Friday, October 26, 2012

Weekly Health Roundup

It’s Friday—time to check in on what’s happening in health!

We’ve seen our share of health news this week—from a malaria outbreak in Greece, thought to be exacerbated by their economic depression, to the roller coaster/soap opera that is Europe’s battle against tobacco.

On the new research front, a recent study from the University of Toronto published in the Proceedings of the National Academy of Sciencefinds that adversity during childhood can yield positive results later in life in the form of persistence and self-control; while a British study soon to be published in Social Indicators Research, finds that fruits and vegetables may not just good for your body, but also for your soul.

But today, we’d like to focus on preparing you and your family for a weather event that is heading up the east coast. Hurricane Sandy is projected to start affecting our area early next week—and we want to make sure you have what you need.

Earlier this year, we shared the results of the inaugural Adelphi University Center for Health Innovation Poll, which found that we just aren’t that prepared for emergencies—mostly because we don’t think we’ll be impacted. According to our poll, 84% of Americans don’t think it’s very likely they will be affected by a disaster. You can hear more from the CHI team about our poll on this podcast.

However, it looks like we may, in fact, be impacted by a weather event in the next few days. We urge you to act upon the poll’s findings and use the time ahead of the storm to prepare yourself and your family.  To assist you, here are some important resources from How to build a basic disaster kit for your family ; Creating a Family Emergency Plan; and What to do Before, During, and After a Hurricane.

Friday, October 19, 2012

Weekly Health Roundup

It’s Friday…which means it’s time for the Center for Health Innovation’s Weekly Health Roundup.

The U.S. presidential debate dominated media coverage this week, with healthcare taking a backseat to foreign policy, the economy, job creation, and other contentious topics Tuesday night.  Nonetheless, you may have caught the candidates’ brief exchanges on women’s health issues, health insurance premiums, and Medicare in between the jabs and hooks.

In honor of World Food Day this week, and at the intersection of food and politics, did you savor Michael Pollan’s article on the political implications of the burgeoning food movement in the New York Times Magazine’s annual Food and Drink issue? Foodies and health-minded individuals will surely pay close mind to California this November as it votes on Proposition 37, requiring genetically modified foods to be appropriately identified and labeled. And speaking of labels, Mark Bittman’s exercise in reimagining a more useful and streamlined food label distills food worthiness down to a numerical score and a traffic light color-coded system. Is this an oversimplification or a step in the right direction?

Peeking ahead to next week, Adelphi relishes National Food Day on October 24 with a series of on-campus events to highlight the need for sustainable, affordable, and healthy food for all. Free events include the Long Island premiere of The Harvest/La Cosecha, the story of migrant child workers working on U.S. farms; a Farmers Market; Iron Chef Competition; and an interactive food memory project.  To kick off National Food Day, famed celebrity chef and motivational speaker Chef LaLa brings her cooking show to Adelphi on Tuesday, October 23. Make sure to check out all of our Food Day-related events.

If an apple a day keeps the doctor away, it seems a vitamin may be a worthy substitute.  Encouraging news for men who take daily multivitamins came from a paper presented at the American Association for Cancer Research conference.  Men taking a daily multivitamin were diagnosed with 8% fewer cancers than their placebo counterparts. 

Saturday, October 13, 2012

Some thoughts about “Homeland” from a clinical psychologist’s point of view interested in epistemology

by Dr. Jacques Barber

There is a first time for everything.  This will be the first time that I blend my interest in psychology with my interest in a TV series.  The series Homeland, which just won several Emmys awards, has many interesting aspects, including many psychological ones.  In fact, there are so many psychological angles to focus on that I will have to be selective. I will focus on Carrie and her psychological struggles.  At the end of the first season, her bipolar disorder is exacerbated by the stress and complexity of the situation that she is trying to solve.  Solving complex problems is stressful; stress and lack of sleep are detrimental to individuals with a tendency to have difficulties maintaining a stable state of mind and emotional balance.  My focus on this blog is to discuss her “disease,”  how her disease leads Carrie to be mistrusted, and how it is easy for “normal” people to dismiss the views of individuals different from themselves.   Furthermore, I will touch on the topic what is “truth” and how do we know it.

The viewer knows that Carrie is onto something when she is suspicious of Brody.  Because her behavior is somewhat erratic and her theories are quite unusual if not “crazy,” her colleagues begin to distrust her.  In fact, it is heartbreaking to see how easily dismissed somebody who sounds crazy can be.  It is easier for those around her to distrust her and to dismiss her Ideas or “hypotheses” than to take them seriously, or even ponder, what she was suggesting.  How can an American hero, a Marine, who has survived hardship during years of captivity, betray his country?  How could he really plan to murder the Vice President of the USA and his entourage (e.g., the defense secretary)?

Many psychologists and psychiatrists have tried to find deep meaning in human behavior, including abnormal behavior.  One of the first was Freud, the father of psychoanalysis, who attempted to explain hysterical symptoms (e.g., hysterical hand paralysis which is a phenomenon that is not consistent with what we know about the neurology of hand function) with a far-reaching theory of the mind.  His psychoanalytic theory of the mind, which some people consider quite farfetched, has recently received some support from neuroscience findings.  This is happening at a time when the popularity of Freudian therapy is declining around the world.  Watching “Homeland” the viewers, however, do not need to understand the deep causes of Carrie’s delusions.  This is not necessary as we know that her views are not delusional.  This is reminiscent of the non trivial saying “Just because someone is paranoid, it doesn’t mean he’s not being followed.”  The viewer knows enough to understand that Carrie’s theories are not off the wall; they are close to reality.  Keep in mind also that the reality is evolving as Brody becomes more involved in what could be called anti-American activities (e.g., collecting secret information from the CIA) than he actually planned initially.

If we stick with what is known, are Carrie’s hypotheses farfetched?  Is she delusional?  Delusions are not a typical feature of bipolar disorder.  Systematic delusions like Carrie’s are more a characteristic of paranoia (now called delusional disorders) or to a lesser extent of schizophrenia.  But we do not need to be too technical here; after all, it is a TV series.  So let’s discuss delusions.  Following the work of Fried and Agassi (1976), I will surmise that in paranoia the delusion is very systematic. How do we know when a systematic delusion is true or when is it false?  Can we even know when a scientific theory is delusional, or when it is true, for that matter?  For example Copernicus was initially dismissed as irrational.  Although much has been written about how, and whether, the validity and truth value of scientific theories can be corroborated, there is little work that takes seriously the question, how do we decide that a delusion is indeed delusional?  Is it when it does not correspond to reality or to the facts? Do we ever have all the facts? These are very basic questions that mental health experts and epistemologists should grapple with but, for the most part, they have not (exception includes Fried and Agassi). Early in my life these questions occupied much of my thinking, and intellectual energy.  The question is: What distinguishes a delusional theory from any kind of theory, including a scientific one?  How do we know that a scientific theory is valid while Carrie’s is not?

She is dismissed. It is also interesting that when, as she is going to receive her first ECT, she remembers that Brody knew Abu Nazir’s son and she asks her sister and the nurse to remind her of that after the ECT. However, the nurse dismissed her.  Yes, it is common for patients under anesthesia to say things that make no sense.  And even if what they express is logical and sensible, how can a nurse or doctor hearing those fragments of thoughts understand them without the context?   Furthermore, the anesthesia nurse has heard many depressed patients (depression is one pole of the bipolar disorder spectrum) saying all kinds of things related to their own lives. Likely she long ago stopped trying understanding what the patients are saying, or meaning. 

I will bet that most viewers feel sympathy towards Carrie; she cares about her country, and she is extremely dedicated.  In fact, she is willing to follow her views in the face of ridicule and adversity.  But in the end she gives up.  She comes to believe she is wrong, and she feels badly (depressed) about having caused harm to Brody and his family.  Is it a coincidence that she is a woman, and that as a woman with mental health issues she is dismissed?

How do we increase tolerance and respect for people who are different from us?  I think the first step is to listen to them and not dismiss them automatically.  I know that this is hard; it’s hard to listen to somebody from the extreme right, or the left, etc.  But one message I take away from the show , even if the writers didn’t intend it, is that it is worth listening to people like Carrie and perhaps even to Brody (note that how his daughter listens to him and the impact it had on him when he decides not to detonate the explosive vest in the bomb shelter). If we listen, we open up the possibility of learning something new. 

Fried, Y. & Agassi, J. (1976) Paranoia: a study in diagnosis.  Boston Studies in Philosophy of Science, Volume 50.  Dordrecht:  D. Reidel Publishing Company

Jacques P. Barber, Ph.D., ABPP is the dean of the Derner Institute of Advanced Psychological Studies at Adelphi University and Emeritus Professor, Perelman School of Medicine, University of Pennsylvania and Adjunct Professor of Psychiatry, New York University Medical School.

Friday, October 12, 2012

Weekly Health Roundup

Another Friday means another Weekly Health Roundup!

We’re starting off this week in Kenya, where researchers at the Harvard School of Public Health spent a year collecting data from the 15 million cell phones used in the country. Why? To map how malaria spreads through the country. The results reveal some surprising information. First—and perhaps most distressing—is that mega-cities, like Nairobi, are seeing increased malaria cases, meaning mosquitoes are learning to adapt to big cities. However, the data also provide encouraging opportunities for better focusing malaria control efforts, as well as dispersing outbreak and treatment information to large groups of people at once.

State-side, the US continues to deal with more reported cases of the rare but non-contagious fungal meningitis thought to be caused by contaminated drugs administered via spinal injection. This interactive map from the New York Times  provides updated information on reported cases. As the number of cases has risen, media coverage has turned its focus, in part, on exploring spinal injections’ big-picture risks, ones that existed well before this recent outbreak.

And before you start thinking that the news is entirely grim this week, a new report by the Centers for Disease Control might make you feel better. Their data indicate that while the average overall life expectancy in the U.S. has remained the same (78.7 years), death rates overall reached a record low. But the most positive finding was that death rates for five of the top 15 causes of death dropped in 2011. Even more encouraging are the declines in death rates from cancer and heart disease, which together, accounted for close to 50% of all deaths in the United States in 2011. Although HIV is not in the top 15 causes of death, it saw a 7.7% in death rate, but researchers warned that it is still a public health concern particularly among the 15-64-year-old populations.

Monday, October 8, 2012

Abortion: From Contentious Debate to a Non-Issue?

by Philip Alcabes, Ph.D.

There hasn’t been much hope in the past few years that concord will calm America’s no-holds-barred struggle over abortion.  But what if abortion were to become a rare event? There’s reason to hope that a new policy approach might make abortion a non-issue, or at least a less inflammatory one.

This week, the Associated Press reports on a study in St. Louis showing that when women have access to a variety of contraceptives at no cost, abortion rates fall dramatically.  In the study of nine thousand women, many of them lacking health insurance, who were given contraceptives of their choice at no cost, only 0.4 to 0.8 percent had abortions per year – far less than the 2 percent per year that, according to the Guttmacher Institute, is the average for women aged 15-44 nationally.

Why does one study signal hope? Because the rules for women’s health services under the new Affordable Care Act (ACA) – the so-called Obamacare law – require that insurance companies cover contraceptive services for women at no out-of-pocket cost

According to the US Health Resources and Services Administration, insurance plans, except for those sponsored by religious organizations, must cover:

“All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.”

For roughly the past decade, there have been about 1.2 million induced abortions each year in the US. The percentage of women who need to end a pregnancy with abortion has not declined much during the decade, according to Guttmacher.

The St. Louis study suggests that widespread access to free contraception – which the ACA should help extend – might decrease the need for abortions dramatically.

There are caveats, of course. There’s the religious-insurance-plan exemption, which will allow contraception to remain financially out of the reach of some women. There’s the chance that opponents of women’s health within Congress could push through an amendment removing the free-contraceptive-access provision of the ACA. 

And there’s the problem of correct use of contraceptives. In surveys of women seeking to terminate unwanted pregnancies in the early 2000s, a high percentage said they had used contraception during the month in which they became pregnant. That is, access to contraceptive methods doesn’t necessarily translate into effective use of those methods. Effective use of contraception has probably improved since the surveys were done – but it’s not clear by how much.

And, it’s possible that the struggle over abortion – embodying as it does a fundamental disagreement as to whether America’s search for justice should be based on deeply held beliefs about good and bad behavior, or on widely shared principles of individual rights – can’t be resolved even if abortion becomes a rare event.

Still, it’s worth wondering whether access to contraception, by dramatically reducing need for abortions, might just allow for the abortion fight to turn into an abortion conversation.

Philip Alcabes is a professor in the Adelphi University School of Nursing and director of the Public Health Program. He is an epidemiologist and has studied the history, ethics, and policy of public health.

Friday, October 5, 2012

Weekly Health Roundup

It’s Friday…which means it’s time for the Center for Health Innovation’s Weekly Health Roundup.

This week brings some encouraging news from the world of epidemiology, where NPR’s health blog reports that scientists recently discovered three new human viruses. What’s so good about that? In these three cases, the viruses were found before impacting more than two or three people. The most recent wide-spread viruses, such SARS—which in 2003 spread to over 8,000 people and caused over 750 deaths—followed a trend of a virus emerging in one location then quickly spreading across the globe. What has changed? In addition to new World Health Organization guidelines on information sharing and advances in genetic sequencing, Dr. John Brownstein of Children’s Hospital in Boston believes that with the social media and communications tools available, that “it’s very difficult to imagine…an important public health event where that information isn’t getting out in some form …I think there’s very few places on Earth where we’re not able to get citizen reporting and information.” He and his colleagues are using tools like HealthMap to keep up-to-the-minute information flowing about outbreaks.  

The United States is dealing with outbreak concerns this week, as a form of rare meningitis continues to spread. The New York Times reports that patients are thought to have become ill from a contaminated steroid. This particular form of meningitis does not spread from person to person, although, infection disease professionals do expect additional cases due to where the contaminated drugs have been shipped.

In more domestic news, the Centers for Disease Control reported that in 2011, close to 1 million teens drove drunk. Their report also showed that drunk driving has gone down by 54% since 1991, which seems like an encouraging trend. However, a Los Angeles Times article is quick to point out that this may simply be a function of increased gas prices coupled with fewer opportunities for teens to drive due to drops in employment opportunities for them. The CDC’s report also offers tips on how parents and teens can work together to further decrease rates of drunk driving and the curb behaviors that influence it.

But what really does help when you are trying to modify your behavior? Rewards? Punishments? How can we truly impact behavioral change? Dr. Kent Bottles, a Senior Fellow at The Thomas Jefferson University School of Population Health in Philadelphia, explores a rise in new web tools designed to help us meet our goals. Sites like Stikk have an “anti charity” option that takes money away from you if you don’t stick to your goals, while Aherk exploits user-supplied embarrassing photos as motivation and GymPlant tracks your workouts via smartphone. Could these tools become commonplace, and potentially helpful, for the next generation of teen drivers?