma is at higher risk for flu-related complications, such as pneumonia. US CDC created a web site with information for people with asthma: http://www.cdc.gov/h1n1flu/asthma.htm?s_tw_flu44

Vaccination

Seasonal Flu Vaccine:

H1N1 has been the focus of attention since the spring, but it is important that we do not forget the risks of the regular seasonal flu. Seasonal flu vaccine has begun to arrive in Maine; US CDC recommends that people at risk for the seasonal flu get vaccinated as soon as it is available:
Children ages 6 months to 18 years
Pregnant women
People 50 years of age and older
People of any age with certain chronic medical conditions
People who live in nursing homes and other long-term care facilities
People who live with or care for those at high risk for complications from flu, including:
Health care workers
Household contacts of persons at high risk for complications from the flu
Household contacts and out of home caregivers of children younger than 6 months old

H1N1 Vaccine:

The FDA has approved the H1N1 vaccine. The vaccines will be distributed nationally after the initial lots become available, which is expected within the next four weeks. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm182399.htm.

Early results from clinical trials indicate that adults age 18 and older may need only one dose of H1N1 vaccine. http://www.hhs.gov/news/press/2009pres/09/20090911a.html

Vaccine planning with communities and schools is well underway to ensure that all Maine children, all health care providers and Emergency Medical Services personnel, pregnant women, and others in high-risk groups for H1N1 are offered H1N1 vaccine as soon as it arrives in Maine.

Lung diseases

Lung disease is one of the top diseases in the United States today. Lung disease is on the rise worldwide. Factors such as air quality play a vital role in the increase in lung disease. Living with lung disease can be tremendously difficult, affecting daily life and the ability to do normal daily activities.

Symptoms of lung disease can vary, depending on the lung disease which has been contracted. Most lung diseases cause difficulty breathing, coughing, airway constriction, and a heavy or tight feeling in the chest. Some lung disease symptoms include fevers, weakness,heart rhythm problems or palpitations, or even blue tinting of the extremities.

Lung diseases such as lung cancers have various causative factors including, cigarette smoking, environmental or occupational exposures, and can be developed after a different type of cancer has been discovered elsewhere in the body. Asthma has hereditary factors, can be caused by second hand smoke or allergies, or other environmental factors. COPD, or chronic obstructive pulmonary disease, is usually caused by smoking cigarettes, although the chronic inhalation of marijuana can cause lung cancer and COPD. Lung diseases such as tuberculosis and legionnaires disease are caused by an infection and can be treated with very aggressive antibiotics.

LungsLungs


There are various risk factors for lung disease, most of which are environmental, although heredity does play a role in some lung diseases such as asthma. Environmental factors include smoking or exposure to second hand smoke, exposure to toxic substances such as asbestos or chemical treatments for fiberglass, allergies, bacteria, or viruses. For instance, asthma can be triggered by second hand smoke, smoking, or allergies but can also have hereditary risk factors. Asbestos exposure creates a serious risk factor for Mesothelioma, a rare but fatal lung cancer.

Diagnosing lung disease requires a physical examination and may require tests which include chest x-rays, blood tests, and lung function tests. Asthma may be diagnosed after a physical examination, listening to the lungs of the patient to detect any wheezing, and a spirometry test which is nothing more complicated than measuring the rate of air flow expelled from the lungs. Diagnosing lung cancer is typically done with x-rays of the chest and blood tests. Phlegm may be tested for cancerous cells, a bronchoscopy or a needle biopsy may be performed, and most doctors will perform a CT scan to take detailed pictures of the inside of the lung.

Complications from lung disease can be widespread, including heart problems related from a lack of oxygen in the bloodstream. Numbness in cold weather and tingling of the extremities can also happen due to a lack of oxygen in the bloodstream. Lung disease can deteriorate the quality of life for the patient, and may eventually lead to death. While it is very rare, fatal asthma attacks have been known to occur. Lung cancer may lead to death if the cancer either can not be controlled or spreads throughout the body.

Treatment for lung disease varies by the type of disease. Asthma suffers typically use an inhaler which delivers medication straight into the bronchioles and opens the airway. Oral medication is now proving to be effective in dealing with asthma. Infectious lung diseases such as tuberculosis and legionnaires disease require high dose antibiotics. Lung cancer is often treated with either radiation treatments, chemotherapy, surgical procedures, or a combination of all three. Lung disease is a serious health risk that costs billions of dollars per year to treat, and researchers are searching for better and more effective treatments for lung disease regularly.

Lung diseases


It is important that individuals with lung disease provide ample self care. Avoiding behaviors which are known to irritate the condition is just practical. People with lung disease should never smoke, avoid second hand smoke, avoid situations that are likely to pass germs from human to human contact or large crowded indoor areas that are likely to carry air born germs, and allergens which may affect the ability to breathe.

Coping with lung disease can be difficult and may affect every factor of daily life. Creating a comfortable sleeping environment, whether that means the use of a fan, dehumidifier, or vaporizer, is vital. Taking the appropriate medications when prescribed is also vital, whether or not the patient is symptomatic at the moment. Listening to the physician’s advice regarding diet and exercise can make a tremendous difference in the life of a lung disease sufferer.

Stepping Out

It's so often the little, unnoticed things. A very brief trip into the north of the Cotswolds yesterday brought me yet again to Stanway. Perched up on the escarpment just off the B4077 east of Toddington, this tiny village has so much to delight the eye. It starts with a war memorial up on the main road that sports on its limestone column a cowering dragon being given a seeing-to by St.George (and lettering by Eric Gill), from where a lane leads down to a simply magnificent 17th century gatehouse connecting the south front of Stanway House with the yew-shaded churchyard. They were doing something to either the yews or the churchyard wall, but as I wandered by I spied these steps. Such a simple thing, here was a way of climbing over the stonework into the grounds. I poked my nose over the wall to see if there were a corresponding couple of projections on the other side, and there were. They reminded me of the Grandmother's Steps on The Cobb in Lyme Regis, such a functional device that obviated the need for a timber stile or indeed a gate. One can only imagine the use they've been put to. Children incorporating them into their games, housemaids lifting their skirts as they hurried to work in the big house, swains on the lower step plighting their troths to those same maidens on Sunday evenings. More about Stanway soon, I expect.

Diabetics on a Low-carbohydrate Diet

Diabetes is a disorder of glucose intolerance. What happens when a diabetic eats a low-carbohydrate diet? Here's a graph of blood glucose over a 24 hour period, in type II diabetics on their usual diet (blue and grey triangles), and after 5 weeks on a 55% carbohydrate (yellow circles) or 20% carbohydrate (blue circles) diet:


The study in question describes these volunteers as having "mild, untreated diabetes." If 270 mg/dL of blood glucose is mild diabetes, I'd hate to see severe diabetes! In any case, the low-carbohydrate, high-fat diet brought blood glucose down to an acceptable level without requiring medication.

It's interesting to note in the graph above that fasting blood glucose (18-24 hours) also fell dramatically. This could reflect improved insulin sensitivity in the liver. The liver pumps glucose into the bloodstream when it's necessary, and insulin suppresses this. When the liver is insulin resistant, it doesn't respond to the normal signal that there's already sufficient glucose, so it releases more and increases fasting blood glucose. When other tissues are insulin resistant, they don't take up the extra glucose, also contributing to the problem.

Glycated hemoglobin (HbA1c), a measure of average blood glucose concentration over the preceding few weeks, also reflected a profound improvement in blood glucose levels in the low-carbohydrate group:

At 5 weeks, the low-carbohydrate group was still improving and headed toward normal HbA1c, while the high-carbohydrate group remained at a dangerously high level. Total cholesterol, LDL and HDL remained unchanged in both groups, while triglycerides fell dramatically in the low-carbohydrate group.

When glucose is poison, it's better to eat fat.

Graph #1 was reproduced from Volek et al. (2005), which re-plotted data from Gannon et al. (2004). Graph #2 was drawn directly from Gannon et al.

How women's bodies have been transformed in the past 60 years...

How women's bodies have been transformed in the past 60 years...
This article from the Daily Mail which compares bodies from the 50's to today's is an interesting read.

Turnabout.... It Leads a Double Life!



"What fun!"
(Click on images to enlarge.)
Source: Modern Beauty Shop, April 1943

Find The Fault No 39

Good morning everybody. I think we'll have lot to talk about here, quite apart from the fact that there are actually two faults, one deliberate and one that would appear to be a genuine error. And has the driver of the lovely open-topped car just finished asking directions from the be-gaitered chap with his stick: "Oh sir, I know how to get there, but not from 'ere".

For the Skin He'll Love to Touch

Never wash you face with hot water! use lukewarm water to start... and finish with cold. Cold water makes a velvet skin!

(Click on image for a larger version.)
Source: How to Find Your Man by Joe Bonomo, 1954

Paleolithic Diet Clinical Trials Part IV

Dr. Staffan Lindeberg has published a new study using the "paleolithic diet" to treat type II diabetics (free full text). Type II diabetes, formerly known as late-onset diabetes until it began appearing in children, is typically thought to develop as a result of insulin resistance (a lowered tissue response to the glucose-clearing function of insulin). This is often followed by a decrease in insulin secretion due to degeneration of the insulin-secreting pancreatic beta cells.

After Dr. Lindeberg's wild success treating patients with type II diabetes or glucose intolerance, in which he normalized the glucose tolerance of all 14 of his volunteers in 12 weeks, he set out to replicate the experiment. This time, he began with 13 men and women who had been diagnosed with type II diabetes for an average of 9 years.

Patients were put on two different diets for 3 months each. The first was a "conventional diabetes diet". I read a previous draft of the paper in which I believe they stated it was based on American Diabetes Association guidelines, but I can't find that statement in the final draft. In any case, here are the guidelines from the methods section:
The information on the Diabetes diet stated that it should aim at evenly distributed meals with increased intake of vegetables, root vegetables, dietary fiber, whole-grain bread and other whole-grain cereal products, fruits and berries, and decreased intake of total fat with more unsaturated fat. The majority of dietary energy should come from carbohydrates from foods naturally rich in carbohydrate and dietary fiber. The concepts of glycemic index and varied meals through meal planning by the Plate Model were explained [18]. Salt intake was recommended to be kept below 6 g per day.
The investigators gave the paleolithic group the following advice:
The information on the Paleolithic diet stated that it should be based on lean meat, fish, fruit, leafy and cruciferous vegetables, root vegetables, eggs and nuts, while excluding dairy products, cereal grains, beans, refined fats, sugar, candy, soft drinks, beer and extra addition of salt. The following items were recommended in limited amounts for the Paleolithic diet: eggs (≤2 per day), nuts (preferentially walnuts), dried fruit, potatoes (≤1 medium-sized per day), rapeseed or olive oil (≤1 tablespoon per day), wine (≤1 glass per day). The intake of other foods was not restricted and no advice was given with regard to proportions of food categories (e.g. animal versus plant foods). The evolutionary rationale for a Paleolithic diet and potential benefits were explained.
Neither diet was restricted in calories. After comparing the effects of the two diets for 3 months, the investigators concluded that the paleolithic diet:
  • Reduced HbA1c more than the diabetes diet (a measure of average blood glucose)
  • Reduced weight, BMI and waist circumference more than the diabetes diet
  • Lowered blood pressure more than the diabetes diet
  • Reduced triglycerides more than the diabetes diet
  • Increased HDL more than the diabetes diet
However, the paleolithic diet was not a cure-all. At the end of the trial, 8 out of 13 patents still had diabetic blood glucose after an oral glucose tolerance test (OGTT). This is compared to 9 out of 13 for the diabetes diet. Still, 5 out of 13 with "normal" OGTT after the paleolithic diet isn't bad. The paleolithic diet also significantly reduced insulin resistance and increased glucose tolerance, although it didn't do so more than the diabetes diet.

As has been reported in other studies, paleolithic dieters ate fewer total calories than the comparison group. This is part of the reason why I believe that something in the modern diet causes hyperphagia, or excessive eating. According to the paleolithic diet studies, this food or combination of foods is neolithic, and probably resides in grains, refined sugar and/or dairy. I have my money on wheat and sugar, with a probable long-term contribution from industrial vegetable oils as well.

Were the improvements on the paleolithic diet simply due to calorie restriction? Maybe, but keep in mind that neither group was told to restrict its caloric intake. The reduction in caloric intake occurred naturally, despite the participants presumably eating to fullness. I suspect that the paleolithic diet reset the dieters' body fat set-point, after which fat began pouring out of their fat tissue. They were supplementing their diets with body fat-- 13 pounds (6 kg) of it over 3 months.

The other notable difference between the two diets, besides food types, was carbohydrate intake. The diabetes diet group ate 56% more carbohydrate than the paleo diet group, with 42% of their calories coming from it. The paleolithic group ate 32% carbohydrate. Could this have been the reason for the better outcome of the paleolithic group? I'd be surprised if it wasn't a factor. Advising a diabetic to eat a high-carbohydrate diet is like asking someone who's allergic to bee stings to fetch you some honey from your bee hive. Diabetes is a disorder of glucose intolerance. Starch is a glucose polymer.

Although to be fair, participants on the diabetes diet did improve in a number of ways. There's something to be said for eating whole foods.

This trial was actually a bit of a disappointment for me. I was hoping for a slam dunk, similar to Lindeberg's previous study that "cured" all 14 patients of glucose intolerance in 3 months. In the current study, the paleolithic diet left 8 out of 13 patients diabetic after 3 months. What was the difference? For one thing, the patients in this study had well-established diabetes with an average duration of 9 years. As Jenny Ruhl explains in her book Blood Sugar 101, type II diabetes often progresses to beta cell loss, after which the pancreas can no longer secrete an adequate amount of insulin.

This may be the critical finding of Dr. Lindeberg's two studies: type II diabetes can be prevented when it's caught at an early stage, such as pre-diabetes, whereas prolonged diabetes may cause damage that cannot be completely reversed though diet. I think this is consistent with the experience of many diabetics who have seen an improvement but not a cure from changes in diet. Please add any relevant experiences to the comments.

Collectively, the evidence from clinical trials on the "paleolithic diet" indicate that it's a very effective treatment for modern metabolic dysfunction, including excess body fat, insulin resistance and glucose intolerance. Another way of saying this is that the modern industrial diet causes metabolic dysfunction.

Paleolithic Diet Clinical Trials
Paleolithic Diet Clinical Trials Part II
One Last Thought
Paleolithic Diet Clinical Trials Part III

H1N1 Infection Control in Health Care Settings

We are increasingly receiving questions on the use of masks vs N95 respirators in health care settings. Below is a review of some major health organizations’ recommendations for infection control in health care settings that you may find helpful. Dora



All recommendations generally agree on the following:

Use of standard and droplet precautions for suspected or confirmed cases of novel H1N1 influenza;
Placing surgical masks on patients with suspected or confirmed novel H1N1 infection at the point of contact with the health care facility;
Placing such patients in a single room, if available, or cohorting them with other infected patients;
Strict adherence to hand hygiene, respiratory hygiene and cough etiquette;
Early recognition and identification of suspected novel H1N1-infected patients upon presentation to a health care facility;
Restriction of visitors and health care workers with febrile respiratory illnesses.




Status of infection control guidance for novel influenza A H1N1



Background: Numerous state and local health agencies previously endorsed the April 29, 2009, World Health Organization (WHO) recommendations (see below) on infection control measures. Subsequently, recommendations by the CDC’s Hospital Infection Control Practices Advisory Committee (HICPAC), the Society for Healthcare Epidemiology (SHEA), the Infectious Diseases Society of America (IDSA) and the Association for Professionals in Infection Control and Epidemiology (APIC), endorsed this approach. Recently, the Institute of Medicine (IOM) issued a report supporting the CDC’s current recommendations, however, the IOM report is only one component of CDC’s current review of their guidance. CDC anticipates that their updated recommendations should be available by or in October.





Since the spring 2009 outbreak of novel influenza A H1N1, infection control recommendations for novel influenza 2009 H1N1 in health care settings have been issued by multiple agencies, expert advisory groups and professional societies. The issue of respiratory precautions has generated controversy largely because of the absence of controlled scientific studies in the clinical setting to guide definitive policy. Consequently, some of the recommendations from different organizations vary with respect to respiratory protection guidance (primarily mask vs. respirator use).





We understand the challenges that variation in recommendations from authoritative organizations may pose for health care system policy makers. Below are excerpts of salient recommendations that may be of use to you in reviewing your infection control policies for the upcoming influenza season. The majority of expert recommendations support the use of standard and droplet precautions, with respirators reserved for high-risk aerosol generating procedures. Maine CDC is not planning to issue guidance until after US CDC issues their updated recommendations in October.





Centers for Disease Control and Prevention (CDC), issued May 13th, 2009 (currently under review), available at, http://www.cdc.gov/h1n1flu/guidance/

May 13, 2009, guidance states that in addition to standard and contact precautions, “All health care personnel who enter the rooms of patients in isolation with confirmed, suspected, or probable novel H1N1 influenza should wear a fit-tested disposable N95 respirator or better.”





World Health Organization (WHO): Issued 29 April, updated July 10, 2009, available at http://www.who.int/csr/resources/publications/swineflu/swineinfinfcont/en/index.html

April 29 guidance and July 10 revision recommend standard and droplet precautions except for aerosol generating procedures where N95 respirator is recommended. July 10 revision recommends N95 protection as for aerosol generating procedures including obtaining specimens by nasopharyngeal aspirate, nasopharyngeal swab, throat swab or bronchial aspirate.





Society for Healthcare Epidemiology (SHEA) issued June 12, 2009, Infectious Diseases Society of America (IDSA) and the Association for Professionals in Infection Control and Epidemiology (APIC), available at http://www.shea-online.org/news/publicpolicy.cfm.

Recommend implementing the same practices recommended to prevent the transmission of seasonal influenza for the novel H1N1 virus: standard and droplet precautions. Recommends enhanced respiratory protection (I.e., N95 respirator) when performing certain aerosol-generating procedures, specifically: bronchoscopy, open suctioning of airway secretions,

resuscitation involving emergency intubation or cardiac pulmonary resuscitation, and endotracheal intubation.

Collection of nasopharyngeal specimens from patients with suspected or confirmed novel H1N1, closed suctioning of airway secretions and administration of nebulized medications should not be considered aerosol-generating and, therefore, do not require enhanced respiratory protection.





CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) Recommendations for Care of Patients with Confirmed or Suspected 2009 H1N1 Influenza Infection in Healthcare Settings - July 23, 2009, available at: http://www.cdc.gov/ncidod/dhqp/hicpac_h1n1.html

Use standard and droplet precautions for care of patients with suspected or confirmed 2009 H1N1 influenza infection.

Use fit tested N95 respirator or higher and consider airborne infection isolation room for aerosol-generating procedures (e.g., bronchoscopy, intubation under controlled or emergent situations, cardiopulmonary resuscitation, open airway suctioning and airway induction).





Public Health Agency of Canada, issued July 28th, 2009, available at http://www.phac-aspc.gc.ca/alert-alerte/h1n1/hp-ps/ig_acf-ld_esa-eng.php Recommend contact and droplet precautions when within 2 meters of a case

Recommend respiratory precautions (N95 respirator or higher) when conducting an aerosol-generating medical procedure.





Institute of Medicine report, September 3, 2009, available at http://www.iom.edu/CMS/3740/71769/72967.aspx

Recommended continuing CDC’s current guidance for respirator use, but notes the limitations on clinical studies and their lack of a charge to consider practical implementation issues.

Berkeley preventing flu in kids with fun handwashing program

With flu season just around the corner — and H1N1 flu a growing concern — health officials in Berkeley, Calif., have found that teaching kids about flu prevention in a fun way can help keep children healthy.

Through its WHACK the Flu program, a community education effort sponsored by the City of Berkeley Public Health Division, officials are driving home the message that good hand hygiene habits are important for preventing the flu. The “WHACK” part of the program’s name is an acronym for a series of flu prevention tips for kids: Wash your hands; Home is for where you stay; Avoid touching your eyes, nose and mouth; Cover your coughs and sneezes; and Keep your distance from people who are coughing or sneezing.

The program trains volunteers to perform a skit on the dangers of “Fred the Flu Germ” and explain all of the many places germs can be found, from noses, to hands and schools. Between giggles from the young ones, the skit shows how to cover mouths when coughing or sneezing and even includes a handwashing song that helps kids learn how long to wash.

The program, which is being used by the Berkeley school district as a preventive measure against H1N1, aka swine flu, leaves kids excited about washing their hands, singing the handwashing song and tickled by the notion that they can avoid the Fred the Flu Germ by whacking the flu.

Because it can be performed anywhere, WHACK the Flu has been used by health workers around the country. Free materials from the program — including the skit, teacher evaluation form and posters — are available online in both English and Spanish. Take a look and help school kids prevent flu in your community today.

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J2 Oh!


I've always had a thing about Morris J-types. Probably because they were once so ubiquitous as Royal Mail vans, but I think it was also because they somehow looked very modern when they first appeared, even though they still sported separate headlamps. Those sliding doors, and what are known as outrigger hinges that let the rear doors fold right back to the bodywork. Amazingly they were first introduced at the Commercial Transport Show in October 1948, so they're almost as old as I am, and for thirty years or so they delighted me with a host of signwriting and liveries. And it still goes on- one even cropped-up in a recent Dr.Who episode as the dark blue van of 1953 television saleman Mr.Magpie. With a raised roofline and hinged doors they of course made ideal ice cream vans, so I was very pleased to see one on my recent visit to Weston-super-Mare. Beautifully lettered, it was a perfect complement to the traditional treats of Carters Steam Fair. Stop me from buying one.

H1N1 Vaccine Study

The New England Journal of Medicine late yesterday published reports showing that inactivated 2009 H1N1 influenza vaccines appear to produce immunity in adults after a single dose. Preliminary analysis of early data from NIH trials appears to align with other findings that a single dose of H1N1 vaccine induces a strong and prompt immune response in most healthy adults. This is good news because, if confirmed and FDA-approved, we will be able to protect a much larger proportion of the population more quickly and conviently, as adult patients may not need a second dose. Similar findings are expected in young adults age 18 and older.

Results in children are not yet available; though vaccine-induced immunity after a single dose of seasonal flu vaccine is limited for children under the age of 9, making it more likely that children may need two doses of H1N1 vaccine. Data from adults was unexpectedly positive; we cannot predict with confidence what the pediatric data will show about the necessity of one vs. two doses.

Basically, this past year we have had two flu seasons – first the usual 2008-9 season, then the 2009 novel H1N1 influenza season, which started in April and has, essentially, continued until now. It appears likely that we will have two vaccines to address this – one, the seasonal vaccine, which is already available, and the second, the 2009 H1N1 vaccine.

Dora