Archive for the ‘Uncategorized’ Category

Time to Decrease Gun Injuries and Deaths in Canada

August 18, 2018

Despite substantial decreases in deaths and injuries caused by firearms over the past few decades in Canada, many other countries still observe better health outcomes in this area.  Throughout Canada, firearm-related deaths are mainly due to suicides, with non-restricted firearms being involved.pie-chart-canadian-gun-deaths-by-cause
These deaths are not primarily related to criminal activity. Although less prevalent, high profile homicides, sometimes targeting multiple individuals, is what is often reported in the news. Sadly, the men and women who are mandated to protect us, our community police officers, are often the victims of these types of criminal acts.

Screen Shot 2018-08-18 at 12.01.01 PMWhen there are fewer guns, there are fewer injuries, and deaths, caused by them. States that have taken measures to regulate and monitor the sales of firearms have fewer people killing themselves, or others, with guns. Although restricted and prohibited firearms are tracked as part of a federal registry in Canada, people in distress are still using non-restricted firearms to take their own lives, or kill others. The province of Quebec responded to this reality by establishing their own registry for non-restricted firearms owned within their territory.

Currently, Bill C-71 is in second reading in the House of Commons, and it proposes increased background checks and better record keeping for these non-restricted weapons. After multiple changes in firearm legislation from past governments, some groups point out that monitoring is less robust than it was decades ago.

In the interest public safety and injury prevention, the federal government should consider reintroduction of a registry for non-restricted firearms to keep them out of the hands of those at risk of harming themselves and others. Although gun ownership in Canada has always been a privilege, and not a right, such measures do not prevent the Canadian sports enthusiast, or indigenous community member pursuing traditional harvesting, from accessing a non-restricted firearm.

A reintroduction of a non-restricted firearms registry should be seen as one part of a multi-pronged effort at suicide prevention that keeps guns out of the hands of distressed members of our communities.

A Domino effect

August 17, 2018

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Hepatitis C has had an increasing incidence in Kentucky, propelled by the increasing use of IV drugs.  The United States has seen a rise in intravenous drug use, believed to be due to prescription of painkillers by physicians. As policy was enacted to cut down on over-prescription, supply dropped as demand remained- leading to people turning to the cheaper and available option of heroin. Unfortunately, this trend has more repercussions than addiction alone. In 2015, 233 people contracted HIV and 167 were infected with Hepatitis C, 35 miles north of Louisville in a town of approximately 4100 people. The spread to Kentucky had already begun.

Kentucky had the highest incidence of Hepatitis C in 2014 at 4%, dropping and now holding steady at 2.3% in 2016. This is still more than triple the national average. Decreasing the sharing of contaminated needles will decrease new blood borne infection incidence.

Originally in 2015, Louisville, Kentucky had a needs-based needle program, which allowed for unlimited needle distribution.  Unfortunately, Kentucky House Bill 160 was amended by the state senate to require injection drug users to produce one dirty needle to exchange for one clean needle at designated exchange centers. Although on the surface this seemed like a logical approach, having to replace each needle with a used one still caused sharing of needles among users who interacted with other users who didn’t attend the needle exchanges, or lost their needles. There is now a restriction of state funding for needs-based programs, which has been the recommended intervention by the CDC.  This is suspected to be due to social stigma against interventions viewed as ‘benefiting’ illicit drug users by giving them ‘free supplies’, rather than rehabilitation programs or punishment.needle-exchange-high-risk-map-v3

What can you do? You can find and alert your state representative that you are for removing the one-for-one needle exchange mandate, by using this link. By removing the political stigma on needle exchanges, we can influence our policy makers to support what the data recommends. We can stop the spread of Hepatitis C and HIV, simply by restoring the law to what we originally had.

Working with Traditional Leaders to Raise the Minimum Marriage Age Law in Niger

August 13, 2018

Niger child marriage

Source: https://plan-international.org/news/2017-09-14-president-niger-commits-ending-child-marriage

Niger has the highest rate of child marriage in the world according to a report from UNICEF in 2018. Child marriage is defined as marriage before the age of 18. The president of Niger made a commitment to raise the minimum marriage age for girls from 15 to 18, but the law has yet to pass. The government has designated the National Committee to Coordinate Actions, situated within the Ministry of Women’s Advancement and Child Protection, with the specific mandate to end child marriage, but it has so far been unsuccessful at galvanizing support among enough members of the National Assembly.

Child marriage in Niger is tied to many religious and social traditions, which is why movement in the National Assembly has been so difficult. Marriage offers economic opportunity for parents and greater social status for the girls, but it comes with several risks. The majority of adolescent pregnancies occur in marriage, and adolescent births have a much higher risk of obstetric complications, death, and poor outcomes for the child. Early marriage limits a girl’s educational attainment. 81% of women who married before 18 had no education compared to only 17% of women with secondary school education. The economic loss from lack of participation in the workforce or early death or disability from pregnancy and delivery complications is significant. One study found ending child marriage in Niger could save the country more than $25 billion between 2014 – 2030.

While there is a growing movement in support of the law from both international and local civil society organizations, passing the law will require the government and civil society to engage directly with the Islamic organizations and leaders that most strongly oppose the law. One organization, Fauziya, works directly with Islamic organizations and has been successful at using trainings and workshops about Islamic traditions and the risks of early marriage to engage religious and traditional leaders in the movement. Fauziya should be an example for other organizations to engage with local leaders to advocate for passing the law so Niger’s girls, and the country as a whole, can prosper.

 

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.

 

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.

CDC 7 Core

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.

Mother teaching child how to drink beer

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.