Blog #12: Key Determinants

Problem Definition: There are relatively high rates of children testing positive for lead poisoning in Baltimore city during the years 2005-2007.


Biological/Developmental
Children ages 6 years and younger are greatly impacted by lead poisoning as compared to adults. Also, pregnant women are also affected. The effects that can be warded of by older children and adults can cause extensive brain damage in a developing child. Lead enters the body through inhalation or ingestion. Small children and pregnant women absorb at least 50 percent of the lead that enters their bodies. The lead absorbed travels through the blood stream and places itself in soft tissue, like that in the liver, kidney, and brain. Most of the lead that enters the body is stored in bones and teeth. Lead in these areas can be stored for 30 years and be released back into the bloodstream during times of high stress such as pregnancy. Lead harms the brain and nervous system, and also damages red blood cells and kidneys.

Social and Cultural
Children in lower income areas are more at risk to be poisoned by lead because they are more likely to live in rundown buildings and apartments which have higher level of leads than necessary. About 20% of residents in Baltimore live with incomes below the poverty line. 9.4% of residents live with incomes below 50% of the poverty line.

Environmental
Baltimore city is an urban area with great amounts of lead still prevalent in homes. Lead paint in homes was not banned until 1977- so about 80% to 90% of the housing stock in Baltimore City contain lead. Lead exposure can come from the home and the outside environment. A major source of lead exposure for millions of Americans water contaminated with lead from lead pipes or from lead solder used with copper pipes. Lead can be found in soil, yards, and playgrounds. Lead can also be found on old painted furniture, toys, and imported children’s jewelry and imported ceramics. Invisible lead dust is released when lead paint is peeling, disturbed, or damaged. This happens most often by the opening and closing of windows and doors.

Economic
Fixing or renovating your house to eliminate these problems can be costly. Average lead paint removal for a standard home built before 1978 is between $10,000 and $30,000. Another option called encapsulation, which applies a “liquid coating of paint that forms a water tight jacket over lead paint,” costs between $600 and $1000.  20% of residents in Baltimore live with incomes below the poverty line. Standard precautions can be rather expensive, totaling over thousands of dollars regardless of which option is chosen- thus putting low-income families in a position to forfeit these changes.

Political

Maryland Reduction of Lead Risk in Housing Law, otherwise known as the Maryland Lead Law. The goal of this law is to “make all privately-owned pre-1950 rental housing units safer for children, while also helping rental property owners and managers to avoid costly lead poisoning litigation by complying with specific lead hazard reduction measures or a dust testing procedure set forth in the statute.” But, this law only covers rental units.

-Thomasina

Blog #11: Magnitude of My Issue

Problem Definition: There are relatively high rates of children testing positive for lead poisoning in Baltimore city during the years 2005-2007.

The only type of surveillance associated with this issue is mandated testing of children by their family care provider or pediatrician. This mandate only exists in some areas- primarily old cities with housing that contain lead paint, such as Baltimore.


Magnitude of the Problem

Lead poisoning greatly impacts children 6 years of age and younger. When exposed as a child, the implications of lead poisoning include learning  and mental disabilities, lowered IQ, hyperactivity, Attention Deficit Disorder, speech delay, hearing loss, slowed or reduced growth, behavioral problems, and violent and aggressive behavior. According to a study conducted by Dr. Hebert Needleman, the leading researcher on childhood lead poisoning, lead poison is a direct cause of antisocial and violent behavior. Lead poisoning can later cause academic failure and juvenile delinquency. High levels of lead poisoning can cause severe cognitive disabilities, coma, or death. Medical treatment can reduce the amount lead in a child’s body, but the damage is irreversible.

Direct Indicators: In 2007, there were 46, 355 children ages 5 and under residing in Baltimore. However, only 18,363 children, ages 0 to 6 years, were tested for lead exposure in 2006. There is a huge gap of children not being tested.  In 2006, 4.6% (843 children) of these children tested positive for lead poisoning. Comparatively, in the entire state of Maryland, the rate of children testing positive for lead poisoning is 0.5%. Relatively, Baltimore still has pretty high rates of childhood lead poisoning.

The main weakness of these statistics is the fact that there is a huge gap of children not being tested. For all we know, the rate can be a lot higher than what is being observed. Even with the mandate, there seems to either be not much compliance or simply no access physically to healthcare for a child to be tested. But, I do believe it's accurate just because it’s not self-reported- it’s mainly through clinics and providers. Also, the evidence of whether or not a child is poisoned by lead is rather concrete with very little room for false results.

Indirect Indicators: . Baltimore claims one of the highest crime rates of cities across America, ranking number 5 for the murder rate. The graduation rate in the city is 62.7% with 45.8% of students graduating on time. 18.1% of children in grades 6-8 are in special education. 43.9% of students with disabilities, of the ages 6-21, are in the less than 21% least restrictive environment. There are 10.1% of children with disabilities age 3-21 with mental retardation, as compared to the 5.3% in Maryland. About 20% of residents in Baltimore live with incomes below the poverty line. 9.4% of residents live with incomes below 50% of the poverty line.

To see these indirect indicators as such, your perspective on the implications of lead poisoning have to follow reality. In other words, you have to believe that lead poisoning is, a root cause of high crime rates academic failure, and mental disabilities in a city. Of course, many arguments can be made against this claim, but it’s pretty hard to deny that lead poisoning is indeed a root cause of many. Again, the strengths of these statistics are that they are reported from the city, so they are presumed to be rather accurate.

Sources

Baltimore City Data Collaborative - Information on Children and Families in Baltimore, Maryland. Web. 24 Oct. 2010. <http://baltimorekidsdata.org/>.

"Baltimore City Health Department Lead Poisoning Prevention Program." Baltimore City Health Department. Web. 20 Oct. 2010. <http://www.baltimorehealth.org/lead.html>.

"Baltimore City QuickFacts from the US Census Bureau." State and County QuickFacts. Web. 01 Nov. 2010. <http://quickfacts.census.gov/qfd/states/24/24510.html>.

Fenton, Justin, and Peter Hermann. "FBI Releases 2009 Crime Stats; Baltimore No. 5 for Murder Rate." Baltimore Sun 24 May 2010. Print.

"Lead Exposure In Children Affects Brain And Behavior." American Academy of Child & Adolescent Psychiatry. Web. 30 Oct. 2010. <http://www.aacap.org/cs/root/facts_for_families/lead_exposure_in_children_affects_brain_and_behavior>.

"Lead Poisoning- Children." The Coalition to End Childhood Lead Poisoning. Web. 31 Oct. 2010. <http://www.leadsafe.org/index.cfm>.

Blog #10: Final Paper Topic

I am still debating whether or not I want to write about this topic, but I am looking to write about Childhood Lead Poisoning in the city of Baltimore or Washington, DC. My paper would address either is prevalence among those in low income areas, in general, or just about homeowners who are not under the Maryland Lead Law. So, basically in Baltimore, there are still about 5% of children testing positive for lead poisoning. In Maryland, the rate is about 0.5%. Also, in Baltimore, there is a huge gap in the number of children being tested. The blood lead level of concern now is for lead poisoning is 10 mL/g. But there is no safe level of lead. Lead poisoning has its greatest impact on children aged 6 years old and younger. They are exposed through lead paint and dust in homes, drinking water, soil, toys, among many other common areas.
This problem is very important because lead poisoning causes many implications. Lead is a neurotoxin and carcinogen. It causes brain damage, mental health issues, violent behavior, academic failure, and many other problems. Because of these hazardous effects, it makes it rather difficult for children to focus and behave and makes them anti-social and violent. This problem is very relevant to Baltimore and Washington, DC because even though this problem has been helped tremendously, these areas still have a widespread prevalence of lead poisoning.
This problem is of interest to me because I've done a lot of research on it and I genuinely love children! I feel like every child should be able to reach their fullest potential. Lead is 100% preventable, but in no way curable! This is not a significantly difficult problem for it to still be causing so much damage in these areas. Lead poisoning has societal implications and  vigorous efforts should be made to address this issue.

-Thomasina :)

PH Blog #9: Reflection...

First, I would like to say I am very glad to have taken this class. It has confirmed my desire to go into Public Health as a career and learn more about it. In the first 'half' of class, I have learned a tremendous amount of information. Topics that I have found rather interesting are chronic diseases, advocacy, health care reform, and obesity. Chronic diseases basically hit home for me. It is one thing to know that some lifestyle behaviors are unhealthy, but another to be faced with the reality of the consequences. With a diabetic mother and a father with heart problems, that reality was almost amplified when I thought about my future and what it would be like if I didn't make lifestyle changes starting now. This lecture prompted me to go see a nutritionist and actually start incorporating exercise into my daily life- and it has been working pretty well for me! With limited income at home since my mother is the only one working, money has always been an issue when it comes to resources such as a nutritionist or a gym- but now that I am here, I have no excuse. So, I'm glad that the lecture basically changed my life.

Advocacy and health care reform fall hand in hand in my perspective. I pretty much loved these lectures because I'm all for healthcare reform and I love when people advocate and teach others to do so, because that's what I'm all about as well- informing people and lending a hand for them to jump on the bandwagon for health care reform!

The obesity lecture was just another one to remind me of the reality of living an unhealthy life. This lecture was almost like a booster to remind me to keep up the changes and realizing that in the end it will all be worth it- for me and my family to come. I also liked it because of the answer or aspect that was given to the answer of why obesity was becoming an epidemic. It was something I've thought about, and it was interesting to hear it thought out by someone else. I also like the way that lecture was presented- very interesting and almost entertaining! Loved it.

I really didn't find anything too surprising. But I have definitely undermined the role of epidemiology in public health, but after reading and hearing about it, I learned that it is actually very necessary and quite helpful. It acts as a support for public health and I'm glad that I see it that way now.

Nothing has really changed since that blog. Like I said earlier, if anything, it’s that this class, well the first 'half' has definitely confirmed my desire of going into public health. I loved the readings in the textbook and have made my decision to keep it- just because it’s such an easy read and presented rather well compared to some textbooks- it wasn't boring. Nevertheless, I still do plan on going into Health Policy, less of the management side. Definitely up for advocacy as well. I'm glad I took this class. I definitely do see the need for public health to continue and expand in our nation and in the world! There is a need for the emphasis on medicine to decrease and the emphasis on public health to increase- and I have seen that it is a necessary measure to be taken to even begin to combat the issues we are facing today.

Until next wwek,

Thomasina

Blog #8: Quarantine/Isolation- Whose right and whose wrong?

The case I will discuss in today's blog is: Decision of the Supreme Court of South Carolina in the case of KIRK v. WYMAN. Quarantine is for those who have been exposed to an infectious disease, but they may or may not become ill. Isolation is for those who are known to be ill with a contagious disease. So, the difference between isolation and quarantine is the knowledge of whether or not you are infected after the exposure.
I definitely think that state health departments should make the decision as to whether someone should be quarantined. I also believe that the guidelines set for this decision should be agreed upon and made known to the public, and when it comes down to the decision, that it be made in honest judgement and meet every provision and requirement of the already set guidelines. As seen in this case, it became quite a sticky situation, especially since Mrs. Kirk believed and was given an opinion from a specialist in London that her form of leprosy was not contagious. Therefore, I think it should be necesary that the public is informed of the guidelines for quarantines. I also think that it should be stated somewhere that outside opinion is invalidated when you are in the city or state because it can never be clearly known if the opinion recieved from an outside source is valid.
Again, I truly do believe that the state should be held responsible for balance the right of the individual versus the right of the community. I believe that it is more appropriate to err to the side of protecting the rights of the community, but not to the extent that the individual is demoralized or humiliated in any way. I feel like, especially when it comes to contagious diseases, that the community at large should be widely protected, only because if it does spread, it only ends up putting more people in danger and can greatly impact the community in a dangerous way. Like the compromises made for Mrs. Kirk for the place she was staying in, I think that should definitely be instituted when relocating an exposed individual. Even thought it is rather inconvenient to her, it should be made to be understood that its for the protection of the community. This, however is a really sticky situation, but I do believe that the power resides with the states to make these decisions, come up with guidelines to be followed, and inform the public.

-Thomasina

Blog #7: Global Health...Spreading health through wealth!

The article I will be discussing today is: The Challenge of Global Health. This article elaborately details the many aspects and factor that play into the success and failures of global health initiatives. It analyzes problems that arise on behalf of the donors, explains the current conditions of these nations, primarily those in sub- Saharan Africa, and illustrates optimal conditions needed for successful initiatives. The article begins by stating the various amounts of rather huge donations given to improve global health. The writer explains how much money is being given but for narrowing targets that hinder progress. The writer also explains many countries are short in health care workers because many, once trained emigrate to wealthier nations through recruitment or seeking a better life; and hold wealthier nations accountable for making situations in these countries worse because of their frequent recruitments. The article goes into much detail about where the money is coming from- whether it be philanthropic work (a significant amount from the Bill and Melinda Gates Foundation), PEPFAR (provided by the Bush administration), individuals, among many other sources.

It also explains how much of this money comes with strings attached and narrow purposes, making it very hard for change to occur. The article then goes on to explain problems with the funds actually being spent appropriately with estimation that about "half of all the funds donated for health efforts in sub-Saharan Africa never reach the clinics and hospitals." The article continues to analyze all these different problems hindering success, but most importantly, near the end, it states the correlation between maternal health and life expectancy and global health. It explains the optimal conditions required for acceptable global health and how donors should broaden their perspectives and be held accountable for the money they supply, and how these are practical solutions for better global health.

The reasons that I see are most valid for the worsening of public health globally in the developing world is definitely the lack of a health force base in these nations as well as the narrow targets of donors. I see these reasons as the leading causes of this worsening because as the article states briefly, you can help a nation as much as you want, but if they can't stand on their own after you leave, then you have actually done them a disservice. The lack of a healthcare force is a hindering factor also in that with all the money supplied, it’s almost like a lot of it has no receiving end and almost like its being thrown in the air for whoever is around to catch- good or not. The narrow targets of donors greatly inhibits progress because though HIV/Aids is a major issue, it’s only a symptom of the lack of funding when it comes to family planning and maternal health- this is the major issue. The narrow targets almost act like a teaser or a deceiver. Yes, a lot of money is being put in to help, but its helping the wrong things and is yielding no progress.

The two markers considered the most important indicators of the status of health care systems in developing countries are maternal health and overall life expectancy. Maternal health is an important marker because "pregnant women survive where safe, clean, round-the-clock surgical facilities are staffed with well trained personnel and supplied with ample sterile equipment and antibiotics"- all characteristics of a general good facility, and what better place to have that than when life is born. Life expectancy is also an important marker because if children can survive passed their 5th birthday in optimal conditions such as safe drinking water, available immunizations, nutritional food, etc. If any of these factors are absent, many do perish- causing low life expectancy.

Two examples of diseases that extend from faulty systems and the lack of sustainability of current donor practices which led to more deadly diseased states than what was first initially encountered are malaria and HIV/Aids. The current donor system contributes to malaria by most of the time increasing the quantity of bed nets handed to children to block disease carrying mosquitoes. The current donor system contributes to HIV/Aids by usually increasing the number of people receiving necessary drugs. The aid in these cases is both "tied to short term numerical targets" rather than addressing the issue of public health itself.

In such a big world, how can you make a difference?

Until next time,

Thomasina

Blog #6: Beware....Whooping Cough Ressurected!

The article I will be discussing today is entitled: Whooping cough makes a comeback; found in The Washington Post. This article talks about the resurgence of whooping cough in California, especially among young infants. Few babies have died, while hundreds have become 'desperately ill.' The article then goes on to discuss the possible factors that may contribute to the resurrection of this horrible illness. Some factors include it being easy for parents to opt out of vaccinations for their children in California; pertussis is more infectious than other diseases and spreads quickly among those unprotected; and even problems with the current vaccine- it being acellular, rather than a whole-cell vaccine. Nevertheless, vaccines did help get rid of whooping cough for some time, even causing some to believe it was no longer in existence. But, the article still cautions parents to make sure their kids are indeed vaccinated, followed up with booster shots as necessary, even in adulthood, to extinguish this spreading and deadly disease.

Herd-immunity is the idea that if most or a good number of people are vaccinated, even those who are not vaccinated are protected as well because it becomes harder for a virus, bacteria, or what have you, to find a vulnerable and susceptible host. This relates to public health's importance of vaccinations in that the idea of 'herd-immunity' becomes a problem if more people are opting out of vaccines because of it, making it easier for infectious diseases to spread. Herd-immunity only stands true if most people are actually vaccinated; this idea becomes dangerous when parents think their children are ok because the other children are vaccinated, but other parents are probably thing the same thing.

There are many reasons why children don't receive the recommended immunizations. Two that originate from patients/parents are the idea that herd-immunity stands true in their community and some parents are afraid of side effects from the vaccine- such as the mistaken association that the measles vaccine causes autism in children, or real side effects such as fevers and seizures. Two that originate from physicians are that the now commonly used acellular vaccines are not as good as the whole-cell vaccines and that without boosters, vaccines may become ineffective. Two that originate from the healthcare system are that vaccine production and availability is decreasing and that vaccines don't seem to be mandatory in some areas.

In dealing with the recent resurgence of whooping cough, it would be a priority for all young children, students, and parents and other adults working with children or students to receive the vaccination or a booster to create the ideal state conducive for herd-immunity so that those who may not have access are also protected. I also think it would be necessary to immediately put into effect mandatory immunizations required before entering school- public, private, or home-schooled. This would prevent any other resurgence in the future.

Some food for thought.

Later,

Thomasina

#5: Link Between Second-Hand Smoke & Lung Caner (Poor Wives!)

This blog is about a study that was done and showed a link between second hand smoke and lung cancer. A cohort study was conducted in Japan to study the consequences to health of factors such as smoking, drinking, occupation, and marital status. In 29 health center districts, 91, 540 non-smoking wives aged 40 and above were followed for 14 years. They were assessed according to the smoking habits of their husbands, and standardized mortality rates for lung cancer were also assessed. The results were that wives of heavy smoker were found to have developed a greater risk for lung cancer than wives of nonsmokers. A 'statistically significant' dose-response relationship was observed. The advantages of using a cohort study are that common exposures can be determined, the sequence of the disease can be established, and multiple outcomes can be examined. With a large sample size, it is very practical for known diseases such as lung cancer.
Second-hand smoke is most definitely an environmental issue- if it weren't, it wouldn't be a public health issue. The definition of environment is all things external to an individual- it can be divided into physical, biological, social, and cultural factors. The basic requirements for a healthy environment consists of CLEAN AIR, clean water, safe food, peaceful settlements, and a stable global environment- emphasis on CLEAN AIR. Just like toxic gases in the air are seen as environmental issues because of the dangers they possess to people and the very atmosphere and environment itself- so are the carcinogens found in tobacco to be perceived. This study illustrates the evident link found between second-hand smoke and lung cancer in a household setting or marital setting. So, the argument can be made that because these women lived with their husbands and almost always with them is the reason why there is a greater risk. But, according to what we learned in lecture this week, when it comes to cancer, there is no such thing as a safe dose. In the dose-response curve for cancer, response equals risk, and a very small dose can increase risk, unlike some other toxins. So, basically allowing tobacco smoke to contaminate the air strips the atmosphere of the requirement for CLEAN air- which is needed for a healthy environment- making it an environmental issue.
This study most certainly supports that second-hand smoke is a cause of lung cancer. According to Hill's Criteria for Causation, a result is more than an association when there is a great strength of association, consistency of association, temporality, a dose response relationship, and biologic plausibility. Association would not equal causation because the results if the study could have been pure chance, the factors could have been confounding (not very likely in this case), and bias. In this study, though chance could have been a significant factor, the rest are not evident because the fact that other cancers and health problems were not seen was noted and that there was a broad range of which the women were selected. The study purposely chose those in urban areas AND agricultural areas. The study also notes that there was a 'statistically significant' dose response observed. According to this criteria and definitions, it can be claimed and asserted that second-hand smoke is a cause of lung cancer.

Noncommunicable Diseases...Out to get you, no matter who you are!

The article Global Noncommunicable Diseases -- Where Worlds Meet discusses the widespread prevalence of noncommunicable diseases around the world regardless of low, middle, or high income country status. It explains how there are common risk factors globally such as high blood pressure, tobacco use, low physical inactivity, obesity, among many others. The article tries to explain the root causes of these problems such as globalization and urbanization, which is happening all around the world. It is more demanding, than proposing, that world organizations and leaders get together to address this issue immediately and claims that it wouldn't be that difficult to do so if everyone cooperates. Lastly, it emphasizes on how important noncommunicable diseases are as compared to the highly recognized and fought communicable diseases and again urges for the world, essentially, to do something about it. 

I am more than surprised that this problem of noncommunicable diseases is affecting everyone alike. I was convinced that this was only a problem Americans faced specifically because of the widespread risk factors that are growing exponentially among its citizens. Other countries, especially low income ones, don't deal with physical inactivity or obesity, because of either poverty or other reasons, but they still get these diseases. This puts me in a state of bewilderment and leads me to believe that these types of diseases go beyond having money or being in a rather well off country. But this may be the case, especially when you look at the chart provided in the article, because of tobacco use which is known to cause some of these diseases as a risk factor, and it is prevalent in each type of country as the number one or number two cause of death (as a risk factor).

Primary prevention is preventing risk factors from taking place. Secondary prevention is the act of treating risk factors. Tertiary prevention is the act of treating the disease. A chronic disease that was not discussed in class is asthma. Though it’s due to genetics, it can still be prevalent due to smoking or obesity, among others. Primary prevention in this case would be teaching the hazardous effects of smoking in primary education, making Physical Education mandatory in schools, and since it’s passed through parents at times, having parents teach their children to be healthy through parent education about what causes asthma. Secondary prevention would include a change in lifestyle- quitting smoking, exercising more, and eating healthier. Tertiary prevention would be to actually treat the asthma with inhalers, humidifiers, and a clean-up of the home of dust and such. From a public health perspective, it would be to provide greater access to this care and easier access.

I do think the effectiveness will differ in developed and under-developed countries because in poorer countries, access to health care is almost impossible and good health care at that. Things in the environment that may be hazardous in a country that is still being developed may be impossible to do on an individual level, and may require government intervention. I feel like these preventions would be a lot easier in a developed country just because health care is usually better, and it’s sometimes easier when wanting to get things done because of abundant resources.

 Until Later,

Thomasina =]

Top 10 Public Health Achievements..Gotta Love It!

Hello All! I'm going to discuss the article: Ten Great Public Health Achievements --United States, 1900-1999. This article talks about how public health has significantly improved the life quality in America then goes on to list in detail ten of the greatest achievements contributing to this success. These successes are: Vaccination; Moto-Vehicle Safety; Safer workplaces; Control of infectious diseases; Decline in deaths from coronary heart disease and stroke; Safer and healthier foods; Healthier mothers and babies; Family planning; Fluoridation of drinking water; and Recognition of tobacco use as a health hazard- in that order. I think it’s a good article that effectively lists out the examples of how public health has helped and encouraged improvement tremendously, as compared to medicine and such. It definitely puts into perspective this aspect of public health and illustrates how much public health actually helps, even though people may not notice too much. The two that resonate with me are 'Healthier mothers and babies' and 'Safer workplaces.' There aren't any really personal reasons as to why I like these two. I simply love children and love to see them grow healthy from birth, and I'm just glad that this improvement to help mothers and babies is effective and just the access to health care for women is great. My mother's first child died a few days after birth after being born premature, and I also being born premature, am grateful that much has been done to improve the infant mortality rate. Also, for the safer workplaces- I remember learning about the horrendous stories in my US History classes in high school, and I am so glad that they have changed, because they were just too terrible! Men, women, AND children were being affected by their work conditions and events that could have been prevented like fires, or machine deaths, and such, could have been avoided. Another public health achievement that should have been listed is the Needle Exchange programs run in a few cities. Even though they are fairly recent and are not used widespread to fight the war on drugs and reduce harm on those that use them, they are still very effective! They have significantly contributed against the spread of HIV among drug users to their partners, children, and each other. This program has prevented many diseases among drug users and its treatment requirement has also helped to get some off drugs. Side note: I don't know if the different laws and regulations that fall under health policy count as a public health achievement in general, but the health policy that has been enacted with guidance of public health is a main factor as to why many of these Top 10 achievements came to pass; and they, whoever 'they' may be, should be given their props. *CLAPS*

Until next week,

Thomasina

BLOG Assignment: Numero Dos! (#2)

This week for my BLOG, I am discussing the article: Study: 2 popular arthritis supplements don't work from the Washington Post. This article describes a study led by Peter Juni, who is the head of the Institute of Social and Preventive Medicine at the University of Bern in Switzerland. The conclusion that came out of this study was that two very popular supplements to treat arthritis, which has been used widely for the past 10 years, actually are ineffective. The study consisted of 3,803 patients who took glucosamine or chondroitin (the two popular supplements that treat arthritis in the hip or knee) or a placebo. The results showed that either supplements, taken separately or together, did better than the placebo. They came to this conclusion by analyzing the results from these patients. This is a public health issue because it is affecting a large number of people, almost the population of the elderly with arthritis problems. But, this opposed to being a medical issue, is better seen as a public health issue because if two of the most popular, widely used supplements don't work, what does? This then shifts our focus to prevention. This was a statement made at the conclusion of the article:

                                

"Some people may want to consider an over-the-counter trial as part of a wider self-management plan which includes exercise and keeping to an ideal weight," [Jane Tadman, a spokeswoman for the charity Arthritis Research U.K] suggested.

This shows how the focus is being shifted to prevention or even treatment. I chose this article because out of all the articles shown in the health section for this week, this sounded interesting and I felt like this was more public health related as compared to the other, maybe more interesting, ones. I feel like this is a relevant issue because, all jokes aside, it shows how gullible or nonchalant people can be when it comes to their medical care. It surprises me that these supplements have been used for so long and is making a lot of profit (Globally, sales of glucosamine supplements hit nearly $2 billion in 2008), especially since it does not even work. This is important mostly when it comes to ethics and when you realize the function of the people making these supplements- people should be given what actually works, especially for a widespread problem such as arthritis. I think it is also important in illustrating the relevance of public health to step in and put interventions in place to determine preventions for arthritis. The type of study done here was an Intervention (Experimental) study. From what I have learned from lectures and readings, strengths of intervention studies include them being successful in showing how effective an intervention is, the outcome can be clearly seen, and illustrates a clear temporal sequence. Weaknesses include ethical constraints; they are time consuming and expensive, and they are inefficient for rare diseases. I'm not too sure of the specifics on how this study was conducted, but insuring that it was done in a randomized and double-blind manner would yield the best results. If this was not done, this would be the best way to strengthen the study.

Thanks for visiting!

Thomasina

***All references to the article taken from http://www.washingtonpost.com/wp-dyn/content/article/2010/09/16/AR2010091606104.html***

Blog Assignment #1- First Official Blog :)

Hello! My name is Thomasina Anane and this is my blog for my Intro to Public Health class. Here I will discuss my perceptions, thoughts, opinions, and much more about topics discussed during lecture and in the readings. I am interested in Public Health because of the many opportunities it presents to change healthcare in America and around the world. As stated in my first unofficial blog, if anyone cared to read it, I am very much interested Universal Healthcare and how it could be implemented in America. I know, if you are turned off by socialist, this is a pretty extreme vision to have. Though I do not consider myself a socialist, I do hold few socialist ideals. Anyway, I am fully aware that there is much opposition against this idea, and I want to clearly understand why. I want to learn of maybe other methods of changing healthcare, and I want to learn about the different ways in approaching healthcare by the route of Public Health. I am taking this class because I believe it will provide the perfect foundation for understanding and insight into Public Health. I believe it will help a lot with my career aspirations and maybe even narrowing down what I'm looking to and also even opening doors as to where else I could help when it comes to Public Health. Also, knowing about all aspects of Public Health, such as Epidemiology, Health Policy, and such, will help a lot in getting a solid base. Public Health, as I have understood it, and the best definition I've seen so far, is Winslow's definition: Public Health is the science and art of preventing disease, prolonging life, and promoting physical health. Public Health can be divided into six disciplines which are: Epidemiology, Statistics, Bio Medical Science, Social & Behavioral Science, Environmental, and Health Policy. These disciplines all work together is promoting and seeking to fulfill Winslow's definition of Public Health. Long-term interests include a career in Public Health, especially in Health Policy. I would love to work in changing healthcare for the better, specifically in America. But, of course, I plan on majoring in Public Health to learn about all these different disciplines and staying open to all of them. My impression of the first two classes is pretty good. I guess I didn't view it as a lecture class, but I don't mind as much. I like that we are able to ask questions and briefly discuss our thoughts in class. But, I do feel like I'm in the right place in taking this class, because I can confidently say that this is what I want to do with my life with every class I attend and page I read in the book. And I love it..!


-Thomasina Anane

First Day of Class...well, for me at least :)

Tonight, I'm going to speak on the discussion that was going on toward the end of lecture today. As I sat their listening to the question Dr. Alexander posed--[Why are there so many bad outcomes even though so much money is being put into healthcare?]--After the numerous attempts by other classmates to answer this question, I was even getting frustrated. But, then we came to a conclusion of how the disparity in healthcare in America is a significant factor pertaining to the many bad outcomes. But then we began to pull apart the roots, causes, and possible solutions to the disparity. This became even more frustrating. After the second round of attempts by my fellow classmates to attempt at answering this question, I was beginning to get a little bit discouraged. Because even after so much work being put into educating those in urban communities where most have no healthcare, even after children having access to healthcare benefits, and EVEN if we gave everyone a plastic card giving them access to healthcare, things would not change. Dr. Alexander then explained about how in those communities, coming in and changing their way of life is almost insulting, and how healthcare can be put at the bottom of lists of priorities when you are trying to figure out how you are going to feed your children. That changes things a whole lot! For so long, I've been an avid advocate for Universal Healthcare, but then again, whose to say thats really the answer or "cure all"? You see, the problem here is almost intangible. Yes, we can see these things, but what can you really do about it? And as our reading in the textbook put it best, also in the best way I remember and understand it, there is a reason why theorist hate those in Public Health- there is a difference between theory and practice, and public health is the practical approach in trying to combat some of society's ills. But, I can say at the least, even though I don't have the answer or solution to the example above, I am encouraged. I am encouraged to think outside of the box; I'm encouraged to look at all aspects of a problem, not just in one dimension; I am encouraged to keep on thinking and trying to answer these questions. Tackling these almost intangible issues looks almost impossible now, but I believe, even after this class, I will have the ability to do just so.

Until Later,
Tommy :)