Tuesday, January 31, 2012

Exercise Decreases Depressive Symptoms

The Blogger and a therapeutic goalkick for emotional well being
We have all heard that exercise is good for cardiovascular health, weight control, etc, but there is growing evidence that exercise can impact emotional well being.

Here is an article recently published in the Archives of Internal Medicine. The authors performed a systematic review and meta-analysis of all related exercise and chronic illness randomized controlled trials. 

Exercise programs decreased depressive symptoms by 30%. Patients with mild -moderate depressive symptoms achieved the largest antidepressant effects.

For those of us addicted to exercise, we must now press on, for the sake of physical well being and, extrapolating liberally from this study, for 'preventive' emotional health.

Friday, January 27, 2012

Contact Precautions and Delirium

Here is another paper suggesting that contact precautions have potential adverse consequences. This time, the focus is delirium.

During the 2-year study period, 60,151 admissions occurred in 45,266 unique nonpsychiatric patients. After adjusting for comorbid conditions, age, sex, intensive care unit status, and length of hospitalization, contact precautions were significantly associated with delirium (75% increased odds of delirium). The association between contact precautions and delirium was seen only in patients who were newly placed under contact precautions during the course of their hospitalization.

A major study limitation was that the onset of delirium in relationship to the time that contact precautions were initiated remains undefined. 

Although no one has proved that contact precautions causes delirium, the association between the two appears real. This should remind us to use contact precautions judiciously and to consider proven delirium prevention strategies on isolated patients.

Wednesday, January 25, 2012

Obesity in Nursing

Source: Nursingcrib.com
It is true that people in healthcare do not always lead the healthiest lives. There are doctors who are overweight, eat unhealthy foods and smoke.

Obesity in the USA is an ongoing concern, and nurses are not immune to the problem. Click here for full access to a study published in The Journal of Nursing Administration. In an analysis of 2,103 female nurses, 55% were obese/overweight. When compared to non-obese nursing colleagues, long work hours and jobs with decreased physical exertion were associated with obesity.

It is ironic that obesity is so prevalent in healthcare workers, who, in theory, should model healthy living. Of course, weight loss requires personal responsibility and a fair amount of self-motivation. Regardless, healthcare systems should strive to promote a work environment that encourages a healthy lifestyle. This includes promotion of walking the stairs and the availability of healthy meals and snacks in the cafeteria. Unhealthful scheduling of shifts should be restricted.

Working in healthcare facilities must allow for healthy habits.

Tuesday, January 24, 2012

The Power of Disgust

Source: NY Times
I came across the topic of 'disgust' twice in as many days. Here is an interesting quick read on the subject.

Apparently, disgust is the new frontier in emotion research. Disgust may be analagous to fear or pain, functioning essentially a noxious stimulus that keeps us from danger. 

Could disgust exist, in part, to keep us safe from the 'cooties'?  Perhaps even keeping plague and pestilence at bay?

For a more in depth read, it may be worth checking out That's Disgusting- Unraveling the Mysteries of Repulsion, by Rachel Herz.  Click here for the NY Times book review.

I plan on checking this out soon.

Monday, January 23, 2012

Happy Birthday Dr. Michael Stevens!

Happy birthday to my friend, colleague and collaborator, Dr. Michael Stevens.  I can think of no better place to have your cake and eat it too, than in the infection control office.

Dr. Stevens, attacking his (belated) birthday cake at VCU Medical Center this afternoon
PS: his Birthday was 1/21/2012

HIV Transmission per Coital Act

An accurate estimate of HIV transmission per episode of heterosexual intercourse is not easy to measure. Here is a study of the highest importance recently published in the Journal of Infectious Diseases that accomplishes what was presumed impossible.

Several important points:
  • The participants were 3297 African (heterosexual) couples
  • Overall HIV infectivity was 1-2 cases per 1000 coital acts
  • The HIV viral load was in the infected partner was associated with increased transmission risk (2.9 fold adjusted rsk of infection per Log10 increment in viral load)
  • There was a 2.14 fold increased risk of transmission if the uninfected partner was Herpes Simplex Virus 2 infected
  • There was 2.65 fold increased risk of transmission if the uninfected partner had genital ulcer disease 
  • Transmission was significantly reduced if the HIV infected partner was on HIV treatment, if condoms were used, and if the male was circumcised
These findings support the strategies of early diagnosis, prompt treatment of HIV and associated sexually transmitted diseases, male circumcision and condom promotion.

Common sense interventions, driven by data.

Sunday, January 22, 2012

Kudos to Kate et al.: ACP Virginia Chapter Associates Meeting

Kate Pearson successfully presented her collaborative work on our Honduras medical relief efforts, this time at the American College of Physicians (ACP) Virginia Chapter Associates Meeting. Kate was the only medical student presenter. Bravo!

Dr. Michael Stevens, along with residents from internal medicine, proudly represented the VCU Department of Medicine research effort. 

Kudos to all.

Kate Pearson- ACP Virginia Chapter- 1/21/2012
VCU Internal Medicine at ACP Virginia Chapter- 1/21/2012

Friday, January 20, 2012

Many High Risk Americans, Including Healthcare Workers Are Not Vaccinated for Hepatitis B

Source: Medicalook
Here is an eye opening report. Many Americans at risk for Hepatitis B infection, including healthcare workers, are not vaccinated for Hepatitis B.

Investigators published a study in the Journal of Infection based on the representative survey responses (Behavioral Risk Factor Surveillance Survey)  of 15,000+ participants. Fifty-one percent of respondents at risk for Hepatitis B were unvaccinated. The authors argue that inadequate vaccination coverage and missed vaccination opportunities are driving the problem. 

Most striking, in my opinion, are healthcare workers who refuse Hepatitis B vaccination. The Hepatitis B vaccine is typically given free of charge by healthcare systems in employee health centers. Access is really not an issue. .

Whether it be an anti-vaccine sentiment in general, an underlying risk taking personality, or just a careless indifference to safety, why would one want to take the risk of acquiring a viral infection that is not easily treated and can result in cirrhosis and liver cancer, especially when a safe and effective vaccine is available?

Thursday, January 19, 2012

A Sugar Tax as Public Health Policy

Here is a provocative paper published in Health Affairs.

Sugar-sweetened beverages are a major contributor to the US obesity and diabetes epidemics. Investigators analyzed the potential impact of a nation-wide,  penny-per-ounce excise tax on these drinks. The tax would reduce consumption of sweetened beverages by 15 percent among adults ages 25-64. Over the period 2010-20, the tax is estimated to prevent 2.4 million diabetes person-years, 95,000 coronary heart events, 8,000 strokes, and 26,000 premature deaths, while avoiding more than $17 billion in medical costs. In addition, the beverage tax would generate approximately $13 billion in annual tax revenue and would reduce the adverse health and cost burdens of obesity, diabetes, and cardiovascular diseases.

Obesity is a conversation topic in the graduate school seminar which I teach. The seminar, aptly titled Contemporary Issues and Controversies in Public Health, generates much discussion, especially on the subject of obesity in the USA. 

The causes of obesity are multiple and include genetic, environmental and dietary factors. The relative contribution of each factor, remains largely unknown, hindering the ability to fully craft and implement evidence based interventions. 

Although a modest tax on sweetened beverages would by no means reverse the obesity epidemic, its potential impact, both financially and from a public health perspective, appears promising.

Wednesday, January 18, 2012

Antimicrobial Textiles in Medicine- On the Rise?

Here is a recent publication in Infection Control and Hospital Epidemiology on antimicrobial textiles.

A  crossover study design was used in an cute care medical ward with 19 beds at a large university hospital. Fourteen types of frequent-touch items made of copper alloy were installed in various locations on an acute care medical ward. These included door handles and push plates, toilet seats and flush handles, grab rails, light switches and pull cord toggles, sockets, overbed tables, dressing trolleys, commodes, taps, and sink fittings. The study surfaces and those of equivalent standard items were sampled once weekly for 24 weeks

The result? Microorganisms were recovered from both types of surfaces; however, significantly fewer copper surfaces were contaminated with vancomycin-resistant enterococci, MRSA, and coliforms, compared with standard surfaces.

We have a study, to be published next week, on a prospective trial of antimicrobial scrubs in the ICU. For a sneak peak at our manuscript click hereWe too discovered that an antimicrobial textile, in this case study scrubs, can decrease the bioburden of MRSA.

So, although the bioburden of hospital pathogens may be impacted, no one has yet proven that antimicrobial textiles can actually decrease the rates of hospital acquired infections. 
That would be the Holy Grail of antimicrobial textile research.

Monday, January 16, 2012

Bath Salts as Designer Drugs and Necrotizing Fasciitis- a Strange Combination

Bath salt- not just for the bath tub anymore
I am spending the week covering our orthopedic infectious diseases consult service, thus, I felt that the focus of this blog post was appropriate.

I came across a headline today on bath salts as the cause of necrotizing fasciitis, known in the vernacular as the flesh eating bacteria. Necrotizing fasciitis is a life threatening infection of the skin and soft tissue resulting in septic shock and even death.  In the journal, Orthopedics, a case of necrotizing fasciiitis following 'bath salts' injection into an arm is reported. 

Working in an urban hospital and in an clinic, I pride myself in having learned much of the drug lingo from my patients during the course of our medical encounters. 'Bath salts' as a street drug was new to me. A quick cross reference of 'Bath Salt' in the Urban Dictionary proved enlightening. Bath salt is a new, designer drug.  It is synthetic, stimulant powder product that contains amphetamine-like chemicals, including mephedrone. These chemicals produce excitement, and have side effects such as rebound depression, paranoia and psychosis. Brand names include Blizzard, Blue Silk, Charge+, Ivory Snow, Ivory Wave, Ocean Burst, Pure Ivory, Purple Wave, Snow Leopard, Stardust, Vanilla Sky, White Dove, White Knight and White Lightning.

Here is an informative Q+A in WebMD on bath salts.

You learn something everyday in this line of work.

Thursday, January 12, 2012

Google Flu Trends- Your Real Time Source for Influenza Activity!

Well I am now back in the USA and back to the grind at L'hospital.

I am turning my attention from low tech medical relief work in Central America to high tech influenza surveillance.  In brief, there is a close relationship between how many people search for flu-related topics on the internet and actual flu-like symptoms in the population. Google Flu Trends activity was significantly correlated with emergency department visits as just reported in an article published in Clinical Infectious Diseases.

Check it out for yourself: Google Flu Trends. Click on the country then the the state, province or region, and, voila, you have a measure of Influenza activity in your area.

For a short yet informative Google Flu Trends video, see below.

What will the Google Boys think of next? 

Tuesday, January 10, 2012

Postcard from Honduras- January 10, 2012

Following a fine meal and a good night's rest at the Hilton in San Pedro Sula, we were ready for the trip home.

After returning our 4X4 pickup at Hertz, we made sure to pick up a parting espresso prior to heading to the gate. En route, security confiscated my toiletries for not storing them in a proper plastic bag.

We paused for a group photo and to update the blog, just prior to boarding.

Another Honduran trip has come to a close. After 72+ hours in country and nearly 1000 kilometers on the odometer, we are properly worn out, yet still optimistic about the June medical relief trip. Good things are afoot.

Thanks for following our adventure.


Monday, January 9, 2012

Postcard from Honduras-January 9, 2012

Another 5am morning. Awoke groggier than ever. The shower in the hotel had warm water, so that was uplifting. Breakfast consisted of oatmeal cookies and peanut butter. Then, I decided to take a morning stroll, with no particular destination.After finding some Nescafe, we headed to the Ministry of Health, to review epidemiologic data and make additional relief trip plans.

Time was in short supply, so we made off for the 90 minute drive to remote and mountainous La Hicaca, our medical relief site. There, we met up with the local nurses and the community leader. We will expand both the clinical and public health services this June with their ongoing critical collaboration.

Prior to leaving La Hicaca, I made sure to visit Catalina, our cook. An impressive mass of red beans was drying in the sun, just outside her home.We passed the school (our impromptu field clinic), then posed for a photo, prior to departing for Olanchito, then San Pedro Sula.

At day's end, and after 8 hours behind the wheel, back in San Pedro Sula, at a rather plush Hilton hotel.

Tomorrow,  Drs. Mason, Stevens and I head back to the USA.

Stay tuned.


Sunday, January 8, 2012

Postcard from Honduras-January 8, 2012

The HPV hotel was comfortable beyond expectation.

We were up at 5 am so as to hit the road to Olanchito and I was in desperate need of a cup of honduran coffee. No such luck at that hour, so we pressed on with sleepy eyes and caffeine deficiency.

After a 4 hour drive, we arrived at Olanchito, and promptly checked into the Hotel Beverly. We did not waste any time and began to prepare for our meetings with our Honduran collaborators.

Today's meeting, over a slow, working lunch was a resounding success. We renewed and expanded our collaborative projects for patient care, hemoglobin-anemia checks, deworming, vitamin delivery, dental varnish and water filtration. This year we will focus our efforts in the rural, mountainous communities only and expand our water filter projects to new, remote households.

Things are shaping for June 2012.

Back at the hotel now, resting, blogging and, by the appearance of the sky, anticipating an imminent cloudburst.

Check back tomorrow.


Saturday, January 7, 2012

Postcard From Honduras- January 7, 2012

We started at 5AM today in Richmond, Virginia. Better late than never, after a diversion to El Salvador, we are finally in Honduras.

Immigration was a well coordinated mess.

We waited, per custom, for our Hertz pick-up truck. One thing I have learned, things are never move quickly or smoothly in Honduras.

Due to the late arrival, we did not make it to Olanchito, rather, we are in the city of El Progresso.

We are staying at the Hotel Plaza Victoria (HPV). An HPV sojourn for 2 infectious diseases physicians, most appropriate.

We have arrived and have yet to accomplish anything.

Big day tomorrow.

Stay tuned.


Honduras Bound- and Almost There

Well we are not off to an auspicious start. We should now be in Honduras but find ourselves on the tarmac in San Salvador! Diverted.
Hope to fly out soon for San Pedro Sula.
Stay tuned.

Friday, January 6, 2012

Old Vacuum Cleaners Release More Bacteria and Dust

During my morning perusal of the the medical literature, I came across these articles on vacuum cleaners. Apparently, older, cheaper vacuum cleaners can aerosolize dust and bacteria. Read about it here in Infection Control Today. The original publication is in Environmental Science and Technology.

I am not really sure of the relevance of this study. At least in a hospital setting, patient care areas should not be carpeted as carpets cannot be properly cleaned and disinfected. 

My administrative office, however, is nicely carpeted. The vacuum cleaner used by our environmental services seems a bit worn out and leaves a funky scent in the air post use. Perhaps I should insist on an upgrade.

I will be in Honduras, as of tomorrow, coordinating our June 2012 relief trip. Expect daily blog updates.

Wednesday, January 4, 2012

HIV Treatment for Prevention

Source: Latinoaids.org
Here is an article in the NY times summarizing the concept of preventing HIV transmission by early diagnosis and treatment.

A recent clinical trial supports the strategy of early treatment and prevention to curb the HIV epidemic. Simply put, an undetectable viral load is associated with greatly diminished risk for HIV transmission.

Science magazine recognized this work as the breakthrough study of the year.

This should challenge infectious diseases specialists to now treat HIV infection upon diagnosis (or as soon as feasible), rather than waiting for symptoms or a specified CD4 cell count level. 

A paradigm shift in HIV management may be at hand.

Monday, January 2, 2012

Human Papilloma Virus Vaccine and Sexual Activity

Source: healblog.net
Just the other night I was at a New Year's Eve party and a young woman was asking me my thoughts about the human papilloma virus (HPV) vaccine. Naturally, as an infectious diseases physician, I am in favor of HPV vaccination.

Here is a recent article of note. The authors explored sexual behavior and demographic correlates of HPV vaccine initiation from a nationally representative survey of adolescent and young adult women. A  total of 1243 girls/women aged 15–24 years responded to questions about receiving HPV vaccine in the National Survey of Family Growth (NSFG). In 2010, demographic and sexual behavior correlates were evaluated in bivariate and multivariate analyses by age.

HPV vaccine initiation was higher among those aged 15–19 years than those aged 20–24 years (30.3% vs 15.9%, p<0.001).  HPV vaccine initiation was greater for those with insurance regardless of age. HPV vaccination was not associated with being sexually active or number of sex partners at either age. Among sexually active adolescents aged 15–19 years, those who received HPV vaccine were more likely to always wear a condom (AOR=3.0).
HPV vaccination will reduce the risk of cervical cancer and is not associated with risky sexual behavior. This is a sensible public health intervention.

Sunday, January 1, 2012

Happy New Year!

The Blogger, at home, avoiding both the hospital and domestic duties.
I am managing to spend the weekend away from the hospital and am quite proud of that.

For the few of you (if any) who are interested in our Central American relief work and who regularly follow this blog, I will be in Honduras next weekend for just over 72 hours.  Will be sure to post daily updates and photos as we work to set up or June 2012 relief trip.

Happy 2012.