Objectives The authors sought to determine the effects of cold-weather periods on budgets and nutritional outcomes among poor American families. Methods The Consumer Expenditure Survey was used to track expenditures on food and home fuels, and the Third National Health and Nutrition Examination Survey was used to track calorie consumption, dietary quality, vitamin deficiencies, and anemia. Results Both poor and richer families increased fuel expenditures in response to unusually cold weather. Poor families reduced food expenditures by roughly the same amount as their increase in fuel expenditures, whereas richer families increased food expenditures. Conclusions Poor parents and their children spend less on and eat less food during cold-weather budgetary shocks. Existing social programs fail to buffer against these shocks.
OBJECTIVE: The prevalence of type 2 diabetes, especially in developing countries, has grown over the past decades. We performed a controlled clinical study to determine whether a community-based, group-centered public health intervention addressing nutrition and exercise can ameliorate glycemic control and associated cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica.
RESEARCH DESIGN AND METHODS: A total of 75 adults with type 2 diabetes, mean age 59 years, were randomly assigned to the intervention group or the control group. All participants received basic diabetes education. The subjects in the intervention group participated in 11 weekly nutrition classes (90 min each session). Subjects for whom exercise was deemed safe also participated in triweekly walking groups (60 min each session). Glycosylated hemoglobin, fasting plasma glucose, total cholesterol, triglycerides, HDL and LDL cholesterol, height, weight, BMI, and blood pressure were measured at baseline and the end of the study (after 12 weeks).
RESULTS: The intervention group lost 1.0 +/- 2.2 kg compared with a weight gain in the control group of 0.4 +/- 2.3 kg (P = 0.028). Fasting plasma glucose decreased 19 +/- 55 mg/dl in the intervention group and increased 16 +/- 78 mg/dl in the control group (P = 0.048). Glycosylated hemoglobin decreased 1.8 +/- 2.3% in the intervention group and 0.4 +/- 2.3% in the control group (P = 0.028).
CONCLUSIONS: Glycemic control of type 2 diabetic patients can be improved through community-based, group-centered public health interventions addressing nutrition and exercise. This pilot study provides an economically feasible model for programs that aim to improve the health status of people with type 2 diabetes.
Objectives
To evaluate recent trends, we examined longitudinal national data on the outpatient use of warfarin in atrial fibrillation (AF), beta-blockers and aspirin in coronary artery disease (CAD), and angiotensin-converting enzyme inhibitors (ACEIs) in congestive heart failure (CHF).
Background
Previous studies indicate that specific cardiac medications are underutilized.
Methods
We used the National Disease and Therapeutic Index (NDTI) (produced by IMS HEALTH, Plymouth Meeting, Pennsylvania) for 1990 to 2002, and the National Ambulatory Medical Care Surveys (NAMCS) for 1990 to 2000 to follow nationally representative samples of outpatient visits. For visits by patients with AF (total N = 14,634 visits), CAD (n = 35,295), and CHF (n = 33,008), we examined trends in the proportion of visits with the selected medications reported.
Results
Warfarin use in AF increased from 12% in 1990, to 41% in 1995, to 58% in 2001 in NDTI; a similar moderation of recent increase was seen in NAMCS. For CAD in NDTI, beta-blocker use increased slowly from 19% in 1990, to 20% in 1995, then to 40% in 2001; NAMCS showed this same pattern. Aspirin use in CAD in NDTI increased from 18% in 1990, to 19% in 1995, to 38% in 2001; NAMCS, however, showed lower use rates. For NDTI, ACEI use in CHF increased from 24% in 1990 to 36% in 1996, but increased to only 39% by 2001, a general pattern also seen in NAMCS.
Conclusions
Both national datasets demonstrate continuing underutilization of these cardiac medications of proven benefit. Although use is increasing, it remains lower than expected, and some increases noted in earlier years have slowed. Substantial public health benefits would result from further adoption of these effective therapies.
For the past several decades, the conventional - and, until recently, the predominant - perspective on development in the international donor community has been that countries are poor because they lack resources, infrastructure, education, and opportunity. By this logic, if rich countries could only transfer enough resources and technology, improve human capacity enough, and support health and education enough, development would occur. To be sure, greater public resources, better physical infrastructure, and stronger public health and education are essential for development. But they are not enough, and they are not most crucial factor.
The Nation's capacity to respond to bioterrorism depends in part on the ability of clinicians and public health officials to detect, manage, and communicate during a bioterrorism event. Information technologies and decision support systems (IT/DSSs) have the potential to aid clinicians (e.g., physicians, nurses, nurse practitioners, and respiratory therapists) and public health officials to respond effectively to a bioterrorist attack.
The Nation's capacity to respond to bioterrorism depends in part on the ability of clinicians and public health officials to detect, manage, and communicate during a bioterrorism event. Information technologies and decision support systems (IT/DSSs) have the potential to aid clinicians (e.g., physicians, nurses, nurse practitioners, and respiratory therapists) and public health officials to respond effectively to a bioterrorist attack.
The Evidence Report from which this summary was taken details the methodology, results, and conclusions of a systematic and extensive search for published materials on the use of IT/DSSs to serve the information needs of clinicians and public health officials in the event of a bioterrorist attack. The information is intended to assist clinicians, public health officials, and policymakers to improve preparedness for a bioterrorism event.
Dr. Chowdhury is a vascular surgeon and pioneering public health leader from Bangladesh who wrote "The Politics of Essential Drugs: The Makings of a Successful Health Strategy: Lessons from Bangladesh." In 1971, Dr. Chowdhury left England to return to what was then East Pakistan and join the war of liberation for Bangladesh. He helped establish a field hospital for freedom fighters and refugees, which lead to the development Gonoshasthaya Kendra (GK) or "The People's Health Center." GK has trained more than 7,000 barefoot doctors, and serves 1,000 villages in 14 Bangladeshi districts. A pharmaceutical factory was established by GK in 1981 which produces medicines on the World Health Organization's essential medicines list; employs 1,500 people and has an $11 million annual budget. One-half of its profits are reinvested and the other half go to GK's other projects. In 1985, Dr. Chowdhury and GK were awarded the Ramon Magsaysay Award (sometimes called the Asian Nobel Peace Prize) and in 1992, the Right Livelihood Award (also known as the alternative Nobel Prize). Dr. Chowdhury was instrumental in convincing the Bangladesh government to adopt a National Drug Policy in 1982. This controversial policy promotes essential medicines and discourages the use of drugs with little therapeutic value. GK hosted the People's Health Assembly in December 2000, which challenged global health organizations to improve public health care for the poor. Dr. Chowdhury is this year's International Honoree of the UC Berkeley School of Public Health Heroes.
Philippines Conference Room
Encina Commons, Room 201
615 Crothers Way Stanford, CA 94305-6006
Executive Assistant: Soomin Li, soominli@stanford.edu
Phone: (650) 725-9911
Douglas K. Owens is the Henry J. Kaiser, Jr. Professor, Chair of the Department of Health Policy in the Stanford University School of Medicine and Director of the Center for Health Policy (CHP) in the Freeman Spogli Institute for International Studies (FSI). He is a general internist, a Professor of Management Science and Engineering (by courtesy), at Stanford University; and a Senior Fellow at the Freeman Spogli Institute for International Studies.
Owens' research includes the application of decision theory to clinical and health policy problems; clinical decision making; methods for developing clinical guidelines; decision support; comparative effectiveness; modeling substance use and infectious diseases; cardiovascular disease; patient-centered decision making; assessing the value of health care services, including cost-effectiveness analysis; quality of care; and evidence synthesis.
Owens chaired the Clinical Guidelines Committee of the American College of Physicians for four years. The guideline committee develops clinical guidelines that are used widely and are published regularly in the Annals of Internal Medicine. He was a member and then Vice-Chair and Chair of the U.S. Preventive Services Task Force, which develops national guidelines on preventive care, including guidelines for screening for breast, colorectal, prostate, and lung cancer. He has helped lead the development of more than 50 national guidelines on treatment and prevention. He also was a member of the Second Panel on Cost Effectiveness in Health and Medicine, which developed guidelines for the conduct of cost-effectiveness analyses.
Owens also directed the Stanford-UCSF Evidence-based Practice Center. He co-directs the Stanford Health Services Research Program, and previously directed the VA Physician Fellowship in Health Services Research, and the VA Postdoctoral Informatics Fellowship Program.
Owens received a BS and an MS from Stanford University, and an MD from the University of California-San Francisco. He completed a residency in internal medicine at the University of Pennsylvania and a fellowship in health research and policy at Stanford. Owens is a past-President of the Society for Medical Decision Making. He received the VA Undersecretary’s Award for Outstanding Achievement in Health Services Research, and the Eisenberg Award for Leadership in Medical Decision Making from the Society for Medical Decision Making. Owens also received a MERIT award from the National Institutes on Drug Abuse to study HIV, HCV, and the opioid epidemic. He was elected to the American Society for Clinical Investigation (ASCI) and the Association of American Physicians (AAP.)