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Despite Mounting Evidence, High School Girls Keep Tanning

(valerieyermal/flickr)

You’re surely aware of all of the information out there clearly explaining why tanning salons are absolutely, unquestionably not a good idea?

Evidently, young America has yet to get the memo.

As a new report from JAMA Internal Medicine found:

Among non-Hispanic white female high school students, 29.3% engaged in indoor tanning and 16.7% engaged in frequent indoor tanning during the previous 12 months. The prevalence of indoor tanning and frequent indoor tanning increased with age.

These numbers  — about 1/3 of high schoolers tanning within the past year — are surprisingly static. A study done by the CDC in 2010 also found about a third of young white women reported indoor tanning.

What’s going amiss? I talked to Emily Colson, a high school senior in South Carolina whose experience closely mirrors the study’s findings. She first started using tanning beds as a freshman, relying on them for occasions with high expectations, like prom and the first week of summer. “I don’t like being pale or being pasty – I think I look a lot better when I’m tanner,” she said. Continue reading

New CDC Estimate: 300K Americans Diagnosed With Lyme Disease Each Year

Tick

If you follow Lyme disease at all, you know that there’s no question that the official prevalence figures fail to capture the true extent of the toll those nasty little disease-spreading deer ticks take. The only question is just how far the official figures fall short of reality.

WBUR’s Lyme Disease series last summer cited these official figures for Massachusetts: 2-4,000 confirmed cases each year. But everyone knows those numbers are laughably low. Dr. Catherine Brown of the Massachusetts Department of Public Health said a more realistic figure might be the 12-14,000 positive lab tests for Lyme disease reported statewide each year. But that’s clearly still low. A leading tick expert estimated that in much of Massachusetts, about 1 percent of the population contracts Lyme each year.

Now, at a major conference on Lyme disease and other tick-borne illnesses under way in Boston, federal health authorities have just released their own more realistic estimate, and it’s about ten-fold their old one. From the CDC press release:

Preliminary estimates released by the Centers for Disease Control and Prevention indicate that the number of Americans diagnosed with Lyme disease each year is around 300,000. The preliminary estimates were presented Sunday night in Boston at the 2013 International Conference on Lyme Borreliosis and Other Tick-Borne Diseases.

This early estimate is based on findings from three ongoing CDC studies that use different methods, but all aim to define the approximate number of people diagnosed with Lyme disease each year. The first project analyzes medical claims information for approximately 22 million insured people annually for six years, the second project is based on a survey of clinical laboratories and the third project analyzes self-reported Lyme disease cases from a survey of the general public.

Each year, more than 30,000 cases of Lyme disease are reported to CDC, making it the most commonly reported tick-borne illness in the United States. The new estimate suggests that the total number of people diagnosed with Lyme disease is roughly 10 times higher than the yearly reported number. This new estimate supports studies published in the 1990s indicating that the true number of cases is between 3- and 12-fold higher than the number of reported cases. Continue reading

Worry About New ‘World Threat’ Virus? Specialist: We Just Don’t Know

You may have seen this headline last week: “World Health Organization says new virus may be ‘threat to entire world.‘” And if you’re like me, you may have been surprised by your own ho-hum reaction. Is this a crying-wolf situation? Have we been warned about too many potentially scary viruses over the last few years? Or are we just getting more used to living with viral uncertainty? Here, Dr. Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital, writes about his own reaction to this latest outbreak in the face of insufficient information.

By Dr. Paul E. Sax
Guest contributor

From one of my close friends — a non-MD — comes this alarming video.

And here’s his email:

Concerned? Terrified? I bet your department is buzzing about this.

Um, not quite — especially since, among the 49 cases in the world (apparently there are five more than the WHO reported), exactly zero have occurred thus far in the United States. As of May 29, 2013, it hasn’t even cracked the front page of the CDC site.

Is MERS-CoV — short for Middle East Respiratory Syndrome Coronavirus — potentially of great concern? Of course. The WHO response seems right, especially with the parallels to SARS.

Coronoviruses (these are not the new Middle East virus) are a group of viruses that have a halo, or crown-like (corona) appearance when viewed under an electron microscope. (Wikimedia Commons)

Coronoviruses (this image is not of the new Middle East virus) are a group of viruses that have a halo, or crown-like (corona) appearance when viewed under an electron microscope. (Wikimedia Commons)

But do we garden-variety infectious disease specialists know how serious it will be on a global basis? Of course not. As with the first SARS cases, the first anthrax cases, the first West Nile cases, the first hantavirus cases, even the first AIDS cases — we really don’t have enough points on the graph yet to make any sort of confident predictions.

And from a practical perspective, the clinical unfamiliarity doesn’t help. If someone walked into our emergency room tomorrow with fever, cough, and respiratory symptoms, would we know how to distinguish MERS-CoV — from the hundreds (OK, thousands) of other causes of similar illnesses?

Initially, not a chance. The denominator of people with these complaints is just too gargantuan. It will probably take someone with a particularly severe respiratory illness, along with the appropriate exposure (“He just returned from a 10-day business trip to Riyadh”) for an astute clinician to make the connection.

So how should we infectious disease doctors, who are supposed to know everything, respond to these emails in the interim? Continue reading

More On Google Flu Trends: Brilliant Predictor Or Cautionary Tale

In case you missed this excellent post on whether ‘Google Flu Trends’ is prescient or wrong, you’ve got a second chance to hear the details today on Radio Boston.

The segment features MIT computer science graduate student Keith Winstein (and my former colleague at The Wall Street Journal) exploring what might account for the dramatic divergence between Google’s flu data and the official CDC flu numbers. “This could be a cautionary tale about the perils of relying on these “Big Data” predictive models in situations where accuracy is important,” Winstein said in an interview with CommonHealth.

Here are some more of his thoughts:

The issue that’s interesting from the computer science perspective is this: Google Flu Trends launched to much fanfare in 2008 — it was even on the front page of the New York Times — with this idea that, as the head of Google.org said at the time, they could out-perform the CDC’s very expensive surveillance system, just by looking at the words that people were Googling for and running them through some statistical tools.

It’s a provocative claim and if true, it bodes well for being able to track all kinds of things that might be relevant to public health. Google has since launched Flu Trends sites for countries around the world, and a dengue fever site.

So this is an interesting idea, that you could do public health surveillance and out-perform the public health authorities [which use lab tests and reports from ‘sentinel’ medical sites] just by looking at what people were searching for.

‘It is often a problem with computers that they only tell us things we already know.’
Google was very clear that it wouldn’t replace the CDC, but they have said they would out-perform the CDC. And because they’re about 10 days earlier than the CDC, they might be able to save lives by directing anti-viral drugs and vaccines to afflicted regions.

And their initial paper in the journal Nature said the Google Flu Trends predictions were 97% accurate…

That was astounding. However, it is often a problem with computers that they only tell us things we already know. When you give a computer something unexpected, it does not handle it as well as a person would.

Shortly after that report of 97% accuracy, we had that unexpected swine flu, which was a different time of year from the normal flu season, and it was different symptoms from normal, and so Google’s site didn’t work very well.

[Carey asks: And the accuracy went down to 20-something percent?]

To a 29 percent correlation, and it had just been 97 percent. So it was not accurate. Continue reading

Is ‘Google Flu Trends’ Prescient Or Wrong?

flu graph

Google in blue, CDC in red. Note the dramatic divergence toward 2013. (Keith Winstein, MIT)

Has Google’s much-celebrated flu estimator, Google Flu Trends, gotten a bit, shall we say, over-enthusiastic?

Last week, a friend commented to Keith Winstein, an MIT computer science graduate student and former health care reporter at The Wall Street Journal: “Whoa. This flu season seems to be the worst ever. Check out Google Flu Trends.”

Hmmm, Winstein responded. When he checked, he saw that the official CDC numbers showed the flu getting worse, but not nearly at Google’s level. (See the graph above.) The dramatic divergence between the Google data and the official CDC numbers struck him: Was Google, he wondered, prescient or wrong?

He began to explore — as much as a heavy grad-student schedule allows — and shares his thoughts here. Our conversation, lightly edited:

I accept the caveat that these predictive algorithms are not your speciality, but still, from highly informed, casual observation, what are you seeing, in a highly preliminary sort of way?

Well, I’m certainly not an expert on the flu. The issue that’s interesting from the computer science perspective is this: Google Flu Trends launched to much fanfare in 2008 — it was even on the front page of the New York Times — with this idea that, as the head of Google.org said at the time, they could out-perform the CDC’s very expensive surveillance system, just by looking at the words that people were Googling for and running them through some statistical tools.

It’s a provocative claim and if true, it bodes well for being able to track all kinds of things that might be relevant to public health. Google has since launched Flu Trends sites for countries around the world, and a dengue fever site.

So this is an interesting idea, that you could do public health surveillance and out-perform the public health authorities [which use lab tests and reports from ‘sentinel’ medical sites] just by looking at what people were searching for.

‘It is often a problem with computers that they only tell us things we already know.’

Google was very clear that it wouldn’t replace the CDC, but they have said they would out-perform the CDC. And because they’re about 10 days earlier than the CDC, they might be able to save lives by directing anti-viral drugs and vaccines to afflicted regions.

And their initial paper in the journal Nature said the Google Flu Trends predictions were 97% accurate…

That was astounding. However, it is often a problem with computers that they only tell us things we already know. When you give a computer something unexpected, it does not handle it as well as a person would.

Continue reading

CDC: Binge Drinking A Serious Problem Among Women, Girls

binge drinkingThe CDC reports that binge drinking among women and girls is a dangerous, often under-recognized problem, with nearly 14 million U.S. women binge drinking about three times a month, consuming an average six drinks per “binge.”

According to the CDC news release:

…binge drinking puts women at increased risk for many health problems such as breast cancer, sexually transmitted diseases, heart disease, and unintended pregnancy. Pregnant women who binge drink expose a developing baby to high levels of alcohol, which can lead to fetal alcohol spectrum disorders and sudden infant death syndrome.

In addition, the report finds that about 1 in 8 women and 1 in 5 high school girls report binge drinking. Binge drinking was most common among women aged 18-34 and high school girls, whites and Hispanics, and women with household incomes of $75,000 or more. Half of all high school girls who drink alcohol report binge drinking.

Binge drinking is defined as consuming four or more drinks on an occasion for women and girls. Drinking too much, including binge drinking, causes about 23,000 deaths among women and girls in the United States each year.

Study Finds ‘Protective’ Weight Just As Diet Resolutions Kick In

obesekid
Whoopsie. Just as all those New Year’s dieting resolutions are kicking in, along comes the latest salvo in the confusing obesity-mortality wars. “Oh, my,” I said this morning when I heard Harvard nutrition expert Walt Willett call this latest study a bunch of “rubbish” on NPR. “They’re playing rough.”

At issue is this simple question: Does being overweight make you die sooner, or might it actually be protective? But of course, very little is simple in the world of nutrition studies, or when links between Body Mass Index and health are concerned.  Here’s the conclusion from the study, that in effect, very obese people tend to die earlier, but more mildly overweight people may tend to live a bit longer:

Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.

And here’s Walt Willett on NPR today: Continue reading

From First Cold To Grave: How Two-Month-Old Brady Died Of Pertussis

Brady Alcaide, of Chicopee, Mass., died at two months old of pertussis.

Brady Alcaide — a happy, healthy six-week-old baby — got his first cold shortly after the new year.

His mother, Kathy Riffenburg, had seen her share of sniffles (she has two older daughters, 8 and 5) and didn’t think much of it. “It was just a little cough and sneeze,” she said. “I wasn’t too worried.”

But a few days later, on January 6, Brady’s fever spiked to 104 degrees. So, in the middle of the night, Riffenburg and her husband Jonathan decided to take the baby to the emergency department at Baystate Children’s Hospital in Springfield, Mass. near their home in Chicopee. Brady tested negative for flu and a common respiratory virus. By early morning, his fever was gone and the family was sent home.

Three weeks later Brady would be dead, a victim of pertussis, or whooping cough, a preventable but highly contagious bacterial disease that has been on the rise in recent decades.

At home, Brady’s breathing became slightly more labored; he’d been diagnosed with bronchiolitis, a swelling and buildup of mucus in the tiny air passages of the lungs, usually due to a viral infection. After another examination later in the week, a pediatrician prescribed albuterol to ease Brady’s symptoms.

On January 16, the Martin Luther King Jr. holiday, Brady started spitting up more and his breathing worsened. This time he was admitted to Baystate’s pediatric ICU, his mother said. A medical team assessed him; and an infectious disease doctor suggested he might have pertussis, though the diagnosis remained uncertain. Indeed, the family didn’t get confirmation of Brady’s pertussis until after his death, when a test for the disease came back positive. “I could have bet my whole life that it wasn’t pertussis,” Riffenburg said, recalling her reaction when the illness was first mentioned. “He wasn’t coughing like I would have imagined. And I didn’t know any infant who ever had pertussis.”

But pertussis, or whooping cough, or “the cough of 100 days” for its generally long duration, has been on the rise since the 1980s, according to the U.S. Centers for Disease Control and Prevention. The disease is characterized by violent, uncontrollable coughing (including the characteristic “whoop” sound) that can make it hard to breathe. But sometimes there is no “whoop.” And infants with pertussis don’t always cough, but may have apnea, a long pause in their breathing. The disease is most common in young children; babies under one are particularly vulnerable and face the greatest risk of death. Continue reading

Breaking News: CDC Estimates U.S. Autism Rate Up To 1 in 88 Kids

Updated at 1:47 PM, March 29th, 2012

boy playing with fountain of water (Camp ASCCA/Flickr)

The CDC estimates the autism prevalence rate among boys is 1 in 54. (Camp ASCCA/Flickr)

The Centers for Disease Control and Prevention just announced that the prevalence rate for autism is up to 1 in 88 children in the U.S. That’s a 23 percent increase from the previous 1 in 110 rate reported three years ago by the CDC.

Debate continues to rage about what is driving the apparent increase; is it genetics, the environment, some combination or other factors? The CDC’s new report doesn’t address any of those tough questions, but suggests better screening and detection is at least in part behind the new numbers. (The NIH’s “working assumption” is there are more children effected and more detected.)

Here’s the agency’s press release:

The Centers for Disease Control and Prevention estimates that 1 in 88 children in the United States has been identified as having an autism spectrum disorder (ASD), according to a new study released today that looked at 2008 data from 14 communities. Autism spectrum disorders are almost five times more common among boys than girls – with 1 in 54 boys identified.

The number of children identified with ASDs ranged from 1 in 210 children in Alabama to 1 in 47 children in Utah. The largest increases were among Hispanic and black children.

The report, Prevalence of Autism Spectrum Disorders – Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008, provides autism prevalence estimates from 14 areas. It was published today in the Morbidity and Mortality Weekly Report.

“This information paints a picture of the magnitude of the condition across our country and helps us understand how communities identify children with autism,” said Health and Human Services (HHS) Secretary Kathleen Sebelius. Continue reading

CDC: Deaths Rise From Serious Stomach Bugs, Mainly In Elderly

Clostridium difficile colonies after 48 hours of growth on a blood agar plate. (Dr. L. V. Holdeman/CDC)

Clostridium difficile colonies after 48 hours of growth on a blood agar plate. (L. V. Holdeman / CDC Public Health Image Library)

This just in from the CDC: Between 1999 and 2007, deaths from stomach inflammation more than doubled — mainly because of virulent new strains of a bacteria called C. difficile. The hugely common norovirus also killed several hundred people a year out of the 20 million it infected. The vast majority of those who died were over 65.

One of our most popular recent posts was Aayesha Siddiqui’s primer on How to Outsmart The Stealty Stomach Bug — I think I’ll read it again right now. From the CDC:

The number of people who died from gastroenteritis (inflammation of the stomach and intestines that causes vomiting and diarrhea) more than doubled from 1999 to 2007, according to a study by the Centers for Disease Control and Prevention. The findings will be presented today at the International Conference on Emerging Infectious Diseases in Atlanta.

Over the eight-year study period, gastroenteritis-associated deaths from all causes increased from nearly 7,000 to more than 17,000 per year. Adults over 65 years old accounted for 83 percent of deaths. Clostridium difficile (C. difficile) and norovirus were the most common infectious causes of gastroenteritis-associated deaths. Continue reading