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Source: Modern Beauty Shop, April 1942

One-stop shopping for flu shot this fall: Seasonal flu vaccine formula to include H1N1 flu strain

Good news for people who grew tired of trying to track down both H1N1 and seasonal flu shots last year: Federal and global health officials have recommended that the seasonal flu vaccine that’ll be used in the United States this fall include the H1N1 strain that sickened so many. That means adults should only need to get one flu shot next season instead of two. (One-stop shopping!)

Each year, the World Health Organization advises vaccine manufacturers on what to include in the seasonal flu vaccine by looking at what strains are circulating and are likely to make people sick. The health agency usually makes its decision in February (aka, now) for the Northern Hemisphere to give the manufacturers time to produce flu shots. (The recommendation for the Southern Hemisphere, which has its flu season at a different time, will come later.)

Here in the United States, a Food and Drug Administration advisory committee backed the WHO recommendation for the vaccine formula this week. The recommendation is that it will be a trivalent vaccine, meaning it’s aimed at three viruses: an A/Perth/16/2009 (H3N2)-like virus, a B/Brisbane/60/2008-like virus and an A/California/7/2009 (H1N1)-like virus.

While it’s good news that the seasonal flu vaccine targets the H1N1 strain, it also means that the H1N1 pandemic flu is here to stay. According to WHO statistics, there have been over 16,000 deaths worldwide attributed to the H1N1 pandemic, which is still ongoing. Remember, even if you received one or both flu shots last year, you still need the vaccination again this fall. So get ready for the flu and get your vaccinations when they become available.


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Storms a timely reminder: Check your emergency stockpile with March 14 clock change

If you had to stay in your home for six days without going out for food, toilet paper or other supplies, how would you fare?

For residents in the Washington, D.C., and mid-Atlantic region this winter, this question was more than hypothetical. Winter storms that buried the area in early February closed schools, stores, workplaces, public transportation, roadways and even the federal government — and left millions of people housebound for days. Those who weren’t within walking distance of grocery-depleted stores were left to make do with supplies that they had on hand, some without power or water. In the end, many people found that they weren’t nearly as prepared as they thought they were.

The storms brought home the message that everyone needs to have an adequate emergency supply on hand at their home at all times. And with daylight saving time just around the corner, now is the perfect time to help spread that reminder in your community. APHA’s Get Ready: Set Your Clocks, Check Your Stocks campaign reminds Americans to check their emergency stockpiles when they change their clocks. People who already have an emergency stockpile of food, water, flashlights and other supplies are asked to make sure that nothing has expired or gone missing, while those without a stockpile are encouraged to create one.

The Get Ready: Set Your Clocks, Check Your Stocks campaign includes free materials you can use to get ready or share with your community, including a shopping checklist (PDF), budget stockpiling tips (PDF), games for kids (PDF), fact sheets and logos. Many materials are also available in Spanish.

Daylight saving time begins Sunday, March 14. Take a lesson from our friends who rode out those storms and find some time to check your emergency stockpile.


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Corn Oil and Cancer?

The benefits of corn oil keep rolling in. In a new study by Stephen Freedland's group at Duke, feeding mice a diet rich in butter and lard didn't promote the growth of transplanted human prostate cancer cells any more than a low-fat diet (1).

Why do we care? Because other studies, including one from the same investigators, show that corn oil and other industrial seed oils strongly promote prostate cancer cell growth and increase mortality in similar models (2, 3).

From the discussion section:
Current results combined with our prior results suggest that lowering the fat content of a primarily saturated fat diet offers little survival benefit in an intact or castrated LAPC-4 xenograft model. In contrast to the findings when omega-6 fats are used, these results raise the possibility that fat type may be as important as fat amount or perhaps even more important.
There's a large body of evidence implicating excess omega-6 fat in a number of cancer models. Reducing omega-6 to below 4% of calories has a dramatic effect on cancer incidence and progression*. In fact, there have even been several experiments showing that butter and other animal fats promote cancer growth to a lesser degree than margarine and omega-6-rich seed oils. I discussed that here.


* The average American eats 7-8% omega-6 by calories. This means it will be difficult to see a relationship between omega-6 intake and cancer (or heart disease, or most things) in observational studies in the US or other industrial nations, because we virtually all eat more than 4% of calories as omega-6. Until the 20th century, omega-6 intake was below 4%, and usually closer to 2%, in some traditional societies. That's where it remains in contemporary traditional societies unaffected by industrial food habits, such as Kitava.

Public Health Update 2/25/10

Maine CDC/DHHS Public Health Update
February 25, 2010

Travel-related Disease Conditions
Maine CDC has investigated multiple cases of travel-related illness since January. During school vacation weeks in February and April, Maine residents may travel to warmer climates, which put them at risk for mosquito-borne diseases. See this health alert for information about travel-related disease conditions: http://bit.ly/ddYiJT

In addition, these two US CDC sites provide advice for relief workers, including travel guidance specific to workers traveling to Haiti: http://wwwnc.cdc.gov/travel/content/relief-workers.aspx and http://emergency.cdc.gov/disasters/earthquakes/responders.asp

US CDC Recommends Universal Annual Flu Vaccination
CDC’s Advisory Committee on Immunization Practices (ACIP) voted Feb. 24 to expand the recommendation for annual influenza vaccination to include all people aged 6 months and older, beginning in the 2010-2011 flu season. The new recommendation seeks to remove barriers to influenza immunization and signals the importance of preventing influenza across the entire population. For more information, see: http://www.cdc.gov/media/pressrel/2010/r100224.htm

The US Food and Drug Administration (FDA) and World Health Organization (WHO) have both recommended that the 2010-2011 seasonal flu vaccine include the 2009 pandemic H1N1 flu strain, along with a type A H3N2 and a type B strain. This inclusion of the 2009 pandemic strain of H1N1 will eliminate the need for two separate flu vaccines next fall. These recommendations typically guide vaccine manufacturers in preparing each season’s flu vaccines.

Please note that protection from the 2009 H1N1 flu vaccine lasts through the whole 2009-2010 season. Children younger than 10 are the only people recommended to receive two doses of H1N1 vaccine this season.

Influenza Activity in Maine and the US
H1N1 activity continues in Maine as well as across the U.S., but in more diminished levels than in November and December. Since the last update, there has been one outbreak of influenza-like illness in a long-term care facility and two hospitalizations due to H1N1 - one in adult older than 64, and an intensive care unit admission of a toddler. Maine’s weekly influenza surveillance reports can be found here: http://bit.ly/b6dCfZ

Virtually all of those hospitalized the past 2 months have not been vaccinated. Almost all are considered high-risk, yet were also not started on antiviral medicines within 48 hours of symptom onset. It is especially important for health care providers to offer vaccine to patients who are now in high risk groups that were not earlier in the season, such as women who are recently pregnant, people who are now caring for infants younger than six months-old, and infants who are now older than six months.

With more than 900,000 doses of H1N1 vaccine distributed in Maine to about 500 health care providers and a variety of free flu clinic settings throughout the state, everyone should consider getting vaccinated against H1N1 flu. This includes seniors (http://bit.ly/9Py6xX), recently pregnant women (http://bit.ly/76KrZb), new parents and caregivers of infants younger than six months (http://bit.ly/5eckZK), and parents of children older than six months (http://bit.ly/7lrdRH). Children ages nine and younger need a second dose of vaccine about a month after the first dose for full immunity.

Vaccine clinics can be located by calling 211 or by visiting www.maineflu.gov. The free clinics are in bold font.


Group A Strep Update
Maine CDC has now received 16 reports of cases of invasive Group A Streptococcal (GAS) infections since January, an increase of 3 cases since the last update.

Cases have been confirmed in Androscoggin, Cumberland, Hancock, Kennebec, Oxford, Penobscot, Somerset, and York counties in people ages 6 through 90. Nine of these have resulted in Streptococcal Toxic Shock Syndrome (STSS), an increase of two since the last update. Five people with STSS have died.

Although GAS is a common bacteria in the throat and skin, often causing strep throat or impetigo, invasive GAS disease is rare, with the five-year median in Maine being 19 cases per year.

There is no reported increase in cases in nearby states, and these patients in Maine do not appear to be associated with a specific area of the state, or with influenza or with health care facilities. More information, including recommendations, can be found in this Maine CDC health advisory http://bit.ly/bswpU2 or this US CDC site: http://bit.ly/cP0vIl.

RSV
Several anecdotal reports indicate possible high rates of Respiratory Syncytial virus (RSV), and the percentage of positive samples tested for RSV at two reference laboratories in Maine is higher than last year at this time. RSV is not a reportable disease in Maine, so exact numbers and rates are not available.

RSV is a contagious viral disease that can lead to serious health problems—especially for young children and older adults. There is no vaccine to prevent RSV. However, there are simple ways you can protect your child or yourself from getting sick during RSV season.

People with cold-like symptoms should cover their coughs and sneezes, wash hands frequently, avoid sharing cups and utensils, and refrain from kissing. Cleaning contaminated surfaces (such as doorknobs) may help stop the spread of viruses.

Symptoms of RSV infection are similar to other respiratory infections. A person with an RSV might cough, sneeze, and have a runny nose, fever, and decrease in appetite. Wheezing may also occur. In very young infants, irritability, decreased activity, and breathing difficulties may be the only symptoms of infection. Most otherwise healthy infants infected with RSV do not need to be hospitalized.

For more information about RSV, see this US CDC web site: http://bit.ly/9mPfDi

County Health Rankings
The University of Wisconsin, with funding from the Robert Wood Johnson Foundation, issued a report titled County Health Rankings, Mobilizing Action Toward Community Health on Feb. 17. Rankings were completed in all 50 states, including Maine. Counties were ranked within states only, with no comparison between states.

The county health rankings and data are available at http://www.countyhealthrankings.org/.

The report helps identify factors that influence health in each county, including health outcomes and health factors. All counties in Maine, regardless of their ranking, have both strengths to celebrate and challenges to address.

For years, public health data have shown that many counties in Maine with lower incomes and educational attainment are less healthy. Such disparities continue to be reflected in these rankings. However, the report also shows significant variation. For instance, some counties with similar socioeconomic profiles have very different rankings for other health factors and for health outcomes, suggesting that a complex array of factors influence the health of our communities.
Maine is already working on addressing our health challenges. It is also important to note that Maine is one of the healthiest states in the nation. The 2009 America’s Health Rankings report released by the United Health Foundation ranked Maine 9th in overall health.

Several years ago, public health stakeholders worked to form a new statewide public health system that addresses health issues across the state and in every community. We continue working to strengthen this system, which includes Healthy Maine Partnerships, Maine CDC District Public Health Units, municipal health departments, local health officers, and District Coordinating Councils.

We hope the data in this report are another motivating factor for Maine people to improve their own health, as well as to become involved with the public health system to improve the overall health of their communities.

One such new resource is the Keep ME Well website, a tool produced by Maine’s public health system that individuals can use to find out how to improve health, stay well and find low cost healthcare services. The site can be accessed at http://www.keepmewell.org/.

Maine CDC has recently posted an updated compilation of comprehensive health indicators for each of Maine’s 8 public health districts, most with state and national comparisons. They can be found at: http://www.maine.gov/dhhs/boh/health_indicator_comparison.htm.

Updates from Federal Partners
• US CDC issued this Q&A about H1N1 and seasonal flu and Hispanic communities: http://www.cdc.gov/h1n1flu/qa_hispanic.htm
• This MMWR describes an outbreak of H1N1 flu on a Peruvian Navy ship in June-July 2009: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5906a3.htm?s_cid=mm5906a3_e%0d%0a
• As of Feb. 17, business associates of HIPAA covered entities must comply with, and are subject to penalties for violations of, the HIPAA Security Rule (http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/index.html).
• New requirements for notifying individuals when their protected health information is breached went into effect Feb. 22. For more information: http://bit.ly/93PXS4

How to Stay Updated
• Follow Maine CDC’s Social Media Updates:
o Facebook (search for “Maine CDC”) http://www.facebook.com/pages/Augusta-ME/Maine-CDC/135584761549
o Twitter (http://twitter.com/MEPublicHealth)
o MySpace (www.myspace.com/mainepublichealth)
o Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
• For clinical consultation and outbreak management guidance call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
• For general questions:
o call 2-1-1 from 8 a.m. to 8 p.m. seven days per week

Where's That Then No 13

A few years ago I turned up here early on a hot summer's evening. Folk were cooking suppers on boats, and the strains of the Archer's signature tune came over the still water. In fact it was very like this 1958 scene, except the boats were more fibreglass and plastic than wood. But the little drainage mill was there, spreading its sails like filigree wings against a deep blue sky. So, where is it, and for extra toast the names of the two rivers that join here.

Magnesium and Insulin Sensitivity

From a paper based on US NHANES nutrition and health survey data (1):
During 1999–2000, the diet of a large proportion of the U.S. population did not contain adequate magnesium... Furthermore, racial or ethnic differences in magnesium persist and may contribute to some health disparities.... Because magnesium intake is low among many people in the United States and inadequate magnesium status is associated with increased risk of acute and chronic conditions, an urgent need exists to perform a current survey to assess the physiologic status of magnesium in the U.S. population.
Magnesium is an essential mineral that many people apparently don't get enough of. One of the many things it's necessary for in mammals is proper insulin sensitivity and glucose control. A loss of glucose control due to insulin resistance can eventually lead to diabetes and all its complications.

Magnesium status is associated with insulin sensitivity (2, 3), and a low magnesium intake predicts the development of type II diabetes in most studies (4, 5) but not all (6). Magnesium supplements largely prevent diabetes in a rat model* (7). Interestingly, excess blood glucose and insulin themselves seem to reduce magnesium status, possibly creating a vicious cycle.

In a 1993 trial, a low-magnesium diet reduced insulin sensitivity in healthy volunteers by 25% in just four weeks (8). It also increased urinary thromboxane concentration, a potential concern for cardiovascular health**.

At least three trials have shown that magnesium supplementation increases insulin sensitivity in insulin-resistant diabetics and non-diabetics (9, 10, 11). In some cases, the results were remarkable. In type II diabetics, 16 weeks of magnesium supplementation improved fasting glucose, calculated insulin sensitivity and HbA1c*** (12). HbA1c dropped by 22 percent.

In insulin resistant volunteers with low blood magnesium, magnesium supplementation for four months reduced estimated insulin resistance by 43 percent and decreased fasting insulin by 32 percent (13). This suggests to me that magnesium deficiency was probably one of the main reasons they were insulin resistant in the first place. But the study had another very interesting finding: magnesium improved the subjects' blood lipid profile remarkably. Total cholesterol decreased, LDL decreased, HDL increased and triglycerides decreased by a whopping 39 percent. The same thing had been reported in the medical literature decades earlier when doctors used magnesium injections to treat heart disease, and also in animals treated with magnesium. Magnesium supplementation also suppresses atherosclerosis (thickening and hardening of the arteries) in animal models, a fact that I may discuss in more detail at some point (14, 15).

In the previous study, participants were given 2.5 g magnesium chloride (MgCl2) per day. That's a bit more than the USDA recommended daily allowance (MgCl2 is mostly chloride by weight), in addition to what they were already getting from their diet. Most of a person's magnesium is in their bones, so correcting a deficiency by eating a nutritious diet may take a while.

Speaking of nutritious diets, how does one get magnesium? Good sources include halibut, leafy greens, chocolate and nuts. Bone broths may also be a source of magnesium. Whole grains and beans are also fairly good sources, while refined grains lack most of the magnesium in the whole grain. Organic foods, particularly artisanally produced foods from a farmer's market, are richer in magnesium because they grow on better soil and often use older varieties that are more nutritious.

The problem with seeds such as grains, beans and nuts is that they also contain phytic acid which prevents the absorption of magnesium and other minerals (16). Healthy non-industrial societies that relied on grains took great care in their preparation: they soaked them, often fermented them, and also frequently removed a portion of the bran before cooking (17). These steps all served to reduce the level of phytic acid and other anti-nutrients. I've posted a method for effectively reducing the amount of phytic acid in brown rice (18). Beans should ideally be soaked for 24 hours before cooking, preferably in warm water.

Industrial agriculture has systematically depleted our soil of many minerals, due to high-yield crop varieties and the fact that synthetic fertilizers only replace a few minerals. The mineral content of foods in the US, including magnesium, has dropped sharply in the last 50 years. The reason we need to use fertilizers in the first place is that we've broken the natural nutrient cycle in which minerals always return to the soil in the same place they were removed. In 21st century America, minerals are removed from the soil, pass through our toilets, and end up in the landfill or in waste water. This will continue until we find an acceptable way to return human feces and urine to agricultural soil, as many cultures do to this day****.

I believe that an adequate magnesium intake is critical for proper insulin sensitivity and overall health.


* Zucker rats that lack leptin signaling

** Thromboxane A2 is an omega-6 derived eicosanoid that potently constricts blood vessels and promotes blood clotting. It's interesting that magnesium has such a strong effect on it. It indicates that fatty acid balance is not the only major influence on eicosanoid production.

*** Glycated hemoglobin. A measure of the average blood glucose level over the past few weeks.

**** Anyone interested in further reading on this should look up The Humanure Handbook

Lindeberg on Obesity

I'm currently reading Dr. Staffan Lindeberg's magnum opus Food and Western Disease, recently published in English for the first time. Dr. Lindeberg is one of the world's leading experts on the health and diet of non-industrial cultures, particularly in Papua New Guinea. The book contains 2,034 references. It's also full of quotable statements. Here's what he has to say about obesity:
Middle-age spread is a normal phenomenon - assuming you live in the West. Few people are able to maintain their [youthful] waistline after age 50. The usual explanation - too little exercise and too much food - does not fully take into account the situation among traditional populations. Such people are usually not as physically active as you may think, and they usually eat large quantities of food.

Overweight has been extremely rare among hunter-gatherers and other traditional cultures [18 references]. This simple fact has been quickly apparent to all foreign visitors...

The Kitava study measured height, weight, waist circumference, subcutaneous fat thickness at the back of the upper arm (triceps skinfold) and upper arm circumference on 272 persons ages 4-86 years. Overweight and obesity were absent and average [body mass index] was low across all age groups. ...no one was larger around their waist than around their hips.

...The circumference of the upper arm [mostly indicating muscle mass] was only negligibly smaller on Kitava [compared with Sweden], which indicates that there was no malnutrition. It is obvious from our investigations that lack of food is an unknown concept, and that the surplus of fruits and vegetables regularly rots or is eaten by dogs.

The Population of Kitava occupies a unique position in the world in terms of the negligible effect that the Western lifestyle has had on the island.
The only obese Kitavans Dr. Lindeberg observed were two people who had spent several years off the island living a modern, urban lifestyle, and were back on Kitava for a visit.

I'd recommend this book to anyone who has a scholarly interest in health and nutrition, and somewhat of a background in science and medicine. It's extremely well referenced, which makes it much more valuable.

More Room At The Inn

As an addendum to the last post, I give you The Wheel & Compass public house at Weston by Welland. Not just because they serve an excellent pint of Banks or Pedigree but because of its connection to the railway nearby. As you can see, it has a slightly odd upper storey that is obviously an addition. Originally this was a two storey ironstone pub with a thatched roof. But the arrival of surveyors in the adjoining fields in the mid-nineteenth century meant that life was to be as upturned as the Welland Valley pastures that surround it. An extra storey was added to the pub as a long dormitory for navvies working on the line. One can only imagine the scenes here on a Friday night. The drunkenness, the brawling, the lusting after women. Actually....

Ruff 'n Fluff... a Practical Cut for the Feather Bob






(Click on the images to view them in all their full-size glory!)
Source: Modern Beauty Shop, June 1942

Railway Echo No 13

It looks plain and ordinary, a house out in the countryside, probably built in the 1970s. Until one looks more closely at the right hand side. Ignore the replacement windows and a little stone built cottage reveals itself. It's just down the road from my village, alone in the fields near a pub we frequently find ourselves in- The Wheel & Compass at Weston-by-Welland. The river is running at the back of the house, but this was a level crossing keeper's dwelling on a lane that crosses the valley from Weston to Slawston Hill. One of many on the line of this branch of the London & North Western Railway (oddly for this part of the world), and to the right of this picture the tracks kept close company with the willow-fringed Welland through Ashley station and on through Rockingham and Seaton, thence to Stamford or, leaving the river, to Peterborough. It closed many years ago, but just off to the left of the photograph is a wood yard on an old junction (soon to be blogged) where they once made pit props and railwaymen tended allotments. It's still open, and this is where I get my logs. A chap working here still remembers steam locomotives snorting and shuffling by as they negotiated the steeper gradients. It's still easy to imagine that on a cold snowy morning, a line of intermittent white smoke drifting off across the valley.

Get Ready Mailbag: If I am over 65, should I get the H1N1 flu vaccine?

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.

I am over age 65. Do I need to get the H1N1 flu vaccine? I heard it is not as big a risk for older people as regular flu. So can I skip the shot?

That’s an interesting question, and it’s easy to see why you may be unsure.

For years now, adults like you — ages 65 and older — have been at high-risk for complications from seasonal flu. But with 2009 H1N1 flu, aka swine flu, this hasn’t been the case. In fact, your age group has had the fewest number of H1N1 cases and serious infections reported. Some tests show a number of older people have some pre-existing immunity to H1N1, meaning you might be less likely to get sick. But that doesn’t mean you are off the hook, as there have been severe infections and deaths from H1N1 in every age group.

When the vaccine first became available, supplies were limited and were being set aside for high-risk groups like pregnant women, young adults and children. But now, the vaccine is much more available. So adults age 65 years and older are being encouraged to get the shot as well. That means if you want to be protected from H1N1, you should get your vaccination ASAP. It’s your safest bet!

Check your local community pharmacy or health department to find a flu vaccination site near you, or visit Flu.gov for a clinic locator.


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Where's That Then? No 12

The English Counties Illustrated is an Odhams book. Once so ubiquitous, these were cheaply produced volumes and usually printed in their hundreds of thousands on huge presses at the side of a by-pass in Watford. Except this one, because I see it's printed in Norwich. The jacket blurb says "This is not a guide book but rather an armchair companion, presenting an interesting and readable picture of each of the English counties". And what companions they are. Amongst many others are S.P.B. Mais, James Wentworth Day, Jack Simmons and John Betjeman. Here he is on the county he once lived in: "Berkshire is like a tattered old shoe, kicking out eastwards from Gloucestershire". For so long ignored, and perhaps a little sniffily, I think these books are now certainly worth seeking out again. Does that help with this morning's location? Probably not, but isn't that typography a treat?

Sunday Times


Please forgive two postings on one day; but I am aware that I've been a bit dilatory in bringing you scenes from Unmitigated England recently. This melancholy dull afternoon in Leicestershire gives me the perfect opportunity to catch up. Sunday lunch has been, and I hope for everybody still is, a very worthwhile institution. Right from childhood (Father: How much did you pay per pound for these bones mother?) and through all the very memorable lunchtimes with the beautiful women and children who have shared my life since, Sunday Lunch has always been very special. Particularly for the wine-fuelled interchanges that have taken place. So, I just have to share two snippets of conversation that have just taken place over the refectory table here. (Lord Ashley at one end, two of my heirs crouched at the other.) Me to the elder of the two (12): "Will you do this for me when I'm old and you've learnt to do a roast pig as good as this?" Son: "Yes of course, if we can remember who you are". Five minutes of quiet eating and then Son the Youngest (6) puts down his knife and fork and says: "I've got a cure for the Black Death". Me: " Bit late, but what is it?" Youngest Son: "Lemons". Me: "That was to prevent scurvy on ships". Reply: "Oh yes", followed by silence and the passing round of the gravy jug.

Eyecatching Model

Sharp-eyed viewers will probably recognise these buildings from a painting in Unmitigated England. They are without doubt my favourite model farm buildings, a mid-19th century group that, along with stables and a half-submerged church, form all that remains of the Normanton estate in Rutland. St.Matthews is now marooned like a baroque lighthouse on nearby Rutland Water, but for all the cycling, walking and messing about in boats going on so near, hardly anybody appears to come down a little lane opposite one of the main, very expensive, car parks. Normanton Lodge farm comes into view from behind a couple of modern barns (that's their shadow in the foreground) on a bend in the road winding across to Empingham. For a long time there was a bright red portable water tank on tracks in the foreground, and it's there in my watercolour. But on Thursday I took advantage of an extremely cold but bright afternoon to do some preliminary work on a future project, and of course I came straight down here to find that much of the detritus in front of the buildings had been cleared away. Snap. Snap. The big house was demolished in 1925, but it doesn't take much imagination to still feel the presence of many farm workers going about their agrarian business in stone built barns, workshops and stockyards. I imagine the chimney had something to do with steam, probably to drive machinery like a sawmill. And somewhere to get warm on a frosty morning.

It’s not too late to protect your children and family from H1N1 flu

Just before last Halloween, 7-year-old Trevor Lin of Clifton Park, N.Y., began showing symptoms of a mild cough, according to his father, Henry Lin. It got worse, and two days later his father brought him to the emergency room. Both doctors and his dad — a general surgeon —believed that Trevor had croup, so he was treated and sent home. But the next day, Trevor collapsed and died two hours later from complications from H1N1.

Unfortunately, Trevor’s story, which Henry Lin recounted during a National Influenza Vaccination Week event last month, is far from the only one involving children. According to the Centers for Disease Control and Prevention, between 880 and 1,810 children died from H1N1 flu from April 2009 to January 2010.


Children are at particular risk from H1N1, also known as swine flu, because their immune systems are not as advanced as adults, making it more dangerous for them to become infected, according to U.S. health officials. That’s why children and those who come into contact with kids are especially encouraged to get the H1N1 vaccine.

Now that more supplies of H1N1 vaccine are available, anyone who wants to get the shot can become protected against the disease — and it’s not too late. While cases of H1N1 have declined in recent months, CDC officials say it’s possible that there could be another wave of flu infections and sporadic cases this summer. So now is the time to get protected.

Visit the Flu.gov clinic locator to find a shot near you, or check with your neighborhood pharmacy. The shot is safe, effective and is the single best way to protect yourself, your family and your community from the spread of H1N1.


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Public Health Update 2/12/10

Maine CDC/DHHS Public Health Update
February 12, 2010


Influenza Activity in Maine and the US
H1N1 activity continues in Maine as well as across the U.S. but in diminished levels than in November and December. There was one outbreak of influenza like illness in a Hancock County K-12 school last week. Nationally and in Maine, virtually all of the influenza viruses identified are the 2009 pandemic strain of influenza A. More information can be obtained at: http://www.cdc.gov/flu/weekly/index.htm#whomap.

Influenza Vaccine
Sanofi Pasteur has shortened the expiration period of all of its 2009 H1N1 influenza vaccine in pre-filled syringes; all lots should now be administered by February 15, 2010 regardless of the expiration imprinted on the package. There are no safety concerns with the recalled lots of 2009 H1N1 vaccine and no re-administration of the vaccine is required. For more information, see this US CDC Q&A: http://www.cdc.gov/h1n1flu/vaccination/qa_recall.htm?s_cid=tw_flu104. Maine health care providers who have received this vaccine have been contacted directly by Maine CDC’s Immunization Program staff.

With more than 900,000 doses of H1N1 vaccine distributed in Maine to about 500 health care providers and a variety of free flu clinic settings throughout the state, everyone should consider getting vaccinated against H1N1 flu. Clinics can be located by calling 211 or by visiting www.maineflu.gov. The free clinics are in bold font.

Parents are reminded to ensure that children younger than 10 years-old get both doses of 2009 H1N1 vaccine. The recommended interval between the first and second dose is 28 days.

Even those not at high-risk for complications from influenza should consider vaccine, because either they themselves can suffer complications or can infect those who are at higher risk for complications. Health care providers who treat people at high risk for complications from influenza (such as those with underlying conditions, pregnant women, young children, and those older than 64) are urged to vaccinate those patients and to treat with antiviral medicines at the onset of symptoms.

Disposing of and Reporting Unused/Expired Vaccine
Health care providers who have sufficient supplies and no longer need vaccine that is being shipped to them should contact their local vaccine coordinator to arrange for redistribution. Unused or expired H1N1 vaccines may not be returned to the distributor. If vaccine cannot be redistributed prior to expiration, the health care provider is responsible for disposing of the vaccine appropriately.

For information on hazardous waste disposal in Maine, see the Biomedical Waste Management Rules (06-096 CMR 900): http://www.maine.gov/sos/cec/rules/06/096/096c900.doc and 38 MRSA Chapter 13, Waste Management: http://www.mainelegislature.org/legis/statutes/38/title38ch13sec0.html

Discarded vaccine needs to be reported to Maine CDC. Providers Please discard the expired vaccine doses as providers do with their other expired medicines and ask them to report the doses discarded on the same weekly reporting form used for vaccine administration (http://www.maine.gov/dhhs/boh/maineflu/schools/documents/Aggregate-H1N1-weekly-reporting_V3.pdf) – please note any discarded doses in the space between the two “Total” cells at the lower right corner of the form with a mark of “Expired (and discarded) doses.”

Group A Strep Update
Maine CDC has now received 13 reports of cases of invasive Group A Streptococcal (GAS) infections since January in Maine. Cases have been confirmed in Androscoggin, Cumberland, Hancock, Kennebec, Oxford, Penobscot, and York counties in people ages 6 through 90. Seven of these have resulted in Streptococcal Toxic Shock Syndrome (STSS), of which three have died. Although GAS is a common bacteria in the throat and skin, often causing strep throat or impetigo, invasive GAS disease is rare, with the five-year median in Maine being 19 cases per year.

There is no reported increase in cases in nearby states, and these patients in Maine do not appear to be associated with a specific area of the state, or with influenza or with health care facilities. More information, including recommendations, can be found in this Maine CDC health advisory http://bit.ly/bswpU2 or this US CDC site: http://bit.ly/cP0vIl.

Earthquakes and Public Health
The American Public Health Association has developed a web page with links to information about relief efforts in Haiti, which includes resources for people who are interested in volunteering: http://www.apha.org/programs/globalhealth/issues/

There are many public health concerns as a result from earthquakes, including those related to victims of the disaster and those related to people traveling to post earthquake zones, such as Haiti, to assist in recovery efforts. These two US CDC sites provide advice for relief workers, including travel guidance specific to workers traveling to Haiti: http://wwwnc.cdc.gov/travel/content/relief-workers.aspx and http://emergency.cdc.gov/disasters/earthquakes/responders.asp

Updates from Federal Partners
US CDC issued an abbreviated Pandemic Influenza Plan template for primary care provider offices, which will allow providers to rapidly (within 1-5 days) develop a pandemic influenza plan: http://www2c.cdc.gov/podcasts/download.asp?af=h&f=761031

Maine Animal Rabies Fourth Quarter Update
Maine CDC provides a quarterly update on animal rabies to veterinarians and other animal health professionals, which may be used to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine. Read the update here: http://www.maine.gov/tools/whatsnew/attach.php?id=91596&an=2

To read the full update, click here: http://bit.ly/bhbbuw

Now... More Waves! (Cover Girls)





(Click on images for the full-size versions.)
Source: Modern Beauty Shop, January 1943

Flu Vaccine Available at Basketball State Championships

Flu clinics will be held at the Maine Principal’s Association high school basketball tournament in Augusta. Clinics will be held February 16th,17th, and 18th. H1N1 (swine flu) and seasonal flu vaccine will be offered at the clinics.

“Now that plenty of vaccine is available we strongly recommend everyone get vaccinated,’’ said Dr. Dora Anne Mills, Director of the Maine CDC. “Although the H1N1 disease surge is on the decline, this virus is expected to circulate for months, if not years, to come. Now is an excellent time to get vaccinated, especially given the amount of vaccine available,” said Dr. Mills.

The clinics will be held:

Feb 17 & 18th
9 AM- 4 PM (Seasonal flu and H1N1)


Feb 16th, 17th & 18th
5:30- 7 PM (H1N1 only)


Augusta Civic Center - Penobscot Room
76 Community Drive, Augusta, Maine

People interested in receiving a vaccine should bring their insurance cards; however, the clinics are free for the uninsured.

These clinics are being provided by Public Health Nursing and Concentra.

For more information about flu, please visit: http://www.maineflu.gov or call 2-1-1 from 8 a.m. to 8 p.m.

Carrot Artery

My neighbour on the adjoining estate has asked me to plug his new venture at the Goldmark Gallery in the market town of Uppingham. Unmitigated Travellers will have heard of this remarkable artcentric world, and now it has joined the blogosphere with a journal called, in true Goldmark fashion, Butchers' Hooks. I'll say no more, but I take this opportunity to remind Lord Carrot that he still has my Atco in his stable block. Held to Ransomes, you might say. I just hope that it has not become enriched with the Pleasing Decay patina that decorates the rest of his desmesne. Oh how I long for idle Saturday May mornings, thinking about that first cut of the year and the smell of freshly-cut grass under the cedars as...(get on with it. Ed.)

Saturated Fat and Insulin Sensitivity

Insulin sensitivity is a measure of the tissue response to insulin. Typically, it refers to insulin's ability to cause tissues to absorb glucose from the blood. A loss of insulin sensitivity, also called insulin resistance, is a core part of the metabolic disorder that affects many people in industrial nations.

It is commonly asserted in journal articles and on the internet that saturated fat reduces insulin sensitivity. The idea is that saturated fat reduces the body's ability to handle glucose effectively, placing people on the road to diabetes, obesity and heart disease. Perhaps this particular claim deserves a closer look.

The Evidence

I found a review article from 2008 that addressed this question (1). I like this review because it only includes high-quality trials that used reliable methods of determining insulin sensitivity*.

On to the meat of it. There were 5 studies in which non-diabetic people were fed diets rich in saturated fat, and compared with a group eating a diet rich in monounsaturated (like olive oil) or polyunsaturated (like corn oil) fat. They ranged in duration from one week to 3 months. Four of the five studies found that fat quality did not affect insulin sensitivity, including one of the 3-month studies.

The fifth study, which is the one that's most commonly cited, requires some discussion. This was the KANWU study (2). Over the course of three months, investigators fed 163 volunteers a diet rich in either saturated fat or monounsaturated fat.
The SAFA diet included butter and a table margarine containing a relatively high proportion of SAFAs. The MUFA diet included a spread and a margarine containing high proportions of oleic acid derived from high-oleic sunflower oil and negligible amounts of trans fatty acids and n-3 fatty acids and olive oil.
Yummy. After three months of these diets, there was no significant difference in insulin sensitivity between the saturated fat group and the monounsaturated fat group. Yes, you read that right. Even the study that's commonly cited as evidence that saturated fat causes insulin resistance found no significant difference between the diets. I'll be generous and acknowledge that the small difference was almost statistically significant (p = 0.053).

What the authors focused on is the fact that insulin sensitivity declined slightly but significantly on the saturated fat diet compared with the pre-diet baseline. That's why this study is cited as evidence that saturated fat impairs insulin sensitivity. But those of you with a science background may be able to spot the problem here. You need a control group for comparison, to take into account normal fluctuations caused by such things as the season, eating a new diet provided by the investigators, and having a doctor poking at you. That control group was the group eating monounsaturated fat. The comparison between diet groups was the comparison that matters most, and it wasn't quite significant.  I think the most you can say about this study is that it provides weak evidence that saturated fat decreases insulin sensitivity.

So we have five studies through 2008, which overall offer little support the idea that saturated fat reduces insulin sensitivity in non-diabetics. Since the review paper was published, I know of one subsequent study that asked the same question (3). Susan J. van Dijk and colleagues fed volunteers with abdominal overweight a diet rich in either saturated fat or monounsaturated fat. I e-mailed the senior author and she said the saturated fat diet was "mostly butter".  After 8 weeks, insulin sensitivity was virtually identical between the two groups. This study appeared well controlled and used the gold standard method for assessing insulin sensitivity, called the euglycemic-hyperinsulinemic clamp technique***.

The evidence from controlled trials is rather consistent that saturated fat has no major effect on insulin sensitivity in humans, at least on time scales of a few months.

UPDATE: other trials have added to this finding.  The large European LIPIGENE randomized controlled diet trial found that substantial differences in SFA intake had no effect on insulin sensitivity over 12 weeks in people with the metabolic syndrome (3b).


* For the nerds: euglycemic-hyperinsulinemic clamp (the gold standard), insulin suppression test, or intravenous glucose tolerance test with Minimal Model. They didn't include studies that reported HOMA as their only measure, because it's not very accurate.

*** They did find that markers of inflammation in fat tissue were higher after the saturated fat diet.

Where's That Then? No 11

The 1900s saw a plethora of partwork magazines that could be collected and then sent away to get bound into one, or many, volumes. Nothing changes then, as we saw once again in the New Year when you could build your own aircraft carrier in weekly instalments. This picture's from a collection called 'Beautiful Britain', (beautifully done as it happens, in half leather) and this fairly fanciful watercolour was by L. Burleigh Bruhl. Any clues, you ask. Well, it's one of the most visited spots in England, but only really since 1839. I've only been here once, and fled. Which isn't really giving it a chance. I expect to hear amazing stories of more profound visits.

Thank You

I'd like to extend my sincere thanks to everyone who has supported me through donations this year. The money has allowed me to buy materials that I wouldn't otherwise have been able to afford, and I feel it has enriched the blog for everyone. Here are some of the books I've bought using donations. Some were quite expensive:

Food and western disease: health and nutrition from an evolutionary perspective. Staffan Lindeberg (just released!!)

Nutrition and disease. Edward Mellanby

Migration and health in a small society: the case of Tokelau. Edited by Albert F. Wessen

The saccharine disease. T. L. Cleave

Culture, ecology and dental anthropology. John R. Lukacs

Vitamin K in health and disease. John W. Suttie

Craniofacial development. Geoffrey H. Sperber

Western diseases: their emergence and prevention. Hugh C. Trowell and Denis P. Burkitt

The ultimate omega-3 diet. Evelyn Tribole

Our changing fare. John Yudkin and colleagues


Donations have also paid for many, many photocopies at the medical library. I'd also like to thank everyone who participates in the community by leaving comments, or by linking to my posts. I appreciate your encouragement, and also the learning opportunities.

Key to a Bright New Complexion





(Click for larger images.)
Source: 1000 Hints Beauty #7, 1956

Little Red Riding Hood

Little Red Riding Hood
Little Red Riding Hood
Little Red Riding Hood

Thorough Borough


A walk through Borough Market is always a particular pleasure, whether the stalls are crowded with produce or not. First there's Southwark Cathedral towering over it all like a lost Cotswold abbey, and then the railway crossing over the Thames and negotiating the tight curves of track over the viaduct to London Bridge station, the wheels squealing like bacon slicers. Unmitigated Readers may have heard me go on in this vein before, but I expect it will be an annual event like reading Three Men In A Boat. To be on this train and look down on the backs of houses and narrow streets is to experience the ghost of Dickens and the faint outlines of a Gustav Dore engraving. We sauntered through on Thursday, admiring hand raised pork pies and these pheasants bringing a whiff of misty shoots out in the Shires to the noise and bustle of London streets. Was ever thus, the countryside meeting London, and what better place than this with the added extra of the Market Porter pub smelling of stale beer on its wooden floors and fresh Harvey's Sussex Bitter in the taps. Sometimes the eyebrows get raised (Scottish Camembert at Neal's Yard) but overall this is a joyous place to be. Right, time to get the game chips prepared and a frypan of bubble and squeak I think.

Winter ♥

Students: Apply now for APHA’s Get Ready Scholarship

APHA is pleased to announce its second annual Get Ready Scholarship. The scholarship is part of APHA’s Get Ready campaign which helps Americans prepare themselves, their families and their communities for all hazards and disasters, including pandemic flu, infectious disease, natural disasters and other emergencies.

The $500 Get Ready Scholarship is designed to encourage students to focus on the importance of emergency preparedness. The scholarship is open to U.S. high school seniors as well as full-time college undergraduate and graduate students, and six winners will be chosen. Scholarship winners, who will also be awarded a one-year APHA membership, will be chosen through an essay contest on emergency preparedness. (Need some essay inspiration? Read the winning submissions from last year’s scholarship round.)

The Get Ready Scholarship will open for applications on Feb. 8 and submissions will be received until April 2, or until contest entry limits are reached. Read the full rules online and start thinking about your essay now!

Know a high school or college student? Forward them this message!

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Maine Public Health Update 2/4/10

Maine CDC/DHHS Public Health Update
February 4, 2010


Dr. Stephen Sears is our new State Epidemiologist
We at Maine CDC are extremely pleased to announce the arrival of Dr. Stephen Sears as our new State Epidemiologist. A well-known infectious disease physician with a master degree in public health, Dr. Sears is from Maine and comes to us after a career that involves hospital administration (MaineGeneral and Mercy Hospitals) as well as infectious disease and public health work. More information can be found at: http://www.maine.gov/tools/whatsnew/index.php?topic=DHS+Press+Releases&id=90686&v=cdc_article.

Influenza Activity in Maine and the US
There has been another death due to H1N1, bringing the total to 19 reported since August. This death occurred in an adult in the 25-49 age group in southern Maine. All deaths related to H1N1 in Maine have occurred among people with underlying health conditions. A total of 11 people in Maine have been hospitalized the past month with H1N1, including 4 children. Of these hospitalizations, 4 included an admission to an intensive care unit, including 1 child and 2 young adults. Only 1 of the 11 had been vaccinated at least a few days prior to illness and only 2 had received early antiviral medicines.

Nationally, influenza activity is reported to be sporadic in most states, with no states reporting widespread activity. Almost all of the influenza viruses identified so far continue to be 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception. More information can be obtained at: http://www.cdc.gov/flu/weekly/index.htm#whomap.

With over 900,000 doses of vaccine distributed in Maine to about 500 health care providers and a variety of free flu clinic settings throughout the state, everyone should consider getting vaccinated with the H1N1 pandemic strain of influenza. Even those not at high-risk for complications from influenza should consider vaccine because either they can suffer complications or can become infect those who are at higher risk for complications.

Health care providers who treat people at high risk for complications from influenza (such as those with underlying conditions, pregnant women, young children, and those older than 64) are urged to vaccinate those patients and to treat with antiviral medicines at the onset of symptoms.

Vaccine can still be found in a number of public clinics, including many that are offering it for free. These can be located by calling 211 or by visiting www.maineflu.gov. The free clinics are in bold font.

Group A Strep Update
Maine CDC has now received 11 reports of cases of invasive Group A Streptococcal (GAS) infections seen in January in Maine. Four of these have resulted in Streptococcal Toxic Shock Syndrome (STSS), of which three have died. Although GAS is a common bacteria in the throat and skin, often causing strep throat or impetigo, invasive GAS disease is rare, with the five-year median in Maine being 19 cases per year. There is no reported increase in cases in nearby states, and these patients in Maine do not appear to be associated with a specific area of the state, or with influenza or with health care facilities. More information, including recommendations, can be found in last week’s health advisory at: www.mainepublichealth.gov or at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcal_g.htm.

Earthquakes and Public Health
There are many public health concerns as a result from earthquakes, including those related to victims of the disaster and those related to people traveling to post earthquake zones such as Haiti to assist in recovery efforts. The US CDC’s earthquake website has helpful information for those who may be involved with the Haiti relief efforts or who are interested in improving their preparations here at home. http://www.bt.cdc.gov/disasters/earthquakes/

Feb. 7 is National Black HIV/AIDS Awareness Day. This article from the Black AIDS Institute describes the HIV/AIDS infrastructure in Haiti after the earthquake: http://www.blackaids.org/ShowArticle.aspx?articletype=SITEFEATURE&articleid=770&pagenumber=1. For more information on HIV/AIDS in Maine, become a fan of Maine CDC’s HIV, STD, and Viral Hepatitis program on Facebook: http://www.facebook.com/pages/Augusta-ME/Maine-HIV-STD-and-Viral-Hepatitis-Program/91975685100

Updates from Federal Partners
US CDC updated this Q&A about the 2009-2010 flu season: http://www.cdc.gov/flu/about/season/current-season.htm
This MMWR discusses H1N1 outbreaks in long term care facilities. There have been 11 such outbreaks in Maine, including one described in this report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5903a3.htm?s_cid=mm5903a3_e%0d%0a
A non-safety, voluntary recall of some .5 mL Sanofi Pasteur pre-filled syringe doses of H1N1 vaccine has been announced. US CDC answers common questions about the recall here: http://www.cdc.gov/h1n1flu/vaccination/qa_recall.htm Maine health care providers with this vaccine are being notified.

Check Out Our Partners on Facebook
Maine CDC: http://bit.ly/cBNhXp
Maine HIV, STD, Viral Hepatitis Program: http://bit.ly/aphqWA Maine WIC Nutrition Program: http://bit.ly/bDFndk
Portland Public Health: http://bit.ly/5bh6wj


Read the full update at : http://bit.ly/9UkoA3

Apples and Potatoes

Quick admin notes

You may have noticed that I switched to screened comments. I finally got annoyed with the spam and unrelated blog links. I try to approve comments as soon as possible, usually within a few hours.

I've been also been posted less often. I've been busy with graduate school, but I still have plenty of great articles to share with you. Hopefully they're worth waiting for!

How to Form Cheek Curls and How to Do a Brush-Out

(Click on image to enlarge.)
Source: 55 Hair Styles (Dell Purse Book), 1972

Where's That Then? No 10

So sorry for the delay this morning. School run, blah blah. Much to say about this place, but anything said would immediately give it away. Nevertheless, I think it's one of the most hauntingly spectacular places in England. That's it really.