Archive for the ‘Uncategorized’ Category

Why are seventy percent of our population suffering from obesity? unfortunate current statistic, according to Qatar biobank report

March 19, 2018

As a medical student , I’ve attended many clinics, but my favorite one was always the endocrine clinic because I felt it combined my interest in medicine and public health. It was really unfortunate to be exposed to the high  number of people who suffered from obesity & obesity related complications, mainly as a result of poor dietary choices.

 

image 101Source: http://www.nytimes.com/2010/04/27/world/middleeast/27qatar.html

A review that looked at food patterns and diet quality among Qatari nationals found that the fatty foods consumed by Qataris  had twice as high level of fat nutrition density than what is recommended by the WHO. Qatar ranks sixth globally for the prevalence of obesity and has the highest rate of obesity among adolescents boys in the middle east region. Latest report from the Qatar Biobank, released in March 2017, showed that 70% of the Qatari population are either obese or overweight. Obesity is a major risk factor for many diseases, most of them unfortunately with debilitating consequences, especially if obesity starts at a young age.

Despite Qatar’s wealthy economy and it’s advancement in the healthcare sector, Qatar focus so far has been mainly on treatment rather than implementing effective prevention programs. A couple of intervention programs have been implanted mostly in terms of providing nutrition counseling clinics which  patients can access either through primary health centers or as referrals from any subspecialty clinic.

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Source:http://www.qatar-tribune.com/news-details/id/54297

The above presented facts, calls for an urgent need to develop practical programs by the Ministry of Public Health. Programs that equip people with the proper diet and exercise education, while taking into consideration the complexity of the culture and the importance of social norms. My idea of an effective intervention is a one that targets different  groups of the society simultaneously, so we can change the society as a whole .We need to work hand in hand with people from various fields to reshape our culture into a more healthier one. We need to reallocate our resources to focus more on interventions rather than on treatment options only. I believe it’s time to step up, and plan for serious actions.

 

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LGBTQ-Inclusive Sex Education for Maryland Schools

March 12, 2018

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In Maryland, all youth, regardless of gender identity or sexuality, deserve the right live healthy lives and thrive in school. For lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth, this can be difficult.

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Research shows that this population is disproportionality at risk of experiencing dating violence and contracting sexually transmitted infections (STIs), including HIV. The CDC furthers this by stating that in 2015, 81% of the youth ages 13-24 who were diagnosed with HIV were gay or bisexual men.

Additionally, a survey on school climate conducted in 2015 found that Maryland public schools are not safe for most LGBTQ students, with 61% of LGBTQ students reporting that they were verbally harassed because of their sexual identity and 45% because of their gender expression. Furthermore, only 1 in 4 students reported being taught positive information about LGBTQ people in school. A hostile school environment can lead to mental health issues for LBGTQ youth, higher absentee and drop-out rates, and even suicide.

Providing LGBTQ-inclusive sex education to middle and high school students is a vital component in empowering this population to thrive.

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With an inclusive curriculum, students obtain medically accurate and age-appropriate information on sexual health that integrates LGBTQ needs. LGBTQ youth learn about health risk behaviors that impact them and how to protect themselves against STIs. Equally important, all students are given the opportunity to explore topics related to sexuality and gender identity in a setting that positively depicts LBGTQ individuals. This helps dispel stigmas and negative stereotypes frequently tied to the LGBTQ community and builds a more welcoming and inclusive school environment.

Picture4Four states and Washington D.C. have passed legislation that mandates public schools provide sex education that respects and addresses the needs of all genders and sexual orientations.

It’s time for Maryland to follow suit and create similar legislation mandating inclusive sex education. In addition, funds should be allocated for the development of supporting materials, resources, and training for educators and school administrators. Research should be conducted alongside these changes to evaluate the impact LGBTQ inclusive-sex education has onSTI/HIV infection rates and bullying in Maryland schools. With these actions, we can help bridge the gap to providing LGBTQ youth with an equal opportunity to live healthy and successful lives.

 

Do as the French do, ban food waste.

March 11, 2018

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Currently, 30 to 40 percent of food produced is wasted in the United States and of this food wasted, 31 percent is lost at the retail and consumer level. This equates to over 133 billion pounds of food being wasted a year (over $161 billion worth of food). This is a completely unnecessary problem of excess in a time period where one in every eight Americans reports being food insecure. This means that at the same time that 133 billion pounds of food is being wasted, 42 million Americans are going hungry.

Thus, in September of 2015, the USDA launched the first national food loss and waste goal in the United States with the goal to achieve a 50 percent reduction in food waste by 2030. However, despite the USDA’s various initiatives to reduce food loss and waste, very little reductions have occurred. As such, it is time to address this issue with a strong policy change that promotes the reduction of food waste.

There is an urgent need to evaluate our current food system and question why Americas lead the world in food waste. Given that, food waste and food loss refer to a total decrease in food throughout the various stages of the food supply chain it is well documented that this leads to less food being available for all, however, this is also a problem of labor, water, energy and land use. 

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As such, the United States should adopt legislation similar to the recently implemented French Food Waste Law, which fines supermarkets that throw away food that is edible or usable for animal feed. This type of legislation would make food donations mandatory, something that is only encouraged by current legislation, thus, improving food security in the United States. Similarly, it would establish the need for accountability at every stage of the food supply chain and the need for improvement of our current food system which is currently failing to feed all Americans. 

Continuing to Improve Antibiotic Stewardship Programs in the U.S., Beginning with Delaware (DE), The First State

March 11, 2018

When modern antibiotics were discovered over a century ago, little did those early researchers know that not only would their discoveries pave the way for significant advancements in the fields of medicine and pharmacology and save millions of lives, but there would come a time when these drugs would become less and less effective as they were being used more and more. Additionally, patients would face an even greater health risk because of potential exposures to antibiotic-resistant organisms, now on the rise.

U.S. Centers for Disease Control (CDC), through investigative studies, have subsequently set forth guidelines and recommendations for implementing Antibiotic Stewardship programs (ASPs) in various health care settings. According to a recent, 2017 report by the CDC, data regarding the antibiotic use specifically in U.S. hospital settings was highlighted as needing improvement. In fact, they detail a trend in more powerful antibiotics being used up to 40% more frequently in the years 2006-2012.

Additionally, the Joint Commission now requires all hospitals, regardless of size, to have ASPs. The CDC guidelines include seven core elements for Hospital Antibiotic Stewardship Programs: Leadership Commitment, Accountability, Drug Expertise, Action, Tracking, Reporting, and Education. And, recent studies have shown that all seven elements need to be implemented in order to be most effective.

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Hospitals networks in the State of Delaware (DE) have taken the mandate to implement Antibiotic Stewardship programs within their hospitals very seriously. They have created a successful partnership, EbrightHealth, to implement ASPs in all 5 major DE hospital systems.

According to the latest data, 75% of all hospitals in DE meet all seven core elements of an Antibiotic Stewardship Program.

DE is undoubtedly doing a great job. However, 25% of hospitals still either have not implemented ASPs or do not meet the 7 Core Elements. EbrightHealth allows each hospital and hospital system to implement an ASP in accordance with their needs and resources, which is understandable considering these are often limiting factor for smaller hospitals. Their allowance is not, however, reasonable, considering they do not mention the necessity of incorporating all 7 Core Elements within an implemented ASP. We propose further collaborations between EbrightHealth, Delaware Division of Public Health, and the DE Healthcare-Associated Infections Advisory Committee (HAIAC), to create a policy ensuring these 7 core elements are incorporated within all DE ASPs.

Alcohol Consumption should be of Public Health concern in Nigeria

March 11, 2018

Alcohol consumption in Nigeria has a minimum legal drinking age of 18 years, but in reality, children are exposed to consumption at a younger age in both rural and suburban parts of the country, though in parts of Northern Nigeria, Alcohol is not authorized for sale, but they are usually available. The major trend now is huge public approval for consumption of Alcohol, without consideration of its Health risks.
Nigeria has different locally produced alcoholic beverages distinguished by regions and ethnic groups. In the North, pito and burukutu are commonly consumed. In the South and parts of the North, palm wine tapped from the palm tree is popular and gotten from the sap of the palm tree while the native gin locally called ogogoro, kai-kai, akpuru-achia, or Sapele water distilled from the fermented palm wine consumed in the Niger-delta area.

Many Nigerians believe that palm wine aids with eye sight and improves lactation in women. Alcohol consumption has generally been part of the cultural fabric of the Nigerian people.

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Mother teaching baby how to drink beer Source: Nigerian Times Newspaper

Majority of the packaged beers are made by the two major Breweries Guinness and Nigerian Breweries, who are responsible for most of the advertisements of Alcohol. Generally, abuse Alcohol can be attributed to the fact that it is a part of daily lives of these communities and for many of them, the greater influence comes from the social and environmental influences that includes cultural history, messages received from advertisements, community practices, adults, and friends about alcohol.

adaptiveimage.enscale.Guinness-Nigeria175-Ret.full.highFederal Road Safety Commission at an Event sponsored by a Major Brewer Source: Guiness Nigeria PLC

Holistic interventions targeting underage drinking and binge drinking among the whole population is needed. Policy makers need to fight against the rising trends linking alcohol consumption and healthy living, Campaigns initiatives focus more on rural areas rather than big cities, because majority of Nigerians live in the rural communities and are the ones involved in brewing or tapping local alcohol. There should be total ban on advertising that makes alcohol consumption look good, by extension ban on social marketing that offers free alcoholic drinks and events organized by Brewers co-sponsored by the stakeholders against alcohol consumption.

Never Again

March 11, 2018

On February 14, 2018, Marjory Stoneman Douglas High School, in Parkland, Florida, experienced a mass shooting in which 17 students and teachers died. It was the 18th US school shooting, just in 2018. However, the aftermath of this shooting was different because of a passionate and determined advocacy group that emerged — Never Again MSD, founded by approximately twenty students who survived the Stoneman Douglas shooting.

The group started on social media as a movement using the hashtag #NeverAgain. They staged protests demanding legislative action to be taken to prevent similar shootings in the future, vocally condemned U.S. lawmakers who have received political contributions from the National Rifle Association (NRA), and played a part in corporations’ revocation of NRA sponsorships and discounts for NRA members.

Due to the high level of activism and mounting pressure on lawmakers to enact change, on March 9, Florida signed into law an array of gun limits that included raising the minimum age to purchase a firearm to 21 and extending the waiting period to three days. The law also imposes restrictions on the possession of “bump stocks,” funds more school police officers and mental health services, broadens law enforcement’s power to seize weapons, and allows certain staff members to carry guns in schools.

Within hours of signing the legislation, the NRA filed a lawsuit in Federal District Court, arguing that Florida’s age restriction was “a blanket ban” that violated the Second Amendment, as well as the 14th Amendment’s guarantee of equal protection. The NRA is considered one of the most influential lobbying groups in Washington.

The result of the NRA’s lawsuit remains to be seen. However, it seems the country has woken up. The NRA now has its hands full having to contend with several other states also considering action since the Parkland shooting. Although the Florida legislation is a victory for Never Again MSD, it needs to continue its advocacy if it wishes to enact change at the national level. Its main focus should be to make its nationwide demonstration, planned for March 24, 2018, as powerful as it can be.

Gun rights have deep roots in this country, its founding, and its history — however, without infringing on gun rights, we can and should as a country pass effective, evidence-based gun laws to prevent senseless acts of violence.

Increasing Safety injection sites (SIS) in Montreal, Canada

March 11, 2018

Montreal is Canada’s second-most populated metropolis and like most cities in North America, it is struggling to fight an increasingly large opioid crisis. Safety injection sites (SIS) are centers in which drug users can inject intravenous drugs with sterile syringes under medical supervision. In addition to decreasing overdose deaths and the spread of HIV and hepatitis, they provide access to addiction treatment and medical care. In Vancouver, Canada, a SIS has existed since 2003 with beneficial outcomes.

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Heroin preparation by a man at a safety injection site in Vancouver, Canada (Darryl Dyck / THE CANADIAN PRESS)

In February 2017, three SIS were launched in Montreal, the first of their kind in Eastern Canada. Their launch has been reportedly successful. The federal Liberal government is giving its full support to the founding of SIS by passing legislation that facilitates the founding of SIS (Bill C-37). As of February 2017, the Federal Minister of Health is reviewing applications for multiple SIS in each major city in Canada including Montreal.

Montreal SIS have recently been launched, but these are not wide-reaching as of yet. There is resistance to SIS from community members who may believe that they will make their neighborhoods unsafe and encourage drug use. In one instance, parents of elementary school children in the Ville Marie neighborhood protested the launch of the SIS run by Spectre de Rue.

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If your area is establishing a local SIS, you might share these concerns. We want to stress that SIS encourage needle injection occuring in the facility instead of in local streets, alleys or public spaces, making your community safer. Furthermore, SIS provide a gateway to addiction and medical treatment. There is an on-duty nurse and counsellor present at each SIS for this purpose. Within a week of SIS opening in Montreal, many drug users visited the facility. The more drug users visit SIS, the fewer syringes are on the streets and the greater the chance that these people will have access to the services they need.
We understand your concern, but the opioid crisis does not just span a concentrated area of the city. It affects the community at large and can affect your children, neighbors, and friends. SIS are effective and make communities safer. There is an abundance of research demonstrating the beneficial effects of SIS programs in Canada, Europe, and Australia. SIS need your support to proliferate. Doing so will save more lives.

The Counter Argument: A Push for Over-the-Counter Naloxone

March 11, 2018

Drug overdoses account for the majority of deaths among individuals under 50, and two thirds of those overdoses are from opioids. Deaths from opioid medications outnumber deaths from automobile accidents, and are soon going to outnumber its peak in 1972. In response to the nearly universal elevating prevalence of overdoses, action must be taken.

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An immediate treatment of opiate overdose is Naloxone; an opiate antagonist that rapidly reverses the symptoms of opioid overdose. While it is not a controlled substance, it is a prescription medication that requires a physician to prescribe the medication prior to dispensing.

It’s readily apparent that naloxone saves lives, and in the state of Michigan, as with many other states, there is an emergency standing order from the chief medical executive to allow for pharmacists to distribute intranasal naloxone. Some pharmacy chains have even allowed for pharmacists to provide prescriptions for naloxone, but this is an unnecessary barrier to obtaining a life-saving medication with no risk of abuse.

The transition of naloxone to an over the counter medication would allow for wider distribution of the medication and increase probability of having the medication available in the time of necessity. Currently, the FDA is pushing for a broad access to naloxone, and broad access is supported as one of the CDC’s three pronged approach towards reducing opioid deaths.

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Despite the universal agreement that naloxone accessibility is an important means of harm reduction, and the aid of the FDA itself, there continues to be harmful barriers to life-saving medication and although states have taken it upon themselves to issue emergency standing orders, after two years, it remains a matter of critical importance that is deadlocked.

PrEP (HIV pre-exposure prophylaxis): reducing the high burden of HIV among young black men who have sex with men

March 11, 2018

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In the United States, the most vulnerable group to acquire HIV is black men who have sex with men (MSM), either gay or bisexual men. There is a concentrated epidemic in this group. Among black men who have sex with men, the age range of 13 to 24 years old is the most affected group. In 2015, 38% of newly diagnosed HIV patients were young black MSM; an increase of 87% between 2005 to 2014. This is mainly attributed to a lack of equitable access to medical care and health education.

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The HIV pre-exposure prophylaxis, best known as PrEP, is a daily pill treatment that is highly effective in preventing the transmission of HIV in groups with high-risk behaviors to contract HIV, such as MSM.

Implementation of PrEP programs for populations with the highest incidence is critical to reducing new infections in the United States. Truvada, the brand name of the PrEP pill, contains two medicines (tenofovir and emtricitabine), and it prevents the establishment of a permanent infection after exposure to HIV through sex.

Now, we have the power to treat HIV-uninfected people and prevent an HIV infection from ever occuring.

There are many challenges of access to PrEP, such as accessibility to healthcare, medication affordability, lack of PrEP information, stigma and discrimination.
According to specialists in Public Health at the Washington University in St. Louis, the access to a health provider who is aware of PrEP treatment and is willing to prescribe it is key for its uptake and adherence. However, this is a huge barrier in Medicaid non-expansion states.

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Although multi-level interventions are needed to increase PrEP access like awareness and affordability, the reduction of the HIV transmission among the most vulnerable group in the US, young black MSM, can be achieved if accessibility to healthcare is increased.

So, the expansion of Medicaid is critical to reaching this goal and it can be accomplished if enough social pressure is applied to convince the governors and state legislators that this is the right path to take. Ultimately, to put an end on the disproportionate burden by HIV that young black MSM are under in the US.

It is time to say NO to this inequality in healthcare and bring the transmission of HIV among young black MSM to ZERO!

How can you give your support?

  1. Contact your state governor and let h/she knows you support the Medicaid expansion!
  2. Contact your state legislator and let h/she knows you support the Medicaid expansion!

A law that permits child labor

March 10, 2018

12 year old Radha comes home from school and then helps her mother make umpteen earthen pots to meet the production deadline of a contractor, leaving her exhausted to do her homework or to wake up in the morning for school.              

The Child Labour (Prohibition and Regulation) Amendment Act, 2016, though advocated as being progressive, has ruined the plight of millions of children like Radha.

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Source: youtube.com/childlabour: girls rolling tobacco in India

Though the act prohibits “the engagement of children (under 14 years) in all occupations and of adolescents (under 18 years) in hazardous occupations and processes” and  has imposed a fine on anyone who employs or permits adolescents to work, it has slashed the list of hazardous occupations for children from 83 to include just mining, explosives, and occupations mentioned in the Factory Act. This means that work in chemical mixing units, cotton farms, battery recycling units, and brick kilns, among others, have been dropped. Further, even the the ones listed as hazardous can be removed, according to Section 4 — not by Parliament but by government authorities at their own discretion.

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Source: UNICEF India

The amendments have tweaked the law in such a way, that children are still available for employment. The only concession to their educational rights is that they are permitted to work in family enterprises only outside school hours and during vacations, where the hours of work are not defined.

Under the new Child Labour Act, some forms of child labour may become invisible and the most vulnerable and marginalised children may end up with irregular school attendance, lower levels of learning and could be forced to drop out of school.  

It is imperative for child health organizations to sensitize communities to the fact that any child or adolescent out of school constitutes child labor. They need to study the root causes that make families want to engage their children in the workforce. Advocacy groups need to appeal to lawmakers to abolish all aspects of child labor, as well as to implement food security schemes and  employment opportunities to encourage families to keep their children and adolescents in schools.