Where's That Then? No 18

Now this location really does still look like this. Could be anywhere, you might think, so I'll give you a big clue. I first discovered it on August 5th 1978, whilst on an excessively self indulgent shoot around England with a photographer, and it was here that we heard on the radio that Victor Hasselblad had died. In memoriam my friend shot film off into the air like a Provo gunman, and his Hasselblad promptly jammed, causing us to revise our plans. (Well, we still went into the pub.) Then we looked at each other, both of us thinking how incredibly appropriate our location was for this to happen. Does that help?

On the Alert

(Click on images for full-size versions.)
Source: American Hairdresser, November 1942

Creature Feature No 8

Oh what a joyful sign! Morph the word 'vicarage' into 'Animal' and we've got a superb cover for Orwell's farmyard classic. And it does what it says on the sign, with a field of hens over the hedge scratching about being admired by a Kellogg's Corn Flakes box rooster. And if all that wasn't enough there's a cut-out pink pig on the ridge of a nearby barn roof and another little sign talking of Homemade Cakes. All that's brilliant about the English countryside in just a twenty yard stretch of road between Southwick and Bulwick in North East Northamptonshire. Quite possibly the best farm sign I've seen; cue Viv Stanshall's Jollity Farm.

Your water supply: Do you have enough stored in case of an emergency?

After an emergency such as tornado, flood or earthquake, the water that comes out of your tap might not be safe to drink — if it’s running at all. That’s why you should be prepared at all times, which means having at least a three-day supply of bottled water in your emergency stockpile.

According to a new water stockpiling fact sheet (PDF) from APHA’s Get Ready campaign, everyone should have at least one gallon of water per person per day stored in their emergency stockpile. That means if you have three people in your family, for example, you’d need to have nine gallons stored — and that’s just for drinking. If you live in a warm area or have pets or kids, you should store even more water.

Other tips in the new fact sheet, which can be downloaded now from the Get Ready Web site, include:
• Purchase commercially bottled water and don’t open it until you need to use it. Check your stockpile twice a year to see if any bottles need replacing.
• Don’t stack your water bottles, as that may cause them to leak. Store them somewhere they will be easy to access in an emergency.
• Stockpile water both at home and work, as you never know where or when an emergency will occur.

The new water stockpiling fact sheet is part of APHA’s Get Ready: Set Your Clocks, Check Your Stocks campaign, which reminds Americans to check their emergency stockpiles when they change their clocks for daylight saving time. The campaign information can be used year-round, however, and is a great addition to health fairs or emergency preparedness events. Organizations can customize the fact sheet with their own logos, so take some time to share it in your community today!

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Maine CDC/DHHS Public Health Update 03/26/10


Maine CDC is conducting numerous in-person debriefings across the state with stakeholders on our H1N1 efforts. In addition, this Maine CDC H1N1 Feedback Survey is being distributed widely. If you have not done so already, please complete the survey and share the link with others.


Maine CDC’s Infectious Epidemiology Program has issued several disease surveillance reports for distribution.

A graph of selected reportable diseases that displays preliminary Year-To-Date (through February, 2010) totals with median Year-To-Date totals for the previous five-year period is available at: http://www.maine.gov/dhhs/boh/ddc/epi/publications/reportable-diseases-0210.pdf. This graph shows higher reported cases of Lyme Disease and Gonorrhea through February than the 5-year median.

The annual surveillance report on Group A Strep can be found here: http://www.maine.gov/dhhs/boh/ddc/epi/airborne/gas_survreport2009.pdf

The annual surveillance report on Group B strep is available here: http://www.maine.gov/dhhs/boh/ddc/epi/airborne/gbs_survreport2009.pdf


What’s New With Flu?

Flu Activity. Virtually all detected influenza activity seen across the country is with the pandemic strain of H1N1. Most states are reporting sporadic, local, or no flu activity. The full national report can be found at: http://www.cdc.gov/flu/weekly/index.htm.

Maine’s influenza activity was coded “sporadic” this week, mainly because of continued reports of influenza-like-illness. Maine’s weekly influenza surveillance report can be found at: http://www.maine.gov/dhhs/boh/influenza_surveillance_weekly_updates.shtml. Maine and the U.S. continue to see virtually no seasonal influenza virus strains except for some very occasional type B. Almost all the detectable influenza viruses remain the pandemic strain of H1N1 influenza.

For the 2010-2011 season, flu vaccine will be recommended for all people. Although Maine CDC does not and never has provided the majority of seasonal flu vaccine in Maine, we are able to purchase sufficient seasonal flu vaccine for the 2010-2011 season for:
· all Maine children ages 6 months to 18 years-old;
· employees of schools that are providing onsite vaccine clinics on school days;
· pregnant women and their partners;
· nursing home employees and residents;
· high risk adults in limited public health settings, the scope and number of such settings determined by our vaccine supply.

The 2010-2011 seasonal flu vaccine will contain the pandemic Type A H1N1 component as well as a strain of Type B and Type A H3N2. Those who received the pandemic H1N1 vaccine will need to also receive the seasonal flu vaccine this coming season. More details about ordering will be coming soon.

Morbid Obesity and Flu: Increasingly the national data are showing that minority populations have been harder-hit by the 2009 H1N1 pandemic than non-minority groups, and there is growing evidence to support early concerns that people who are morbidly obese are at greater risk of serious 2009 H1N1 complications.

Don’t Forget Spring Break: With spring break coming up and large numbers of students expected to travel both domestically and internationally, vaccination of college-age students, who have been hard-hit by illness during this pandemic, continues to be recommended. Vaccine clinics can be located by calling 211 or by visiting www.maineflu.gov. The free clinics are in bold font.

Ongoing Flu Issues:

Flu activity, caused by either 2009 H1N1 or seasonal flu viruses, may rise and fall, but is expected to continue, especially in areas that did not see large surges in disease and/or did not have high vaccine rates. Testing for and reporting of cases and outbreaks to Maine CDC continue to be important strategies to track the virus’s spread.

It is still important to continue to offer the H1N1 vaccine to those at high risk for severe disease or those who are in a high priority category and who may have been missed earlier. If someone is vaccinated now, they can still receive the seasonal flu vaccine in the fall, which will contain the 2009 H1N1 strain. Those who should be focused on for ongoing H1N1 flu vaccination include:
women who are now pregnant;
infants who are now 6 months of old or older;
caregivers and household contacts of newborns and other young infants;
people 65 and older who may have been waiting for others to be vaccinated;
those with chronic diseases;
all young people ages 6 months to 25 years of age; and
all health care workers and EMS, including caregivers of people with developmental and/or physical disabilities.

Disposing of and Reporting Unused/Expired Vaccine
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, in compliance with Maine’s biomedical and/or hazardous waste rules. However, US CDC is working on a possible centralized national system for disposal of vaccine, and we will know more about this later this month.

Discarded vaccine needs to be reported to Maine CDC. Providers should 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.”


TB Elimination: Together We Can! was the U.S. theme for World TB Day on March 24. World TB Day is observed each year to commemorate the date in 1882 when Robert Koch announced the discovery of Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB).

Tuberculosis is a disease caused by bacteria that usually infects the lungs but can affect any part of the body. TB is spread through the air when a person with active TB disease of the lungs or throat coughs, speaks, sneezes or sings. Signs and symptoms include a cough lasting 3 weeks or more, night sweats, fatigue, weight loss, coughing up blood, fever, and chills.

Worldwide, TB remains one of the leading causes of death from infectious disease. Each year, approximately 9 million persons around the world become ill with TB, and nearly 2 million TB-related deaths occur worldwide. In the United States, however, the number of reported TB cases is at an all-time low with 17 consecutive years of decline.

Although both the nation and the state of Maine have successfully achieved decreased numbers of tuberculosis cases, there is still much to be done in the elimination of TB in at-risk populations, including minorities, foreign-born persons, substance abusers and those associated with homelessness who account for a disproportionate percentage of TB cases.

In 2009, Maine had 9 cases of TB, the same number of cases that were reported in 2008. Males accounted for 6 of the cases (67%). The median age of cases was 48 years (range 5-86 years). Risk factors included substance abuse (33%), homelessness (11%), and foreign-born status (44%).

The state of Maine is actively engaged in partnerships and collaborations with community-based organizations throughout the state to reach this population and succeed in the elimination of TB. For more information: http://www.cdc.gov/Features/WorldTBDay/

Maine CDC has recently identified TB among two people who are homeless in Cumberland County. More information on this can be found at:


US CDC has established a new rabies webpage, which includes updated ACIP recommendations on human rabies post-exposure prophylaxis and new content organization: http://www.cdc.gov/rabies/

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. The 4th quarter update is available here: http://www.maine.gov/tools/whatsnew/attach.php?id=91596&an=2


The US Food and Drug Administration (FDA) has learned that DNA material from porcine circovirus type 1 (PCV1) is present in Rotarix, a vaccine used to prevent rotavirus disease. Although there is no evidence at this time that this DNA material poses a safety risk, finding the material was unexpected and FDA is assessing the situation. As a result, FDA is recommending that clinicians temporarily suspend the use of Rotarix. FDA will keep the public and clinical community updated through www.fda.gov.

Rotavirus vaccines are given by mouth to young infants to prevent rotavirus disease, which can cause severe diarrhea and dehydration. Rotavirus disease causes the deaths of more than 500,000 infants around the world each year, primarily in low- and middle-income countries. Before the introduction of vaccination, the disease caused more than 50,000 hospitalizations and several dozen deaths in the United States each year.

There are two licensed rotavirus vaccines in the United States: RotaTeq (Merck) and Rotarix (GlaxoSmithKline). Because RotaTeq was licensed in 2006 and Rotarix in 2008, most children vaccinated in the United States received RotaTeq.

RotaTeq is made using a different process from Rotarix. Preliminary studies on the RotaTeq vaccine, both by the academic research team and by FDA, have not shown the presence of PCV1 DNA. FDA is working with Merck to confirm these findings.

Within approximately four to six weeks, FDA will convene an advisory committee to review the available data and make recommendations on the licensed rotavirus vaccines. FDA will also seek input on the use of new techniques for identifying viruses or viral particles in vaccines.


First Lady Michelle Obama and US DHHS Secretary Kathleen Sebelius announced last week that Maine is one of 9 states to receive American Recovery & Reinvestment Act funds focused on preventing obesity. Maine’s award is $4.28 million over a 2-year period.

Maine CDC’s Division of Chronic Disease conducted a mini-RFP process prior to submitting the federal application, which resulted in the selection of two Healthy Maine Partnerships – Healthy Portland and Communities Promoting Health Coalition, which serves the Sebago Lakes region.

To view a complete listing of grant awardees, visit http://www.hhs.gov/recovery/programs/cppw/grantees.html

To view a fact sheet on Communities Putting Prevention to Work visit http://www.hhs.gov/recovery/programs/cppw/factsheet.html

To learn more about Communities Putting Prevention to Work, visit http://www.hhs.gov/recovery and http://www.cdc.gov/chronicdisease/recovery


· 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 on flu, call 2-1-1 from 8 a.m. to 8 p.m. seven days per week

Interesting Articles in the AJCN

I just received an RSS alert for the American Journal of Clinical Nutrition's latest articles. This upcoming issue is full of very interesting material:

1. Dr. Neil D. Barnard reviews food consumption patterns in the US from 1909 to 2007 (1). This is something I've written about a number of times. The most notable change is that industrial seed oil use has increased by more than 3-fold in the last 40 years, and even more in the last 100 although he doesn't provide those numbers. Butter and lard use declined sharply. Meat consumption is up, but the increase comes exclusively from poultry because we're eating the same amount of red meat we always have. Grain consumption is down, although it peaked around 1900 so it may not be a fair comparison with today:
In the late 1800s, wheat flours became more popular and available due to the introduction of new [high-gluten] wheat varieties, [low extraction] milling techniques, and transport methods, and during this time new breakfast cereals were introduced by John Harvey Kellogg, CW Post, and the Quaker Oats Company. Thereafter, however, per capita availability of flour and cereal products gradually dropped as increased prosperity, improved mechanization, and transport (eg, refrigerated railway cars) increased competition from other food groups. [Then they partially rebounded in the last 40 years]
2. Dr. S.C. Larsson published a paper showing that in Sweden, multivitamin use is associated with a slightly higher risk of breast cancer (2).

3. Soy protein and isoflavones, which have been proposed to do everything from increase bone mineral density to fight cancer, are slowly falling out of favor. Dr. Z.M. Liu and colleagues show that soy protein and/or isoflavone supplementation has no effect on insulin sensitivity or glucose tolerance in a 6 month trial (3). This follows a recent trial showing that isoflavones have no effect on bone mineral density.

4. Dr. Ines Birlouez-Aragon and colleagues showed that high-heat cooked (fried and sauteed) foods increase risk factors for diabetes and cardiovascular disease (insulin resistance, cholesterol, triglycerides), compared to low-heat cooked foods (steamed, stewed) in a one-month trial (4). The high-heat diet also reduced serum levels of long-chain omega-3 fatty acids and vitamins C and E.

5. Dr. Katharina Nimptsch and colleagues showed that higher menaquinone (vitamin K2) intake is associated with a lower cancer incidence and lower cancer mortality in Europeans (5). Most of their K2 came from cheese.

6. And finally, Dr. Zhaoping Li and colleagues showed that cooking meat with an herb and spice blend reduced the levels of oxidized fat during cooking, and reduced serum and urinary markers of lipid oxidation in people eating the meat (6).

High Protein Diet - Top High Protein Low Carbohydrate Foods For Lean Muscles

Protein is most essential of all the nutrients which help a person in building lean muscles. Without protein, the muscle and tissues cannot grow. A high protein diet does not only help to build muscles but also keeps a body healthier. This diet should be low in carbohydrate as it has saturated or trans-fat in it. A person must eat proteins like egg, milk, meat and cheese and he must avoid carbohydrates like potatoes, bread, pasta or rice which will make the body bloated.

Here is a diet which contains high protein and low carbohydrate to build lean muscles:

1. Milk- Milk is considered to have a complete protein which helps in building muscles. Drinking milk is a great way to achieve your daily protein target. A person must take milk in skimmed form. He should drink 2 cups of skim milk in a day which does not contain any trans-fat. It helps to speed up the muscle recovery after lot of workout.

2. Eggs- This is a healthy source of supplement and has a very high protein in it. Egg protein has an excellent source of vitamins and nutrients that feed the muscles and tissues to become stronger. The egg white contains 0 grams of fat. So the egg white is an excellent form of protein.

3. Fish- This is one of the best sources of protein. It helps a person to gain weight and build muscles rapidly. Fish must be eaten after baking it properly and should be taken 2-3 times a week. It also contains a very high amount of 3-omega fatty acids which is very helpful to build muscles.

4. Red meat- Another high protein diet is red meat. This meat is extremely lean and has a great source of protein. It contains iron and vitamins that can help for growth of muscles.

Dr Oz's High Fiber Diet - Top 3 Low Fat High Fiber Weight Loss Diets by Dr Oz

Dr. Oz is a well known heart surgeon and suggests that a low fat diet is very good for heart as it has low cholesterol. The world cancer research fund has surveyed that this kind of diet is very good to prevent cancer and also helps in losing weight. To maintain a healthy body, low fat diet is essential for a human being to stay away from several diseases.

Taking fiber in your diet is very important for a good health. The best sources of fiber are vegetables, fruits, nuts, legumes and whole grain foods. It has many benefits such as improving blood sugar control, reducing cholesterol, and lowering risk of heart disease. This will have a positive effect on the digestive system.

The five food that a person need to avoid while having a balanced diet. These are as follows:

· Trans-fats · Saturated fat · Sugar · Anything that is 'Enriched' · High fructose corn syrup
According to Dr. Oz, an individual can opt for low fat high fiber diet, but need to incorporate the following points

· Intake plenty of water. At least 8-10 glasses/day should be taken. · You should take small portions of meals and that too on time. Dr. Oz recommends eating after every 3 hours that will keep your blood sugar even. The meal should have low calorie high fiber diet which can be helpful in cutting down the body fat. · Exercise regularly and taking plenty of rest is necessary. · Add lots of fruits and vegetables to your diet. · Fiber must be added to your diet, as it will also help to reduce risk of colon cancer. · You should stop taking caffeine in your diet. · Add green tea to your diet instead of tea or coffee. · Eliminate sugar from your diet. · Oily foods must be ignored.

To conclude, one must follow this diet properly to maintain a healthy body and lose body weight quickly. It also strengthens the immune system of the body and tones the body shape, thereby providing best physique to an individual.

Work on you r odds

Just about every time we pick up a newspaper or a magazine we find a do or don't article regarding our health. There are articles on preventing cancer, heart trouble, high blood pressure and many more aliments. On other pages you will find an equal number of articles telling you what is wrong with most of the food we eat. It is a catch 22 syndrome with most of us not knowing what is right or what is wrong.

After much research and some common sense thinking I have come up with my own code of good health living requirements. Since I have reached the ripe young age of almost 77 years and my primary care doctor is not getting rich from my semi-annual visits, I have come up with a plan that will give you greater odds for living a long and healthy life.

The first thing you need to do is "move." No, not to another location, but to exercise in some small way every day, walking is great, jumping on an small indoor trampoline, (which I try to do everyday,) doing some vigorous household activity or go to the gym. Do something that requires at least 30 minutes of active movement every day and you will lower your risk for just about everything.

Every time you exercise you reduce the production of free radical cells in your body. Many diseases come from an accumulation of free radicals, these cells work on making your good cells become dysfunctional.

Use the stairs instead of an elevator, park farther away at work or when you shop, take a brisk walk around the block at lunchtime, do something to get you and your body moving.

Eat a salad and some fruit each day. Fruits and vegetables are great antioxidant fighters, blueberries, strawberries, spinach and red and green peppers are high in antioxidants. You can lower you risk of heart disease and certain cancers just by eating at least 3 servings of veggies each day and that is not hard to do.

Watch your weight. Being healthy means not being overweight, by watching the portions you eat, you can lose even those awful five pounds you have been trying to lose for years. Obesity can cause heart disease, diabetes, high blood pressure and many other diseases. Think smaller and not larger portions and you will be healthier.

Omega-3 fatty acid is of great benefit in preventing many diseases, again helping to prevent heart disease, diabetes and others. Fish is a great source of Omega-3 fatty acids and if you are not too fond of fish, walnuts, almonds, and flaxseed are good sources along with omega-3 supplements, if all else fails.

Wear your seat belt. Now how is that going to make you live a long and healthier life? By keeping you alive in case of an accident on the road, about 55 percent of the people killed in accidents were not wearing their seatbelts. Keep in mind the life you save, may very well be your own.

Eat whole grains like oatmeal for breakfast. Whole grain bread, brown rice and air-popped popcorn are also good for you. Whole grains along with fruit and vegetables can delay the onset of osteoporosis, heart disease and even dementia. Eating oatmeal or another multi-grain cereal for breakfast can help you to lose weight and keep it off, as it has been proven that those who eat a good breakfast tend to eat less during the rest of the day.

Learn to relax, take a deep breath and sit for at least 10 minutes each day. You deserve to relax and your body needs to relax, even if it is for 10 minutes. Stress is a silent killer and your body needs to have an opportunity to sit and do nothing. Take time to think about some of your favorite things, your garden, a book you are reading, listen to some soothing music, do something that is relaxing for you and takes away the stress and strain of the day for at least for a few minutes.

Stay smoke free! Smoking is one of the leading causes of preventable deaths. Smoking is linked to at least fifteen different types of cancers and it also leads to heart disease and osteoporosis. Yes, giving up smoking can be hard, but would you rather be living a healthy life and live longer or finding yourself huffing and puffing after climbing a few steps because you could not give up that cigarette?

Get enough sleep. Did you know that night owls (those who do not think they need to sleep) are at a greater risk for diabetes, high cholesterol, high blood pressure and a long list of other things. Us chickens, those who feel that when it is dark, we need to go to our roost and sleep will stay much healthier. Fewer than five hours a night is not good, you put your whole body at risk and who, for heaven sakes can function on five hours or less and do a good job.

Most research has shown that the average person needs between 7 ½ to 8 ½ hours each night and should get that amount on a regular basis. If you are getting the proper amount of sleep for you and your body, you will not need an alarm clock to wake up at your regular time.

Keep your bedroom an oasis for sleep, leave your work on the dining room table along with the laptop computer and let your bedroom be a place to relax and sleep.

Well, that is it for now, this is my code of requirements that has kept me very healthy for 77 years and has made my odds for living a longer and healthier life a good one. I wish you a long and healthy life and just for fun, put one or two of my ideas into practice in your life and see how much better you feel.

Melodic Waves

(Click on images for full-size versions.)
Source: American Hairdresser, November 1942

New Review of Controlled Trials Replacing Saturated fat with Industrial Seed Oils

Readers Stanley and JBG just informed me of a new review paper by Dr. Dariush Mozaffarian and colleagues. Dr. Mozaffarian is one of the Harvard epidemiologists responsible for the Nurse's Health study. The authors claim that overall, the controlled trials show that replacing saturated fat with polyunsaturated fat from industrial seed oils, but not carbohydrate or monounsaturated fat (as in olive oil), slightly reduces the risk of having a heart attack:
These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.
Looking at the studies they included in their analysis (and at those they excluded), it looks like they did a nice job cherry picking. For example:
  • They included the Finnish Mental Hospital trial, which is a terrible trial for a number of reasons. It wasn't randomized, properly controlled, or blinded*. Thus, it doesn't fit the authors' stated inclusion criteria, but they included it in their analysis anyway**. Besides, the magnitude of the result has never been replicated by better trials-- not even close.
  • They included two trials that changed more than just the proportion of SFA to PUFA. For example, the Oslo Diet-heart trial replaced animal fat with seed oils, but also increased fruit, nut, vegetable and fish intake, while reducing trans fat margarine intake. The STARS trial increased both omega-6 and omega-3, reduced processed food intake, and increased fruit and vegetable intake. These obviously aren't controlled trials isolating the issue of dietary fat substitution. If you subtract the four inappropriate trials from their analysis, which is half the studies they analyzed, the significant result disappears. Those four just happened to show the largest reduction in heart attack mortality...
  • They excluded the Rose et al. corn oil trial and the Sydney Diet-heart trial. Both found a large increase in total mortality from replacing animal fat with seed oils, and the Rose trial found a large increase in heart attack deaths (the Sydney trial reported total mortality but not CHD deaths).
The authors claim, based on their analysis, that replacing 5% of calories as saturated fat with polyunsaturated fat would reduce the risk of having a heart attack by 10%. Take a minute to think about the implications of that statement. For the average American, that means cutting saturated fat nearly in half to 6% of energy, which is a challenge if you want to eat a normal diet. It also means nearly doubling PUFA intake, which will come mostly from seed oils if you follow the authors' advice.

So basically, even if the authors' conclusion were correct, you overhaul your whole diet and replace natural foods with industrial foods, and...? You reduce your 10-year risk of having a heart attack from 10 percent to 9 percent. Without affecting your overall risk of dying. The paper states that the interventions didn't affect overall mortality.

* Not even single blinded.  Autopsies were not conducted in a blinded manner. Physicians knew which hospital the cadavers came from, because autopsies were done on-site. There is some confusion about this point because the second paper states that physicians interpreted the autopsy reports in a blinded manner. But that doesn't make it blinded, since the autopsies weren't blinded. The patients were also not blinded, though this is hard to accomplish with a study like this.

** They refer to it as "cluster randomized", which I feel is a misuse of that term.  The investigators definitely didn't randomize the individual patients: whichever hospital a person was being treated in, that's the food he/she ate. There were only two hospitals, so "cluster randomization" in this case would just refer to deciding which hospital got the intervention first. I don't think this counts as cluster randomization.  An example of cluster randomization would be if you had 10 hospitals, and you randomized which hospital received which treatment first.  It's analogous to individual randomization but on a group scale.

Where's That Then? No 17

Another well-photographed English village. A regular in books called things like Our Homeland in Colour, I haven't seen it pictured in recent years. But it still looks like this, much as it did in 1972 when I used to drive here in my Mini Moke to pick up the Sunday papers from a shop on the left hand side of the photograph.

My New Favorite Youtube Channel

My new favorite Youtube channel:

Youtube Video - How To Handle Long Hair 1962

Youtube Videos - Vintage Long Hair Styling

Swinging Longies

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

Oh the 70's!

Selected Prevention, Public Health & Workforce Provisions in the Patient Protection and Affordable Care Act (HR 3590)

from Trust for America's Health (www.healthyamericans.org)

Selected Prevention and Public Health Provisions

Essential Health Benefits Requirements (Sec. 1302) – Includes an essential health benefits package that covers essential health benefits defined by the Secretary and limits cost-sharing. Included in the general benefit categories are preventive and wellness services and chronic disease management, maternity and newborn care, mental health and substance use disorder services, and pediatric services, among other things.

Coverage of Preventive Health Services (Sec. 2713) – Stipulates that a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for:
(1) evidence based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the US Preventive Services Task Force (USPSTF);
(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the CDC with respect to the individual involved;
(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by HRSA;
(4) with respect to women, additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by HRSA;States that for the purposes of this Act, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009.

States that nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to deny coverage for services that are not recommended by the Task Force.

Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan (Sec. 4103) – Provides Medicare Part B coverage, with no co-payment or deductible, for personalized prevention plan services. Personalized prevention plan services means the creation of a plan for an individual that includes a health risk assessment and may include other elements, such as updating family history, listing providers that regularly provide medical care to the individuals, BMI measurement, and other screenings and risk factors. The personal prevention plan would take into account the findings of the health risk assessment and would be completed prior to or as part of a visit with a health professional. The personalized health advice and referral may include community-based lifestyle interventions to reduce health risks and promote self-management and wellness, as well as lists of risk factors and a screening schedule.

Directs the Secretary to establish publicly available guidelines for health risk assessments, standards for interactive telephonic or web-based programs to furnish health-risk assessments and a health risk assessment model.

Removal of Barriers to Preventive Services in Medicare (Sec. 4104) – Waives coinsurance requirements for most preventive services, requiring Medicare to cover 100 percent of the costs. Services for which no coinsurance or deductible would be required are the personalized prevention plan services, an initial preventive physical examination and any covered preventive service if it is recommended with a grade of A or B by the USPSTF. Clarifies that cost sharing for colorectal cancer screening services would be waived.

Evidence-Based Coverage of Preventive Services in Medicare (Sec. 4105) – Provides the Secretary with the authority to modify coverage of existing preventive services, consistent with USPSTF recommendations. It would allow the Secretary to withdraw Medicare coverage for services not rated as A, B, C, or I by the USPSTF.

Improving Access to Preventive Services for Eligible Adults in Medicaid (Sec. 4106) – The current Medicaid State option to provide other diagnostic, screening, preventive, and rehabilitation services would be expanded to include: (1) any clinical preventive service recommended with a grade of A or B by the USPSTF and (2) with respect to adults, immunizations recommended by the Advisory Committee on Immunization Practices and their administration. States that cover these additional services and vaccines, and also prohibit costsharing for such services and vaccines, would receive an increased Federal medical assistance percentage (FMAP) of one percentage point for these services.

Coverage of Comprehensive Tobacco Cessation Services for Pregnant Women in Medicaid (4107) - States would be required to provide Medicaid coverage for counseling andpharmacotherapy for tobacco cessation by pregnant women. Prohibits cost-sharing for these services.

Incentives for Prevention of Chronic Diseases in Medicaid (Sec. 4108) – Directs the Secretary to award grants to States to carry out initiatives to provide incentives to Medicaid beneficiaries who successfully participate in a healthy lifestyles program and demonstrate changes in health risk and outcomes. The program shall be comprehensive, evidence-based, widely available, and easily accessible and shall be proposed by the state and approved by the Secretary. It shall be designed to address the needs of Medicaid beneficiaries to achieve: ceasing the use of tobacco;controlling or reducing weight; lowering cholesterol; lowering blood pressure; avoiding the onset of diabetes or improving management of diabetes.
The programs shall last for 5 years. The section includes impact assessments, evaluation and reporting requirements. The section appropriates $100 million for the program, out of any funds not otherwise appropriated in the Treasury.

National Prevention, Health Promotion & Public Health Council (Sec. 4001) – Creates a Council within HHS to provide coordination and leadership at the Federal level, and among Federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system and integrative health care in the U.S. & to develop the National Prevention Strategy. The Council shall be composed of departmental Secretaries from across the federal government, with the Surgeon General serving as Chair.

National Prevention and Health Promotion Strategy (Sec. 4001) – Tasks the Council with creating a national strategy to: set goals and objectives for improving health through federally-supported prevention, health promotion and public health programs, establish measurable actions and timelines to carry out the strategy, and make recommendations to improve Federal prevention, health promotion, public health and integrative health care practices.

Prevention and Public Health Fund (Sec. 4002) Establishes a fund, to be administered through the Office of the Secretary at HHS, to provide for an expanded and sustained national investment in prevention and public health programs (over the FY 2008 level). The Fund will support programs authorized by the Public Health Service Act, for prevention, wellness and public health activities, including prevention research and health screenings and initiatives, such as the Community Transformation grant program, the Education and Outreach Campaign for Preventive Benefits, and immunization programs. Funding levels: FY 2010 - $500 million; FY2011 - $750 million; FY 2012 - $1 billion; FY 2013 - $1.25 billion; FY 2014 - $1.5 billion; FY 2015 and each fiscal year thereafter- $2 billion.

Community Health Centers and the National Health Service Corps Fund (Sec. 10503) -Creates a Community Health Center Fund that provides enhanced funding for the Community Health Center program, the National Health Service Corps, and construction and renovation of community health centers. Fund totals $10 billion over 5 years. **Of note, the President’s proposal would invest $11 billion in Community Health Centers over five years.

Clinical and Community Preventive Services Task Forces (Sec. 4003) – Defines, clarifies duties of, and provides better coordination between the U.S. Preventive Services Task Force and the Community Preventive Services Task Force.

Education & Outreach Campaign Regarding Preventive Benefits (Sec. 4004) - Directs the Secretary to provide for the planning and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the lifespan.

Requires the Secretary, acting through the CDC Director, to establish and implement a national science-based media campaign on health promotion and disease prevention. Directs the Secretary, acting through the CDC Director, to enter into a contract for the development and operation of a Federal Internet website personalized prevention plan tool. Funding for activities authorized under this section shall take priority over funding provided by CDC for grants with similar purposes. Funding for this section shall not exceed $500 million.

Directs the Secretary to provide guidance and relevant information to States and health care providers regarding preventive and obesity-related services that are available to Medicaid enrollees, including obesity screening and counseling for children and adults. States shall design a public awareness campaign to educate Medicaid enrollees regarding availability and coverage of such services. The Secretary shall report on the status and effectiveness of these efforts.

School-Based Health Centers (Sec. 4101) – Directs the Secretary to award grants to support the operation of school-based health centers, with an emphasis on communities with barriers in access to health services. Out of any funds in the Treasury not otherwise appropriated, there is appropriated for each of the fiscal years FY 2010-2013 $50 million for expenditures for facilities and equipment or similar expenditures. Authorizes the Secretary to award grants to pay the costsassociated with expanding and modernizing existing buildings for use as a School-Based Health Center.

Oral Health (Sec. 4102) Directs the Secretary (subject to the availability of appropriations) to establish a 5-year national public health education campaign focused on oral healthcare prevention and education. Establishes demonstration grants to show the effectiveness of research-based dental caries disease management. Includes various oral health improvement provisions relating to school-based sealant programs, oral health infrastructure, and surveillance.

Community Transformation Grants (Sec. 4201) – Authorizes CDC to award competitivegrants to State and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence-base of effective prevention programming. Eligible entities shall submit to the Director a detailed plan including the policy, environmental programmatic and as appropriate infrastructure changes needed to promote healthy living and reduce disparities. Activities may focus on creating healthier schoolenvironments, creating infrastructure or programs to support active living and access to nutritious foods, smoking cessation and other chronic disease priorities; implementing worksite wellness; working to highlight healthy options in food venues; reducing disparities; and addressing special population needs. The section includes evaluation and reporting requirements.

Healthy Aging, Living Well; Evaluation of Community-Based Prevention; and WellnessPrograms for Medicare Beneficiaries (Sec. 4202) - Authorizes the Secretary, acting through the CDC Director, to award competitive grants to health departments and Indian tribes to carry out five-year pilot programs to provide public health community interventions, screenings, and when necessary, clinical referrals for individuals who are between 55-64 years old. Grantees must design a strategy to improve the health status of this population through community based public health interventions. Intervention activities may include efforts to improve nutrition,increase physical activity, reduce tobacco use and substance abuse, improve mental health and promote healthy lifestyles among the target population. Screenings may include mental health/behavioral health and substance abuse disorders; physical activity, smoking and nutrition; and any other measures deemed appropriate by the Secretary. The section includes an evaluation component.

The Secretary shall conduct an evaluation of community-based prevention and wellness programs and develop a plan for promoting healthy lifestyles and chronic disease self-management for Medicare beneficiaries. The evaluation shall include programs sponsored by the Administration on Aging that are evidence-based and have demonstrated potential to help Medicare beneficiaries reduce their risk of disease, disability and injury by making healthy lifestyle choices. CMS and AOA shall also conduct an evaluation of exiting community prevention and wellness programs. The Secretary shall submit a report to Congress on recommendations to promote healthy lifestyles and chronic disease self-management for Medicare beneficiaries; relevant findings; and the results of the evaluation.

Removing Barriers and Improving Access to Wellness for Individuals with Disabilities (Sec. 4203) – Requires the establishment of standards for accessible medical diagnostic equipment for individuals with disabilities.

Immunizations (Sec. 4204) – Authorizes states to obtain additional quantities of adult vaccines through the purchase of vaccines from manufacturers at the applicable price negotiated by the Secretary and authorizes a demonstration program to improve immunization coverage.

Reauthorizes the Immunization Program under Section 317 of the PHSA. Requires a GAO study and report on Medicare beneficiary access to vaccines and coverage of vaccines under Medicare Part D.

Nutrition Labeling of Standard Menu Items at Chain Restaurants (Sec. 4205) – Establishes nutrition labeling of standard menu items at chain restaurants (20 or more locations doing business under the same name). This includes disclosing calories on menu boards and in a written form, available on request, additional information pertaining to total calories and calories from fat, amounts of fat and saturated fat, cholesterol, sodium, total and complex carbohydrates, sugars, dietary fiber, and protein.

Demonstration Project Concerning Individualized Wellness Plan (Sec. 4206) – Directs the Secretary to establish a pilot program to test the impact of providing at-risk populations who utilize community health centers funded under this section an individualized wellness plan designed to reduce risk factors for preventable conditions identified by a comprehensive risk factor assessment.

Reasonable Break Time for Nursing Mothers (Sec. 4207) – Requires employers to provide reasonable break times for nursing mothers and a place, other than a bathroom, which may be used to express breast milk. Employers with less than 50 employees shall not be subject to this requirement if it would impose an undue hardship by causing significant difficulty or expense.

Research on Optimizing the Delivery of Public Health Services (Sec. 4301) – Directs the Secretary, acting through the CDC Director, to fund research in the area of public health services and systems. Research shall include examining best practices relating to prevention, with a particular focus on high priority areas identified by the Secretary in the National Prevention Strategy or Healthy People 2020; analyzing the translation of interventions to real-world settings;and identifying effective strategies for organizing, financing or delivering public health services in real world community settings, including comparing State and local health department structures and systems in terms of effectiveness and cost.

Understanding Health Disparities: Data Collection and Analysis (Sec. 4302) – Requires the Secretary to ensure that any ongoing or federally conducted or supported health care or public health program, activity, or survey collects and reports, to the extent practicable, data on race,ethnicity, gender, geographic location, socioeconomic status, language and disability status, inaddition to data at the smallest geographic level. The Secretary shall analyze the data to detect and monitor trends in health disparities and disseminate this information to relevant Federal agencies.

Employer-Based Wellness Programs (Sec. 4303) – Directs CDC to provide employers with TA, consultation and tools in evaluating wellness programs and build evaluation capacity among workplace staff. Directs CDC to study and evaluate employer-based wellness practices. Clarifies that any recommendations, data or assessments carried out under this part shall not be used to mandate requirements for workplace wellness programs.

Grants for Small Businesses to Provide Comprehensive Workplace Wellness Programs(Sec. 10408) - Directs the Secretary to award grants to small businesses to provide employees with access to comprehensive workplace wellness programs.

Pain Management (Sec. 4305) – Calls for an IOM Conference on Pain and includes various provisions relating to pain research and pain care education and training.

Funding for Childhood Obesity Demonstration Project (Sec. 4306) – CHIPRA established a Childhood Obesity Demonstration Project and authorized $25 million for FY 2009-2013. This section appropriates $25 million for the Secretary to carry out the demonstration project in FY 2010 – FY 2014.

Effectiveness of Federal Health and Wellness Initiatives (Sec. 4402) - Requires the Secretary of HHS to evaluate all existing Federal health and wellness initiatives and report to Congress concerning the evaluation, including conclusions concerning the reasons that such existing programs have proven successful or not successful and what factors contributed to such conclusions.

Better Diabetes Care (Sec. 10407) - Directs the Secretary, acting through the CDC Director, to prepare on a biennial basis, a national diabetes report card. Directs the Secretary and the IOM to study the impact of diabetes on the practice of medicine and the level of diabetes medical education that should be required prior to licensure, board certification and board recertification.

Cures Acceleration Network (Sec. 10409) - Requires the NIH Director to establish a Cures Acceleration Network to accelerate the development of high need cures, including the development of medical products and behavioral therapies.

Centers of Excellence for Depression (Sec. 10410) - Establishes a Network of HealthAdvancing National Centers of Excellence for Depression.

Programs Relating to Congenital Heart Disease (Sec. 10411) - Authorizes the Secretary, acting through the Director, to establish programs relating to congenital heart disease, including the formation of a National Congenital Heart Disease Surveillance System.

Young Women’s Breast Health Awareness and Support of Young Women Diagnosed withBreast Cancer (Sec. 10413) - Establishes a public education and a healthcare professional education campaign regarding women’s breast health.

National Diabetes Prevention Program (Sec. 5316) - Creates a CDC National DiabetesPrevention Program targeted at adults at high risk for diabetes, which entails a grant program for community-based diabetes prevention program model sites.

Selected Workforce Provisions

National Health Care Workforce Commission (Sec. 5101) – Establishes a commission toserve as a national resource for Congress, the President, States and Localities, determine whether the demand for health care workers is being met, identify barriers to coordination and encourage innovation. It shall disseminate information on retention practices for health care professionals and shall review current and projected health care workforce supply and demand and make recommendations regarding healthcare workforce priorities, goals and policies. The Commissionshall communicate and coordinate with a variety of federal agencies and departments. Specific topics to be reviewed include health care workforce supply and distribution, health care workforce education and training capacity; existing education loan and grant programs, the implications of federal policies; the healthcare workforce needs of specific populations, and recommendations creating or revising loan repayment and scholarship programs. Public health professionals are included in the definition of health care workforce and the definition of healthprofessionals. Public health workforce capacity is also included in the high priority areas list.

State Health Care Workforce Development Grants (Sec. 5102) – Establishes a competitive healthcare workforce development grant program to enable Statepartnerships to complete comprehensive planning and to carry out activities leading to coherent and comprehensive health care workforce development strategies at the State and local levels.

Authorizes $8 million for planning grants and $150 million for implementation grants for FY 2010 and such sums for each subsequent year.

Health Care Workforce Program Assessment (Sec. 5103) – Codifies the existing National Center for Health Care Workforce Analysis to provide for the development of information describing the health care workforce and the analysis of related issues and collect, analyze and report data related to programs under this title. The National Center and relevant regional and State centers and agencies shall collect labor and workforce information and provide analyses and reports to the Commission.

Public Health Workforce Recruitment and Retention Programs (Sec. 5204) – Establishes a public health workforce loan repayment program to eliminate critical public health workforce shortages in Federal, State, local and tribal public health agencies. Individuals receiving assistance must work at least three years in these agencies. In FY 2010, $195 million is authorized to be appropriated for this program, and such sums as necessary for FY 2011-2015. Sec. 5205 creates allied health workforce recruitment and retention programs.

Training for Mid-Career Public and Allied Health Professionals (Sec. 5206) - Authorizes the Secretary to make grants or enter into contracts to award scholarships to mid-career public health and allied health professionals to enroll in degree or professional training programs. Authorizes $60 million for these programs in FY 2010 and such sums as necessary for FY 2011-2015.

Elimination of cap on Commissioned Corps (Sec. 5209) This section strikes the required cap of 2,800 for members of the Regular Corps.

Establishing a Ready Reserve Corps (Sec. 5210) - Assimilates active duty Ready Reserve Officers into the Regular Corps & establishes a Ready Reserve to participate in training exercises, be available and ready for involuntary calls to active duty during national emergencies and public health crises, be available for deployment and for backfilling positions left vacant during deployment of active duty Corps members, and be available for service in isolated, hardship & medically underserved communities. This section authorizes $5 million for FY 2010– FY 2014 for carrying out the duties and responsibilities of the Commissioned Corps under this section and for recruitment and training; and $12.5 million for the Ready Reserve Corps for FY 2010 – FY 2014.

Grants to Promote the Community Health Workforce (Sec. 5313) – Directs the Director of CDC to award grants to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers.

Epidemiology-Laboratory Capacity Grants (Sec. 4304) Directs the Secretary (subject to the availability of appropriations) to establish an Epidemiology and Laboratory Capacity Grant Program to award grants to eligible entities to assist public health agencies in improving surveillance for and response to infectious diseases and other conditions of public health importance. Authorizes $190 million for each year of fiscal years 2010-2013 to carry out this section.

Fellowship Training in Public Health (Sec. 5314) – Authorizes funding for fellowship training in applied public health epidemiology, public health laboratory science, public health informatics, and expansion of the epidemic intelligence service in order to address documented workforce shortages in State and local health departments. Authorizes, for each of fiscal years 2010 through 2013, $5 million for epidemiology fellowship training programs, $5 million forlaboratory fellowship training programs; $5 million for the Public Health Informatics Fellowship Program; and $24,500,000 for expanding the Epidemic Intelligence Service.

Training in General, Pediatric and Public Health Dentistry (Sec. 5303) – Authorizes the Secretary to make grants to, or enter into contracts with, a school of dentistry, public or nonprofit private hospital or a public or private nonprofit entity to plan, develop and operate or participate in an approved professional dentistry program; to provide financial assistance to dental students, residents, practicing dentists and dental hygiene students, and for other purposes.

United States Public Health Sciences Track (Sec. 5315) Authorizes the establishment of a United States Public Health Sciences Track with authority to grant appropriate advanced degrees in a manner that uniquely emphasizes team based service, public health, epidemiology, and emergency preparedness and response. Students receive tuition remission and a stipend and are accepted as Commissioned Corps officers with a 2-year service commitment for each year of school covered. Included among the graduates shall be 100 public health students annually. Includes a provision that would develop elite federal disaster teams.

Preventive Medicine & Public Health Training Grant Program - Directs the Secretary to award grants to or enter into contracts with eligible entities to provide training to graduate medical residents in preventive medicine specialties.

Untangled Notts

And so to the northernmost outposts of Nottinghamshire. Quite by accident I found myself on an old section of the Bawtry to Gainsborough road at a place remarkably called Drakeholes, and this pair of delightful, if somewhat forlorn, pair of lodges. Until recently they were apparently so overgrown they looked like they were constructed with architectural growths of ivy and other rampant vegetation. Now it's all been cleared away in anticipation of restoration, revealing the lodges as almost X-rays of buildings with the appearance of red brick both under the peeling stucco and in precariously revealed foundations. They once heralded a now lost driveway to Wiseton Hall, built in the early eighteenth century for the Acklom family but demolished and replaced by a smaller house in 1960. Equally remarkable is the fact that the foreground seen here is in fact the start of a tunnel on the Chesterfield Canal, which just to the north makes a sudden right-hand turn before decanting into the broad reaches of the River Trent at West Stockwith. A tiny brick tunnel entrance is just out of shot, adding another fascinating glimpse of an all but forgotten age.

Fatty Liver: It's not Just for Grown-ups Anymore

The epidemic of non-alcoholic fatty liver disease (NAFLD) is one of my favorite topics on this blog, due to the liver's role as the body's metabolic "grand central station", as Dr. Philip Wood puts it. The liver plays a critical part in the regulation of sugar, insulin, and lipid levels in the blood. Many of the routine blood tests administered in the doctor's office (blood glucose, cholesterol, etc.) partially reflect liver function.

NAFLD is an excessive accumulation of fat in the liver that impairs its function and can lead to severe liver inflammation (NASH), and in a small percentage of people, liver cancer. An estimated 20-30% of people in industrial nations suffer from NAFLD, a shockingly high prevalence (1).

I previously posted on dietary factors I believe are involved in NAFLD. In rodents, feeding a large amount of sugar or industrial seed oils (corn oil, etc.) promotes NAFLD, whereas fats such as butter and coconut oil do not (2). In human infants, enteric feeding with industrial seed oils causes severe liver damage, whereas the same amount of fat from fish oil doesn't, and can even reverse the damage done by seed oils (3). [2013 update: obesity is probably the main contributor to NAFLD.  Obesity is associated with ectopic fat deposition in a number of organs, including the liver]

So basically, I think excessive sugar and industrial oils could be involved NAFLD, and if you look at diet trends in the US over the last 40 years, they're consistent with the idea.

I recently came across a study that examined the diet of Canadian children with NAFLD (6). The children had a high sugar intake, a typical (i.e., high) omega-6 intake, and a low omega-3 intake. The authors claimed that the children also had a high saturated fat intake, but at 10.5% of calories, they were almost eating to the American Heart Association's "Step I" diet recommendations**! Total fat intake was also low.

High sugar consumption was associated with a larger waist circumference, insulin resistance, lower adiponectin and elevated markers of inflammation. High omega-6 intake was associated with markers of inflammation. Low omega-3 intake was associated with insulin resistance and elevated liver enzymes. Saturated fat intake presumably had no relation to any of these markers, since they didn't mention it in the text.

These children with NAFLD, who were all insulin resistant and mostly obese, had diets high in omega-6, high in sugar, and low in omega-3. This is consistent with the idea that these three factors, which have all been moving in the wrong direction in the last 40 years, contribute to NAFLD.

* Fatty liver was assessed by liver enzymes, admittedly not a perfect test. However, elevated liver enzymes do correlate fairly well with NAFLD.

** Steps I and II were replaced by new diet advice in 2000. The AHA now recommends keeping saturated fat below 7% of calories.  However, the new recommendations focus mostly on eating real food rather than avoiding saturated fat and cholesterol.

Lessons from the H1N1 flu pandemic one year in

It’s been a long year for those of us following the H1N1 flu pandemic and even longer for the health workers on the front lines fighting the flu. As we approach the one-year anniversary of its arrival, what have we learned?

Let’s start with the numbers. Since the Centers for Disease Control and Prevention first began tracking the outbreak in April 2009 through mid-February 2010, researchers estimate that about 59 million Americans were infected with H1N1, roughly 98,000 people were hospitalized and about 3,900 people died from H1N1-related deaths. While the virus was widespread, health officials are relieved that the virus was not as lethal as some feared. Thankfully, reports of H1N1 flu activity have slowed over the last couple of months, although we could experience another wave.

And how about our response? According to a recent assessment by U.S. Department of Health and Human Services Secretary Kathleen Sebelius, preparedness and partnerships have paid off.
"Working with partners in government, industry and around the world, we rapidly characterized the virus, developed a candidate vaccine, made sure it was safe and began production," Sebelius said. "By acting quickly, we made the first doses of the vaccine available in October, less than six months after the flu was identified."

She noted that new partnerships with groups such as schools and businesses helped spread the word about H1N1 flu and the new vaccine quickly, and helped get three times as many health workers out to vaccinate people against H1N1 than for usual childhood immunization efforts. That was very helpful for vaccinating children, one of the high-risk groups. And partnerships with neighborhood clinics allowed the government to create an online flu shot locator that helped people easily find a nearby clinic.

As for challenges? Sebelius said the nation needs safe and effective vaccines that can be developed more quickly and more reliably. Health officials would like to respond to any future crisis within weeks, not months.

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Simple behaviors can limit the spread of H1N1 flu, study finds

Simple, common-sense behaviors — such as discussing how to prevent influenza at home, covering your nose and mouth when you cough or sneeze and washing your hands often — can help reduce the risk of family members passing the virus on to one another, a new study finds.

For the study, published in the April 1 issue of The Journal of Infectious Diseases, researchers surveyed household members of ill students from the New York City high school where the H1N1 flu outbreak was first documented in April 2009. In households where discussions of flu prevention and transmisson were held, H1N1 virus transmission was reduced by 40 percent.

Study researchers, who were with the New York City Department of Health and Mental Hygiene and Centers for Disease Control and Prevention, said the finding could be especially relevant in the event of a pandemic where a vaccine is not readily available.

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How to: Set Bangs

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

Book Review: The Primal Blueprint

Mark Sisson has been a central figure in the evolutionary health community since he began his weblog Mark's Daily Apple in 2006. He and his staff have been posting daily on his blog ever since. He has also written several other books, edited the Optimum Health newsletter, competed as a high-level endurance athlete, and served on the International Triathlon Union as the anti-doping chairman, all of which you can read about on his biography page. Mark is a practice-what-you-preach kind of guy, and if physical appearance means anything, he's on to something.

In 2009, Mark published his long-awaited book The Primal Blueprint. He self-published the book, which has advantages and disadvantages. The big advantage is that you aren't subject to the sometimes onerous demands of publishers, who attempt to maximize sales at Barnes and Noble. The front cover sports a simple picture of Mark, rather than a sunbaked swimsuit model, and the back cover offers no ridiculous claims of instant beauty and fat loss.

The drawback of self-publishing is it's more difficult to break into a wider market. That's why Mark has asked me to publish my review of his book today. He's trying to push it up in the Amazon.com rankings so that it gets a broader exposure. If you've been thinking about buying Mark's book, now is a good time to do it. If you order it from Amazon.com on March 17th, Mark is offering to sweeten the deal with some freebies on his site Mark's Daily Apple. Full disclosure: I'm not getting anything out of this, I'm simply mentioning it because I was reviewing Mark's book anyway and I thought some readers might enjoy it.

The Primal Blueprint is not a weight loss or diet book, it's a lifestyle program with an evolutionary slant. Mark uses the example of historical and contemporary hunter-gatherers as a model, and attempts to apply those lessons to life in the 21st century. He does it in a way that's empowering accessible to nearly everyone. To illustrate his points, he uses the example of an archetypal hunter-gatherer called Grok, and his 21st century mirror image, the Korg family.

The diet section will be familiar to anyone who has read about "paleolithic"-type diets. He advocates eating meats including organs, seafood, eggs, nuts, abundant vegetables, and fruit. He also suggests avoiding grains, legumes, dairy (although he's not very militant about this one), processed food in general, and reducing carbohydrate to less than 150 grams per day. I like his diet suggestions because they focus on real food. Mark is not a drill sergeant. He tries to create a plan that will be sustainable in the long run, by staying positive and allowing for cheats.

We part ways on the issue of carbohydrate. He suggests that eating more than 150 grams of carbohydrate per day leads to fat gain and disease, whereas I feel that position is untenable in light of what we know of non-industrial cultures (including some relatively high-carbohydrate hunter-gatherers). Although carbohydrate restriction (or at least wheat and sugar restriction) does have its place in treating obesity and metabolic dysfunction in modern populations, ultimately I don't think it's necessary for the prevention of those same problems, and it can even be counterproductive in some cases. Mark does acknowledge that refined carbohydrates are the main culprits.

The book's diet section also recommends nutritional supplements, including a multivitamin/mineral, antioxidant supplement, probiotics, protein powder and fish oil. I'm not a big proponent of supplementation. I'm also a bit of a hypocrite because I do take small doses of fish oil (when I haven't had seafood recently), and vitamin D in wintertime. But I can't get behind protein powders and antioxidant supplements.

Mark's suggestions for exercise, sun exposure, sleep and stress management make good sense to me. In a nutshell: do all three, but keep the exercise varied and don't overdo it. As a former high-level endurance athlete, he has a lot of credibility here. He puts everything in a format that's practical, accessible and empowering.

I think The Primal Blueprint is a useful book for a person who wants to maintain or improve her health. Although we disagree on the issue of carbohydrate, the diet and lifestyle advice is solid and will definitely be a vast improvement over what the average person is doing. The Primal Blueprint is not an academic book, nor does it attempt to be. It doesn't contain many references (although it does contain some), and it won't satisfy someone looking for an in-depth discussion of the scientific literature. However, it's perfect for someone who's getting started and needs guidance, or who simply wants a more comprehensive source than reading blog snippets. It would make a great gift for that family member or friend who's been asking how you stay in such good shape.

What is Maine's HealthInfoNet?

HealthInfoNet is an important statewide patient information resource that can help support health care providers’ treatment of patients. Clinicians from around Maine have reported on how they are using HealthInfoNet today to improve their access to patient clinical information when they need it most.

Take eight minutes to learn more about HealthInfoNet from Maine clinicians who are finding real value in using the statewide health information exchange. As you'll see, the video includes interviews from sites across the state. Just click on this link: http://www.youtube.com/watch?v=sXJXg4vNbOM.

Cell Phone Use and Possible Health Effects

A number of people have been asking about possible health effects from cell phone use. Below is an excerpt from the US FDA’s website that is an excellent brief summary of the knowledge to date. Links to additional resources are also included.

Do cell phones pose a health hazard?

Many people are concerned that cell phone radiation will cause cancer or other serious health hazards. The weight of scientific evidence has not linked cell phones with any health problems.

Cell phones emit low levels of radiofrequency energy (RF). Over the past 15 years, scientists have conducted hundreds of studies looking at the biological effects of the radiofrequency energy emitted by cell phones. While some researchers have reported biological changes associated with RF energy, these studies have failed to be replicated. The majority of studies published have failed to show an association between exposure to radiofrequency from a cell phone and health problems.

The low levels of RF cell phones emit while in use are in the microwave frequency range. They also emit RF at substantially reduced time intervals when in the stand-by mode. Whereas high levels of RF can produce health effects (by heating tissue), exposure to low level RF that does not produce heating effects causes no known adverse health effects.

The biological effects of radiofrequency energy should not be confused with the effects from other types of electromagnetic energy.

Very high levels of electromagnetic energy, such as is found in X-rays and gamma rays can ionize biological tissues. Ionization is a process where electrons are stripped away from their normal locations in atoms and molecules. It can permanently damage biological tissues including DNA, the genetic material.

The energy levels associated with radiofrequency energy, including both radio waves and microwaves, are not great enough to cause the ionization of atoms and molecules. Therefore, RF energy is a type of non-ionizing radiation. Other types of non-ionizing radiation include visible light, infrared radiation (heat) and other forms of electromagnetic radiation with relatively low frequencies.

While RF energy doesn’t ionize particles, large amounts can increase body temperatures and cause tissue damage. Two areas of the body, the eyes and the testes, are particularly vulnerable to RF heating because there is relatively little blood flow in them to carry away excess heat.

Cell Phone Use and Children
The scientific evidence does not show a danger to any users of cell phones from RF exposure, including children and teenagers. The steps adults can take to reduce RF exposure apply to children and teenagers as well.
• Reduce the amount of time spent on the cell phone
• Use speaker mode or a headset to place more distance between the head and the cell phone.

Some groups sponsored by other national governments have advised that children be discouraged from using cell phones at all. For example, The Stewart Report from the United Kingdom made such a recommendation in December 2000. In this report a group of independent experts noted that no evidence exists that using a cell phone causes brain tumors or other ill effects. Their recommendation to limit cell phone use by children was strictly precautionary; it was not based on scientific evidence that any health hazard exists.

Cell Phones (excerpt above is from this website)http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/HomeBusinessandEntertainment/CellPhones/default.htm

Radiofrequency Safety

Wireless Safety

National Cancer Institute (part of National Institutes of Health)
Fact Sheet on Cell Phone Use and Cancer Risks