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In Yale Environment 360, Sonia Shah highlights a promising trend: communities in Mexico, China, Tanzania, and elsewhere are adopting non-chemical methods to control the populations of mosquitos that transmit malaria. They’ve seen their numbers of malaria cases drop, and dramatically reduced their use of the pesticide DDT.

In addition to the environmental health risks that DDT poses, its continued use often results in mosquitos becoming resistant to the pesticide – or, they can adapt to interventions like insecticide-treated bednets by changing the times and places in which they bite, which Shah reports has happened in Dar es Salam.

Here are some of the non-chemical approaches that Shah describes:

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By Anjana Padmanabhan

What can 50 cents buy?

A pencil? Erasers? Gum?  Not really the essentials.

What if you found out that with just 50 cents you could save a life? That the change you find under the couch, or in your pockets could vastly improve a child’s future, or increase a woman’s access to education?

For many of us who are fortunate enough not to be part of the world’s  “bottom billion” (most of whom earn less than $1.25 per day), 50 cents doesn’t make much of a difference to our lives. But for those who live in areas ravaged by poverty and degradation, it can literally mean the difference between life and death.

So you must be wondering, how exactly can just 50 cents help save lives?

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The American Psychiatric Association has just released draft revisions for the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for a two-month comment period. (The DSM-5 will be published in May 2013.) Because mental health professionals and healthcare payers rely on the DSM for diagnoses, changes to it can influence millions of people.

A few specific diagnoses – especially bipolar disorder in children and autism spectrum disorder – are getting a lot of the attention, but the draft revisions also include an important change in how diagnoses are made. A new “dimensional assessment approach” will take into account the severity of patients’ symptoms as well as the number of symptoms of particular disorders they exhibit. NPR’s Kathleen Masterson, citing an example from DSM task force member Dr. Darrel Reiger, explains:

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Of the many wrenching stories coming out of Haiti, two stories about the public-health challenges facing earthquake survivors do a particularly good job encapsulating just how daunting the weeks ahead will be.

In the Los Angeles Times, Shari Roan reports that emergency medical responders “will have to create a public health system on the fly.” Only one hospital is functioning, and the large numbers of people infected with HIV and tuberculosis will struggle to access the treatments they need. Many Haitians are already undernourished, so it’s crucial that food shortages be addressed – but, as most of us have already heard, transporting basic supplies is difficult given heavily damaged infrastructure. Roan goes on to explain how a range of illnesses can spread under current conditions:

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The first regulatory agenda under OIRA chief Cass Sunstein was published today in the Federal Register [link to its 237 pages .]  The document includes a narrative of Labor Secretary Solis’ vision for worker health and safety, mentioning these specific hazards: crystalline silica, beryllium, coal dust, airborne infectious agents, diacetyl, cranes and dams for mine waste.   The document purports to “demonstrate a renewed commitment to worker health,” yet the meat of the agenda tells a different story for particular long-recognized occupational health hazards.

Take, for example, MSHA’s entry on respirable coal mine dust, a pervasive hazard associated with reduced lung function, chronic bronchitis, emphysema, progressive massive fibrosis, and more.  Despite an announcement last week by Labor Secretary Solis and MSHA Asst. Secretary Joe Main saying they want to “end new cases of black lung among the nation’s coal miners,” they aren’t planning to PROPOSE any regulatory changes for 10 months.   That’s a “renewed commitment to worker health”?   Hardly.

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The US Department of Health and Human Services’ Healthy People program, which for the past several decades has provided “science-based, 10-year national objectives for promoting health and preventing disease,” has opened its 2020 iteration for public comment. Between October 30 and December 31, 2009, the public is welcome to provide feedback on the proposed objectives as individuals, as part of an organization, or anonymously. These objectives span a number of health topics, and many extend outside of the public health and health care sectors.

Comment on the draft objectives.

Attend a public meeting to comment in person.

Despite global efforts to improve access to clean water and sanitation, 2.6 billion people, or half of the developing world, lack access to even an “improved” latrine to allow for a basic level of hygiene and protect water supplies from contamination.

A lack of adequate funding and high-level commitment to the problem have certainly hampered efforts to meet the Millennium Development Goal target of halving the proportion of people who lack adequate sanitation (from 1990 levels) by 2015. There’s also a challenge that I found surprising the first time I heard of it: you can give people latrines or toilets, but that doesn’t mean they’ll use them. Apparently, unless people see the need for latrines and value them, the facilities may sit unused or turn into storage sheds (a problem that has sparked the Community-Led Total Sanitation movement).

The Washington Post’s Emily Wax brings us news of a trend in rural India that’s raising the profile of sanitation improvements: women are refusing to marry unless the prospective grooms provide them with toilets. An earlier article by the Christian Science Monitor’s Ben Arnoldy reports that the “No toilet, no bride” campaign by the government of the Haryana state has helped increase the percentage of homes with toilets from 5% to 60% in just four years. Apparently, making sanitation sexy can improve public health.

by revere, cross-posted from Effect Measure

If you are hesitating to be vaccinated for swine flu this year, perhaps this post will help you make up your mind. If it does, I hope it pushes you to get vaccinated, but whatever persuasion we attempt here will only be from a recital of what we know of the epidemiology of this pandemic. Because it is the different epidemiology that is the main feature, not the clinical characteristics or the virulence of the virus. So far this looks pretty much like a standard influenza A virus — except for the epidemiology. Since I’m an epidemiologist, you might expect me to think this is important, and I do. Epidemiology is the public health science that studies the patterns of illness in populations. One kind of pattern we study is who is getting sick. And it is a change in this pattern that is one of the big differences between a pandemic strain and a seasonal strain.

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by revere, cross-posted from Effect Measure

For the first time in medical history we may be seeing an influenza pandemic unfold in real time, but that doesn’t mean we know what we are seeing. There remains some uncertainty about virulence, both in terms of how often it kills and how it kills when it does kill. You’d think both would be easy to determine, but those who have been following along know the problem of how often infection with this virus kills is made almost impossible by not knowing how many people it is infecting. But what about the question of how it kills? There are mainly three scenarios of interest: primary viral pneumonia (the flu virus destroys the deep lung tissue on its own); primary viral pneumonia superimposed by a secondary bacterial infection; death by secondary bacterial invaders with the damage from the flu virus playing little part. In seasonal flu and previous pandemics bacterial infection has played a prominent part in the immediate cause of death. Two small series reporting clinical details of severe cases have been previously reported, 30 hospitalized cases from California and subsequently 10 critical care patients in Michigan. Neither showed evidence of bacterial co-infection. If this virus is acting differently we need to know it.

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by revere, cross-posted from Effect Measure

I just got my seasonal flu shot. It was free and my medical center is encouraging everyone to get one. I wouldn’t be telling the truth if I said I didn’t feel it at all, but in all honesty, I hardly felt it. They must be using smaller needles these days. Anyway, given that most circulating flu virus is pandemic swine flu H1N1, for which a vaccine is not yet available (coming soon to a clinic near you, we’re told), you might wonder why I — or anyone –would bother. I’ll do my best to explain my reasoning, but I’ll grant at the outset I may have missed some good reasons or have reasons that are fallacious — you decide. The pandemic has produced lots of questions that don’t have easy answers. But I’ve been asked here a number of times what I was going to do and why, so I thought I’d give you an explanation.

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