New Post at a site we watch, pazonehealth.org.


Learn about parasitic disease! Fun Fun Fun!hydatid-being-removed-from-brain-e1506534933194.jpg

http://www.pazonehealth.org/single-post/2017/09/27/Hydatid-Disease-Part-IV

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Rabies: 9 years and things are not getting better


 rabid dog
For about nine years now, I have been traveling to Baltimore on a semi-annual basis. I go to the Johns Hopkins Bloomberg School of Public Health and deliver, more or less, the same talk, year after year,  about rabies.
9 years, and more deaths.
It’s part of the vector-borne section of the course. While not a vector-borne disease (unless we wish to think of dogs as a vector between us and bats–a bit of a stretch, if you ask me), rabies is considered one of the Neglected Tropical Diseases (NTDs), and because it’s a preventable cause of horrific and needless suffering it needs to be somewhere.
Opening Salvo
I always preface my talk with two informal survey questions:
  1. Does anyone know what the OIE is?
  2. Does anyone know what One Health is?
Answers:
  1. OIE stands for Office International des Epizooties, or World Organisation for Animal Health (yes, they use the British spelling of “organization, which I think is a political statement, but that’s another post). It’s kind of like the WHO for animals, and it is based in Paris.
  2. One Health is a concept advanced by the American Veterinary Medical Association, the CDC, and other organizations. The CDC states “One Health recognizes that the health of people is connected to the health of animals and the environment. The goal of One Health is to encourage the collaborative efforts of multiple disciplines-working locally, nationally, and globally-to achieve the best health for people, animals, and our environment.”
I think that over the years, I’ve had maybe three ‘yes’ answers to these questions, combined. The conclusions are obvious:
  1. The OIE is failing in its mission to educate the other health professions, as well as the general public, on the importance of animal health, both as it relates to animals alone and to human health as well.
  2. The One Health concept is a failed attempt by the veterinary profession to assert its presence into discussions of public health. It represents the profession’s inability to move itself from the general world of agriculture (where it is also clearly important) and place itself among the disciplines of other health sciences.
(As a veterinarian, we are used to being the red headed stepchild of the medical professions, so this doesn’t really surprise or irk me. Sometimes, we even create brilliant concepts, like One Health, so we can pretend that it’s really a thing for those outside of our bubble.)
So, what’s the problem here, specifically regarding rabies?
Let me preface this by saying that , I don’t really trust rabies statistics. The latest updates I’m reading estimate the annual number of rabies deaths at 59,000.  Given that most of these deaths come from rural areas in Africa and Asia with poor access to treatment and prevention, I’m not sure how they come up with that number. (On my to-do list: contact a rabies epidemiologist.) What I do know is that when I first started giving the talk, the number was 25,000 – 50,000. The range itself, varying by 100% of the low number, inspires doubt in and of itself.
That noted, the trend over the past nine years is at best level, and at worst shows an increase of 18%. Rabies does not get a lot of attention. Most diseases of the poor—Chagas’ disease, cysticercosis, leishmaniasis, hydatid disease, and others—get little attention. AIDS/HIV, tuberculosis, and malaria are the exceptions, but two of those are not restricted to poor areas overseas. Rabies kills “only” 59,000 people a year, a number that pales in comparison to the other diseases listed here. But working on one disease does not preclude working on another.  Rabies is low hanging fruit. The numbers of rabies deaths are skewed towards children.  Rabies is not a medical mystery. The bottom line is that no one should die the horrible death that comes with rabies infection.

 

Depression in Teenage Girls and Young Women: Is it getting worse?


menace-1-1
From Hyperbole and a Half, a great blog on depression

 

Yes, that does seem to be the case, in spite of increased awareness, better medications, and supposedly less stigma.

This from NPR

This from MarketWatch

And this from the peer-reviewed journal Pediatrics

RESULTS: The 12-month prevalence of MDEs increased from 8.7% in 2005 to 11.3% in 2014 in adolescents and from 8.8% to 9.6% in young adults (both P < .001). The increase was larger and statistically significant only in the age range of 12 to 20 years. The trends remained significant after adjustment for substance use disorders and sociodemographic factors. Mental health care contacts overall did not change over time; however, the use of specialty mental health providers increased in adolescents and young adults, and the use of prescription medications and inpatient hospitalizations increased in adolescents.

Back From Haiti


vbrio
Vibrio cholerae bacterium

haiti
American Aid Worker Kate Bartow addresses a crowd following the recent unrest.

Was I safe?

The week before I arrived, Guy Philippe, a leader in the 2004 coup to overthrow the government of Jean-Bertrand Aristide, was arrested on drug trafficking charges and extradited to the United States. Seen by some as an affront to the nation’s sovereignty, there were protests in Haiti, and several groups felt it necessary to evacuate their missionaries or aid workers, or else had them seek shelter among United Nations forces. The arrest was also seen as a last-chance effort to apprehend Philippe, as he was days away from being sworn in as a Senator, which would have rendered him immune to prosecution (senators in Haiti have passed a law which places them above the law.)

I was blissfully unaware of all of this before I left.  My family was even more unaware. If they had read this account from the NY Times they would have been driving me crazy with phone calls and warning me not to go. My cousin Nettie would have said, “Are you CRAZY?” and my older sister would have been yelling at me on the phone. The article wasn’t published until the day after I left  ( a week after the event), highlighting its relative lack of importance in the American mind, especially in the run-up to the Disastrous Inauguration. The arrest was reported a week earlier by the BBC and the Miami Herald.

Haiti is a small country, only slightly larger than Vermont. However, distances are much greater than they would be in the US due to the conditions of the roads. The problems that occurred were far from where I spent my time. My presence in Haiti was relatively cloistered, and if I hadn’t been told about these events I would not have learned of them otherwise in the course of my visit.

Haiti disbanded its military in 1995, partially in response to military coups, partially out of financial necessity. There is a national police force, and the United Nations peacekeeping forces have been in the country for over a decade for police and stability operations. The UN forces are viewed by some as occupiers, and they are responsible as well for the current cholera epidemic. UN soldiers reintroduced cholera to Haiti following the 2010 earthquake, and though on the decline, the disease continues to cause morbidity and mortality.

 

The term “basket case” arose during WWI as a rather cruel way to refer to a quadruple amputee. It now refers to something or someone that is such a mess that it is unable to help itself, most often a person who is suffering from a mental or emotional problem that renders him or her less than functional. 

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TUESDAY TANTRUM: Influenza. Loneliness. Bad business. Vaccinations.


fluI just got a chilling thought.

If I get influenza this winter,

I am fucked. Really fucked. Why? Because I have no friends here. None. If I missed work, someone would call and wonder where I am, but other than that, no one would check up on me. I would have to go to the store and spread my germs, because I wouldn’t have any other way to get food. In addition to the pain of illness would be the added pain of isolation and fear. My 11 year-old daughter would be worried and try to make sure I was OK, but she’s just an 11 year-old who would be in the custody of her mother , Fräulein Schadenfreude, who really hates me and might even take some cruel pleasure in the fact I was alone in my misery. Not that she’s bitter or anything.

I’ve had the flu before. It was debilitating. I was febrile and in pain for a full week. Yeah, sometimes it’s “just the flu”, but at other times it’s the disease that kills around 36,000 Americans per year ( a lot more  Americans than Ebola, West Nile Virus, Eastern Equine Encephalitis  will). Fortunately it’s rare, but other times flut has been the epidemic that has knocked off 3-5% of the world’s population. It’s not the flu—it’s the ‘flu, dumbspeak for influenza.

All in all,I was well cared for. I was at my girlfriend’s mother’s house.  We had driven down to Atlanta for Christmas(see what happens when you date a shiksa!) , and it was my first time meeting the family. I think I made a good first impression.

People with strong connections heal better and are in better general and mental health. Living in isolation is toxic—it can literally shorten your life. What is the worst punishment we can give (short of the death penalty)? Solitary confinement. Lock ‘em up, and let ‘em go nuts.

So winter’s coming up. Whaddaya gonna do?

flu2

First of all, don’t be a moron, and go get your flu shot.

Your immune system is not a muscle. Don’t think that by “stressing” it with exposure to a virus is going to make it stronger.  The flu shot cannot give you the flu, nor will it cause autism, cause narcolepsy, or make you vote for Rick Perry. Unless you are allergic to eggs or religiously opposed( a weak reason, in my humble opinion), there is no reason not to get it. If you are under 50, get the intranasal—it shows better efficacy.

What population needs vaccination the most? School-age children. They run off to the viral exchange facility 5 days out of 7, and they are the super spreaders of the disease. If you want to protect infants and the elderly, it’s better to vaccinate school -age children than vaccinating those groups. I’m not going to argue science with whackos who think that vaccines are poison distributed widely. They can join my raw milk friends and throw a party. Go get your children vaccinated, or you are a parasite worse than Echinococcus multilocularis.

Secondly, don’t go to  work sick.

I worked at a horrible corporate veterinary practice where the manager (where do they find these people? They went through 5 managers in a little over a year. The Company bought into the ridiculous Business School Conceit that if you know how to manage a convenience store you also know how to manage a machine shop or a veterinary practice—the falsity of this claim was demonstrated on a hourly basi, oh how we loved the days when she was off! ) Anyway, as I was saying the manager announced at an office meeting one day that “if anyone is sick and can’t come in to work,  you still have to come in unless you find a replacement.” My response was, “As soon as I hear of anyone coming in with a fever, I’m leaving, and I will recommend that anyone else leave.” I don’t see why the employees should have to do the manager’s job of finding a replacement (other than the manager’s desire to shift the blame off of herself, in addition to  cruelly burdening a sick person with a bad task). And it is sheer lunacy to have sick people come into work. Massachusetts is contemplating a paid sick leave law. Only slavemasters and fools (aka “job creators”) would oppose such a law.

flu3

Thirdly, make sure you’ve got some strong connections.

If you’re sick, you’re going to need friends. If you’re not, they are going to make your life better. Remember: it’s a long winter.

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