How can college students help improve health delivery in Boston’s inner city? #BU #BC #NU #tufts

A lot of my students at local universities belong to organizations that do fundraisers. Often, it feels like little thought goes into these projects. The event feel like excuses for parties and resume entries. Which is fine. But if they really want to do some good, they might consider this program, HeathLeads. I requires more than a tux or an afternoon behind a table in the student union. Note that two of the Boston volunteers won Rhodes scholarships this year.

This video is about the Baltimore project. Click here for more on Boston effort.

Are we prepared for a Japanese-style nuclear disaster?

Two items on nuclear power today. Juliette Kayyem,  a former homeland security adviser for both Massachusetts and the US Department of Homeland Security, asks on today’s Globe Op/Ed page: Can the US handle a nuclear disaster?

The White House planning document for a nuclear event essentially admits that the public would be foolish to rely too heavily on the government. Sheltering in place (for any contingency) requires a few minutes to prepare your home with basic essentials, including water and food, and to ensure that your loved ones know where to go in the event that all communications are disrupted. It is that simple; no drama, no duct tape…

There is no doubt that nuclear safety will be the subject of a heated debate in the months to come. And that debate may serve as an important opportunity to challenge not only the nuclear industry’s assumptions about plant safety, but also our own assumptions about empowering ourselves to protect our well-being.”

Also, the investigative group ProPublica asks how well plant operators are prepared.As this story notes,  Mass Democratic Rep. Ed Markey has been pushing for safer rules and is not pushing harder.  

Can the US handle a nuclear disaster?

by John Sullivan, Special to ProPublica March 13, 2011

Published with permission.

As engineers in Japan struggle to bring quake-damaged reactors under control [1], attention is turning to U.S. nuclear plants and their ability to withstand natural disasters.

Rep. Ed Markey, a Massachusetts Democrat who has spent years pushing the Nuclear Regulatory Commission toward stricter enforcement of its safety rules, has called for a reassessment. Several U.S. reactors lie on or near fault lines, and Markey wants to beef up standards for new and existing plants.

“This disaster serves to highlight both the fragility of nuclear power plants and the potential consequences associated with a radiological release caused by earthquake related damage,” Markey wrote NRC Chairman Gregory Jaczko in a March 11 letter [2].

Specifically, Markey raised questions about a reactor design the NRC is reviewing for new plants that has been criticized for seismic vulnerability. The NRC has yet to make a call on the AP1000 reactor [3], which is manufactured by Westinghouse. But according to Markey, a senior NRC engineer has said the reactor’s concrete shield building could shatter “like a glass cup” under heavy stress.

The New York Times reported last week [4] that the NRC has reviewed the concerns raised by the engineer, John Ma, and concluded that the design is sufficient without the upgrades Ma recommended. Westinghouse maintains that the reactor is safe [5].

Boiling water reactors [6], like the ones hit by the Japanese earthquake, are built like nested matroyshka [7] dolls.

The inner doll, which looks like a gigantic cocktail shaker and holds the radioactive uranium, is the heavy steel reactor vessel. It sits inside a concrete and steel dome called the containment. The reactor vessel is the primary defense against disaster — as long as the radiation stays inside everything is fine.

The worry is that a disaster could either damage the vessel itself or, more likely, damage equipment that used to control the uranium. If operators cannot circulate water through the vessel to cool the uranium it could overheat and burn into radioactive slag — a meltdown.

Reports say a partial meltdown is suspected [1] in two of three reactors at the Fukushima Daiichi Nuclear Power Station in Japan, which was hit by the 8.9 magnitude quake and ensuing tsunami.

Reactors have multiple layers of equipment to make sure this never happens. But last year, Markey asked Congress’s investigative agency [8], the Government Accountability Office, to look into a long list of nuclear safety issues, including earthquake and flood protection.

Markey cited the 2007 Chuetsu earthquake [9] (6.6 magnitude) that hit the Kashiwazaki-Kariwa nuclear plant. The quake started a fire, spilled some low-level radioactive waste and damaged equipment that was not critical to the reactor. It led Japanese regulators to reassess earthquake danger near the plant, and Markey wanted GAO to see whether NRC had been on top of earthquake risk in the U.S.

As seen here, Hurricane Gustave damaged the River Bend Nuclear Generation Station in St. Francisville, La. (NRC photo provided by Union of Concerned Scientists)

He also listed a few cases in which other natural disasters had damaged nuclear plants, like a 1998 tornado that knocked out power to the Davis-Besse [10] plant outside Toledo, Ohio, or Hurricane Andrew, which knocked out power to the Turkey Point [11] plant south of Miami site for five days in 1992. In 2008, Hurricane Gustav damaged the River Bend Nuclear Generation Station in St. Francisville, La. [12]

At both Davis-Besse and Turkey Point, the plants’ emergency diesel generators kept the equipment running until crews fixed the power lines.

News reports have said the Fukushima Daiichi Nuclear Power Station went to backup diesel power after the quake but lost it, along with the ability to keep cooling water flowing.

Edwin Lyman, a senior scientist with the Union of Concerned Scientists, told Reuters [13] that U.S. reactors don’t have adequate backup power. “We do not believe the safety standards for U.S. nuclear reactors are enough to protect the public today,” he told the news agency.

NRC spokesman David McIntyre said the agency was not granting interviews about the Japan quake. He pointed to the agency’s website, which does have a lot of information on the seismic issues.

For instance, NRC regulations require that every plant is built to survive an earthquake larger than the strongest ever recorded in the area. The agency says it periodically updates earthquake estimations as more detailed information becomes available.

Most recently, the NRC spent five years reassessing earthquake risk for nuclear plants in the Midwest and eastern United States. The results of the study [14], which were released last September, confirmed that the plants were built to withstand the heaviest quake likely for their area.

However, the NRC found that the risk of earthquake was greater than expected in some areas, so the agency plans further research [15].

In an NRC meeting on earthquake safety last September, Torrey Yee, an engineer for the San Onofre nuclear plant near San Diego, said designers evaluate two levels of earthquakes: the maximum possible quake for a site; and an “operating basis” quake, usually about half of the maximum strength.

The critical structures and equipment at the plant are built to withstand the maximum quake, and the plant has to shut down for inspection if it sustains a quake higher than the operating basis.

The 104 commercial reactors [16] in the United States produce 20 percent of the nation’s power.

Are Boston hospitals prepared for a nuclear power plant meltdown?

Updates and other local sites on nuclear accidents, health and hospitals:

• The state’s nuclear emergency plan.
• BU/UMass nuclear accident preparedness program
• From Children’s Hospital Boston: Decontamination of Children – Preparedness and Response for Hospital Emergency Departments
• Boston-based  “Chernobyl Children Project USA arranges medical care in the U.S. for children suffering from a wide variety of ailments and places them with volunteer host families during their stay.”
• C-10 “is an acronym for Citizens Within the Ten-Mile Radius, a 5,000 member grassroots organization founded in 1986 to challenge evacuation plans for the Seabrook Station nuclear reactor.”
• HHS site.

 A few cites:

J Nucl Med Technol. 2004 Mar;32(1):22-7.

Radiation disaster response: preparation and simulation experience at an academic medical center.

Department of Health Physics and Radiopharmacology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. aschleipman@partners.org

Abstract

OBJECTIVES: A mass casualty disaster drill involving the simulated explosion of a radiation dispersal device (dirty bomb) was performed with the participation of multiple hospitals, emergency responders, and governmental agencies. The exercise was designed to stress trauma service capacities, communications, safety, and logistic functions. We report our experience and critique of the planning, training, and execution of the exercise, with special attention to the integrated response of the Departments of Nuclear Medicine, Health Physics, and Emergency Medicine.

METHODS: The Health Physics Department presented multiple training sessions to the Emergency Medicine Department, Operating Room, and ancillary staff; reviewing basics of radiation biology and risk, protection standards, and detection of radiocontamination. Competency-based simulations using Geiger-Müller detectors and sealed sources were performed. Two nuclear medicine technologists played an important role in radiation discrimination-that is, assessment of radioactive contamination with survey meters and radionuclide identification based on gamma-spectroscopy of wipe smears from patients’ clothing, skin, and orifices. Three Health Physics personnel and one senior Nuclear Medicine staff member were designated the radiation control officers for assigned teams triaging or treating patients. Patients were triaged and, when indicated, decontaminated.

RESULTS: Within a 2-h period, 21 simulated victims arrived at our institution’s Emergency Room. Of these, 11 were randomized as noncontaminated, with 10 as contaminated. Decontamination procedures were implemented in a hazardous materials (HAZMAT) decontamination trailer and, for the 5 patients with simulated serious injuries, in a designated trauma room. A full debriefing took place at the conclusion of the exercise. Staff largely complied with appropriate radiation protection protocols, although decontamination areas were not effectively controlled. The encountered limitations included significant lapses in communications and logistics, lack of coordination in the flow of patients through the HAZMAT trailer, insufficient staff to treat acute patients in a radiation control area, additional personnel needed for transport, and insufficient radiation safety personnel to control each decontamination room.

CONCLUSION: Nuclear Medicine personnel are particularly well qualified to assist Health Physics and Emergency Medicine personnel in the preparation for, and management of, mass casualty radiation emergencies. Simulation exercises, though resource intensive, are essential to an institution’s determination of response capability, performance, and coordination with outside agencies.

Surg Clin North Am. 2006 Jun;86(3):601-36.

Nuclear terrorism: triage and medical management of radiation and combined-injury casualties.

Flynn DF, Goans RE.

US Army Reserves Medical Corps, Office of the Command Surgeon, 94th Regional Readiness Command, 11 Saratoga Boulevard, Devens, MA 01434, USA. daniel_f_flynn_md@cchcs.org

Abstract

This article addresses the medical effects of nuclear explosions and other forms of radiation exposure, assessment of radiation dose, triage of victims, definitive treatment of radiation and combined-injury casualties, and planning for emergency services after a terrorist attack involving a nuclear device. It reviews historical events of mass radiation-induced casualties and fatalities at Hiroshima, Chernobyl, and Goiania, and discusses various scenarios for nuclear terrorism.

Study: Massachusetts ties for #1 in child health

The ever reliable Commonwealth Fund — a national health policy group — has a new report out comparing state measure of children’s health. Massachusetts was ranked No.1, with an asterick.  

The 14 states in the top quartile of the overall performance ranking—Iowa, Massachusetts, Vermont, Maine, New Hampshire, Rhode Island, Hawaii, Minnesota, Connecticut, North Dakota, Pennsylvania, Wisconsin, Kansas, and Washington—often perform well on multiple indicators and across dimensions (Exhibit 2). At the same time, the Scorecard finds that even the leading states have opportunities to improve: no state ranks in the top half of the performance distribution on all indicators. At the other end of the spectrum, states in the bottom quartile generally lag in multiple areas, with worse access to care, lower rates of recommended prevention and treatment, poorer health outcomes, and wide disparities related to income, race/ethnicity, and insurance status….

The State Scorecard on Child Health System Performance, 2011, examines states’ performance on 20 key indicators of children’s health care access, affordability of care, prevention and treatment, the potential to lead healthy lives, and health system equity. The analysis finds wide variation in performance across states. If all states achieved benchmark performance levels, 5 million more children would be insured, 10 million more would receive at least one medical and dental preventive care visit annually, and nearly 9 million more would have a medical home. The findings demonstrate that federal and state policy actions maintained and, in some cases, expanded children’s insurance coverage during the recent recession, even as many parents lost coverage. The report also highlights the need for initiatives specifically focused on improving health system performance for children. The report includes state-by-state insurance coverage projections for children once relevant provisions of the Affordable Health Act are implemented.

Smoking at the Globe, Times

The days of the smokey newsroom are over but the papers are full of stories about evil weed.

A front page Globe story asks –Too many cigarette ads in lower-income neighborhoods?

A dozen years after Massachusetts attempted to ban storefront tobacco ads within 1,000 feet of schools and playgrounds, a prohibition thwarted by a tobacco company’s legal challenge, the signs remain prolific and prominent in Boston’s lower-income neighborhoods, especially those with substantial African-American and Hispanic populations.

On today’s Globe op-ed page, a wine shop worker bemoans his new title: “tobacco retail clerk“:

I work a couple days a week in a wine and cheese shop, which has a number of advantages, not the least of which is buying Hendrick’s gin at a good price.

Among the items offered for sale are cigarettes and cigars. That makes me a tobacco retail clerk. And that being so, I was recently informed that my training class was to be on such and such a day. Class? To sell cigarettes?

An editorial in Sunday’s paper said – Get the cigs out of the movies.

WATCHING CHARACTERS smoke in movies is the single most powerful pro-smoking influence for children: It accounts for 44 percent of kids who smoke pick up a cigarette for the first time, according to an analysis of four separate studies.

That’s why it is good news that the number of smoking incidents in movies has steadily gone down in the last few years, according to a new study by researchers at the University of California San Francisco. The study, published by the Centers for Disease Control and Prevention, found that among the top-grossing movies released in the United States between 1991 and 2009, smoking incidents peaked at around 4,000 in 2005 and have since dropped by half, to a little below 2,000 for 2009. Last year was also the first time that just over one half of top-grossing movies didn’t show any tobacco use at all. Encouragingly, and perhaps partly as a result, the nationwide rates of trying cigarettes among high-school students dropped from 54 percent in 2005 to 46 percent in 2009.

Hold on — The NY Times has a piece on “hold-out” smokers and their sidewalk community.

Parliament, Marlboro, Winston, Benson & Hedges glow throughout the day in this canyon as smoker after smoker dashes down, lights up and vanishes again like a wisp of smoke. Between drags, they gab into their cellphones, soak in the solitude, pace to the curb and back, or chat briefly, most conversations lasting only as long as the ember at the tip of their cigarettes.

Finally, if your doc prescribes the other weed, make sure your drug-testing boss approves it too. Also from the Times:

Residents in 14 states and Washington can now appeal to their doctors for prescriptions for medical marijuana to help them with their pain.

Their employers, however, may not be so understanding.

In some cases, workers have been fired for failing drug tests despite having prescriptions saying, in effect, that what they are doing is legal according to the laws of their states.

Though the number of such cases appears to be small, they are exposing a new legal gray area, with workers complaining of rights violations and company officials scratching their heads over how to enforce a uniform policy for a drug that the federal government has not recognized as having a legitimate medical purpose.

Children’s doc : More research needed on environmental links to early pubery

From the NY Times:

A new study finds that girls are more likely today than in the past to start developing breasts by age 7 or 8.

The research is just the latest in a flood of reports over the last decade that have led to concern and heated debate about whether girls are reaching puberty earlier, and why it might be happening….

Dr. Catherine Gordon, a pediatric endocrinologist and specialist in adolescent medicine at Children’s Hospital Boston, said that so far, most evidence showed that neither breast development nor menstrual age had changed for white girls of normal weight.

The new study included 1,239 girls ages 6 to 8 who were recruited from schools and examined at one of three sites… The group was roughly 30 percent each white, black and Hispanic, and about 5 percent Asian.

At 7 years, 10.4 percent of white, 23.4 percent of black and 14.9 percent of Hispanic girls had enough breast development to be considered at the onset of puberty….

Dozens of studies have been published in the years since. Arguments continue, but many doctors accept the idea that heavier girls often develop earlier. And subsequent studies have also found that black and Hispanic girls mature earlier than whites, even when weight is taken into account. No one knows why. Though breasts may be sprouting earlier, the average age of first menstruation, between 12 and 13, has not really changed…

Dr. Gordon said it would be important to continue the studies, and to try to find out whether environmental chemicals were having an effect.

Get healthier with web games

Beyond exergaming.

The Institute of Medicine anbd HHS will host a public forum today: The Community Health Data Forum: Harnessing the Power of Information to Improve Health in Washington, DC. The morning session will debut a number of recently developed applications that use community health data before an audience of highly influential policymakers and all attendees.

Watch it online.

This Boston-based project will be there: Community Clash is“a Web-based game that allows players to compare their community’s health to other cities.”  

The Institute of Medicine and HHS will host a public forum, The Community Health Data Forum: Harnessing the Power of Information to Improve Health, in Washington, DC. The morning session will debut a number of recently developed applications that use community health data before an audience of highly influential policymakers and all attendees.

The afternoon session includes a series of working groups that will begin at 12:15 p.m. and adjourn at 2:00 p.m. During this session, smaller groups will discuss additional ideas and the needs of various stakeholders with respect to the Community Health Data Initiative and how to translate these opportunities into functioning applications by the end of 2010.

“Exergaming” and “rehabtainment”

 Can an organization be forgiven for adding those words  to the lexicon? Maybe, if “The Games for Health Project” can find a way to make Farmville into exercise. 

This conference is ongoing and geared toward professionals, not teen gamers.  Starting today at the Harbor Hyatt and running through Thursday.

The Games for Health Project – Sixth Annual Games for Health Conference

Exploring the role of interactive videogames in health and healthcare at the 2010 Games for Health Conference with 40+ sessions covering topics such as global health, exergaming, surgery simulation, health education, cognitive and emotional health and more. Opening keynote May 26 by Sony’s Dr. Richard Marks, with additional keynotes by game developer Chaim Gingold. Tickets and info: www.gamesforhealth.org.

“Our biggest and most advance event ever promises to provide great insight to the growing worlds of exergaming/active games, health training games, disease management efforts, and much much more.  ”

 

Cape Cod water: A cocktail of antibiotics, bug spray and scotchguard

Speaking of disease detectives, Newton’s Silent Spring Institute has been monitoring potentially toxic chemicals in the water and homes in Cape Cod and the news is not good.

From a report released today.

 Tests of 20 wells and two distributions systems supplying drinking water on Cape Cod found that 75 percent of the wells and both distribution systems had detectable levels of emerging contaminants such as pharmaceuticals and consumer product chemicals, primarily coming from septic systems.

The results were released today by Silent Spring Institute.  Nine water districts on Cape Cod voluntarily participated in the study.  The study provides some of the first information in the U.S. about impacts of septic systems on groundwater used for drinking water.

Septic systems are the most likely source for most of the 18 chemicals detected, which include nine pharmaceuticals, an insect repellent, halogenated organophosphate flame retardants and perfluorinated chemicals.  The two most frequently detected chemicals were sulfamethoxazole, an antibiotic commonly used to treat urinary tract infections and pneumonia, and PFOS, used in stain-resistant and nonstick coatings, as well as fire-fighting foams.  Levels of these compounds were among the highest reported in US drinking water, except in a few cases of industrial contamination.  The widespread presence of antibiotics has raised the possibility of promoting development of antibiotic-resistant pathogens.  PFOS and the related compound PFOA, which was also detected in this study, are hormone disrupting compounds that have been associated at higher exposure levels with effects on the thyroid, mammary gland, cholesterol metabolism, immune system, cancer, and growth and development.

“We found many contaminants in Cape Cod’s drinking water supply, indicating that current policies are not adequate to prevent emerging contaminants from getting into drinking water. Septic systems are the main source,” said Laurel Schaider, Ph.D., a research scientist at Silent Spring Institute.  “Water suppliers who participated in this study are very forward-looking in their approach to protecting water quality for the future.”  Monitoring for the test chemicals is not required and there are no regulatory standards for them.

Researchers will hold a public meeting to discuss the findings and answer questions at 3 p.m. today at the Barnstable Town Hall.

 

 

 

 

New book: Disease detectives may have saved your life

Vermont writer Mark Pendergrast’s new book, Inside the Outbreaks, “is a history of the Epidemic Intelligence Service, the front-line disease detectives of the CDC.  It covers an amazing array of medical mysteries all over the world, from an insider’s perspective.”  Find more, as well as some rave reviews, on his page.

Since its founding in 1951 by Alexander Langmuir as a service/training program, the Epidemic Intelligence Service, working out of the CDC· in Atlanta, Georgia, has sent out over 3,000 officers to combat every imaginable human (and sometimes animal) ailment. 

These young people—doctors, veterinarians, dentists, statisticians, nurses, microbiologists, academic epidemiologists, sociologists, anthropologists, and now even lawyers — call themselves “shoe-leather epidemiologists.” EIS officers have ventured over the globe in search of diseases, sometimes in airplanes, in Jeeps, on bicycles, aboard fragile boats, on dogsleds, atop elephants and camels. 

EIS officers generally have performed their tasks without fanfare or notice.  They have saved uncountable lives, preventing uncontrolled spread of disease and diagnosing problems before they escalated.  They even may have saved your life, though you were probably unaware of it…

The overarching take-home lesson from this history, though, is that dollars spent on public health surveillance and prevention programs are cost-effective.  In the United States, we tend to react to health problems and seek heroic individual clinical resolutions, spending most of our health budget on extreme measures.  Because public health efforts like those of the EIS are largely invisible – few people know they are being protected – they are both undervalued and underfunded, despite their efficiency.