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Lead paint, lead pencil, lead bullet

Do you remember the ordeal in Flint, Michigan? The city decided to change its water supply from Lake Huron to the Flint River to save money. Furthermore, the city was not treating the water properly with an anti-corrosive agent so not only was the iron from the main water pipes leaching into the water supply, it was also pulling water from the residents’ pipes as it flowed into their houses. As a result, the community members were being exposed to levels of lead. The children here started suffering from lead exposure and lead poisoning. Their blood lead levels were sometimes double or triple what their records showed their previous toddler blood lead levels to be. This event reignited the national conversation about lead poisoning and environmental health.

Flint is not isolated in their lead level problems. In April, 2018, news broke about elevated lead levels in the Chicago water supply. Even though many of us think of lead exposure as an “old fashioned” problem affecting our parents or even our grandparents, recent studies have shown that this is not the case. Lead and metal exposure should still be part of our discussion when it comes to health and safety today.

Lead is a metal that is a natural part of our earth. It is used in many manufactured items such as paint, pipes, toys, glassware, and even gasoline around the world. The problem with this element is that it can accumulate in the body and cause dangerous changes in our health. This is why some lead containing products, such as paint and gasoline, are banned in the United States. However, there is still possibility of lead exposure to products made before regulation was put into place or from objects that are imported into our country.

There is no safe blood level of lead. According to the CDC “at least 4 million households have children living in them that are being exposed to high levels of lead.” Lead exposure can have negative effects on almost all body systems. The WHO states that lead can be “distributed to the brain, liver, kidney and bones.” Lead also decreased vitamin D levels in our body. The biggest risk is to the brain and nervous system. It can accumulate in stores found in the teeth and bones. This means that small exposures over time can have a compounding effect. These affects are particularly dangerous for children because they are still developing and their digestive tract can absorb over 50% of the lead they are exposed to (as opposed to 15% in adults).

In children, lead poisoning can cause brain damage, slowed development, learning and behavior problems as well as hearing and speech problems. These symptoms can contribute to decreased attention span and lower IQ scores. As a result, these children may struggle in school and may be prevented from reaching their full potential as adults.

There are some treatments available for patients who have elevated lead levels. If someone is acutely affected by the ingestion of a large amount of lead over a short time, a gastric lavage (stomach pump) can be used to remove lead containing material. For chronic treatment, chelation therapy can be used. These molecules bind to lead in the body to prevent its absorption. However, there is little information about the treatment available to manage the developmental and behavioral affects of lead poisoning. There is also very little information available about how beneficial those types of treatments may be.

In fact, lead exposure is so important that it is an objective of the Healthy People 2020 campaign. There is education on their website as well as detailed plans to mobilize and implement changes. There is also a National Lead Poisoning Prevention Week every year. (This past year it was October 22-28). The goal of this event is to raise awareness as lead exposure as a preventable issue and to encourage the implementation of programs and outreach in the community.

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Achoo!

If you live in Texas, like I do, you are probably more than aware that this Spring has been a terrible allergy season. Hopefully the rest of the country has been able to avoid the abundant amount of pollens, grasses, and molds that cause allergy symptoms that have been plaguing Texas over the past few weeks. But, if you are like many of us Texans and suffering from allergy symptoms, let’s learn a little more about what causes these seasonal reactions.

In the United States, spring allergy season usually runs from February to early summer as trees and plants transition from winter conditions to the warm summer weather. Additionally, a wet and rainy spring can encourage plant growth, increasing pollen counts and leading to a worse allergy season. However, there is also an allergy season in the later summer and fall as the weather transitions from warm to cool. Some regions have worse allergy symptoms than others. Apparently, Knoxville, Tennessee is the worse place in the US for spring allergies. Pollen is the biggest aggravator of seasonal allergies and every year, the pollen count continues to rise.

Some traditional medications for seasonal allergies include antihistamines, nasal steroid sprays and decongestants. According to the FDA, “Antihistamines reduce or block symptom-causing histamines and are available in many forms, including tablets and liquids.” Nasal steroids are usually sprayed into the nose to treat nasal inflammation. Decongestants are used to treat congestion symptoms. There are natural practices that can also be used to treat allergies, with some possible (although inconsistent) effectiveness. For instance, some probiotics may affect the immune system, including the body’s allergy response. Probiotics can be found in foods like kefir, kimchee, sauerkraut, yogurt and kombucha. Another possible treatment is honey. The concept reasons that since honey contains small amounts of pollen, honey ingestion can help someone increase their tolerance of pollen. Thus, making them less sensitive to pollen and lessening their allergy symptoms. An alternative school of thought is that honey may have antihistamine or anti-inflammatory effects that can counteract your body’s histamine response. Congestion and runny nose can be managed with the use of a neti pot which rinses the nasal sinuses. However, it is important to use only filtered or sterile water in these devices. Improper use can lead to serious illness or possibly death. This was the case of a Louisiana man and woman who died from a brain eating amoeba infection in 2011 after using tap water in their neti pot.

For people who suffer from seasonal allergies, tracking pollen counts and knowing what types of grasses, trees, and pollens aggravate your symptoms can be a great help and indicator of your symptoms. On high pollen count days, it may be better to keep windows closed and stay inside. Additionally, if your allergies continue to progress for a long time, knowing what the allergy season is like in your area may help advise your decision to meet with your doctor to discuss additional symptom management. A great website to track pollen and allergy demographics in your area is pollen.com.

Famous Names

Florence Nightingale

A few weeks ago, when I was composing my draft of post topics for the upcoming month, I chose to write about a well known but often under recognized figure, Florence Nightingale, as my public health figure. Little did I know just how suiting this choice would be given that May 6 is National Nurses Day. (National Nurses Week is from May 6-12). This month’s “Famous Name in Public Health” was a game changer in the structure of our health care system. It is because of her that the field of nursing became such an invaluable profession and why all of us should treat every day like Nurse’s day. So, let’s get started!

Florence Nightingale was born in 1820 to a wealthy family. In 1851, she completed her nursing training in Germany. At the time, the was not a well respected profession and her choice to pursue the career went against the norm for women of her status at the time and concerned her parents. You see, nursing was poorly paid and widely considered to be a job for the poor. There was a negative, unprofessional reputation surrounding nurses at the time. So why did Ms. Nightingale choose nursing? Her profound Christian beliefs made her feel that helping the poor and needy was her moral duty and that nursing was a call from God.

When the Crimean War broke out in 1854, Florence became one of the many nurses that tended to the soldiers. She traveled to Constantinople from London where she worked at Scutari hospital, an under equipped facility. Ms.Nightingale was in charge of the female nurses working in Turkey. She worked in aiding the sick and wounded soldiers, as well as tending to their needs. Her staff improved the sanitation and conditions of the facility. They provided food, blankets, and even wrote to the soldier’s families. It was during this time that she earned her name, “Lady of the Lamp” because she would tend to soldiers by lamplight after the medical officers had retired for the night. Her endless care and morality improved the conditions of the hospital and of the patients. Her role and active leadership made the use of nurses in military hospitals an outstanding success.

When Florence returned to England at the end of the war, in 1856, she campaigned for nursing reforms and increased sanitation in hospitals. Donations that she collected for the Nightingale Fund were used to start a nursing school at St. Thomas’ Hospital in 1860. She continued to campaign to improve health conditions in hospitals through advocacy and numerous publications. She authored more than 200 books regarding nursing, hospital planning, and facility organization, both in management and in literal floor plan designs of hospital wards. Florence used her prior education (a luxury of her family’s wealthy status) to evaluate and then revolutionize hospital systems. She set up a systematic record keeping system and found a causal link between sanitation levels and death rate. Her work was one of the first to recognize that social phenomena could be objectively measured and analyzed. She was determined to reform the health care system so the issues she encountered during the Crimean War would never impact civilians at home.

Florence Nightingale’s reform efforts were so successful that soon there were nursing schools teaching her methods around the world. She was also involved in the creation of the International Red Cross. Through her work, she transformed nursing into a respected profession and her efforts did not go unnoticed. Florence received the Royal Red Cross in 1883 and then she became the first woman to earn the Order of Merit in 1907.

Florence Nightingale passed away in 1910, but her legacy lives on.

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Barbara Bush’s Literate America

This week’s post is in honor of the lovely former first lady, Barbara Bush. She passed away on Tuesday, April 17, 2018. Known as the nation’s “first grandmother” or even “America’s grandmother” due to her motherly nature and white locks, she was respected by millions of Americans, regardless of race, class, or ethnicity. Throughout her husband’s presidency, she became an advocate of family literacy, with a passion for books and reading.

In 1991, Lady Bush helped pass the National Literacy Act. The goals of this act are to,

“(1) conduct specified research and demonstrations; (2) assist Federal, State, and local agencies in developing, implementing, and evaluating literacy policy by establishing a national data base and providing technical and policy assistance and development model systems; (3) provide program assistance, training, and technical assistance for literacy programs throughout the United States; (4) collect and disseminate information on a variety of promising methods; (5) review and make recommendations on uniform reporting, performance measures, and program standards; and (6) provide a toll-free long-distance telephone line for literacy providers and volunteers.”

The Literacy Act established a literacy center that focused on adult education through state grants and monitoring of local programs. The goal was to amend the Adult Education Act so it could provide educational resources to adults through eligible programs, such as commercial drivers in partnership with educational agencies, colleges, or universities. It also set up parameters for literacy programs for incercerated adults. Additionally, it amended the Elementary and Secondary Education Act to allow for better distribution of inexpensive reading materials to children with special needs and provide grants for public literacy programs- especially those functioning in areas with low education levels or areas with few financial resources. Additionally, it provided amendments for the Higher Education Act, as well as the Domestic Volunteer Service Act.

In addition to this, Lady Bush founded the Barbara Bush Foundation for Family Literacy. The mission of this organization is “providing access to family literacy programs in which both parents and children work toward their educational goals.” This is a noble goal because a reported 36 million adults in the United States have low literacy skills, and 1 in 4 cannot read above a 5th grade level. Due to this information, the foundation has worked in community outreach with goals to improve our nation’s literacy levels. As a matter of fact, the Foundation, “has raised and provided more than $110 million in support to create or expand family literacy programs in all 50 states and the District of Columbia” in addition to supporting more than 160 programs, creating positive results throughout the nation.

Why does literacy matter so much? Well, not only does a parent’s literacy level predict their child’s future literacy level, it also plays a major role in their health and functioning in society. For instance, this study indicates that individuals with low literacy levels are “unable to adequately prepare for or respond to an emergency” because most health information is written at an 8th grade reading level or beyond. This is much higher than the average 5th grade reading level of many Americans. This is so much of a public health issue that even a Canadian study recommended that physicians give written instructions to patient at a 5th grade reading level or below. A great example of the impact illiteracy has on someone’s health and wellness can be found here.

Lady Bush was not alone in her passion for creating a literate nation. The United Nations has recognized the issue as public health problem to be addressed. The American Public Health Association has a very definitive stance on the issue, stating that communities, organizations, and the government should be involved in improving health literacy rates because “limited health literacy affects Americans of all ages, races, incomes, languages, cultures, and education levels.” As such, Barbara Bush was not alone in her stance, but rather a national leader for a movement that is backed both at home and globally. Her efforts pushed the envelope and fueled the national efforts to improve our country’s literacy, for all.

The former first lady and “first grandmother” will be missed by many, but her efforts will continue to move forward. Even in death, she still contributes to the improvement of the lives of millions of Americans through her various organizations.

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Allergies, Asthma, and Antibiotics?

A new study titled “Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood” was released earlier this month in the JAMA Pediatrics. It is a noteworthy finding in the debate among medical professionals regarding the proper prescribing practices and metrics they should be using to guide their treatment plans for bacterial infections.

This is not the first time a link between antibiotics and allergic diseases has been investigated. There is a study from 2017 that correlates antibiotic use in early childhood to the development of asthma, although there is no link between antibiotics and asthma exacerbation episodes. An even earlier study from June, 2007 presents concerns for a link between asthma and broad spectrum cephalosporin usage. The study states that, “asthma was significantly more likely to develop in children who had received antibiotics in the first year of life at age 7 years [and] the association with asthma was observed for antibiotic use in non-respiratory tract infections,” particularly in association with broad spectrum cephalosporins.

Of course with any study, there are limitations to the findings we outlined above. Perhaps the 2007 study, which focused on children in Manitoba, Canada has some other differentiating factor that was not discussed in the study. Maybe their water is different or the cooler climate has an effect that was not accounted for. The new study I cited at the start of this post lists its possible limitations at the end of the study (as all good studies should). Things like misdiagnoses, mismanagement of treatments or a biased sample population can play a role in affecting the results the scientists found. Dr.Arnaout at Cook Children Medical Center in Fort Worth brings an important discussion of understanding the limitations of a study to the forefront of these new conclusions. We are still learning about the body’s development and how it interact with treatments.

As a matter of fact, a 2014 study by the University of Manchester notes that these findings may be the result of a third variable. An article in on the University of Manchester website summarizes the study by stating, “impaired viral immunity and genetic variants on a region of chromosome 17 that increase the risk of both antibiotic use in early life and later asthma.” So, while there may be increasing evidence of a link between antibiotics and allergic diseases, we still do not have definitive proof of the correlation, only the absence of something disproving the correlation (which is the basis of science as it is!)

As we continue to learn more about antibiotics and how they affect our bodies, more studies like this are likely to be released in the future. The practice of medicine is just that, a practice. New discoveries will be made and the course of practice will evolve as we continue to improve and refine our management of health and disease.

Famous Names · Uncategorized

Sir Edwin Chadwick

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Recently, this blog has had a lot of posts about health conditions that are unequally distributed among the population, causing increased health problems among people affected by poverty. Notably, last week’s Guinea Worm post and my recent <a href="https://theartofahealthyheart.wordpress.com/2018/02/15/serving-the-medically-underserved/"Serving the Medically Underserved post. As a result, I wanted to talk about someone who has worked to lessen health disparities by being an advocate for the poor. I felt that the best way to start this conversation is to recognize that this issue is not a new problem. It’s something we have been struggling with for literally centuries. In my search for an individual fitting to this role, I found one name kept popping up on my search, Sir Edwin Chadwick. He is widely thought to be one of the most influential public health figures of the 1800s. So, without further ado, this month’s Famous Name in Public Health is, of course, Sir Edwin Chadwick!

Sir Edwin Chadwick was born in England in 1800. During his studies to become a lawyer, Sir Chadwick became interested in social and political reform while studying law in London. During this time, Sir Chadwick developed the concept of the “sanitary idea” based on science and integrated with the miasma theory. This concept proposes that diseases are caused by poisonous vapors in the air. Thus areas of the community that smell foul (mostly impoverished areas in this time period) are the causes of illness and disease among the population that lives there. Although we now know that this theory is not correct, the concept persisted for a long time because of the (yet unknown) association between bacteria and their production of malodorous scents. Around the time that Sir Chadwick’s concept of the “sanitary idea” began to grow and fuel his investigation of sick wards he took the position assistant commissioner on the poor-law commission. The following year he was appointed as the secretary of the royal commission. His work helped contribute to the future passing of the Ten Hours Act which limited “the work of women and young persons (aged 13–18) in textile mills to ten hours a day for five days in the week and eight hours on Saturday.”

Next, he worked on the Poor Laws of England. The Poor Laws were established in 1601 during the English period of depression to combat unemployment and famine. In essence, the laws classified groups of people within a each parish based on their ability to work and provide for themselves and their family. Additionally, these laws gave the local government the means to tax those able to pay and to provide relief to those in need of assistance. However, by the 1800s, these laws were in need of updating and reform. This led to the creation of the Poor Law Amendment Act. This amendment set up the Poor Law Commission to supervise local parishes, and it removed the assistance given to able bodies workers as a means to stimulate the workforce.

In 1848, he successfully campaigned for the passage of the The Public Health Act. This act is considered one of the greatest achievements in the public health history of England. This act allowed states to become the “guarantor of standards of health and environmental quality and provided resources to local units of government to make the necessary changes to achieve those standards.” This allowed things like water supply and sewage and waste management to be managed by the local government using governmental funds as a means to manage the health problems of the population (notably caused by things like the industrial revolution and urbanization). This act was incredibly controversial at the time because there was still no known link between the environment, germs and health. As a result, the act only lasted 5 years before it failed to be renewed by the government. However, this was not a loss for Sir Chadwick, as his legacy became enduring through the crating of the Public Health Act of 1875, which consolidated a lot of the legislation surrounding public health and created a uniformed administrative body to carry out the policies.

The works of Sir Chadwick extends broadly. His involvement in a variety of public health matters contributed to the eventual passing of many acts and reforms by the government. For example, beyond his investigation into child labor laws, he contributed to the Employers’ Liability Act concerning on the job injuries of adult workers. He also contributed to drainage work and matters of military sanitation to relieve troop suffering. He campaigned for the maintenance of railway systems as a public health issue. Sir Chadwick’s interests and perspectives were revolutionary and controversial at the time, but many of his arguments proved valuable and true in the future. His work helped contribute to the overall improvement in sanitation and maintenance of sanitation and living conditions for the entire population of England.

Overall, Sir Edwin Chadwick became one of the greatest social reformers in England of his time. He received knighthood in 1889 before passing away one year later on July 6, 1890.

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Life Update

Hello everyone!

As it is the start of a new month, I thought this was the best time to give you all a bit of information before continuing on to our regular, monthly “Famous Names in Public Health” series. This blog will be undergoing some changes over the next few months, so I just wanted to give you all a little life update. (Don’t worry, it’s all good things!)

I have been accepted to Texas Tech El Paso Paul L. Foster School of Medicine for the class of 2022. (I know, it’s quite a mouthful!) As such, my schedule will be changing and the direction of this blog might change a bit too as I delve more into the medical side of health care and disease treatment. However, don’t be discouraged! I have also been accepted to UT Health School of Public Health‘s master of public health program at their El Paso campus. Thus, my pursuit of public health and education will continue!

Over the next 4 years, I will be completing my MD/MPH in El Paso and I hope to take you all on the journey with me. My blog posts will continue, as I said above, but the content might change a bit or occasionally incorporate a life update like this one. I am hoping to continue to post on a regular basis, but starting in July, posts might come out every 2 weeks instead of on a weekly basis. As always, suggestions and feedback are always welcome!

-Tristan