Global Health: Ideas and Ideals

Source: Harvard.edu

The last several weeks we have been planning our return to Honduras for our medical relief trip. So, finally, I dove into an Infectious Diseases Clinics of North America publication on global health. A recent article, on the evolving meaning of global health, can be found here.


For those of you who are interested, here are some salient points:


Although the definition of global health is broad, the guiding principal lies in practical approaches to equity, human rights, and evidence-based interventions and actions.


From Julio Frenk’s Address at the Harvard School of Public Health Commencement,
June 7, 2007: Actions are guided by two powerful sources of illumination—ideas and ideals. Ideas take the form of knowledge derived from science. Ideals take the form of values derived from ethics. Ideas can be transforming to the evidence base for sound decision making. Ideals can be transformed into the integrity base for coherent action.


Ain't that the truth.

Hand Hygiene-State of the Art

There is scholarly review on hand hygiene in this month's Infection Control and Hospital Epidemiology.


Few, if any, need convincing that hand hygiene is an effective risk reduction strategy for infection prevention. The gold standard for hand hygiene remains trained observers, however, this is time consuming,costly, laborious and likely subject to bias. Measuring the amount of sanitizer consumed is a surrogate and less accurate measure of capturing hand hygiene in a healthcare setting.


I was encouraged to read that electronic hand hygiene monitoring systems  (utilizing wireless systems to monitor room entry and exit of healthcare workers and their use of hand hygiene product dispensers) can provide individual and unit-based data on compliance hand hygiene.These systems are varied and include badges (tags) that can provide healthcare workers with real-time reminders to clean their hands upon entering and exiting patient rooms. We studied one such product. Hand hygiene, in our experience, skyrocketed with electronic surveillance.


Other studies suggest that electronic hand hygiene monitoring systems are associated with increased hand hygiene compliance. 


Of course, these systems are expensive, however, if we are serious about infection prevention and patient safety, then they are worth it.

Staphylococcus aureus Decolonization- Variation Abounds

There is a lot of coverage and controversy when it come to Staphylococcus aureus and methicillin-resistant S. aureus (MRSA).


A recent publication in Infection Control and Hospital Epidemiology confirms that significant variation exists, even among infectious diseases specialists, for decolonizing a patient of Staphyloccus prior to an elective procedures. As most staphylococcal infections arise from one's own endogenous strain, reducing the bacterial burden is a proven infection prevention intervention.


The investigators surveyed infectious disease physicians to determine their preoperative Staphylococcus aureus screening and decolonization practices. Sixty percent reported preoperative screening for S. aureus. However, specific screening and decolonization practices are highly variable, are focused almost exclusively on methicillin-resistant S. aureus, and do not include testing for mupirocin or chlorhexidine resistance.


Variation on screening and decolonization exist as neither method is fully effective at either detecting or eradicating S.aureus.


At present, we cannot easily detect all staphylococcal carriers and prevent all related infections.

Too Much Care in Primary Care?

Are we a nation that is overtreated by our doctors? Medical writer Shannon Brownlee would agree with this comment and has written extensively on the subject in her book Overtreated. I highly recommend reading it.


Do primary care physicians share a similar point of view? A recent study in the Archives of Internal Medicine explores this theme.



The investigators conducted a nationally representative mail survey of US primary care physicians randomly selected from the American Medical Association Physician Masterfile (response rate, 70%; n = 627).


Forty-two percent of US primary care physicians believe that patients in their own practice are receiving too much care; only 6% said they were receiving too little. The most important factors physicians identified as leading them to practice more aggressively were malpractice concerns (76%), clinical performance measures (52%), and inadequate time to spend with patients (40%). Physicians also believe that financial incentives encourage aggressive practice: 62% said diagnostic testing would be reduced if it did not generate revenue for medical subspecialists (39% for primary care physicians). Almost all physicians (95%) believe that physicians vary in what they would do for identical patients; 76% are interested in learning how aggressive or conservative their own practice style is compared with that of other physicians in their community.


So many primary care doctors believe that their patients are receiving too much care. The cause appears multifactorial and includes fear of litigation, financial incentives and insufficient time with patients. 


Perhaps a peer to peer comparison could affect a change in practice or perhaps it could reinforce collective, non-evidence based practice. Most encouraging, in my view, is that many respondents were interested in feedback on their practice style. 

A Fat Tax

Source: Freakonomics.com

I have blogged before about our growing obesity epidemic (pun intended).


Here is an article by Mark Bittman on a 'Fat' Tax. Another related article is found here on the Freakonomics website.


Essentially, the Danes have implemented an excise tax on foods high in saturated fat. At play is a similar principle applied to other unfavorable items. As one increases cost (through taxation), consumption of alcohol and cigarettes decreases. The goal is to decrease the consumption of high fat foods by increasing cost to the consumer. 


Now the rate of obesity in Denmark is significantly lower than the USA, so this is forward thinking indeed. It remains to be seen, however, what impact an excise tax will truly have on both decreasing the consumption of foods high in saturated fat and curbing the obesity trend.


One can quit smoking but one simply cannot quit eating.


Time will tell.

Football (Soccer) as a Public Health Initiative

The Blogger at a football 'wellness' session
on a windy field in Richmond, Virginia

Okay...this is now too good to be true. My two passions- medicine and football (soccer) in collaboration.


A recent article published in the  European Journal of Applied Physiology explores the health impact of a football 'wellness' program in homeless men.  Read the summary here.

Fifty-five men enrolled in the study and were randomized either to receive soccer training two or three times a week or to serve as a control group. After 12 weeks, the group who regularly played soccer reduced their body fat and lowered their blood pressure and cholesterol levels, compared with the control group. The soccer players also improved other markers of cardiovascular health.

Football as a public health initiative. I love it.

For another interesting read, check out How Soccer Explains the World by Franklin Foer.

A must read.

Calling the Nurse "Doctor"

Source: NY Times

Here is an article in Sunday's New York Times about nurse practitioners with doctorate degrees. The trend extends to pharmacists and physical therapists. It is becoming increasingly routine for patients that someone who is not a physician uses the title of doctor


Rightly, healthcare workers are entitled to introduce themselves as "Doctors" if they have a doctoral degree. However, this could be misleading to the patients. It may not be clear to patients that the "doctor" is a nurse, pharmacist or physical therapist.


At stake is also a potential erosion of physician power. 


It will be interesting to see how this plays out in the long run.