Category: Uncategorized

GOP Bill Halts in Senate

Remember back in May when the GOP health bill passed in the House? The momentum stopped there.
The Senate failed to pass a GOP-proposed Health Law yesterday. Senate Majority Leader Mitch McConnell says they’re going to try again early next week, though it doesn’t seem like this will be a promising attempt either. Analysts attribute this to many deep-rooted factors:  the Republican party as a whole not unified behind an action plan other than repealing the ACA, the taking away of funding and resources without a viable exchange, and a severe lack of public hearings and drafting.
Provisions included in a draft of the bill last week including capping funding for Medicaid, and giving states the power to opt out of insurance regulations substantiated in the Affordable Care Act. This fielded much opposition from more moderate Republicans. They cite problems  such as too “deep cuts” to Medicaid, and an insufficient means to account for the expenses of changing the insurance system. This opposition was especially strong in Republican states like Ohio that had expanded Medicaid under the ACA.
Now, Republican Senators are working on re-drafting a “repeal and delay” bill that would phase out aspects of the ACA over a two year time frame–a version of this bill passed in 2015. Of note, the draft of this bill to be debated does not include an amendment proposed by Senator Ted Cruz. According to a report conducted by the Department of Health and Human Services, this amendment might actually result in broader coverage and lower premiums. The quality and correctness of this report is already under great criticism by healthcare and insurance analysts.
Sources: The New York Times, Kaiser Health News

Physiology and Space Travel

Next week will mark the 48th anniversary of the first manned moon landing, conducted by Apollo 11 on July 20th, 1969. It marked a momentous and patriotic moment for the United States, which remains the only country to have successfully accomplished this task, and for the field of aeronautics as a whole. Indeed, “a giant leap for mankind”! (more information about the landing itself here).

Long space missions like Apollo 11 are also a huge physiological feat. Conditions on Earth aren’t the same as they are in space, or on other celestial bodies. Microgravity and radiation effects, just to name two, are really different on the moon than they are here at home. When you go on a mission to Mars, for instance, your body goes through three separate gravity fields. And when you are in the spacecraft, you are exposed to a very contained and unique ecosystem. Scientists back home monitor saliva, urine and blood content to ensure latent viruses, like herpes or Epstein-Barr, are not reactivated.  Astronauts are also subject to about ten times more radiation than normal when they visit the space station, which can have immediate as well as longer term effects on the central nervous system.

As one article published in the Canadian Medical Association Journal sums it up, “astronauts are people with normal physiology who live in an abnormal environment”. Here are some changes the body makes in order to adapt, or acclimatize, to space travel (summarized from this nifty table here):

  • Fluid re-distribution (a temporary in-flight decreased flow to the legs, and increased flow to the head and torso)
  • Neurovestibular effects (the motion sickness astronauts can expect to feel when traveling)
  • Muscle mass changes (mass will decrease up to 30% and will regain/recover post-flight)
  • Bone demineralization (a loss of almost 60-70% in calcium, as well as decreased thyroid activity and Vitamin D production, which recovers upon returning to Earth)
  • Psychosocial effects (Weariness and emotional effects)
  • Immune dysregulation

There are some measures that can be taken to counter these effects, including the following: exercise, negative pressure space suits, anti-nausea medication, resistance training, diet supplements, and exposure to artificial gravity during flight.

Curious to learn more? Here are a few more fascinating reads to get you started from Harvard, the Smithsonian, and StatNews.

Side Note–if you’re a local NC reader, I hope you’ve visited Morehead Planetarium, on UNC’s Chapel Hill campus! Apollo mission astronauts Neil Armstrong, Buzz Aldrin, and Michael Collins all trained here–as well as other space giants.

 

Turmeric’s Health Benefits

To this day, if I’m feeling a little under the weather, my parents will prescribe a healthy dose of turmeric. Sore throat? Teaspoon of turmeric in warm milk. Acne acting up? Make a turmeric paste. Feeling weary? Add some more turmeric in your veggies when you cook.

Turmeric is a naturally bitter spice, but my ma and pa are right–it’s somewhat of a super food! It’s an anti-oxidant as well as an anti-inflammatory agent. It’s also been known to have anti-fungal and anti-cancer properties.

Curcumin, the phytochemical that gives turmeric it’s trademark yellow color, makes up about 2-5% of turmeric, but is responsible for most of its recognized therapeutic effects. It was first extracted from turmeric in the early 1800s and since then has been used extensively in Asian cooking, religious ceremonies, and for medicinal purposes. It works by regulating transcription factors (proteins that are important in converting DNA to RNA, which then codes for genes). It is also thought to bind to cellular proteins, and to be able to help stop the growth of tumor cells.

But wait, there’s more! With that strong yellow color, it makes a very effective natural food coloring, and can function as a preservative of sorts. All in all, not a bad spice to throw in the mix every now and again.

I think I may just roll my eyes a little less the next time my mom tells me drink a warm cup of haldi (Hindi for turmeric) milk before bed.

Potato & Peas Stew

In the heat of June you wouldn’t expect to crave a warm stew. The summer storming we had last week, though, got me thinking about my mom’s comforting potato and pea stew. It’s warm, just a tad spicy, filling, and pretty healthy! Try it out next time the clouds look gloomy:

Ingredients:

4 tbsp oil

1 tbsp cumin seeds

3 large potatoes

1 12 oz bag of frozen peas

3 medium tomatoes

4 cloves garlic

2-4 oz water

Seasoning: turmeric, coriander powder, salt

Fresh cilantro, for garnish

 

Heat oil, then add in cumin seeds and minced garlic. Saute until golden brown. Add in cubed potatoes, and some water. Then cover and let cook until potatoes are almost done. Add in chopped tomatoes, mushing and mixing until well combined. Add in frozen peas. Season with salt, turmeric, and coriander powder, to taste.

When potatoes are cooked through, garnish with chopped cilantro.

Serve over rice or with naan/roti.

Enjoy 🙂

What’s Ruining Healthcare, Again?

Forbes published an article earlier this week titles “10 Ways Lack of Communication is Ruining Healthcare”. If you’ve been following healthcare at all since January, “ruining healthcare” is not an unfamiliar term to hear tossed around, but wouldn’t you think that was all due to politics.

It may or may not be surprising to you that the tragedy they’re referring to is lack of communication–between hospitals, between health care workers, between patients and providers, between institutions…..gaps, all around!

If you need a little inspiration after reading that article, check out this TED talk by Eric Dishman, on why and how healthcare is a team sport:

Switchpoint Conference-2017

Switchpoint is an annual conference brought to North Carolina by IntraHealth.

With a massive stage that hosted a diverse array of speakers and presenters, the energy in the Haw River Ballroom last week was almost tangible last Thursday and Friday, for the 7th annual conference.

The day I attended was filled to the brim–speakers ranging from behavioral economics to digital epidemiology to “Artivism”, break-out sessions with hands-on activities, and live music. One of the main goals of the conference was to allow speakers of similar mindsets, from across the country, to network and connect. That’s a cool thing to see happen before your eyes.

I’ll leave it to you to check out the speakers’ profiles and the microlab sessions made available to participants, form your own opinions or get inspired as the case may be. But I will say that as a Health Communication student, it was a nifty experience and definitely provided some food for thought. I’d highly recommend it to other students in this field or in public (especially global) health.

And on that note, to the other students: good luck finishing of the semester strong!

 

 

Summer Tanning

With summer just around the corner, the beach calls: sun, sand, and a chance to get the long-awaited tan. Carefree, however, doesn’t mean careless. It’s important to remember that, as our first defense against the outside world, the skin is subject to a lot of damage. About 90% of melanoma cases are caused by UV exposure (which can occur with indoor tanning or unprotected exposure to the sun).

The Journal of Health Communication reported in a March 2017 article that one way to more effectively convey the long-term negative impact of tanning beds was by pairing them with images of skin cancer or wrinkles. The study showed that these messages were more effective than images depicting short term effects. A 2008 study reports a 75% increase in risk for melanoma with use of artificial tanning devices, and a higher risk when first UV exposure via indoor tanning is in the teenage years. Looking at two decades of targeted campaigns, it attributes, in part, an increase in indoor tanning to a failure of messages to influence tanning attitudes.

The CDC defines indoor tanning as using a tanning bed, booth, or sunlamp–all of which expose users to UVA and UVB rays. This may lead to increased risk for melanoma, basal cell carcinoma, squamous cell carcinoma as well as cancers of the eye and cataracts. Their site also cites a 2014 article that estimates more than 400,000 of indoor tanning related cancer cases per year in the United States.

This is a significant burden–in fact, the FDA proposed a rule that would restrict minors from participating in indoor tanning.

Sources:

http://www.news-medical.net/news/20170425/Images-showing-impacts-of-indoor-tanning-may-be-effective-in-communicating-health-risks.aspx

Robinson JK, Kim J, Rosenbaum S, Ortiz S. Indoor Tanning Knowledge, Attitudes, and Behavior Among Young Adults From 1988-2007. Arch Dermatol. 2008;144(4):484-488. doi:10.1001/archderm.144.4.484

Sontag, J. M., & Noar, S. M. (2017). Assessing the Potential Effectiveness of Pictorial Messages to Deter Young Women from Indoor Tanning: An Experimental Study. Journal of Health Communication, 1-10.

Wehner, M. R., Chren, M. M., Nameth, D., Choudhry, A., Gaskins, M., Nead, K. T., … & Linos, E. (2014). International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA dermatology, 150(4), 390-400.

 

 

Naming Flu Viruses-Nothing to Sneeze At!

By Arshya Gurbani

I’m sorry about the title, too. I heard a pretty ridiculous pun today, and I guess they’re just contagious…much like the flu.

That’s right–sure as the sun rising each morning and the certain as the pride every Tarheel felt following last week’s momentous basketball victory…flu season is back again. In the US, flu season tends to peak somewhere between December and March. A highly variable virus, influenza strains are often different than the previous years’, which leads to the need to constantly update and refine  recommended vaccines for the year. It’s why you have to go back to get a flu shot every year.

Of course, it’s important to know what you can do to prevent getting ill. If you need a refresher, quick shout-out to a fellow UpstreamDownstream blogger from the past: Surviving Flu Season.  But I thought it’d be kind of fun to talk about the influenza virus itself. (You may roll your eyes at “fun” but you’re still reading…)

There are 4 types of the influenza virus, A-D. Influenza A and B are the most common causes of the seasonal epidemic known as the flu that afflicts the US. The A viruses has hemagglutinin and neuramidase surface proteins, also called H and N subunits. That’s where the name of a particular strain comes from. Remember the H1N1 pandemic in 2009? That’s right–the H1 refers to 1 of 18 known H subtypes, and N1 refers to one of 11 known N subtypes. Both of these proteins live on the outside layer of the virus, also known as the viral envelope. They act sort of like bridges, connecting the virus to our cell membranes by latching on to one of the sugars in our cell membranes, sialic acid–H helps the virus enter our cell, and N helps it leave. Pretty nifty, right? Here’s a helpful visual from David Goodsell’s “Molecule of the Month” blog featuring H and N:

 

 

As mentioned earlier, the strain of influenza virus most prevalent in any given season can change. Now that we have a vague idea of the naming system, let’s talk about which strains vaccines recommended for the 2016-2017 season protect against. There are 3-component and 4-component vaccines:

  • A/California/7/2009 (H1N1)pdm09-like virus
  • A/Hong Kong/4801/2014 (H3N2)-like virus
  • B/Brisbane/60/2008-like virus (B/Victoria lineage)
  • B virus called B/Phuket/3073/2013-like virus (B/Yamagata lineage) –only in 4 component vaccines

So far this season, according to a Morbidity and Mortality report looking at data from Oct-Feb, the A(H3N2) virus has been the most prevalent. Around 94% of infections were caused by Influenza A, and 98% of these were attributed to the H3N2 strain. Overall, the report says, it’s been a pretty moderate season.

I hope you enjoyed that brief dip into biology–who knows, if enough of you did, maybe this post can go, you know ….viral.

References:

https://www.cdc.gov/flu/about/viruses/types.htm

https://www.cdc.gov/flu/about/season/flu-season-2016-2017.htm

http://blog.h1n1.influenza.bvsalud.org/en/2009/09/10/molecule-of-the-month-presents-hemagglutinin-and-neuramidase/

 

 

Promoting Healthy Habits? Tell a Story

Researchers at the University of Southern California have been studying how narrative influence health behavior. They wonder if it might not be more effective to present information as a story. Their results thus far show that, in fact, this may be the case.

Narrative communication has been defined “any cohesive and coherent story with an identifiable beginning, middle, and end that provides information about scene, characters, and conflict; raises unanswered questions or unresolved conflict; and provides resolution”.

A recent article published by the Contributor and re-published by US News  discusses a study that attribute the greater success of narrative-driven presentation to 2 key factors: 1) identification with characters and 2) transportation to and absorption in the story. Both of these psychological processes assist with retaining information. Harnessing this to create characters that are identifiable role models is the key, the author says, to reducing health disparity.

Not surprised by this finding? It does seem somewhat intuitive that something with a story-line is more appealing. The point is, it’s not necessarily how we think to present a message with a scientific or health-rooted concern. We tend to rely on facts, or on recommendations. The article suggests that collaboration across disciplines is important in reaching the most beneficial results.

Utilizing narrative can be tricky, however. A 2016 article on the subject, published in Health Affairs, notes some possible limitations to incorporating narrative into clinical practice. For instance, it may be hard to generalize data that is based on narrative–it may not appeal widely nor have equal effect in diverse populations. Confidentiality may be another barrier. These make it difficult, the authors say, to translate good narrative into practice. They do offer some recommendations on how to address the problem. However, it’s clear that there is a gap to be bridged.

It’s a good reminder that sometimes data collected is only a glimpse of the human it represents.

References:

Dohan, D., Garrett, S. B., Rendle, K. A., Halley, M., & Abramson, C. (2016). The importance of integrating narrative into health care decision making. Health Affairs, 35(4), 720-725.

Hinyard, L. J., & Kreuter, M. W. (2007). Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview. Health Education & Behavior, 34(5), 777-792.

https://www.usnews.com/news/healthcare-of-tomorrow/articles/2017-03-03/stories-are-better-than-lectures-at-teaching-us-about-health

 

GOP Proposal for the American Health Care Act in the works

The Huffington Post reported this morning that the American Medical Association (AMA) is joining other big names in health and patient advocacy to push back against the GOP proposed health bill to replace The Affordable Care Act.

The AMA has historically been a key voice in health care, often opposing national level reform in order to protect clinical practice. However imperfect the 2010 roll-out of the Affordable Care Act (ACA/ObamaCare was), they agree that certain aspects of the ACA should not be rolled back now. In particular, they agreed that the ACA allowed for Medicaid expansion to cover more lower income individuals. They make the argument that the newly proposed bill provides government subsidies based on age, rather than income, which would be  problematic and cause loss of coverage and higher costs.

Other groups that are pushing back against this reform include the American Health Care Association, the American College of Physicians, the American Hospital Association, the National Center for Assisted Living, and the National Health Council. So who actually agrees with the proposed bill? The medical device industry, who claim that cutting taxes on medical devices will allow for growth in innovation that will eventually lead to better care. The counter argument to this claim, it seems, is that though quality of care must indeed improvement, this is irrelevant if people who need it cannot even afford coverage.

If you’d like to read up more on the proposal, the American Health Care Act, and how it differs from what is currently in place, check out Kaiser Health News’ article on the subject. They explain the funding changes the proposal suggests: how tax credits for insurance will change, the addition of caps to the current Medicaid funding, benefits fort he wealthy, penalties for those who have gaps in coverage, and a change to a free market system.

As expected, much is still unclear, but the calls to slow down the repeal process while details are ironed out appears to be quite loud.

Sources (linked in text): The Huffington Post, Kaiser Health News, U.S. Department of Health and Human Services