NEW BLOG - GO TO www.writehealthy.com

It's been a while (ok, 2 months) since I last posted, but I was enjoying my time free of both work and school, which NEVER happens. In that time I learned I would be going to East Africa to follow around some researchers working toward the control and elimination of the disease schistosomiasis. As I write this I am sitting in a lab in Kenya.

Since I will be blogging about the experience, I decided to use the opportunity to start a new blog under the same name on WordPress. So just go to www.writehealthy.com to learn about my adventures in Kenya and Zanzibar with researchers and snails. I promise I'll explain what schisto is, but you have to go to the new blog to find out. 


It isn't much to look at right now but it'll get better with some love.

Thanks,

Laura

Pharmacists can do more than fill your prescription bottles

The role of the pharmacist is changing in the US as we begin to need more services for chronic diseases and disease prevention. Learn about what Georgia pharmacists are up to in the public health sector on Georgia Health News.

Chronic disease management - Support for rural diabetics

I'll admit that chronic disease management is a topic I tend to neglect. Vaccines, superbugs and exotic diseases are sparkly and controversial, but I've been focused on wildlife parasites and global diseases when examples of the effects of chronic disease seem to be everywhere I turn.

Chronic disease is a growing problem that correlates with our lengthening life span, and diabetes has become a hugely common disease worldwide associated with lifelong illness, mortality and other diseases such as obesity and cardiovascular disease. 

According to the American Diabetes Association, 8 percent of Americans suffer from diabetes, an alarming number that reinforces the idea that the modern American lifestyle is not a healthy one. Add in a family history of diabetes and late diagnosis or inadequate management of the disease, and diabetes becomes a serious public health problem. In Georgia, the incidence of diabetes has expanded from 4.4 per 1000 in 1999 to 10.7 in 2008, a 143 percent increase.

The issue may be further compounded in rural areas, which are typically poorer, where access to proper resources like nutritious food and health education services may be lacking. 

So when I began to visit Hartwell, I expected to hear about diabetes as a common health concern. I was right. And while the prevalence of diabetes itself is worrisome, I learned that many diabetic patients in Hart County don't, or can't, comply with the directions their doctors give them to manage their diabetes. 

Noncompliance stems from a number of causes: Unemployment in Hart County is near 13 percent, and people eat what they can afford. The same goes for medications. Still others just aren't willing to change their lifestyles, or aren't aware of what they're eating. Some find the effort of checking glucose levels and monitoring food intake to be too much, and just don't do it.

But in Hartwell and surrounding areas, a local health care system has attempted to give diabetic residents a chance to get the education they so badly need to deal with the disease properly.

Ty Cobb Healthcare System, which serves both Hart and Franklin counties, offers an outpatient diabetes education center as a part of its health and wellness services. Patients can meet with a dietician, receive one-on-one, individualized consultations and attend group sessions on various topics related to diabetes. 

Rene Starrett, the clinical wellness coordinator for Ty Cobb, sees patients regularly upon referral from local primary care physicians. Most of her patients are Type 2 diabetics who experienced adult onset, and are usually over 50. She offers them a comprehensive overview of diabetes and helps them understand what changes they will need to make in their lifestyles, how to take their medications and how to monitor effectively. Many of the patients Starrett sees can get more in-depth, instructive knowledge from her than a physician who can tell patients to eat well, but not what eating well means.

Part of Starrett's approach to diabetes education is that support is just as important as knowledge when it comes to diabetes, a disease that requires intense personal management and surveillance. "A support system is very important," said Starrett. "Diabetes is very much about the patient."

I saw evidence of this at one of the free group sessions focused on monitoring strategies. Most of the attendees were older women, and I was surprised by the number of pre-diabetics who came for information. They came from several nearby towns, since these groups are the only free available group resource for pre-diabetics and diabetics.

Starrett acted as a member of each patient's support team, offering empowerment and advice for long-term health goals. For those suffering from diabetes, action in the now is most important, but it's easy to get discouraged or overwhelmed. 

What quickly became apparent was that this group is a way for those experiencing the same issues to help each other cope, share what they'd learned and encourage healthy behaviors in others. One woman expressed that fear of pain kept her from checking her blood sugar, which elicited a huge response and an influx of advice. Others expressed the difficulties of watching diet and understanding what causes changes in blood sugar, whether it's stress or eating an extra piece of bread at dinner. 

Regardless of the concern, someone always had an answer. These support groups show that diabetes, and chronic diseases, aren't just about managing the physical aspects of illness. They are just as much about having the mental resources and support to lead a healthy, productive life. 

The word of the day is: FOOD

In researching my feature story and attending the Association of Health Care Journalists Conference in Philadelphia, I have spent the better part of the month immersed in the broad topic of food.

A pig house at Wilson Swine Farm in Hartwell, Ga. 

I discovered the smell of a swine house, the ins and outs of a cattle farm and the changing regulations applied to what eventually ends up in our stomachs.

Food is much more than what we buy to satisfy hunger, whether it's a box of off-brand pasta or a hunk of fancy cheese. There is a complex process that lies behind what we see on our shelves; but for most of us, food just magically appears on our plates, and we leave it at that. What I've learned about the process of making our food products is troubling, to say the least.

Around 80 percent of the antibiotics consumed in this country are given to livestock, or close to 18 million lbs. And that's not because all the cows have bacterial infections. Antibiotics, the same ones prescribed to us when we get an infection, are encouraged as a way of speeding up the growth process in these animals. The big issue here is that, while eating a steak that was once fed antibiotics won't hurt you personally, everyone is affected collectively by resistance to drugs that we rely on to save lives.

Last year the FDA, CDC and US Department of Agriculture all testified before Congress that there is a link between overuse of antibiotics in food animals and the rising incidence of antibiotic-resistant strains of bacteria.

And while it may seem as simple as cutting down on the wanton use of antibiotics in healthy animals, industry officials will always fight it.

The idea of antimicrobial resistance is a beast, but the message I got out of this session at AHCJ is that current regulations and public education on the subject are inadequate, a theme that seems to be recurrent when talking about food safety.

And food safety is on everyone's minds lately due to recent outbreaks of salmonella that leave the entire country, and my mother, in a panic over what's safe to buy.

The new Food Safety Modernization Act was signed into law in January, marking some major changes in how food production is regulated. The panel at AHCJ focused on how far the bill goes in actually making a difference in food safety for the United States. The act is focused on prevention rather than reaction, which has been the FDA's primary role for years.

Surprising to me was the fact that the law had not been modified at all since 1938, and little had changed since its creation in 1908.

With one in six people becoming sick from food-borne illnesses annually (CDC), it seems obvious that the bill needed to be updated along with the evolving nature of our food industry.

So what does the new bill do for us as consumers?

For starters, under the new bill, not only can the FDA now mandate recalls of products, but it will also conduct more frequent inspections of facilities. If a company is associated with unsafe food, the FDA will be able to suspend its registration, halting distribution of the affected product. Retailers will also be required to place placards advising customers of a recalled product.

For the first time, there will be standards for the safe and correct production and harvesting of produce, with exemptions for smaller farms and individually-produced food.

Organic tomatoes in a greenhouse at the
UGA Horticulture Farm in Watkinsville.

Additionally, suppliers must now produce written safety plans to be provided to the FDA, who will also have access to any food safety records. And international suppliers, who bring in about 15 percent of our food, won't be left out. Before, only around 1 percent of imports were checked; now international suppliers must provide proof of certification and can be barred from entry into the US if found in violation of standards or if they deny an inspection by the FDA.

So there is now more real-time protection of consumers, with better prevention methods in place and the FDA taking on extended monitoring responsibilities.

But while the bill seems like a major step up, there are still problematic areas. For example, 20 percent of the food industry (meat and dairy production) is actually regulated by the USDA. The FDA also has no authority to issue civil penalties to violators of safety standards, only administrative detention.

This is, however, where collaboration becomes key. Without partnerships among national, state and local government agencies, food producers and other stakeholders, real progress in food safety won't happen. Because of the complexity of the bill, we aren't likely to see any immediate changes, but hopefully it will result in safer, more reliable food production.

Our local Subway just started to stock spinach again ... and I'm hoping it stays that way.

Sustainability on the farm

Scott Fleming, manager of Wakefield cattle farm in Hartwell, was kind enough to tell me about the farm and what sustainability means to him. Not only is the farm beautiful, with acres of forested land alongside green pastures, but it is also known as an example of environmental consciousness in an industry where sustainability is rare.

Check out the video, featuring photos of Wakefield and the University's organic farm in Watkinsville. Farming really is a way of life in Georgia, but it doesn't have to harm the land that feeds us.

A more high quality video is available at http://vimeo.com/22782695

A new hospital in Lavonia may bring specialty care closer

A new partnership between a group of physician-investors and Ty Cobb Healthcare System will provide Hart and Franklin Counties with a new, updated hospital and will hopefully attract specialty physicians to the area.

Check out the article at Georgia Health News: http://www.georgiahealthnews.com/2011/03/22/rural-health-build-it-specialists-come/

The NACCHO adventure

A few weeks ago I attended the National Association of City and County Health Officials (NACCHO) Public Health Emergency Preparedness Summit. I attended three sessions on different emergency preparedness topics.

The final session, on which I wrote a blog post, was on the importance of public health officials collaborating with faith and community-based organizations for emergency preparedness. This is a big issue when it comes to communicating risks to groups of people with specific belief systems and traditions. Add in a lack of trust in government, and it's difficult to effectively persuade certain groups to take the necessary steps to prepare for emergencies.

Check out the blog post here.

HPV vaccines: More than meets the eye

I learned a lot these past few weeks. I learned that what I thought I knew about HPV was all wrong, or at least incomplete.

Cervical cancer has been huge, especially on TV, for the past few years. All of a sudden my doctor is telling me to get vaccinated for HPV, and she makes it sound like I'm going to die if I don't. The message I got from all of this was: get vaccinated or you might develop cervical cancer because it's a huge risk.

But I and millions of other women are missing a lot of crucial information.

Human papillomavirus (HPV) is the most commonly sexually transmitted infection in the United States, and the world. So common, in fact, that half of all sexually active men and women will contract HPV at some point in their lives. Hm. Didn't know that.

However, HPV usually comes and goes without a sound and leaves no lasting effects. There are over 100 strains, and many of them don't do a thing to us.

But then there are the ones that do. Two strains of the virus -- HPV-16 and 18 -- are associated with cancer development. Two others -- HPV-6 and 11 -- are associated with 90 percent of genital warts. There are two vaccines that protect against the cancer-causing strains, Gardasil and Cervarix, and the former also protects from the wart-causing strains.

And while the common misconception is that HPV only causes cervical cancer, the infection can actually cause several cancers, although half of the cancers caused by it are cervical. Anal cancer is also the result of HPV infection, especially in men who have sex with men. Other cancers include vaginal, penile, throat and vulvar. So it seems the HPV vaccine, which a new study shows can prevent infection in men as well as women, is a blessing for many at-risk individuals. 

However, I typed "harmful HPV" into Google one day, and the first thing to pop up was "harmful HPV vaccines."

A lot of the fear associated with any vaccine comes from action taken when there is no perceivable immediate threat. For HPV, the fact that this is a sexually transmittable infection makes it even more uncomfortable for many parents to consider concerning their adolescent children, since the vaccine is most effective before sexual activity begins. Because of this, the vaccine may be thought of as a gateway for sexual activity. Right now uptake in American women is woefully low, less than 30 percent, although it has been rising. 

According to 2010 Centers for Disease Control and Prevention research, major barriers to vaccination include "belief that a child does not need the vaccine, lack of sufficient vaccine knowledge, and the fact that the child was not sexually active."

Another study published in the journal Pediatrics in 2010 found that physicians themselves often didn't have the facts correct about HPV, some mistaking the most common age of transmission as over 30 when in fact it is under age 30. And while almost all of the pediatricians and family practitioners surveyed offered HPV vaccines to 11- and 12-year-old girls, many of them did not strongly recommend it and expressed reservations toward vaccinating younger girls for sexually transmitted infections. 

Add in cost and negative media coverage, including anti-vaccination movements, and a parent may see more value in avoiding the vaccine than attempting it.

In rural communities, these barriers can be magnified. The stigma associated with STIs can prevent parents from getting their kids vaccinated, and might prevent men from getting vaccinated if it is made routine in the future. 

So what can be done to increase uptake in girls and women, as well as to encourage vaccination in boys and men if the benefits lead to routine immunization of them also?

Dr. Joel Palefsky, one of the lead authors of the new study of HPV vaccination in men and boys, believes that the key is education. "People need to better understand the connection between HPV and the diseases that we're trying to prevent," he said. "Obviously, many people have tried to do that [educate], but I think it's still a black box to many people."

Rhonda Dyar, the nurse manager of Hart County's health department, agrees. "Its important to educate them [patients] on the risks of not getting vaccinated, use details and encourage it prior to sexual activity," she said. False information is a problem she notices when parents do refuse the vaccination for their children. 

The possibilities of this vaccine are expanding; in the future it could be used as a preventative for several diseases, especially if uptake in females increases or both sexes routinely get vaccinated. None of those possibilities will come to fruition, however, if education and understanding of the link between the vaccine and disease don't increase. 

The state of health in Hart County

The thing I love most about the drive from Athens to Hart County? Cows. Oh, and the occasional miniature donkey or goat. They're cute but they serve a purpose, of course; the large number of farms in the area contributes to the county's position as fifth in agricultural sales for the state (2007).

After my first few visits, however, I learned that Hart County is much more than just farmland.

Hart County is a rural county with a population of around 24,000. While smaller than most counties in Georgia,  it also boasts an active community and an interesting make-up.

I learned that what was once an area rich in textiles now relies heavily on income from it's man-made lake, Lake Hartwell, which attracts part-time residents, retirees, and vacationers. While there are more affluent residents around the lake, according to Ilka McConnell, UGA's Hart County Archway Partnership professional, they are more the exception than the norm. Those who live in Hartwell, the county seat, tend to have less income and work in industrial settings. The county's unemployment rate as of December, 2010 was 12 percent, with 19.7 percent of individuals living under the poverty level.

Many of the health problems in Hart County seem to stem from lifestyle and income, and are often compounded by a lack of health care services. The county is designated as a health care professional shortage area as well as having a medically underserved population. There is a single hospital in Hartwell with 82 beds, but the beds on the first floor aren't in use. There is also a MedLink clinic to provide primary care, as well as a few other family practitioners.

When it comes to acute care, the hospital is able to provide several services but more often patients are referred to physicians in places like Athens or Anderson, SC for specialized treatment in cardiovascular diseases, neurology, oncology, etc. Interestingly, there is a "wellness" center adjacent to the hospital that specializes in cosmetic procedures such as vein care, Botox injections and various laser treatments.

When speaking with Rhonda Dyar, the Nurse Manager at the local health department, I learned that many of who live in Hart County depend on the health department for all of their health needs, like child health care, women's health care and other services that are lacking in the county or unaffordable. She also said that the tiny clinic, usually equipped with only two nurses, is constantly behind on meeting the needs of its clients and is often booked solid.

As with most rural areas, major health issues in the county include cardiovascular diseases, obesity and diabetes. That obesity and diabetes are problems is evident simply by driving around town. The first restaurant I spotted when I first visited was a McDonald's right in the center of downtown, directly across from the police station. Leading causes of death for the area waiver around lung cancer, heart disease and stroke, which is representative of the US, but the rates are exaggerated for Hart County.

Lisa Graham, an RN and legal nurse consultant at the Hart County Hospital, told me that diabetes and obesity are both cyclical problems in the area that stem from lifestyle, surroundings and income. In fact, she stated that for many diabetes patients, noncompliance with medications and diet is often due to a lack of viable options.

Mary Lowery, an RN at the hospital, reiterated this by saying that people "eat what they can afford," stressing the social and economic aspects not only of diabetes and obesity, but of most health problems in the area. 

"You're gonna buy your cigarettes and alcohol before you buy your food."

Both Lowery and Graham said that the state of the economy has put a damper on health care in the county, preventing some from accessing critical medications or preventative measures. Add in the few available health care services within a close distance of Hart County residents, and you have a recipe for lasting chronic diseases and an unhealthy population.

There is another side to the county's health story, however.

There is a surprisingly long list of local charities, nonprofit organizations, support groups, clubs, and churches that do or could be used to address health care issues in the county. The hospital hosts weight-loss, substance abuse and other meetings. Diabetes support groups and education are rising in popularity, and the school system takes a proactive stance on nutrition and sports.

Hart County, in a nutshell, appears to me to have several county-wide health concerns. But what I also saw when meeting residents or driving around town is a relatively close-knit community with the desire to grow.