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Posts Tagged ‘public health

What can we learn from disease stigma’s long history?

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What can we learn from disease stigma’s long history?.

Written by huehueteotl

November 27, 2012 at 11:13 pm

Size Does Not Matter, Thinking Does…

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… at least when health prospects are concerned. In a study to examine the impact of desired body weight on the number of unhealthy days subjects report over one month, researchers at Columbia University Mailman School of Public Health found that the desire to weigh less was a more accurate predictor of physically and mentally unhealthy days, than body mass index (BMI). In addition, the desire to lose weight was more predictive of unhealthy days among Whites than among African-Americans or Hispanics, and among women than among men.

After controlling for actual BMI and age, the researchers found that men who wished to lose 1 percent, 10 percent, and 20 percent of their body weight, respectively, reported 0.1, 0.9 and 2.7 more unhealthy days per month than those who were happy with their weight. Among women, the corresponding increase in numbers of reported unhealthy days was 0.1, 1.6 and 4.3. Persons who were happy with their weight experienced fewer physically unhealthy days (3.0 vs 3.7) and mentally unhealthy days (2.6 vs 3.6) compared with persons unhappy with their weight.

“Our data suggest that some of the obesity epidemic may be partially attributable to social constructs that surround ideal body types,” said Peter Muennig, MD, MPH, Mailman School of Public Health assistant professor of Health Policy and Management. “Younger persons, Whites, and women are disproportionately affected by negative body image concerns, and these groups unduly suffer from BMI-associated morbidity and mortality.”

Approximately 66% of the more than 150,000 U.S. adults studied wanted to lose weight, and about 26% were satisfied with their current weight. With respect to BMI, 41% of normal weight people, 20% of overweight people, and 5% of obese people were happy with their weight. Older persons were also more likely to feel positively about their weight than were younger persons. However, in all models, perceived difference was a stronger predictor than was BMI of mentally and physically unhealthy days.

The researchers emphasize that there is a large body of evidence suggesting that social stress adversely affects mental health as well as physical health. “Our findings confirmed that there was a positive relationship between a person’s actual weight and his or her desired weight and health, be it physical or mental,” observed Dr. Muennig.

Obesity is one of the greatest public health threats. Over 7 million quality-adjusted life years are lost annually as a result of excess body weight in the United States alone. There is evidence that discrimination against heavy people is pervasive, occurring in social settings, the workplace, and the home. These processes are likely internalized, leading to a negative body image that also may serve as a source of chronic stress.

“The data add support to our hypothesis that the psychological stress that accompanies a negative body image explains some of the morbidity commonly associated with being obese. Our finding that the desire to lose weight was a much stronger predictor of unhealthy days than was BMI further suggests that perceived difference plays a greater role in generating disease,” said Dr. Muennig.

Am J Public Health. 2008 Jan 30 [Epub ahead of print]
I Think Therefore I Am: Perceived Ideal Weight as a Determinant of Health.
Columbia University.

Objectives. We examined whether stress related to negative body image perception and the desire to lose weight explained some of the body mass index-health gradient. Methods. We used 2003 Behavioral Risk Factor Surveillance System data to examine the impact of desired body weight, independent of actual body mass index, on the amount of physically and mentally unhealthy days by race, ethnicity, and gender. Results. The difference between actual and desired body weight was a stronger predictor than was body mass index (BMI) of mental and physical health. When we controlled for BMI and age, men who wished to lose 1%, 10%, and 20% of their body weight respectively suffered a net increase of 0.1, 0.9, and 2.7 unhealthy days per month relative to those who were happy with their weight. For women, the corresponding numbers were 0.1, 1.6, and 4.3 unhealthy days per month. The desire to lose weight was more predictive of unhealthy days among women than among men and among Whites than among Blacks or Hispanics. Conclusions. Our results raise the possibility that some of the health effects of the obesity epidemic are related to the way we see our bodies.

Written by huehueteotl

February 13, 2008 at 3:07 pm

Let Us Eat And Drink; For To Morrow We Shall Die.

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At least Isaiah xxii. 13 (AV) has it like this. he did not know that overweight smokers are an even less financial burden for public health. They simply die soonest, causing the least cost in health care systems.

A new research paper suggests that preventing obesity might result in increased public spending on medical care. Many countries are currently developing policies aimed at reducing obesity in the population. However, it is not currently clear whether successfully reducing obesity will also reduce national healthcare spending or not. Pieter van Baal and colleagues, from the National Institute for Public Health and the Environment in the Netherlands, created a mathematical model to try to answer this question.

In their study, van Baal and his co-workers created three hypothetical populations of 1000 men and women, all aged 20 years at the start: a group of obese, never-smoking individuals; a group of healthy-never smoking individuals of normal weight; and a group of smokers of normal weight. The model produced an estimate of the likely proportion of each group who would encounter certain long term (chronic) diseases, and then estimated what the approximate cost of medical care associated with each disease was likely to be. The researchers found that the group of healthy, never-smoking individuals had the highest lifetime healthcare costs, because they lived the longest and developed diseases associated with aging; healthcare costs were lowest for the smokers, and intermediate for the group of obese never-smokers.

However, the authors argue that although obesity prevention may not be a cure for increasing expenditures, it may well be a cost-effective cure for much morbidity and mortality and importantly contribute to the health of nations.

Should Isaiah’s biblical ammendment be then. “Eat, drink, smoke and be merry, for tomorrow we diet”? Mind, this is a mathematical model comparing life-time-health-costs. Main target of medicine is not keeping public health cheap but people healthy until old age! A Perspective by Klim McPherson, from Oxford University in the UK, who was not involved in the study, discusses the implications of these findings and comments that “it would be wrong to interpret the findings as meaning that public-health prevention (e.g., to prevent obesity) has no benefits”; the quality of life experienced by individuals, and other factors, must also be taken into account when planning interventions aimed at improving public health.

van Baal PHM, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, et al. (2008)

Lifetime medical costs of obesity: Prevention no cure for increasing health expenditure.

PLoS Med 5(2): e29. doi:10.1371/journal.pmed.0050029

BackgroundObesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to compare those to similar costs attributable to smoking, and to discuss the implications for prevention.

Methods and Findings

With a simulation model, lifetime health-care costs were estimated for a cohort of obese people aged 20 y at baseline. To assess the impact of obesity, comparisons were made with similar cohorts of smokers and “healthy-living” persons (defined as nonsmokers with a body mass index between 18.5 and 25). Except for relative risk values, all input parameters of the simulation model were based on data from The Netherlands. In sensitivity analyses the effects of epidemiologic parameters and cost definitions were assessed. Until age 56 y, annual health expenditure was highest for obese people. At older ages, smokers incurred higher costs. Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position. Alternative values of epidemiologic parameters and cost definitions did not alter these conclusions.


Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.

Written by huehueteotl

February 7, 2008 at 4:23 pm

what I read, and what I don’t – Sunday, January 13 2008

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On Wednesday, Jan. 16 2008, I read, that a man who pleaded guilty Tuesday to ripping the head off a duck in the lobby of a St. Paul, Minn., hotel is not a horrible person. His attorney said: “He’s really a nice young man, he’s humble, he’s hard-working, he was a good student and worked hard to get the job he did,” said attorney Michael Colich. “Nobody’s been willing to look at what good things he’s done in his life and what good things he’ll do in his life.”

Ramsey County District Judge Margaret Marrina said it appeared Clark, 26, had “a substantial amount to drink” before the incident. He will be sentenced next month, the newspaper reported. Although attorney and the prosecution agreed on a sentence — no more than 45 days in jail, two years of probation, 40 hours of community service, a $500 fine, restitution and no pet ownership for two years [sic] — the judge will decide.

On Sunday, Jan. 13, 2008, I read, that “violence is a leading cause of death for Iraqi adults and was the main cause of death in men between the ages of 15 and 59 years during the first 3 years after the 2003 invasion.Although the estimated range is substantially lower than a recent survey-based estimate, it nonetheless points to a massive death toll, only one of the many health and human consequences of an ongoing humanitarian crisis.”

A large national household survey conducted by the Iraqi government and WHO estimates that 151 000 Iraqis died from violence between March 2003 and June 2006.

The study found that on average 128 Iraqis per day died of violent causes in the first year following the invasion and that the average daily violent death toll was 115 in the second year and 126 in the third year. More than half of the violent deaths occurred in Baghdad.

nota bene: “Some homes could not be visited because of high levels of insecurity and more people move residence in times of conflict. These factors were taken into account in the analysis as they may affect the accuracy of the survey work,” said Salih Mahdi Motlab Al-Hasanawi, Minister of Health of Iraq. “Nonetheless, the survey results indicate a massive death toll since the beginning of the conflict.”

That makes a cruel arithmetical average of  123,33 Iraqui lives per day for the first three years of what U.S. President George Bush called a job for US troops to render Iraq democratic and stable.

What I don’t read is,  that any judge were to decide, how many days in jail, how many years of probation, how many hours of community service, how big a fine, restitution a human life in Iraq is worth. And who of the Bush administration is going to be sentenced…

see also:

what i read, and what i don’t… wed, 14 march 2007:U.S. President George Bush said at the Pentagon U.S. troops will stay in Iraq until “the job is done”

Written by huehueteotl

January 17, 2008 at 4:27 pm

For Weight Control You Will Need To Walk More Than 10,000 Steps A Day

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A collaborative study involving 14 researchers from the U.S., Australia, Canada, France, and Sweden has established preliminary guidelines for how many steps per day people should accumulate for weight control.

“We have put together recommendations for different age groups, but the material is more robust when it comes to women,” says Anders Raustorp, University of Kalmar, one of those taking the initiative for the study and director of the Swedish component. For women up to the age of 50 and for men, 10,000 steps a day is not sufficient for weight control.

The researchers have used the same pedometer, Yamax/KeepWalking LS2000, and identical methods in the various countries for determining the Body Mass Index (BMI). A group of 3,127 healthy adults, 19–94 years of age, with a mean age of 47, including 976 men, participated in the study. The research team has previously published recommendations for children aged 6–12 establishing that girls should accumulate 12,000 steps and boys 15,000 steps every day.

Anders Raustorp has done pioneering work when it comes to introducing the pedometer in Swedish research and Swedish public health efforts. One acclaimed study last autumn showed that if individuals set up goals and keep a journal for successive increases, their activity rises by 27% over a four-month period compared with a control group. Setting targets is thus a key to success.

The targets are based on recommendations developed by high-quality pedometers. Anders Raustorp emphasizes the importance of using validity-tested pedometers with no filter function. It is also important to bear in mind that more research is needed for the preliminary recommendations to be regarded as definitive.

The table below shows the steps-per-day recommendations for weight control

Age women – Steps per day

* 18-40 12 000 steps per day
* 40-50 11 000
* 50-60 10 000
* 60- 8 000

Age men – Steps per day

* 18-50 12 000
* 50- 11 000

JPAH, 5(Supplement 1), January 2008, Copyright © 2008

BMI-Referenced Cut Points for Pedometer-Determined Steps per Day in Adults

C. Tudor-Locke, D.R. Bassett, Jr., W.J. Rutherford, B.E. Ainsworth, C.B. Chan, K. Croteau, B. Giles-Corti, G. Le Masurier, K. Moreau, J. Mrozek, J.-M. Oppert, A. Raustorp, S.J. Strath, D. Thompson, M.C. Whitt-Glover, B. Wilde, J.R. Wojcik
Full Article Table of Contents for Vol. 5, Iss. Supplement 1

Background: The goal of this study was to establish preliminary criterion-referenced cut points for adult pedometer-determined physical activity (PA) related to weight status defined by body mass index (BMI). Methods: Researchers contributed directly measured BMI and pedometer data that had been collected (1) using a Yamax-manufactured pedometer, (2) for a minimum of 3 days, (3) on ostensibly healthy adults. The contrasting groups method was used to identify age- and gender-specific cut points for steps/d related to BMI cut points for normal weight and overweight/obesity (defined as BMI <25 and ³25 kg/m2, respectively). Results: Data included 3127 individuals age 18 to 94 years (976 men, age = 46.8 ± 15.4 years, BMI = 27.3 ± 4.9; 2151 women, age = 47.4 ± 14.9 years, BMI = 27.6 ± 6.4; all gender differences NS). Best estimated cut points for normal versus overweight/obesity ranged from 11,000 to 12,000 steps/d for men and 8000 to 12,000 steps/d for women (consistently higher for younger age groups). Conclusions: These steps/d cut points can be used to identify individuals at risk, or the proportion of adults achieving or falling short of set cut points can be reported and compared between populations. Cut points can also be used to set intervention goals, and they can be referred to when evaluating program impact, as well as environmental and policy changes.

Written by huehueteotl

January 13, 2008 at 5:47 pm

Most Ancient Case of Tuberculosis Found In 500,000-Year-Old Human

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Evidence Suggests Vitamin D Deficiency Endangers Migrating Populations

Although most scientists believe tuberculosis emerged only several thousand years ago, new research from The University of Texas at Austin reveals the most ancient evidence of the disease has been found in a 500,000-year-old human fossil from Turkey.

The discovery of the new specimen of the human species, Homo erectus, suggests support for the theory that dark-skinned people who migrate northward from low, tropical latitudes produce less vitamin D, which can adversely affect the immune system as well as the skeleton.

Professor John Kappelman holds a plaster cast replica of the cranium of the newly discovered young male Homo erectus specimen<br /> from western Turkey

Professor John Kappelman of The University of Texas at Austin holds a plaster cast replica of the cranium of the newly discovered young male Homo erectus specimen from western Turkey. The fossil is 500,000 years old and was recovered from a block of travertine stone as it was being sawed into tiles for the building stone market.

Prior to this discovery in western Turkey, which helps scientists fill a temporal and geographical gap  in human evolution, the oldest evidence of tuberculosis in humans was found in mummies from Egypt and Peru that date to several thousand years ago.

Paleontologists spent decades prospecting in Turkey for remains of Homo erectus, widely believed to be the first human species to migrate out of Africa. After moving north, the species had to adapt to increasingly seasonal climates.

The researchers identified this specimen of Homo erectus as a young male based on aspects of the cranial suture closure, sinus formation and the size of the ridges of the brow. They also found a series of small lesions etched into the bone of the cranium whose shape and location are characteristic of the Leptomeningitis tuberculosa, a form of tuberculosis that attacks the meninges of the brain.

After reviewing the medical literature on the disease that has reemerged as a global killer, the researchers found that some groups of people demonstrate a higher than average rate of infection, including Gujarati Indians who live in London, and Senegalese conscripts who served with the French army during World War I.

The research team identified two shared characteristics in the communities: a path of migration from low, tropical latitudes to northern temperate regions and darker skin color.

People with dark skin produce less vitamin D because the skin pigment melanin blocks ultraviolet light. And, when they live in areas with lower ultraviolet radiation such as Europe, their immune systems can be compromised.

John Kappelman, professor of anthropology at The University of Texas at Austin, is part of an international team of researchers from the United States, Turkey and Germany who have published their findings in the Dec. 7 issue of the American Journal of Physical Anthropology.

It is likely that Homo erectus had dark skin because it evolved in the tropics, Kappelman explained. After the species moved north, it had to adapt to more seasonal climates. The researchers hypothesize the young male’s body produced less vitamin D and this deficiency weakened his immune system, opening the door to tuberculosis.

“Skin color represents one of biology’s most elegant adaptations,” Kappelman said. “The production of vitamin D in the skin serves as one of the body’s first lines of defenses against a whole host of infections and diseases. Vitamin D deficiencies are implicated in hypertension, multiple sclerosis, cardiovascular disease and cancer.”

Before antibiotics were invented, doctors typically treated tuberculosis by sending patients to sanatoria where they were prescribed plenty of sunshine and fresh air.

“No one knew why sunshine was integral to the treatment, but it worked,” Kappelman said. “Recent research suggests the flush of ultraviolet radiation jump-started the patients’ immune systems by increasing the production of vitamin D, which helped to cure the disease.”

View of the inside of a plaster cast of the skull of the newly discovered young male Homo erectus from western Turkey
View of the inside of a plaster cast of the skull of the newly discovered young male Homo erectus from western Turkey. The stylus points to tiny lesions 1-2 mm in size found along the rim of bone just behind the right eye orbit. The lesions were formed by a type of tuberculosis that infects the brain and, at 500,000 years in age, represents the most ancient case

American Journal of Physical Anthropology 7 Dec 2007 Early View DOI 10.1002/ajpa.20739
Brief Communication
First Homo erectus from Turkey and implications for migrations into temperate Eurasia
John Kappelman 1 *, Mehmet Cihat Alçiçek 2, Nizamettin Kazanc 3 4, Michael Schultz 5, Mehmet Özkul 2 4, evket en 6
1Department of Anthropology, The University of Texas, Austin, TX
2Department of Geological Engineering, Engineering Faculty, Pamukkale University, Denizli, Turkey
3Department of Geological Engineering, Engineering Faculty, Ankara University, Ankara, Turkey
4JEMIRKO, Turkish Association for Protection of Geological Heritage, Ankara, Turkey
5Zentrum Anatomie der Georg-August-Universität, Göttingen, Germany D-37075
6Laboratoire de Paléontologie du Muséum National d’Histoire Naturelle, Paris, France
email: John Kappelman (

*Correspondence to John Kappelman, The University of Texas at Austin, Anthrop and Archeol, 1 University Station C3200, Austin, TX 78712-0303, USA

Remains of fossil hominins from temperate regions of the Old World are rare across both time and space, but such specimens are necessary for understanding basic issues in human evolution including linkages between their adaptations and early migration patterns. We report here the remarkable circumstances surrounding the discovery of the first fossil hominin calvaria from Turkey. The specimen was found in the Denizli province of western Turkey and recovered from within a solid block of travertine stone as it was being sawed into tile-sized slabs for the commercial natural stone building market. The new specimen fills an important geographical and temporal gap and displays several anatomical features that are shared with other Middle Pleistocene hominins from both Africa and Asia attributed to Homo erectus. It also preserves an unusual pathology on the endocranial surface of the frontal bone that is consistent with a diagnosis of Leptomeningitis tuberculosa (TB), and this evidence represents the most ancient example of this disease known for a fossil human. TB is exacerbated in dark-skinned peoples living in northern latitudes by a vitamin D deficiency because of reduced levels of ultraviolet radiation (UVR). Evidence for TB in the new specimen supports the thesis that reduced UVR was one of the many climatic variables presenting an adaptive challenge to ancient hominins during their migration into the temperate regions of Europe and Asia. Am J Phys Anthropol, 2007. © 2007 Wiley-Liss, Inc.

see also:

American Journal of Physical Anthropology Volume 134, Issue S45 , Pages 85 – 105

Research Article

Human pigmentation variation: Evolution, genetic basis, and implications for public health

Esteban J. Parra
Department of Anthropology, University of Toronto at Mississauga, Mississauga, ON, Canada L5L 1C6

email: Esteban J. Parra ( Correspondence to Esteban J. Parra, Department of Anthropology, University of Toronto at Mississauga, 3559 Mississauga Road North, Room 212 North Building, Mississauga, ON, Canada L5L 1C6

Pigmentation, which is primarily determined by the amount, the type, and the distribution of melanin, shows a remarkable diversity in human populations, and in this sense, it is an atypical trait. Numerous genetic studies have indicated that the average proportion of genetic variation due to differences among major continental groups is just 10-15% of the total genetic variation. In contrast, skin pigmentation shows large differences among continental populations. The reasons for this discrepancy can be traced back primarily to the strong influence of natural selection, which has shaped the distribution of pigmentation according to a latitudinal gradient. Research during the last 5 years has substantially increased our understanding of the genes involved in normal pigmentation variation in human populations. At least six genes have been identified using genotype/phenotype association studies and/or direct functional assays, and there is evidence indicating that several additional genes may be playing a role in skin, hair, and iris pigmentation. The information that is emerging from recent studies points to a complex picture where positive selection has been acting at different genomic locations, and for some genes only in certain population groups. There are several reasons why elucidating the genetics and evolutionary history of pigmentation is important. 1) Pigmentation is a trait that should be used as an example of how misleading simplistic interpretations of human variation can be. It is erroneous to extrapolate the patterns of variation observed in superficial traits such as pigmentation to the rest of the genome. It is similarly misleading to suggest, based on the average genomic picture, that variation among human populations is irrelevant. The study of the genes underlying human pigmentation diversity brings to the forefront the mosaic nature of human genetic variation: our genome is composed of a myriad of segments with different patterns of variation and evolutionary histories. 2) Pigmentation can be very useful to understand the genetic architecture of complex traits. The pigmentation of unexposed areas of the skin (constitutive pigmentation) is relatively unaffected by environmental influences during an individual’s lifetime when compared with other complex traits such as diabetes or blood pressure, and this provides a unique opportunity to study gene-gene interactions without the effect of environmental confounders. 3) Pigmentation is of relevance from a public health perspective, because of its critical role in photoprotection and vitamin D synthesis. Fair-skinned individuals are at higher risk of several types of skin cancer, particularly in regions with high UVR incidence, and dark-skinned individuals living in high latitude regions are at higher risk for diseases caused by deficient or insufficient vitamin D levels. Yrbk Phys Anthropol 50:85-105, 2007. © 2007 Wiley-Liss, Inc.

Written by huehueteotl

December 9, 2007 at 12:56 pm

Implications Of The New HIV Estimate For India

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The 2007 UNAIDS/WHO AIDS epidemic update recently released has revised the global estimate of HIV/AIDS primarily due to a major reduction of the estimate for India to 2.5 million people living with HIV/AIDS, which is less than half of the previous official estimate of 5.7 million people. This revision is based on new population-based data from the National Family Health Survey in India.


A commentary published in the Lancet on World AIDS Day by health research experts at The George Institute India, explains the basis of this drop and the implications for future planning of HIV/AIDS control in India. Author Professor Lalit Dandona, Senior Director of The George Institute India and Chair of International Public Health at The University of Sydney School of Public Health, said today, “The data from the recent National Family Health Survey support the findings from similar studies we conducted in southern India, where we showed that the previously used official method for estimation of HIV burden in India was in fact not valid, and led to a 2•5 times higher estimate than what is actually the case.”

Professor Dandona explains that well-designed scientific population-based surveys provide a more reliable representation of HIV in India, compared to the official method used so far, which extrapolated data directly from large public-sector hospitals to the population. “The official method overestimated the burden of HIV in India as the profile of patients visiting large public-sector hospitals is quite different from the population at large, in terms of disease distribution including HIV,” he said.

Professor Dandona believes that the new and much reduced HIV estimate for India has several implications. “We can now see that the official method for annual estimation of HIV prevalence in India needs revision. The new figures show the projected number of people needing HIV treatment over the next decade, and the associated resources needed, will be less than previously anticipated.”

Importantly, the new HIV estimate for India indicates that HIV rates as seen in sub-Saharan Africa will not occur in India, says Professor Dandona. HIV prevention efforts in India should therefore be targeted directly at high-risk groups, such as sex workers, men who have sex with men, mobile populations (migrant labourers and truckers), people with other sexually transmitted infections, and injection drug users. Other areas of focus should include counselling, testing, prevention of transmission from mother to child, and blood-transfusion safety.

In addition, Professor Dandona says the public-health approach for HIV control in India needs to become more scientific. “The establishment of a reliable estimate of HIV burden in India is only an initial step, what’s needed now is more scientific effort to understand the dynamics of HIV spread in India and the impact of interventions on HIV control in India,” he said.
Source: The Lancet – Vol. 370, Issue 9602, 1 December 2007, Pages 1811-1813
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Drop of HIV estimate for India to less than half
Lalit Dandona, Rakhi Dandona

Written by huehueteotl

December 4, 2007 at 12:31 pm