Tuesday, June 17, 2008

Fatal dog attacks in Canada

Approximately 15 deaths per year, on average, are attributed to dog-bite injuries in the United States. Victims are usually children. With an average of 1 to 2 deaths per year attributed to fatal attacks by dogs, the pattern in Canada appears to be somewhat similar to that in the United States. However, there are several differences in the epidemiology of dog-bite related deaths between the two countries. Here is the abstract from a study on fatal dog attacks in Canada (Can Vet J 2008;49:373–378) that highlights the differences. [Link]

Tuesday, June 3, 2008

Dr. Sheela Basrur, voice of reason during Toronto's SARS crisis

Dr. Sheela Basrur, the public health doctor, who appears to have calmed and charmed Canada even while Toronto was reeling under the fearful SARS crisis, passed away on June 2, 2008. She was only 51.

I am touched by how much Dr.Basrur seems to mean to Canada at a national level and to the average Canadian. Having lived in the US, I find it hard to imagine similar levels of warmth, public affection and emotions extended towards a public health professional/doctor over there (think CDC) even if they had worked through something as new and scary as SARS. Several factors have aligned together in her case, of course, but not least of which is the comparative smallness of the Canadian population that seems to tap into a 'close-knit community' feel when needed.

A female co-worker remembers bumping into her one day during the crisis as she emerged from a washroom. The co-worker told Dr. Basrur that she looked great and the doctor responded by saying she felt so tired.
“And I said Sheela, you're great,” said the co-worker. “The whole city loves you and is counting on you. And this morning on the radio I heard the host of the morning show say that he knew it was OK to go out because the little doctor with the glasses said it was.”

Toronto Star has a picture gallery and a collection of videos on their site [Link].

I was living in the US during Toronto's SARS crisis, so the first time I heard her voice over the radio was only about a few months ago. She was talking about her cancer and her experience of the health care system as a patient. She was so candid, calm and composed despite probably knowing that the prognosis for her was not good. I felt immense respect and yes, affection, for this stranger whom I have never personally known. You can listen to parts of this interview on the June 2 show of 'As It Happens.' [Link]

As a mother myself, I could not hold back the rush of emotions that swept through my body when I read yesterday that her daughter is only 16 years old.

Of interest to public health and medical students: how her travels to Nepal and India shaped her extraordinary career in public health [Link].

Friday, April 18, 2008

Pets as sentinels

Our cats and dogs, our companion animals, live in our homes, picking up the same chemicals we pick up. If we expect some of those chemicals to affect our health adversely, we can expect to see similar effects in our pets too. Not only that, but as their life spans are shorter (i.e., they age at a faster rate) the endpoints we are concerned with may manifest themselves sooner in our pets than in us.

But first, we need to show that pets actually pick up some chemicals in their systems. Which is what several groups have done in the past. Several more will undoubtedly continue to carry on such work. Read and hear about one such recent effort. [Link]

Thursday, March 20, 2008

Dr. Rosling's presentation with Trendalyzer software

Not only do you learn to present data more effectively, but you also get a 20-minute crash-course on the importance of sub-group analysis, changing socio-economic trends around the world, and their influence on the health indicators. [Link]

Found via Dr. Buttery's blog.

Wednesday, March 12, 2008

Surrogate motherhood

In animal husbandry, surrogate motherhood is not a new concept. Prized foals or heifers with desirable traits and genes are carried to term by "lesser" individuals within the breed or even occasionally, by individuals of related species. The focus is typically on aspects of efficiency--the gestation and delivery by multiple gestational moms during which time the genetic or donor mom is either aging or competing/producing (i.e., doing what a mare or a prized dairy cow is bred to do). We instinctively understand how humans benefit from this scheme. The assumption is that nature is happy with the chosen super(ior) mom. But we don't ever ask what's in it for the surrogate moms.

In humans, it is another story of course, although surrogate motherhood in people is less common. The answers can surprise us. But the development brings with it a whole new set of questions.

Dr. Naina Patel of Anand, Gujarat, alternatively referred to as Dr. Nayana Patel elsewhere, dominates most articles I read (in North America) about surrogate motherhood in India. In these articles she plays twin roles simultaneously--highlighting her role as the Director of the Akanksha Infertility Clinic and voicing her concerns about the lack of regulations by the Indian Medical Council. Clearly there is an unavoidable conflict of interest for her although she is on record claiming ethical and moral thought processes (but some may consider her ethics and morality selective and subjective). For example, as reported in the WebMD article:

But [Dr.Patel] refuses to treat gay couples, revealing her deeply conservative cultural roots. "I get e-mails from gays and lesbians," she says, "some of them very well written — but I don't feel right about helping them."

If empowerment of impoverished Indian women is one major goal of her program, why discriminate against gay couples who have a legal right to become parents in the countries they originate from?

Nowhere in these articles did I find any description or explanation about what happens when the health of the surrogate mother deteriorates on account of the surrogate pregnancy. Perhaps the situation has not come about yet. It is true that the potential surrogate moms are carefully chosen to be at low-risk for most pregnancy-related adverse events and are even more carefully monitored once they become pregnant. But what happens to the family of the surrogate mother in case of medical emergencies or tragic circumstances arising from the invasive procedures and/or pregnancies? This is a question that is also asked by C.P.Puri, Director of National Institute for Research in Reproductive Health [Link here.] With only about 50 surrogate pregnancies reported from India thus far, sorting out the legal and ethical nuances may not yet be a priority for the country; but I cannot help but think that all political hell will break lose if and when there will be one well-publicized adverse (health) incident.

It is interesting to see how the law regarding surrogacy differs in different countries. Canada, U.K. and parts of Australia do not permit commercial, but allow altruistic, surrogacy. In Israel, commercial surrogacy is legalized but altruistic and familial surrogacy is banned based on religious principles. In the United States, a large number of states have banned all forms of surrogacy (Reilly DR, 2007). The nuances in the ethical and legal aspects of caring (by a physician or another health-care worker) for a surrogate mother are well articulated in the following articles. Read here, here and here.

Wednesday, February 20, 2008

Midlife Suicide--On the radar of Public Health professionals

A NYT article by Patricia Cohen highlights recent findings about "an unusually large increase in suicides among middle-aged Americans in recent years."

A new five-year analysis of the nation’s death rates recently released by the federal Centers for Disease Control and Prevention found that the suicide rate among 45-to-54-year-olds increased nearly 20 percent from 1999 to 2004, the latest year studied, far outpacing changes in nearly every other age group. (All figures are adjusted for population.)
...The question is why...
Experts say that the poignancy of a young death and higher suicide rates among the very old in the past have drawn the vast majority of news attention and prevention resources. For example, $82 million was devoted to youth suicide prevention programs in 2004... Suicide in middle age, by comparison, is often seen as coming at the end of a long downhill slide, a problem of alcoholics and addicts, society’s losers.
“There’s a social-bias issue here,” said Dr. Eric C. Caine, co-director at the Center for the Study of Prevention of Suicide at the University of Rochester Medical Center, explaining why suicide in the middle years of life had not been extensively studied before.
There is a “national support system for those under 19, and those 65 and older,” Dr. Caine added, but not for people in between, even though “the bulk of the burden from suicide is in the middle years of life.”
Of the more than 32,000 people who committed suicide in 2004, 14,607 were 40 to 64 years old (6,906 of those were 45 to 54); 5,198 were over 65; 2,434 were under 21 years old.

Read the article in its entirety here. [Link.] The reader comments are worth a read.

Tuesday, February 12, 2008

Can we fight bird flu by thinking globally and acting locally?

Ashfak Bokhari has written an articulate, to-the-point piece on the corporate roots of the dreaded bird flu in Dawn, Pakistan's English newspaper.
...[It] is the industrialisation of today’s poultry sector which is creating conditions for bird flu to emerge again and again and spread rapidly. The example of Bangladesh is quite illustrative. The country is seen as a success story of the “livestock revolution”, having converted about half of its national poultry production from backyards to intensive and semi-intensive industrial farms. The micro-credit NGO, the Bangladesh Rural Advancement Committee (BRAC) was instrumental in this transition by financing groups of poor women to set up thousands of mini-factory farms.

In the process the BRAC became a major, vertically integrated poultry corporation, with its own large-scale hatcheries, poultry farms, and feed mills that supply the smaller units...In 2005, the government contracted [BRAC] to monitor “hotspots ” in the country where migratory birds flock, and to convert the country ’s open-house hatcheries into bio-secure closed facilities. But these actions failed to stop the bird flu outbreak of March 2007 which happened at a completely closed poultry farm – one of the country’s largest broiler operations and hatcheries. From there, it spread quickly through the smaller model farms and some other large-scale operations.

But what happened in Laos is a different story. The major reason why the country has not suffered widespread bird flu outbreaks like its neighbours (Hong Kong, Thailand, Vietnam and China are the most affected) is that there is almost no contact between its small-scale poultry farms, which produce nearly all of the domestic poultry supply, and its commercial operations, which are integrated with foreign poultry companies.

Laos effectively stamped out the disease by closing the border to poultry from Thailand and culling chickens at the commercial operations...[U]nlike in Thailand and Vietnam, small-scale farmers in Laos are not supplied by big companies with day-old chicks or feed and, outside of its capital, poultry is produced and consumed locally. Poultry production is also more spread out in Laos. It is less dense, less integrated and less homogeneous – all of which keeps bird flu from spreading and evolving into more pathogenic forms.

The Laos experience suggests that the key to protecting backyard poultry and people from bird flu is to protect them from industrial poultry and poultry products. ...Traditional farmer knowledge and biodiversity combined with simple bio -security measures appropriate to small farms may be all that is required to manage the disease effectively in most rural communities. [Link]
The article, which you can read in its entirety here, is thought-provoking. However, intensive farming and industrialization of farm production mechanisms were embraced in the last century not only for corporate profits, but also to efficiently produce enough to meet the basic needs of a growing population worldwide. (Whether these needs were met is a different can of worms.)

As a student interning in mega-dairies and doing rounds in vertically integrated poultry farms, I thought of the trend as 'quantity first and foremost.' All practices and developments were data driven. You couldn't argue with production numbers even as you simultaneously learnt about endangered breeds and lack of biodiversity in livestock. I am not even touching upon the issues of public health and hygiene that are to be considered while packaging and transporting milk and meat to consumers concentrated in mega-cities.

Perhaps national objectives, for the most part, were deliberately and necessarily narrow. Perhaps people did not ask all the right questions, and systems did not put a value on differing viewpoints.

Wednesday, February 6, 2008

The Imposter Syndrome

Dr. Richard Sigurdson, Dean of the Faculty of Arts and Professor of Political Studies at the University of Manitoba, has an enlightening introduction to the phenomenon known as the Imposter Syndrome.
... the term "Impostor Phenomenon" (IP) was coined by psychologist Pauline Rose Clance. Working with psychotherapist Suzanne Imes in 1978, she discovered a condition of self-doubt and failure to internalize success in a sample of more than 150 high-achieving women. [Link]
Now I know. After 16 years of post-secondary education and 3 further years of post-doctoral training, I learn that there is possibly a term to describe what I experienced all those years. Ironically, I learn about it at a time when I finally feel self-assured and confident enough to look forward to a potentially meaningful and successful academic career ahead of me. All it took for me to experience this transformation was to work on my own for the past 2 years--identify a new research area, write my own papers for peer review from start to finish, and call my successes (and my failures) my own--without the comfort of support and timely criticism that are usually taken for granted within established research groups. It also helps that I am no longer living on a post-doctoral salary. Much as I hate to put it in writing in a public place, the fact remains that being paid comparatively better also makes me want to prove to myself and to my seniors that I am worth the price.

How else can I explain the change in my attitudes and beliefs toward myself and my professional scope? Except for age (and marriage and motherhood), all other background variables I came with when I stepped into a postgraduate program in North America remain the same after all these years. I am left to conclude that age (or rather, accompanying maturity and personal life experiences), relative independence at work, and some tangible rewards have finally made me lose my fear of failure and gain a realistic perspective of my role in an ever-expanding world of research possibilities limited only by the imagination. (The finiteness of research funding and publishing space in journals are blissfully and temporarily forgotten on purpose).

Monday, January 28, 2008

Towards an environmentally friendly diet

A comprehensive NYT article titled 'Rethinking the Meat Guzzler' by Mark Bittman, who is not a vegetarian, can be found here. Health of the environment is the major focus of his arguement.

Thursday, January 17, 2008

Painless curriculum

Canadian survey reports Veterinary Medicine grads received more designated hours on training and education in pain than other Health Sciences students, including grads in Medicine, Dentistry, Nursing, Pharmacy.

My first thought was along the lines of "this must be because pet owners expect (and demand) more options in pain management for their pets." Perhaps, we have a lot more to learn from veterinary medicine and veterinary medical systems than just the mechanism of diseases in animal models. What is good for the goose should be good for the goose-farmer.

The survey report answers some questions you should have at this point. The average of 87 hours of formally designated pain content in the veterinary curriculum was based on data provided by 3 schools, one of which reported 200 hours. This skewed the mean considerably in favor of vet schools. (However, compare this with the maximum reported hours of 24 and 38 for the disciplines of dentistry and medicine, respectively). Figure 1 in the report details the extent of integrated content across several courses and/or clinical conferences. Fifty-four percent of the (non-veterinary) respondents reported pain content was integrated into several general courses. All respondents indicated pain content is mandatory. So breathe deeply, people. All is not left to chance, although as the study investigators indicate human health professional students could be introduced to more structured pain in their curriculum.