In this blog post, I will be discussing some key determinants of malaria in Nigeria.
Malaria in Nigeria. as in many other countries, cannot be attributed to a single cause. Numerous determinants, including biological, socio-cultural, economic, and environmental, cause and contribute to this deadly infectious disease in Nigeria. The gender inequality in Nigeria is a social determinant of malaria. Nigerian women are more likely to be poor, uneducated, and without political power compared to Nigerian men due to gender discrimination in the country. Therefore, there is a neglect of women's health and this leads to potential problems in the infant developmental process. Thus, Nigerian women, especially pregnant mothers, are at an increased risk of having untreated malaria due to this gender discrimination. Another social determinant of malaria in Nigeria is the barriers to health care access. This may include lack of money, transportation, and conflicting cultural and religious beliefs. Education is another social determinant of malaria in Nigeria. Only 68% of all Nigerians are educated, implying that many Nigerians are not aware of the implications of malaria and the preventive measures available. Biological determinants of malaria in Nigeria include genetic susceptibility. Many Sub-Saharan Africans lack what is called a Duffy blood factor, which is an important mechanism that can limit parasite growth in the red blood cells. Without this protective mechanism, many Nigerians are not protected against severe diseases such as malaria. Also, the parasites that cause malaria are especially resistant to antibiotics, making treatment very difficult with drugs. An environmental determinant of malaria in Nigeria is warm temperature and high rainfall in the country. Mosquitos tend the thrive in sub-tropical/tropical areas, which makes Nigeria a very good mosquito breeding area. Also, human engineering projects destroys the natural terrain, and this favors increased mosquito breeding by creating new breeding sites. Poverty is an economic determinant of malaria. A striking 70% of Nigerians fall below the poverty line. Therefore, many Nigerians cannot afford the preventive measures such as bednets and insecticide sprays. Malaria is also a cause of economic burden because when a family member catches the disease and falls ill, he or she cannot go to work and make money for the family.
1.http://www.who.int/social_determinants/country_action/NIGERIA%20Dr%20ADETUNJI%20Labiran.pdf
2.http://origem.info/FIC/pdf/Breman%20et%20al%20Ears%20Hippopotamus_AJTMH%2001.pdf
3.http://www.rbm.who.int/cmc_upload/0/000/015/330/415680a_r.pdf
4.http://www.nationsencyclopedia.com/economies/Africa/Nigeria-POVERTY-AND-WEALTH.html
Sunday, November 28, 2010
Friday, November 19, 2010
The Magnitude of Malaria in Nigeria
In this post, I will be addressing the magnitude of the problem my final paper will be on.
Problem Statement (not final): Malaria in Nigeria has caused millions of deaths in the country and has had a enormous toll on the economic and social structures of the country.
Malaria causes around 250,000 deaths in children under five every year in Nigeria. An enormous proportion of the country's hospital resources are devoted to treating malaria and the medical staff work overtime all the time. Among the 151 million people in Nigeria, 110 million are clinically diagnosed with malaria. In Nigeria, malaria causes 11% of maternal deaths, and 60% of out-patient visits and 30% of hospitalizations are malaria related. Around $870 million are used every year for prevention and treatment of malaria in Nigeria and the toll on the country's economy is significant. Therefore, malaria has a great burden on society because it not only affects people physically, it affects people mentally, psychologically, and financially. As a result, the economic and social development of the country will be hindered.
Surveillance is rigorously implemented in assessing malaria in Nigeria. Records from all health facilities in the country are reported to the organizations responsible for data collection. Data is collected using standardized tools and there is a monthly reporting system for malaria in Nigeria. The organizations then analyze the data and decide what types of programs should be implemented in preventing and treating malaria and how the limited resources can be most effectively used.
There are several indicators of malaria in Nigeria. Direct indicators include the fact that Nigeria's under 5 mortality rank is number nine in the world, as described by UNICEF. Also, only 8% of Nigerian households own at least one insecticide treated bednet (ITN), 6% of Nigerian children under age 5 sleep under ITNs and 33% of Nigerian children under age 5 receive anti-malarial drugs, documented by the Department of Health Services. Indirect indicators include a high prevalence rate (3.1) of HIV in Nigerians aged 15-49, documented by the Joint United Nations Program on HIV/AIDS. Other indirect indicators include the fact that only 47% of Nigerians use improved drinking water sources and only 30% use improved sanitation facilities, as studied by a combination of organizations including UNICEF and The World Health Organization.
There are several strengths and weaknesses of the above indicators. Bednets are very effective and cost-effective in preventing malaria so the use of bednets and the prevalence of malaria are directly but not exclusively related. Malaria has an enormous toll on children and the high ranking Nigeria received in its under 5 mortality rate means that malaria is widespread in this country. The high prevalence rate of HIV resembles a link to a high prevalence rate of malaria because the two diseases are mutually cohesive. Also, improved sanitation and a cleaner water source decreases the spread of malaria, as studies have shown. The weakness of the above indicators is that most of them were all conducted as surveys of Nigerians. Surveys bring up all kinds of voluntary response bias and are not the best type of data collection.
sources:
1. http://www.unicef.org/infobycountry/nigeria_49472.html
2. http://mobileactive.org/malaria-kills-getting-63-million-bednets-nigerians-rapidsms
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1890276/
4. http://nmcpnigeria.org/?p=m-and-e
5. http://www.unicef.org/infobycountry/nigeria_statistics.html
Problem Statement (not final): Malaria in Nigeria has caused millions of deaths in the country and has had a enormous toll on the economic and social structures of the country.
Malaria causes around 250,000 deaths in children under five every year in Nigeria. An enormous proportion of the country's hospital resources are devoted to treating malaria and the medical staff work overtime all the time. Among the 151 million people in Nigeria, 110 million are clinically diagnosed with malaria. In Nigeria, malaria causes 11% of maternal deaths, and 60% of out-patient visits and 30% of hospitalizations are malaria related. Around $870 million are used every year for prevention and treatment of malaria in Nigeria and the toll on the country's economy is significant. Therefore, malaria has a great burden on society because it not only affects people physically, it affects people mentally, psychologically, and financially. As a result, the economic and social development of the country will be hindered.
Surveillance is rigorously implemented in assessing malaria in Nigeria. Records from all health facilities in the country are reported to the organizations responsible for data collection. Data is collected using standardized tools and there is a monthly reporting system for malaria in Nigeria. The organizations then analyze the data and decide what types of programs should be implemented in preventing and treating malaria and how the limited resources can be most effectively used.
There are several indicators of malaria in Nigeria. Direct indicators include the fact that Nigeria's under 5 mortality rank is number nine in the world, as described by UNICEF. Also, only 8% of Nigerian households own at least one insecticide treated bednet (ITN), 6% of Nigerian children under age 5 sleep under ITNs and 33% of Nigerian children under age 5 receive anti-malarial drugs, documented by the Department of Health Services. Indirect indicators include a high prevalence rate (3.1) of HIV in Nigerians aged 15-49, documented by the Joint United Nations Program on HIV/AIDS. Other indirect indicators include the fact that only 47% of Nigerians use improved drinking water sources and only 30% use improved sanitation facilities, as studied by a combination of organizations including UNICEF and The World Health Organization.
There are several strengths and weaknesses of the above indicators. Bednets are very effective and cost-effective in preventing malaria so the use of bednets and the prevalence of malaria are directly but not exclusively related. Malaria has an enormous toll on children and the high ranking Nigeria received in its under 5 mortality rate means that malaria is widespread in this country. The high prevalence rate of HIV resembles a link to a high prevalence rate of malaria because the two diseases are mutually cohesive. Also, improved sanitation and a cleaner water source decreases the spread of malaria, as studies have shown. The weakness of the above indicators is that most of them were all conducted as surveys of Nigerians. Surveys bring up all kinds of voluntary response bias and are not the best type of data collection.
sources:
1. http://www.unicef.org/infobycountry/nigeria_49472.html
2. http://mobileactive.org/malaria-kills-getting-63-million-bednets-nigerians-rapidsms
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1890276/
4. http://nmcpnigeria.org/?p=m-and-e
5. http://www.unicef.org/infobycountry/nigeria_statistics.html
Friday, November 12, 2010
Malaria in Sub-Saharan Africa
In this blog post, I will address what my final paper topic is on and give background information on it and why I am interested in the topic.
For my final paper, I plan on addressing malaria in Sub-Saharan Africa. Malaria is a disease that is caused by a parasite that uses mosquitos as its vector to humans. Victims of malaria experience flu-like symptoms and if left untreated, they will die. Malaria is especially prevalent in temperate areas such as Sub-Saharan Africa. According to the CDC, in 2008, there were 190-311 million cases of malaria worldwide and 700 thousand to one million deaths, most occurring in Sub-Saharan Africa (http://www.cdc.gov/MALARIA/). Malaria can also be spread from a pregnant mother to her infant child. There are many reasons why malaria is especially prevalent in Sub-Saharan Africa. Sub-Saharan Africa is home to the deadly species of mosquitos that transmit malaria and since this place is very temperate, these mosquitos thrive in this region. Also, many Sub-Saharan Africa countries lack the medical and public health infrastructure and resources to deal with malaria prevention. Furthermore, the disease has shown increasing drug resistance to past antibiotics and has mutated in even dangerous forms. The problem is complicated by the fact that money donated to malaria prevention campaigns by the World Health Organization (WHO) usually ends up in the hands of African military and political groups seeking for personal benefit due to the lack of infrastructure and the confusion when it comes to distribution of resources. Malaria is such a big problem in Sub-Saharan Africa because it causes the economic system to be unstable. When people are infected, they are unable to go to work and thus, become poor because they are receiving no wages, which is bad for both the person and the company/place he or she works for.
Malaria prevention includes bed nets, indoor insecticide sprayings, vaccines, and DDT. Bed nets are the most probable and cost efficient among these. However, it is difficult to ensure that all Africans are properly using bed nets. Indoor insecticide sprayings are very effective but they cause toxic and smelly odors. Vaccines are obviously the most effective prevention measure and in recent years, there has been a lot of research done on developing a malaria curing vaccine. However, all the vaccines that have been introduced so far have not had great success and the anti-drug resistant nature of the malaria causing parasite makes it difficult for researchers to develop such a vaccine. Also, vaccines are expensive, so it will not be available to the general Sub-Saharan Africa public. DDT is another very effective prevention measure but it has caused a lot of controversy over the use of it when dealing with malaria. DDT itself introduces many other dangerous side effects and depending on the individual, it can cause many unpleasant reactions.
I am interested in malaria because I am surprised by its pervasiveness and its effect on the economies of Sub-Saharan African countries. I am amazed by how such a disease can make the economies of 20 or so countries suffer so much. Also, the nature of the disease is very interesting to research on because of its uniqueness. Furthermore, the issue of malaria not only involves public health preventions and medicinal cures, but also involves governments of other countries seeking power in the region by getting involved, numerous global organizations trying to provide help, and military regimes within the Sub-Saharan African countries trying to seek personal empowerment. The issue covers public health, medicine, politics, warfare, and international relations, and that is what interests me the most.
For my final paper, I plan on addressing malaria in Sub-Saharan Africa. Malaria is a disease that is caused by a parasite that uses mosquitos as its vector to humans. Victims of malaria experience flu-like symptoms and if left untreated, they will die. Malaria is especially prevalent in temperate areas such as Sub-Saharan Africa. According to the CDC, in 2008, there were 190-311 million cases of malaria worldwide and 700 thousand to one million deaths, most occurring in Sub-Saharan Africa (http://www.cdc.gov/MALARIA/). Malaria can also be spread from a pregnant mother to her infant child. There are many reasons why malaria is especially prevalent in Sub-Saharan Africa. Sub-Saharan Africa is home to the deadly species of mosquitos that transmit malaria and since this place is very temperate, these mosquitos thrive in this region. Also, many Sub-Saharan Africa countries lack the medical and public health infrastructure and resources to deal with malaria prevention. Furthermore, the disease has shown increasing drug resistance to past antibiotics and has mutated in even dangerous forms. The problem is complicated by the fact that money donated to malaria prevention campaigns by the World Health Organization (WHO) usually ends up in the hands of African military and political groups seeking for personal benefit due to the lack of infrastructure and the confusion when it comes to distribution of resources. Malaria is such a big problem in Sub-Saharan Africa because it causes the economic system to be unstable. When people are infected, they are unable to go to work and thus, become poor because they are receiving no wages, which is bad for both the person and the company/place he or she works for.
Malaria prevention includes bed nets, indoor insecticide sprayings, vaccines, and DDT. Bed nets are the most probable and cost efficient among these. However, it is difficult to ensure that all Africans are properly using bed nets. Indoor insecticide sprayings are very effective but they cause toxic and smelly odors. Vaccines are obviously the most effective prevention measure and in recent years, there has been a lot of research done on developing a malaria curing vaccine. However, all the vaccines that have been introduced so far have not had great success and the anti-drug resistant nature of the malaria causing parasite makes it difficult for researchers to develop such a vaccine. Also, vaccines are expensive, so it will not be available to the general Sub-Saharan Africa public. DDT is another very effective prevention measure but it has caused a lot of controversy over the use of it when dealing with malaria. DDT itself introduces many other dangerous side effects and depending on the individual, it can cause many unpleasant reactions.
I am interested in malaria because I am surprised by its pervasiveness and its effect on the economies of Sub-Saharan African countries. I am amazed by how such a disease can make the economies of 20 or so countries suffer so much. Also, the nature of the disease is very interesting to research on because of its uniqueness. Furthermore, the issue of malaria not only involves public health preventions and medicinal cures, but also involves governments of other countries seeking power in the region by getting involved, numerous global organizations trying to provide help, and military regimes within the Sub-Saharan African countries trying to seek personal empowerment. The issue covers public health, medicine, politics, warfare, and international relations, and that is what interests me the most.
Sunday, November 7, 2010
Reflection on first half of course
In this blog post, I will be reflecting on the first half of the Intro to Public Health class and my thoughts and impressions so far.
I believe this class has been very interesting so far. The lectures are enjoyable because they are all taught by various faculty selected from the Bloomberg School of Public Health and they all are very knowledgable about their respective topics. The online course readings have been entertaining to read and although the textbook may be boring to read sometimes, it still presents some interesting things such as giving case studies and historic examples of public health problems and their respective solutions. I feel like my knowledge of public health has vastly expanded and I would like to continue to learn more about this broad area of study.
Personally, I found that the area of infectious diseases and bioterrorism were interesting to me. I feel like these two areas relate to my interest in biology and are topics that combine public health and biology. I also like history, so learning about the history of infectious diseases and their various historic examples are of particular interest to me. Bioterrorism is a interesting topic because of the psychological impact it has. Even though anthrax and other bioterrorism mechanisms have not killed many people, the psychological impact that it penetrates into society is huge. I would like to take further courses related to infectious diseases and/or bioterrorism later on in my college experience.
To me, the most surprising thing is that chronic diseases are now more pervasive than infectious diseases. I had no prior knowledge of public health so as a child, I thought that infectious diseases are the most dangerous and probably the most widespread types of diseases in the world in part due to the inherent "danger" in its name. However, I found out in this course that chronic diseases are actually the most pervasive type of disease and it is also becoming the most widespread disease in developing countries. It makes sense because as countries develop and industrialize, the risk factors for chronic diseases will increase and risk factors for infectious diseases can be prevented through advanced research on the causes of the infectious diseases.
Initially, I took this class because I wanted to know what public health does and how it relates to medicine. Throughout my childhood, I witnessed many public health disasters and I wanted to know what public health does in these types of situations and their powers and limitations. Many things have certainly changed since my first blog post. Now, I have a general understanding of all the areas of public health. I know that it covers many more areas of study than I initially thought it did and I now know that public health is intertwined with medicine, law, and politics. After taking more than two months of this class, I feel like I definitely have more respect for public health because it deals with saving the maximum number of lives as possible and the issues and problems that public health officials face are almost always as difficult if not more difficult than those that doctors face in the field of medicine. My public health interest has definitely increased as a result of taking this course because I am now aware to the numerous aspects of public health that are available for study. I definitely plan to take more upper level public health classes and pursue a major in this area of study.
I believe this class has been very interesting so far. The lectures are enjoyable because they are all taught by various faculty selected from the Bloomberg School of Public Health and they all are very knowledgable about their respective topics. The online course readings have been entertaining to read and although the textbook may be boring to read sometimes, it still presents some interesting things such as giving case studies and historic examples of public health problems and their respective solutions. I feel like my knowledge of public health has vastly expanded and I would like to continue to learn more about this broad area of study.
Personally, I found that the area of infectious diseases and bioterrorism were interesting to me. I feel like these two areas relate to my interest in biology and are topics that combine public health and biology. I also like history, so learning about the history of infectious diseases and their various historic examples are of particular interest to me. Bioterrorism is a interesting topic because of the psychological impact it has. Even though anthrax and other bioterrorism mechanisms have not killed many people, the psychological impact that it penetrates into society is huge. I would like to take further courses related to infectious diseases and/or bioterrorism later on in my college experience.
To me, the most surprising thing is that chronic diseases are now more pervasive than infectious diseases. I had no prior knowledge of public health so as a child, I thought that infectious diseases are the most dangerous and probably the most widespread types of diseases in the world in part due to the inherent "danger" in its name. However, I found out in this course that chronic diseases are actually the most pervasive type of disease and it is also becoming the most widespread disease in developing countries. It makes sense because as countries develop and industrialize, the risk factors for chronic diseases will increase and risk factors for infectious diseases can be prevented through advanced research on the causes of the infectious diseases.
Initially, I took this class because I wanted to know what public health does and how it relates to medicine. Throughout my childhood, I witnessed many public health disasters and I wanted to know what public health does in these types of situations and their powers and limitations. Many things have certainly changed since my first blog post. Now, I have a general understanding of all the areas of public health. I know that it covers many more areas of study than I initially thought it did and I now know that public health is intertwined with medicine, law, and politics. After taking more than two months of this class, I feel like I definitely have more respect for public health because it deals with saving the maximum number of lives as possible and the issues and problems that public health officials face are almost always as difficult if not more difficult than those that doctors face in the field of medicine. My public health interest has definitely increased as a result of taking this course because I am now aware to the numerous aspects of public health that are available for study. I definitely plan to take more upper level public health classes and pursue a major in this area of study.
Friday, October 29, 2010
Public Health and Law
In this blog post, I will be summarizing a court case regarding public health and its complications and addressing some public health legal issues.
The specific court case in the article regarded whether or not a woman called Miss Mary Kink, who had gotten anesthetic leprosy, should be sent to the city pesthouse. Miss Kink got affected by this contagious disease while working on missionary efforts in Brazil but she had developed anesthetic kind of leprosy, which is not dangerous to the community. Furthermore, she is an elderly woman who has lived and been part of the community of Aiken for a long time and has not spread this disease to anyone else. The city board of health stated that Miss Kink be placed in the city pesthouse or she move out of the city. Miss Kink and her doctor complained and stated their reasons for complaint to the city court judge, Judge Aldrich. Miss Kink is a woman of culture and comfort, so moving her to the city pesthouse would make living very difficult for her. Also, the city pesthouse was usually a place to keep African Americans who had developed smallpox. Furthermore, the city pesthouse was located very close to a city waste dumping site where waste was incinerated and the foul odors were present in the pesthouse. After reviewing and prolonging the case for months, the court ruled that Miss Kink could stay in the city and does not have to be sent to the city pesthouse or move out of the city.
The difference between quarantine and isolation is quite clear. A person is sent to isolation when he or she is known to become ill from a contagious disease. The person is isolated from the general population and can make no contact with other people to prevent people from catching the contagious disease. A person is quarantined when he or she is only known to be exposed to a contagious disease. It is unknown whether the person has actually developed the contagious disease. The person is told to remain in specific locations (such as his or her house) to prevent the person from spreading the disease to others. In most cases, state and local public health authorities decide whether or not a person should be quarantined. Their power comes from the US Constitution. According to the article, the principles of constitutional law governing health regulations provides the legislation of the rights of the individual vs. the rights of the community. In specific cases, it is up to the courts to interpret this law and decide how to balance these rights. Personally, I believe that it is more appropriate to err on the side of protecting the rights of the community because the ultimate goal is to protect as many people as possible. However, there has to be an empirical statistical analysis of each option and decide whether quarantining the individual will actually provide better prevention to those who are not yet affected by the disease.
-YP
The specific court case in the article regarded whether or not a woman called Miss Mary Kink, who had gotten anesthetic leprosy, should be sent to the city pesthouse. Miss Kink got affected by this contagious disease while working on missionary efforts in Brazil but she had developed anesthetic kind of leprosy, which is not dangerous to the community. Furthermore, she is an elderly woman who has lived and been part of the community of Aiken for a long time and has not spread this disease to anyone else. The city board of health stated that Miss Kink be placed in the city pesthouse or she move out of the city. Miss Kink and her doctor complained and stated their reasons for complaint to the city court judge, Judge Aldrich. Miss Kink is a woman of culture and comfort, so moving her to the city pesthouse would make living very difficult for her. Also, the city pesthouse was usually a place to keep African Americans who had developed smallpox. Furthermore, the city pesthouse was located very close to a city waste dumping site where waste was incinerated and the foul odors were present in the pesthouse. After reviewing and prolonging the case for months, the court ruled that Miss Kink could stay in the city and does not have to be sent to the city pesthouse or move out of the city.
The difference between quarantine and isolation is quite clear. A person is sent to isolation when he or she is known to become ill from a contagious disease. The person is isolated from the general population and can make no contact with other people to prevent people from catching the contagious disease. A person is quarantined when he or she is only known to be exposed to a contagious disease. It is unknown whether the person has actually developed the contagious disease. The person is told to remain in specific locations (such as his or her house) to prevent the person from spreading the disease to others. In most cases, state and local public health authorities decide whether or not a person should be quarantined. Their power comes from the US Constitution. According to the article, the principles of constitutional law governing health regulations provides the legislation of the rights of the individual vs. the rights of the community. In specific cases, it is up to the courts to interpret this law and decide how to balance these rights. Personally, I believe that it is more appropriate to err on the side of protecting the rights of the community because the ultimate goal is to protect as many people as possible. However, there has to be an empirical statistical analysis of each option and decide whether quarantining the individual will actually provide better prevention to those who are not yet affected by the disease.
-YP
Saturday, October 23, 2010
Global Health Problems and Concerns
In this blog post, I will be summarizing the article "The Challenge of Global Health" by Laurie Garrett. Then, I will be discussing some of my thoughts and opinions on the article.
This article basically addresses the issues regarding global health and the effectiveness of the measures taken to deal with them. Nowadays, a lot of money from various organizations (WHO, NGOs, private donors) have generously been donating money to deal with the health problems in developing countries. However, due to the lack of organization and that most of the money is directed towards specific diseases rather than public health in general, it is likely that we will not reach our global health expectations. One major reason is that most of the proposed public health projects are created by wealthy nations, experimented on under a limited scope, and don't allow the developing communities being served say what they need. The author then starts giving a history of global health and the role that organizations play. The author claims that the surge in funding and donations to global health is a direct result of the HIV/AIDS pandemic. It all started towards the turn of the 21st century and has since involved numerous nations. Nations opt to take part in contributing to global health for various reasons such as moral duty, public diplomacy, and self-protection against the disease itself. Finally, the author talks about why global health problems are still a high priority despite the increasing amount of funds provided. Problems include the money not being used efficiently and effectively, lack of coordination amongst public health organizations, ignorance of the true needs of developing communities, and others.
In my opinion, the biggest reason why the surge in public health funds is still not enough to counter the issue of global health problems is that the money is not being utilized and distributed effectively. There are many reasons for this. Developing countries receiving the aid such as areas in Sub-Saharan Africa do not have the public health infrastructure (hospitals, clinics) to distribute these resources. Also, money leaks out to transportation costs, random employees, the black market, and other underground business since corruption is prevalent in these areas. Furthermore, the lack of a stable government in these countries means that there are flaws in the coordination of distributing the resources.
According to the article, the two markers for public health success in developing countries are increased maternal survival and increased overall life expectancy. Maternal survival is a key indicator of public health success because in order for a pregnant woman to survive, the environment, personnel, and equipment involved in the delivery needs to be as best as possible to ensure a high success rate. Therefore, if the country has these resources and personnel available, it means that the country has a good overall health care system. Overall life expectancy is an indicator of public health success because the average person in a country lives, the better the quality of health in that country. It means that the water is cleaner leading to less contamination, the mosquito population is low leading to low rates of malaria, and immunizations are available for prevalent infectious diseases.
The author indicates that some public health measures have caused more harm than good. For example, many of the hospitals and clinics in developing countries reuse syringes for vaccinations, inadequately sterilize surgical instruments, and lack testing for blood-bank systems, all of which could increase the spread of HIV to the patients that are vaccinated (for preventable diseases) and the general population. Another example of how public health measures may have caused more harm than good is the concern about influenza spreading across the world. Public health measures dealing with this issue include donating money and inventing methods to prevent the spread of influenza. However, the developing nations lack hospital personnel, public health experts, and research scientists to perform the preventive methods. Also, coordination requires the presence of public health infrastructure, which these countries also lack.
This article basically addresses the issues regarding global health and the effectiveness of the measures taken to deal with them. Nowadays, a lot of money from various organizations (WHO, NGOs, private donors) have generously been donating money to deal with the health problems in developing countries. However, due to the lack of organization and that most of the money is directed towards specific diseases rather than public health in general, it is likely that we will not reach our global health expectations. One major reason is that most of the proposed public health projects are created by wealthy nations, experimented on under a limited scope, and don't allow the developing communities being served say what they need. The author then starts giving a history of global health and the role that organizations play. The author claims that the surge in funding and donations to global health is a direct result of the HIV/AIDS pandemic. It all started towards the turn of the 21st century and has since involved numerous nations. Nations opt to take part in contributing to global health for various reasons such as moral duty, public diplomacy, and self-protection against the disease itself. Finally, the author talks about why global health problems are still a high priority despite the increasing amount of funds provided. Problems include the money not being used efficiently and effectively, lack of coordination amongst public health organizations, ignorance of the true needs of developing communities, and others.
In my opinion, the biggest reason why the surge in public health funds is still not enough to counter the issue of global health problems is that the money is not being utilized and distributed effectively. There are many reasons for this. Developing countries receiving the aid such as areas in Sub-Saharan Africa do not have the public health infrastructure (hospitals, clinics) to distribute these resources. Also, money leaks out to transportation costs, random employees, the black market, and other underground business since corruption is prevalent in these areas. Furthermore, the lack of a stable government in these countries means that there are flaws in the coordination of distributing the resources.
According to the article, the two markers for public health success in developing countries are increased maternal survival and increased overall life expectancy. Maternal survival is a key indicator of public health success because in order for a pregnant woman to survive, the environment, personnel, and equipment involved in the delivery needs to be as best as possible to ensure a high success rate. Therefore, if the country has these resources and personnel available, it means that the country has a good overall health care system. Overall life expectancy is an indicator of public health success because the average person in a country lives, the better the quality of health in that country. It means that the water is cleaner leading to less contamination, the mosquito population is low leading to low rates of malaria, and immunizations are available for prevalent infectious diseases.
The author indicates that some public health measures have caused more harm than good. For example, many of the hospitals and clinics in developing countries reuse syringes for vaccinations, inadequately sterilize surgical instruments, and lack testing for blood-bank systems, all of which could increase the spread of HIV to the patients that are vaccinated (for preventable diseases) and the general population. Another example of how public health measures may have caused more harm than good is the concern about influenza spreading across the world. Public health measures dealing with this issue include donating money and inventing methods to prevent the spread of influenza. However, the developing nations lack hospital personnel, public health experts, and research scientists to perform the preventive methods. Also, coordination requires the presence of public health infrastructure, which these countries also lack.
Friday, October 15, 2010
Whooping Cough is on the rise again!
In this blog post, I will be summarizing the Washington Post article, "Whooping cough makes a comeback." Then I will be talking about herd immunity and vaccinations in public health.
This article basically states that whooping cough, considered a disease of the past, is starting to rise again starting in California. If the right preventive measures are not taken, this disease could spread nationally and with an infection rate greater than smallpox, has potential to be a very serious public health issue. Whooping cough is also a cyclical disease, meaning that it has its highs and lows in terms of infection rates. It is a very dangerous disease because of its high infection rate and various characteristics that differ from most other diseases. The bacteria that causes whooping cough, Bordetella pertussis, initially only causes minor symptoms in its host and once it is detected, the disease is usually too late to treat. The article gives an example of a woman's child who died because he was detected with this disease too late.
Herd immunity is a theory that states that if a portion of the population is vaccinated against a particular disease, this will provide protection for the unvaccinated portion of the population from that disease. The logic behind this is that if a large portion of the population is vaccinated and since infectious diseases are passed from person to person, this chain of infection is going to be less significant. Normally, those who do not receive vaccinations will experience some sort of negative side effect upon vaccination. Therefore, the public health importance here is that if most of the population who can be vaccinated are vaccinated, the rest of the population who, for whatever reason, cannot take the vaccination will be protected because it is harder for the infectious disease to get to them since the majority of the population will be immune to the disease.
This article basically states that whooping cough, considered a disease of the past, is starting to rise again starting in California. If the right preventive measures are not taken, this disease could spread nationally and with an infection rate greater than smallpox, has potential to be a very serious public health issue. Whooping cough is also a cyclical disease, meaning that it has its highs and lows in terms of infection rates. It is a very dangerous disease because of its high infection rate and various characteristics that differ from most other diseases. The bacteria that causes whooping cough, Bordetella pertussis, initially only causes minor symptoms in its host and once it is detected, the disease is usually too late to treat. The article gives an example of a woman's child who died because he was detected with this disease too late.
Herd immunity is a theory that states that if a portion of the population is vaccinated against a particular disease, this will provide protection for the unvaccinated portion of the population from that disease. The logic behind this is that if a large portion of the population is vaccinated and since infectious diseases are passed from person to person, this chain of infection is going to be less significant. Normally, those who do not receive vaccinations will experience some sort of negative side effect upon vaccination. Therefore, the public health importance here is that if most of the population who can be vaccinated are vaccinated, the rest of the population who, for whatever reason, cannot take the vaccination will be protected because it is harder for the infectious disease to get to them since the majority of the population will be immune to the disease.
The revival of whooping cough especially in California is due to numerous reasons. First, it is legal and easy for parents in California to refuse vaccinations for their children. Vaccination laws differ among different states and California is lenient in terms of an individual choosing whether or not to get vaccinated. The reason they opt to not be vaccinated is that there was a rumor that vaccinations cause autism, brain damage, and other negative side effects. Parents also believe in herd immunity, thinking that if their children's peers all get vaccinated, their children will be protected against the disease as well. Also, these days, physicians give children acellular vaccines instead of whole-cell vaccines because acellular vaccines are considered safer. However, they are not as effective in curing whooping cough than whole-cell vaccines are. Also, the Pertussis bacteria (the bacteria that causes whooping cough) has evolved and mutated and is more resistant to vaccines nowadays. Therefore, the vaccines used earlier up to the mid 1990s are not as effective as the newly developed vaccines. Furthermore, this bacteria is very good at hiding and is hard to detect even with advanced biological tools used by researchers. The whooping cough vaccination, unlike other vaccinations, does not 100% prevent someone from getting the disease, so one can get infected even after being vaccinated.
Public Health policymakers should educate the general population about whooping cough and inform them of its various unique characteristics. Therefore, people will be more cautious and parents will be more willing to let their children get vaccinated. Policymakers should provide evidence that states that there are no negative side effects in getting vaccinated for this disease. Also, parents should be informed that herd immunity will only work up to a certain point (herd immunity threshold). That is, a certain level of the community needs to be vaccinated in order for herd immunity to operate. Therefore, all children who don't experience negative side effects should be vaccinated. Also, biomedical researchers should continue doing ongoing research on this disease and not just reject it as a "disease of the past." This bacteria has shown that it can mutate and evolve various mechanisms to continue to infect even those who are vaccinated. Also, researchers should be informed that this bacteria is very hard to detect even with the most advanced scientific tools so they should perform numerous trials and scrutinize their results carefully.
Friday, October 8, 2010
Non-smokers is not an independent group!
In this blog post, I will be discussing the effect that smoking husbands have on the development of lung cancer for their non-smoking wives. I will be summarizing a study done in Japan regarding this subject.
This study was a Cohort study that interviewed and followed 122,261 men and 142,857 women age 40 years and above. The population was separated into non-smoking wives of smoking husbands and non-smoking wives of non-smoking husbands. The objective of this study was to determine whether wives of smokers have an increased risk of lung cancer development. The results showed that 346 women deaths occurred during the 14 year follow up period. 174 of these women were non-smoking women who were married to smoking husbands. The results yielded a two tailed p-value of 0.00097, which means that the null hypothesis is rejected in favor of the alternative hypothesis since the results are statistically significant because it was not the result of chance. In this case, the null hypothesis was that non-smoking women of smoking husbands and non-smoking women of non-smoking husbands have the same chance of developing lung cancer. Since the p-value, 2*0.00097 < alpha (0.05 most of the time), we will accept the alternative hypothesis, which, in this case, was that non-smoking women of smoking husbands have a greater chance of developing lung cancer than non-smoking women of non-smoking husbands. The study also concluded that husbands' smoking and alcohol drinking habits have no effect of their non-smoking wives' risk of developing other types of major cancers other than lung cancer. Also, the effect of passive smoking was compared with the effect of direct smoking, yielding a relative risk of developing lung cancer by passive smoking of 1.8 compared to a relative risk of 3.8 for direct smokers. Therefore, the study showed a dose-response relationship between passive smoking and the risk of developing lung cancer.
The advantage of this study is that it allowed the examination of multiple outcomes of non-smoking wives of smoking husbands. For instance, the study showed a relation between husbands' smoking habits and deaths from emphysema and asthma in their wives. Also, the study found that the risk of developing other types of cancer, such as stomach and cervical cancer, in non-smoking wives did not increase with smoking husbands. In my opinion, second hand smoking is an environmental health issue because when the primary smoker exhales the smoke, this smoke is inhaled by people who are standing within the vicinity of the primary smoker. Therefore, these people will inhale these bad chemicals and toxics, including carcinogens, and increase their chances of developing lung cancer, since the above study has showed a dose-response relationship between passive smoking and lung cancer. Since these toxic chemicals exhaled by the primary smoker permeates the environment and affects all of those around the primary smoker, a smoke-free environment is needed to protect people from second hand smoking. Therefore, second hand smoking is an environmental problem because toxic chemicals are released into the air. Although association does not always imply causation, I believe that the results of this study support second hand smoking as a cause of lung cancer. The results from the study concluded a dose-response relationship between second hand smoking and the development of lung cancer. Although most dose-response relationships have a safe amount of dose one can take before experiencing an adverse response, cancer does not have this safe threshold. Therefore, the chance of developing cancer is linearly proportional to amount of dose taken by the subject. Thus, the more dose of carcinogen taken, the greater the chance you might develop cancer. So in this case, the more toxics inhaled by a second hand smoker, the greater the chance that person will develop lung cancer.
This study was a Cohort study that interviewed and followed 122,261 men and 142,857 women age 40 years and above. The population was separated into non-smoking wives of smoking husbands and non-smoking wives of non-smoking husbands. The objective of this study was to determine whether wives of smokers have an increased risk of lung cancer development. The results showed that 346 women deaths occurred during the 14 year follow up period. 174 of these women were non-smoking women who were married to smoking husbands. The results yielded a two tailed p-value of 0.00097, which means that the null hypothesis is rejected in favor of the alternative hypothesis since the results are statistically significant because it was not the result of chance. In this case, the null hypothesis was that non-smoking women of smoking husbands and non-smoking women of non-smoking husbands have the same chance of developing lung cancer. Since the p-value, 2*0.00097 < alpha (0.05 most of the time), we will accept the alternative hypothesis, which, in this case, was that non-smoking women of smoking husbands have a greater chance of developing lung cancer than non-smoking women of non-smoking husbands. The study also concluded that husbands' smoking and alcohol drinking habits have no effect of their non-smoking wives' risk of developing other types of major cancers other than lung cancer. Also, the effect of passive smoking was compared with the effect of direct smoking, yielding a relative risk of developing lung cancer by passive smoking of 1.8 compared to a relative risk of 3.8 for direct smokers. Therefore, the study showed a dose-response relationship between passive smoking and the risk of developing lung cancer.
The advantage of this study is that it allowed the examination of multiple outcomes of non-smoking wives of smoking husbands. For instance, the study showed a relation between husbands' smoking habits and deaths from emphysema and asthma in their wives. Also, the study found that the risk of developing other types of cancer, such as stomach and cervical cancer, in non-smoking wives did not increase with smoking husbands. In my opinion, second hand smoking is an environmental health issue because when the primary smoker exhales the smoke, this smoke is inhaled by people who are standing within the vicinity of the primary smoker. Therefore, these people will inhale these bad chemicals and toxics, including carcinogens, and increase their chances of developing lung cancer, since the above study has showed a dose-response relationship between passive smoking and lung cancer. Since these toxic chemicals exhaled by the primary smoker permeates the environment and affects all of those around the primary smoker, a smoke-free environment is needed to protect people from second hand smoking. Therefore, second hand smoking is an environmental problem because toxic chemicals are released into the air. Although association does not always imply causation, I believe that the results of this study support second hand smoking as a cause of lung cancer. The results from the study concluded a dose-response relationship between second hand smoking and the development of lung cancer. Although most dose-response relationships have a safe amount of dose one can take before experiencing an adverse response, cancer does not have this safe threshold. Therefore, the chance of developing cancer is linearly proportional to amount of dose taken by the subject. Thus, the more dose of carcinogen taken, the greater the chance you might develop cancer. So in this case, the more toxics inhaled by a second hand smoker, the greater the chance that person will develop lung cancer.
Friday, October 1, 2010
Noncommunicable Diseases - Worlds Coming Together
In this blog post, I will be summarizing the article, "Global Noncommunicable Diseases - Where Worlds Meet" by NEJM. Then, I will be discussing my thoughts and opinions on this matter.
This article basically shows the increasing importance of preventive care for noncommunicable diseases. Noncommunicable diseases, such as heart disease, cancer, and diabetes, are becoming increasingly prevalent. According to the article, six of the top ten risk factors of all deaths are associated with noncommunicable diseases. Non-communicable diseases, unlike most communicable diseases, affect countries of all income levels. The reason for this is that as developing countries become more developed, they are becoming more urbanized. This results in demographic and lifestyle shifts that introduce bad habits such as eating excessively, which increases the chance of heart disease. This is quite a paradox because globalization is key to economic development and the improvement of health, but it also causes a higher incidence of noncommunicable diseases. There are multiple causes for noncommunicable diseases and these diseases can have lifelong impacts. In addition, monetary incentives for industries and interest groups hinder policy makers' effectiveness in dealing with the control of the risk factors behind noncommunicable diseases. This problem can be dealt with by a combined proactive intervention plan from all areas of society nationally and globally. It is surprising that there is a great overlap between the leading risk factors for death in both the richest and poorest countries. For example, the causes of high blood pressure, such as smoking and obesity, are usually applied to rich countries. It is hard to imagine citizens of poor countries having enough money to buy tobacco when there are definitely more pressing concerns. However, this may be likely the case because since most poor countries do not have a stable agricultural infrastructure or meat industry, they rely on foods rich in fats and oils, which are usually cheaper than agricultural goods or fresh produce. Therefore, the accumulation of these oils and fats into the blood vessels ultimately results in high blood pressure.
An example of a chronic disease is Epilepsy, a brain disorder that causes clusters of nerve cells to signal sudden motions. Primary prevention avoids the development of a disease by eliminating the risk factors associated with the disease. In this case, primary prevention deals with genetic screening and prenatal diagnosis in the pregnant mother for the genes that cause Epilepsy. Secondary prevention deals with preventing a disease from occurring among those who are at risk. In the case of Epilepsy, secondary prevention includes wearing seat belts, bicycle helmets, or anything that prevents head injury. Tertiary prevention is preventing a disease from worsening for those who already have the disease. In this case, various medications would be used for those who have epilepsy. The effectiveness of these prevention strategies would be more effective in more developed countries because there are more vehicles (more opportunity for head injury) and money for medications in developed countries whereas developing countries may not have as many risk factors or enough money for tertiary prevention. Also, in more developed countries, motor safety and bike riding policies may be easier to implement with an organized government rather than a government yet fully established, as in the case with most developing countries.
This article basically shows the increasing importance of preventive care for noncommunicable diseases. Noncommunicable diseases, such as heart disease, cancer, and diabetes, are becoming increasingly prevalent. According to the article, six of the top ten risk factors of all deaths are associated with noncommunicable diseases. Non-communicable diseases, unlike most communicable diseases, affect countries of all income levels. The reason for this is that as developing countries become more developed, they are becoming more urbanized. This results in demographic and lifestyle shifts that introduce bad habits such as eating excessively, which increases the chance of heart disease. This is quite a paradox because globalization is key to economic development and the improvement of health, but it also causes a higher incidence of noncommunicable diseases. There are multiple causes for noncommunicable diseases and these diseases can have lifelong impacts. In addition, monetary incentives for industries and interest groups hinder policy makers' effectiveness in dealing with the control of the risk factors behind noncommunicable diseases. This problem can be dealt with by a combined proactive intervention plan from all areas of society nationally and globally. It is surprising that there is a great overlap between the leading risk factors for death in both the richest and poorest countries. For example, the causes of high blood pressure, such as smoking and obesity, are usually applied to rich countries. It is hard to imagine citizens of poor countries having enough money to buy tobacco when there are definitely more pressing concerns. However, this may be likely the case because since most poor countries do not have a stable agricultural infrastructure or meat industry, they rely on foods rich in fats and oils, which are usually cheaper than agricultural goods or fresh produce. Therefore, the accumulation of these oils and fats into the blood vessels ultimately results in high blood pressure.
An example of a chronic disease is Epilepsy, a brain disorder that causes clusters of nerve cells to signal sudden motions. Primary prevention avoids the development of a disease by eliminating the risk factors associated with the disease. In this case, primary prevention deals with genetic screening and prenatal diagnosis in the pregnant mother for the genes that cause Epilepsy. Secondary prevention deals with preventing a disease from occurring among those who are at risk. In the case of Epilepsy, secondary prevention includes wearing seat belts, bicycle helmets, or anything that prevents head injury. Tertiary prevention is preventing a disease from worsening for those who already have the disease. In this case, various medications would be used for those who have epilepsy. The effectiveness of these prevention strategies would be more effective in more developed countries because there are more vehicles (more opportunity for head injury) and money for medications in developed countries whereas developing countries may not have as many risk factors or enough money for tertiary prevention. Also, in more developed countries, motor safety and bike riding policies may be easier to implement with an organized government rather than a government yet fully established, as in the case with most developing countries.
Friday, September 24, 2010
Major Public Heath Achievements of the 20th Century
In this blog post, I will be summarizing and commenting on the course reading "Ten Great Public Health Achievements in U.S. 1900-1999."
After reading this article, I am astounded by the broad impact of public health. All ten of these public health achievements have greatly contributed to the overall health of the United States population. Thus, as stated in the article, these public health innovations helped achieve a 25 year increase in overall life expectancy over the past century. Although all ten of the achievements are very important, I believe that the most important public health innovation of the 20th century is the series of vaccination that has virtually eradicated smallpox and polio, and has controlled other infectious diseases such as measles, mumps, and rubella. Nowadays, all babies that are born receive some sort of vaccination of MMR (measles, mumps, rubella), influenza b, and tetanus. Most of these vaccinations need to be administered again every ten years due to the fact that these infectious diseases can mutate and become immune to previous vaccinations. By being able to control the outbreak of these infectious diseases, millions of lives have been saved. Therefore, these vaccinations, in my opinion, is the most important public health achievement of the 20th century.
A public health achievement that I can particularly resonate with is motor-vehicle safety. Like most teenagers, I am new to driving and have only had my license for two years. Therefore, there is a higher chance that I might get into an accident than someone who is an experienced driver would. With the advent of safer cars and seat belts/air bags, this could not only reduce my personal injury should I get into an accident but also reduce the injury of the person I get into an accident with. Being a teenager, I am well aware of the problem of drinking and driving. Teenagers have high adrenaline in their blood and mix that with alcohol and there will most likely be accidents on the road. However, motor safety laws have been very strict about drinking and driving and permit only the slightest amount of alcohol level if you are driving. The police has also been very effective in enforcing these laws. The problem of drinking and driving affects me because back in high school, if I am driving home from a friend's house, I do not want to be on the road with drunk drivers or speeding drivers. Although I may drive perfectly and obey all the laws, I cannot control the other person's driving and should I get into an accident, we will both get injured even though I may have done nothing wrong on my part. Therefore, this sometimes makes me think twice about driving at night.
I believe that the improvement of mental health should be included in this list. According to The US Department of Health and Human Services, about 1 in 4 US adults suffer from some type of mental disorder with major depression as the leading cause of disability in the US. However, research over the past decades have made great strides in understanding the biological causes of mental disorder and developing mental treatment/interventions. Nowadays, there are numerous programs and drugs that patients suffering from mental problems can look to for help. This is a very important achievement because there are now services out there to help this particular segment of the population.
After reading this article, I am astounded by the broad impact of public health. All ten of these public health achievements have greatly contributed to the overall health of the United States population. Thus, as stated in the article, these public health innovations helped achieve a 25 year increase in overall life expectancy over the past century. Although all ten of the achievements are very important, I believe that the most important public health innovation of the 20th century is the series of vaccination that has virtually eradicated smallpox and polio, and has controlled other infectious diseases such as measles, mumps, and rubella. Nowadays, all babies that are born receive some sort of vaccination of MMR (measles, mumps, rubella), influenza b, and tetanus. Most of these vaccinations need to be administered again every ten years due to the fact that these infectious diseases can mutate and become immune to previous vaccinations. By being able to control the outbreak of these infectious diseases, millions of lives have been saved. Therefore, these vaccinations, in my opinion, is the most important public health achievement of the 20th century.
A public health achievement that I can particularly resonate with is motor-vehicle safety. Like most teenagers, I am new to driving and have only had my license for two years. Therefore, there is a higher chance that I might get into an accident than someone who is an experienced driver would. With the advent of safer cars and seat belts/air bags, this could not only reduce my personal injury should I get into an accident but also reduce the injury of the person I get into an accident with. Being a teenager, I am well aware of the problem of drinking and driving. Teenagers have high adrenaline in their blood and mix that with alcohol and there will most likely be accidents on the road. However, motor safety laws have been very strict about drinking and driving and permit only the slightest amount of alcohol level if you are driving. The police has also been very effective in enforcing these laws. The problem of drinking and driving affects me because back in high school, if I am driving home from a friend's house, I do not want to be on the road with drunk drivers or speeding drivers. Although I may drive perfectly and obey all the laws, I cannot control the other person's driving and should I get into an accident, we will both get injured even though I may have done nothing wrong on my part. Therefore, this sometimes makes me think twice about driving at night.
I believe that the improvement of mental health should be included in this list. According to The US Department of Health and Human Services, about 1 in 4 US adults suffer from some type of mental disorder with major depression as the leading cause of disability in the US. However, research over the past decades have made great strides in understanding the biological causes of mental disorder and developing mental treatment/interventions. Nowadays, there are numerous programs and drugs that patients suffering from mental problems can look to for help. This is a very important achievement because there are now services out there to help this particular segment of the population.
Friday, September 17, 2010
New Study Sheds Hope For Those With Aggressive Thyroid Cancer Tumors
In this post, I will be discussing a recent study of a newly developed drug that could possibly treat the most aggressive form of thyroid cancer.
Thyroid cancer refers to malignant tumors on the thyroid gland. The thyroid gland is an organ in the throat that helps control body temperature, heat rate, and blood pressure. Thyroid cancer is a public health issue because according to the National Cancer Institute (NCI), there are about 37,000 new cases of thyroid cancer each year in the US alone. Although thyroid cancer may affect people of all age groups, it is most prevalent amongst women and the elderly. The study I am about to talk about focuses on the most aggressive form of thyroid cancer, which according to the article, affects about five percent of all thyroid cancer patients. This form of thyroid cancer cannot be successfully treated by conventional means and patients must turn to chemotherapy, which is pretty unpopular and also not very effective.
In the study performed by Dr. Julian Molina at the Mayo Clinic, 37 patients with the most aggressive form of thyroid cancer took a new drug called pazopanib everyday. After a period of time (not specified by the article), results showed that tumor size decreased by at least 30 percent in almost half of the patients. Dr. Molina emphasized that pazopanib is not a cure for the most aggressive form of thyroid cancer, but rather a way to decrease the symptoms and growth of the tumor.
This study was a clinical trial in which there was only the intervention group and no control group. Due to the fact that there were only 37 patients in the study, there are clearly many weaknesses of this specific study. Even Dr. Molina said, "future research needs to be done on larger populations in order to confirm the findings." Also, the fact that there was no control group present in the study meant that there is no comparability. However, the reason for this small number of patients is that pazopanib is a new drug so people are wary of what side effects the drug may cause. In fact, 16 patients in the study had to reduce their pazopanib dosage because they were experiencing negative side effects. Also, the fact that many ethical issues arises when dealing with clinical trials discourages many patients from participating.
This study could be strengthened in many ways. There are many advantages of clinical trials such as randomizing patients into two groups, a treatment group and a control group. The purpose of randomizing patients into these two groups is to avoid bias and to increase comparablity of the groups to determine if intervention is associated with a better outcome. Therefore, increasing the number of patients being studied and randomizing them into a treatment group and control group would definitely better support the results. However, the disadvantage of clinical trials is the many ethical issues involved when conducting experiments on actual human beings. In the past, these ethical dilemmas have even sometimes made it to the Supreme Court.
Link: http://www.msnbc.msn.com/id/39239797/ns/health-cancer/
Thyroid cancer refers to malignant tumors on the thyroid gland. The thyroid gland is an organ in the throat that helps control body temperature, heat rate, and blood pressure. Thyroid cancer is a public health issue because according to the National Cancer Institute (NCI), there are about 37,000 new cases of thyroid cancer each year in the US alone. Although thyroid cancer may affect people of all age groups, it is most prevalent amongst women and the elderly. The study I am about to talk about focuses on the most aggressive form of thyroid cancer, which according to the article, affects about five percent of all thyroid cancer patients. This form of thyroid cancer cannot be successfully treated by conventional means and patients must turn to chemotherapy, which is pretty unpopular and also not very effective.
In the study performed by Dr. Julian Molina at the Mayo Clinic, 37 patients with the most aggressive form of thyroid cancer took a new drug called pazopanib everyday. After a period of time (not specified by the article), results showed that tumor size decreased by at least 30 percent in almost half of the patients. Dr. Molina emphasized that pazopanib is not a cure for the most aggressive form of thyroid cancer, but rather a way to decrease the symptoms and growth of the tumor.
This study was a clinical trial in which there was only the intervention group and no control group. Due to the fact that there were only 37 patients in the study, there are clearly many weaknesses of this specific study. Even Dr. Molina said, "future research needs to be done on larger populations in order to confirm the findings." Also, the fact that there was no control group present in the study meant that there is no comparability. However, the reason for this small number of patients is that pazopanib is a new drug so people are wary of what side effects the drug may cause. In fact, 16 patients in the study had to reduce their pazopanib dosage because they were experiencing negative side effects. Also, the fact that many ethical issues arises when dealing with clinical trials discourages many patients from participating.
This study could be strengthened in many ways. There are many advantages of clinical trials such as randomizing patients into two groups, a treatment group and a control group. The purpose of randomizing patients into these two groups is to avoid bias and to increase comparablity of the groups to determine if intervention is associated with a better outcome. Therefore, increasing the number of patients being studied and randomizing them into a treatment group and control group would definitely better support the results. However, the disadvantage of clinical trials is the many ethical issues involved when conducting experiments on actual human beings. In the past, these ethical dilemmas have even sometimes made it to the Supreme Court.
Link: http://www.msnbc.msn.com/id/39239797/ns/health-cancer/
Friday, September 10, 2010
My Background and Initial Impressions
My name is Yunpeng Gao and this is my blog. In this blog, I will be introducing myself, describing what public health is, and my initial impressions on this subject.
I grew up in a family devoted to science and medicine. Both my parents were doctors in China and my grandmother was a nurse. When we came to the US, my parents started pursuing medical research. As a result, scientific discussions were unavoidable at the dinner table throughout my childhood. Therefore, even as a child, I have dreamed of becoming a doctor saving lives or a medical researcher driving science forward by finding new cures for diseases. However, as I became older and more mature, I realized that public health was also a viable career option. Throughout my childhood, I have witnessed on television numerous public health disasters such as 9/11, the mad cow crisis, Hurricane Katrina, and the SARS epidemic, to name a few. Through these events and more, I have realized that if I wanted to help as many people as I can, I should pursue a career in public health. However, in contrast to medicine/research, public health is a very new subject to me because I don't have prior background or mentors that I can look up to. That is why I am taking this course so I can gain a deeper understanding of public health. As for my long term interests, I plan to major in public health and obtain a Masters in Public Health. Although I have developed a new interest in public health, my passion for medicine and research have not waned. Therefore, I am not quite sure whether my professional goals will be in medicine and research or public health.
This comes to the question "What is Public Health?" From what I've learned in the first couple of classes, public health is the general well-being of people's health and the measures the people and government are taking to improve their health. Unlike medicine, public health centers around everyone's health and strives to improve the health of the general public. As a result, public health administrators and implementers often do not get the respect that doctors get from directly attending to a patient's needs. I also learned about the three core functions of public health: Assessment, Policy development, and Assurance. Public health administrators gather information about the health of a population, then develop policies on how to improve the health of the community, and finally, make sure the services are available and accessible to everyone in the community. This is the essence of public health.
My initial impressions on the first couple of classes were that this class is going to be very interesting since there will be numerous discussions and debates. Discussion and debate makes the class interesting and more engaging because it lets people share their unique views on certain public health policies or events. By getting input from people of all backgrounds and cultures, we can see what public health means in another person's perspective. Therefore, I am looking forward to learning more about public health and gaining insight into all perspectives of it.
I grew up in a family devoted to science and medicine. Both my parents were doctors in China and my grandmother was a nurse. When we came to the US, my parents started pursuing medical research. As a result, scientific discussions were unavoidable at the dinner table throughout my childhood. Therefore, even as a child, I have dreamed of becoming a doctor saving lives or a medical researcher driving science forward by finding new cures for diseases. However, as I became older and more mature, I realized that public health was also a viable career option. Throughout my childhood, I have witnessed on television numerous public health disasters such as 9/11, the mad cow crisis, Hurricane Katrina, and the SARS epidemic, to name a few. Through these events and more, I have realized that if I wanted to help as many people as I can, I should pursue a career in public health. However, in contrast to medicine/research, public health is a very new subject to me because I don't have prior background or mentors that I can look up to. That is why I am taking this course so I can gain a deeper understanding of public health. As for my long term interests, I plan to major in public health and obtain a Masters in Public Health. Although I have developed a new interest in public health, my passion for medicine and research have not waned. Therefore, I am not quite sure whether my professional goals will be in medicine and research or public health.
This comes to the question "What is Public Health?" From what I've learned in the first couple of classes, public health is the general well-being of people's health and the measures the people and government are taking to improve their health. Unlike medicine, public health centers around everyone's health and strives to improve the health of the general public. As a result, public health administrators and implementers often do not get the respect that doctors get from directly attending to a patient's needs. I also learned about the three core functions of public health: Assessment, Policy development, and Assurance. Public health administrators gather information about the health of a population, then develop policies on how to improve the health of the community, and finally, make sure the services are available and accessible to everyone in the community. This is the essence of public health.
My initial impressions on the first couple of classes were that this class is going to be very interesting since there will be numerous discussions and debates. Discussion and debate makes the class interesting and more engaging because it lets people share their unique views on certain public health policies or events. By getting input from people of all backgrounds and cultures, we can see what public health means in another person's perspective. Therefore, I am looking forward to learning more about public health and gaining insight into all perspectives of it.
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