Tag Archives: Public health

Time series: what conclusions can we draw from ?

8 Nov

Here below is a link toward a time series published by the French Agency for pharmaceutical safety (aka ANSM). Although the method is well described and doesn’t raise any concern, nevertheless the interpretation that is done from the results in the discussion is subjected to caution.

My expression of concern is motivated by the fact that the authors of the study link the lowering of the incidence of pulmonary embolism to the lowering of sales of third and fourth generations of contraceptive pills.

Indeed a cofactor can explain the concomitant lowering of both time series:
the large warning campaign in the medias with messages about a) the risks attached to those third and fourth generations of contraceptive pills AND b) the risks of pulmonary embolism (ie blood clots in the lung) every woman faces under contraceptive pills, no matter the generation of the contraceptive pill.

Thus the practitioners could have been more attentive to the risk for all their patients and stopped the contraceptive pill, even for the first and second generation of pill, in case of any doubt (eg a phlebitis of the leg or a tobacco addiction).

One thing is for sure: the results of this study show that the campaign in the media had an impact in term of public health, but no causality can be formally drawn between the lowering of the sales of the third and fourth generations of contraceptive pills and the lowering of pulmonary embolism from the results of this study.

The study:

Etude de l’impact de la modification récente des méthodes de contraception sur la survenue d’embolies pulmonaires chez les femmes de 15 à 49 ans (07/11/2014) application/pdf (316 ko)

http://ansm.sante.fr/content/download/69461/886199/version/1/file/Etude-COC-Embolie-pulmonaire2014.pdf

INDICATORS FOR MONITORING THE HEALTH OF THE POPULATION – FINAL REPORT

11 May

The French government has issued a report enlisting the available surrogates of risk factors, health determinants and health status of the population at a nation’s wide level.
Some experts from the self employed workers social scheme (RSI) participated to the panel of experts.
In many cases, to construct the surrogates the authors of the report plans to use the reimbursement databases of the national mandatory health care insurance schemes. It is the case for example when the surrogate is a recourse rate to a category of treatment or medicine (anti hypertensive treatment; opioid addiction treatment …).
Feel free to consult the report (in French) here:

http://www.drees.sante.gouv.fr/indicateurs-de-suivi-de-l-etat-de-sante-de-la-population,11299.html

and here:
INDICATEURS DE SUIVI DE L’ÉTAT DE SANTE DE LA POPULATION RÉVISION 2013 – RAPPORT FINAL

Changing Mindsets -Strategy on health Policy and Systems research

22 Dec

The report referenced below with its internet link reflects the strong incentives given by the WHO to enhance the articulation between research in health systems and research in health policy in one hand and the decision making at the political level in the other hand in the realm of health care and health coverage. Nine countries are studied, including China, Thailand and Nepal for the Asian part of the World.

http://www.who.int/alliance-hpsr/alliancehpsr_changingmindsets_strategyhpsr.pdf

Europe is the theater of a Greek tragedy

14 Feb

When egoism strikes men, it is also contagious for nations.

English: The logo of Greece's health ministry.

Image via Wikipedia

I have selected for the benefit of my readers some articles issued by The Lancet, a prestigious medical journal, focusing on the consequences of the Greek economic and political crisis on Health Services. Greece is in Europe; nevertheless this country seems abandoned by the Europeans. After the world war two in Europe, starting from ruins, a welfare system was reconstructed. Nowadays it seems like we assist exactly to the reverse: Europe, starting from a well build welfare system is being ruined. In both cases only the will of human beings is at work. After World war two those men in charge were the former resistance fighters while now they are bankers and traders. Even perhaps the latter could be the grand sons of the formers. With their Marshall plan the USA helped Europe in the past. But now it seems that no one would stand up for that purpose.

Greece’s financial crisis dries up drug supply:

Eva Karamanoli; http://www.thelancet.com Vol 379 January 28, 2012

Resume: The pharmacies run short of medicine as important as Parkinson treatment or Epilepsy treatment. International pharmaceutical laboratories hesitate to deliver their product to Greece because of the lowering that government imposed to the price of medicines in the context of health budgets cuts. Patients have to pay in cash pharmacist before holding medicine because social security funds take months to reimburse; if not wholesalers cannot deliver the drug to the pharmacist.

 

Health eects of financial crisis: omens of a Greek tragedy:

Alexander Kentikelenis, Marina Karanikolos, Irene Papanicolas, Sanjay Basu, Martin McKee, David Stuckler; http://www.thelancet.com Vol 378 October 22, 2011

Resume: The rate of suicides has grown during the crisis, as well of the rate of HIV or Sexual Transmissible Infections (secondary to an increase of drug users and prostitution). Criminality rates have also increased (homicide and theft). Primary care practitioner consultations have not been implemented although they were needed while rate of admission in public hospitals has increased.

 

Increased suicidality amid economic crisis in Greece

Marina Economou, Michael Madianos, Christos Theleritis, Lily E Peppou, Costas N Stefanis; http://www.thelancet.com Vol 378 October 22, 2011

Resume: The suicide rate has increased by 40% since the beginning of the crisis. It is highly associated with the economic distress in the surveyed population.

 

IMF and European co-workers attack public health in Greece

Konstantinos Triantafyllou, Chryssi Angeletopoulou ; http://www.thelancet.com Vol 378 October 22, 2011

Resume: At the demand of the International Monetary Fund and the European Central bank, health care spending cuts will lead Greece to lose 26 000 public health workers (of whom up to 9100 doctors). According to the author the inevitable consequence will be the worsening of the health of the population as it has been already observed in all the countries previously “aided” by the IMF in the world. But this latest fact is contested by the IMF.

 

Debt crisis strains Greece’s ailing health system

Eva Karamanoli; http://www.thelancet.com Vol 378 July 23, 2011

Resume: In order to cut spending, clinics will be merged and a special body of primary care will be created to alleviate the public hospital’s burden. Indeed, in one hand public hospitals are lacking or in short supply of elementary material such as gloves, IVs, gazes or medicines and the patients undergoes long waiting times while in the other hand people use public hospitals instead of private practices not to have to advance the money because Social security reimbursements have to be waited for months.

To say it short, the overall situation is: Health insurance fund owes money to health providers who themselves owes money to wholesalers who owes money to pharmaceutical industry. The health services strongly have to be rebooted in Greece.

 

Greek academic psychiatry and neurology before the firing squad?

Thomas Paparrigopoulos, Ioannis Liappas; http://www.thelancet.com Vol 378 July 23, 2011

The most important psychiatric hospital in Greece whose chiefs of departments are also keys opinion leaders in their speciality experience a 30 % budget cut. Greek academic psychiatrists are now an endangered specie which need urgently to be preserved.

 

Works consulted (in the same order):

http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673612601299.pdf

http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611615560.pdf

 

http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611616383.pdf

 

http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611616395.pdf

 

http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611611525.pdf

 

http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611611586.pdf

 

Science shows how people can adopt a better behavior in life

7 Feb

Science helps you to live a better life.

baby eating from spoon

Readingto Scientific studies results in more efficiency in the way you should conduct your own life.

For example: The School of Psychology, University of Nottingham, Nottingham, UK reveals that letting your babies feeding themselves with their fingers leads to less risk of them becoming fat when they will grow up than feeding them with a spoon.

 

Other example: two researchers at the University of Toronto’s Rotman School of Management finds that thinking your time worth money will lead you to less enjoy your leisure time and benefit of less happiness in your life.

 

Last example: the Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine,Sendai,Japan, confirms that drinking 5 cups or more of green tea per day would guarantee people to age without disability.

 

There is no need for sectarian or magical beliefs in order to leave a better life because all the here above commandments or precepts stem from scientific rationale studies implemented by honest scientists (as warranted by the quality of the institution they belong to).

 

Links to the scientific papers:

 

First study: Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case controlled sample.

http://bmjopen.bmj.com/content/2/1/e000298.full.pdf+html

 

Second study: Time, money, and happiness: How does putting a price on time affect our ability to smell the roses?

http://www.rotman.utoronto.ca/facBios/file/DeVoe%20and%20House,%20JESP.pdf

 

Third study: Green tea consumption and the risk of incident functional disability in elderly Japanese: the Ohsaki Cohort 2006 Study.

http://www.ajcn.org/content/early/2012/01/24/ajcn.111.023200.full.pdf+html

 

 

 

 

Prison valley

27 Nov

Prison valley, posted with vodpod

Professor Patrick Morvan tell us in his blog that in the State of California, there are 50 death per year motivated by a lack of health care and that up to 700 prisoners are enlisted in a waiting list to attend a Doctor visit.
In France an author, Dr Véronique Vasseur,had published a book, on the subject that is very similar with the problem faced in California.
The prison industry is not exposed to unemployment during times of economic crisis but prisoner’s access to health care is a real public health issue!

You can access to the entire free movie entitled Prison Valley by clicking here.

cancer mortality

6 Nov

According to the INVS, mortality from cancer has diminished since 1990. I notice that this was the case especially for the two localizations that have benefited from screening: prostate cancer for men with the generalized use of PSA in individual screening and breast cancer for women with the generalization of organized screening with mammogram. These cancer mortality statistics published by the well-known French epidemiologist Catherine Hill are very encouraging with regard of public health.  They must contribute to the recent debate on whether screening for prostate and breast cancer is justified. In my opinion people who are not in favor of such screening should look closely to the figures that Catherine Hill reports.

You can get access to the full text report on mortality from cancer here:

Catherine Hill Report

Reference:
Hill C, Doyon F, Mousannif A. Évolution de la mortalité par cancer en France de 1950 à 2006. Saint-Maurice (Fra) : Institut de veille sanitaire, mai 2009, 272 p. available on: http://www.invs.sante.fr

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