PHA Written Publication Issues

The Public Health Advocate Online Publication will be posting Public Health Advocate Written Publication issues! Below are Issues 14, Fall 2011 and Issue 15, Spring 2012. Take a read through UC Berkeley's premier publication distributed bi-annually throughout campus. Click on the links below to read the complete 2011-2012 issues!

FALL 2011: http://issuu.com/berkeleypha/docs/pha_fall_2011

SPRING 2012: http://issuu.com/berkeleypha/docs/pha_spring_2012

Head and Brain Injuries Induce Early Onset of Death

By Penelope Chuah

Yesterday, BBC published an article highlighting the fatal effects of post-head injuries. The analysis supports the fact that “injuries to the head can leave victims susceptible to early death” leading to a three times greater risk of death compared to people who did not suffer any damage to the brain (BBC).

Damage to certain brain areas can cause severe impairment to fundamental physical and mental body controls, some of which include motor function, memory function, executive function, and regions involved in personality formation. The frontal lobe, for example, is a region that specializes in memory function, executive function, and personality formation. When the frontal lobe undergoes damage from a concussion or repeated forceful strikes to the area, completing cognitive tasks becomes difficult, as well as initiating behavior and organizing tasks becomes impaired (Jagust). Furthermore, the frontal lobe is the area that involves personality formation. When this region is affected, preservation and inappropriate behavior with feelings of agitation develop. Among damage to these functional areas, The BBC article concludes that “common causes of premature death among those who had suffered previous brain injury included suicide, being a victim of assault or suffering fatal injuries, for example in a car crash” (BBC). Overall, brain and head injury commonly cause a change in potentially fatal mental and physical behavior. Punch-Drunk Syndrome exemplifies the effects of head injuries and the likelihood of the onset of premature death. This syndrome is common in boxers or those who are taking constant impact to the head. This eventually leads to cognitive and behavioral alterations that include personality changes and depression, accompanied with motor weakness. Problems in the brain lower the reserve and increase the potential of having problems with amyloid plaques and neurofibrillary tangles, a type of protein and fiber, respectively, that contribute to the onset of Alzheimer’s disease through neuronal degradation (Jagust).

Traumatic injuries to the brain can trigger a series of neuronal degradation that is particularly destructive to brain and bodily function, causing a higher risk of death. The brain, with all its intricacies and production of complex output, is a lot more fragile than people expect and require a lot more protection than given.

Sources:

Brain blow leaves life-long dangers. (2014, January 15). BBC News. Retrieved January 16, 2014, from http://www.bbc.co.uk/news/health-25747704

Dr. William Jagust, UC Berkeley, Public Health/Cognitive Science 129

Painkillers: Regulations and Recommendations

By Nisha Chandra

Last month, the FDA made a recommendation to change the way doctors prescribe hydrocodone
painkillers. These painkillers are the highest prescribed medications in the US and include narcotics like
Vicodin, which are legal but highly addictive. These types of painkillers have long been a problem in
America because of the potential for drug abuse. In fact, in the last ten years, more than 100 thousand
have died from overdoses of hydrocodone medication.

Drug companies claim that they have reduced the risk of addiction by adding a drug called
acetaminophen, which is found in Tylenol, to hydrocodone painkillers. However, very little evidence
exists to prove whether acetaminophen actually lowered the risk of abuse.

Efforts in the past to rectify the problem have been met by opposition from lobbyists. Drug companies,
patients-rights groups, and the AMA all oppose restrictions on hydrocodone drugs. The stated reason
for this opposition is that additional regulations will decrease access to those who truly need it. And
these lobbyists have been persuasive. A bill in the House of Representatives to restrict prescriptions
of hydrocodone medication was shut down by a representative from Michigan who had received 300
thousand dollars in campaign contributions from drug companies.

Still, public health advocates pushed for more restrictions. The FDA previously looked into the problem
in 2008, but at that time concluded that there was no need to tighten restrictions on hydrocodone
drugs. But they reversed that decision last week. Now, the FDA recommends that the pain pills should
be moved from Schedule III to Schedule II. Schedule II drugs are ones that are deemed more dangerous
and are more strictly regulated. The FDA also recommended that patients should only be able to get
refills for hydrocodone painkillers for 90 days before having to see a doctor. Previously, the limit was 6
months. Doctors are trained to see the symptoms of addition, and more frequent visits to the doctor are
hoped to cut down on prescription abuse. Additionally, patients will have to take a prescription to the pharmacy for a refill, instead of having their doctors call it in. This may have negative effects for those who live in rural areas and those without access to transportation.

Still, this is just a recommendation from the FDA, not actually law. It will become law when the
department of health and human services approve these recommendations and when the DEA adopts them. These approvals are expected to take place and will result in changes happening early next year.

References:
http://www.nytimes.com/2013/10/25/business/fda-seeks-tighter-control-on-prescriptions-for-class-of-
painkillers.html

http://www.bloomberg.com/news/2013-10-24/u-s-recommends-tighter-control-on-hydrocodone-pain-
pills.html

Taking the First Step with Walk with a Doc

By Mint Bhetraratana

Four months ago, I found myself at the helm of a flip camera, a device that I was less than comfortable using, despite being a part of the tech-savvy generation. I was volunteering at a health conference in Oakland and was assigned to videotape the day’s events and interview some of the guest speakers. Everyone that I met was a health professional of some sort, having already found their calling and belonging to an organization that worked to better the community through public health means, while I, a Berkeley student on the brink of graduation, was simply there to help out and explore.

Little did I know that by the end of the day, I would find something to be a part of, too.

One of the guest speakers that I spoke with was Dr. David Sabgir, a physician from Columbus, Ohio who had flown all the way from his hometown to talk about his non-profit called Walk with a Doc.

“Hmm,” I thought the first time he told me and which I soon would realize is a common mistake people make, “Walk with a Dog.”

Of course, Walk with a Doc has nothing to do with this 4-legged creature (although we do encourage man’s best friend to walk with us!), but instead, is about encouraging the community to do the very simple act of walking.

Walking, as is often dismissed as just a necessary means of getting from one place to another, has a lot of health benefits. By walking 30 minutes a day, you are effectively lowering your blood pressure and cholesterol levels, reducing your risk of obesity, improving your immune system, and decreasing stress – thus making you a healthier, happier person!

With this in mind, Dr. Sabgir sought out a way, as a cardiologist, to help his patients prevent the onset of hypertension and cardiovascular disease (which to this day, is the number one cause of death in America) by encouraging them to be more physically active…and to do it with them.

So, in 2005, he founded Walk with a Doc, an organization that not only hosts monthly 2-mile walks with a leading physician, but which also provides free blood pressure screenings, healthy snacks, and giveaways like shirts, pedometers, and water bottles to encourage community members to continue walking long after the culmination of the event.

It was a simple idea – the merging of clinical medicine with a doctor’s advice and public health practice with a blood pressure check and a walk in the park.

I mulled over the concept in my head and concluded that, as someone who grew up playing tennis and soccer and even coached others in these sports, and as someone who learned about the obesity epidemic in public health classes, I wanted to be a part of this growing movement. (And indeed, Walk with a Doc is growing – with over 100 walks in the U.S., Australia, and Russia!)

After reconnecting with Dr. Sabgir after the conference and expressing my interest in getting involved with a Bay Area chapter of Walk with a Doc, he introduced me to the program’s director, Liz Mace. To my surprise, she told me that there wasn’t a Walk with a Doc chapter here, but that she would help me to start one.

I took some time to think about the task ahead of me: would I be up to the challenge of creating a chapter of a non-profit, something that I had no experience doing before? Would I be ready to take on a commitment that I knew would require much of my free time and energy?

I wasn’t sure what the answers were to these questions yet, but I decided that I would test the waters and find out.

And so began my journey with Walk with a Doc, which would involve several hours of sending and receiving e-mails, maintaining an Excel sheet that documented my every decision, talks with local physicians, visits to cafes and businesses for donations, and other tasks that I won’t go into detail here. I will however, share with you a few things that I’ve learned thus far while working on this project.

1. I have to pick myself up when the going gets tough.

It’s an unfortunate reality that there will be obstacles in the way of planning an event –whether it be a cynical opinion or a schedule that doesn’t hold up. It’s easy to allow these road bumps to add up until the point when you start doubting yourself. But when that happens, it’s important to remind yourself why you got involved in the first place; it’s an opportunity to reinforce your passion and commitment for a project. For me, I like to take a look at pictures from past Walk with a Doc events and remember the important message that this organization is getting across to thousands of people. I think of the impact that an event like this can have on a community and also consider that:

2. If I surround myself with supportive people, the obstacles can be conquered.

There are times when an individual can do a task, and there are times when a team of people can do it better. For public health initiatives, the latter is the better option. It’s crucial to interact with people who are supportive of the cause and of you. I was fortunate to come across with and connect with individuals from The City of Berkeley, Lifelong Medical Center, and Walk with a Doc, as well as the many business sponsors who believed in this program and who believed in me. Their relentless support truly helped me maintain the foundation for which I alone could not support.

Taking the time to reflect about Walk with a Doc has allowed me to think back to when I first heard about this program and which brings me to another lesson that I learned:

3. Do not discount the little things because if you let them grow, they can lead to greater opportunities.

Four months ago, I would not have thought that volunteering to take pictures at a health conference would have led me to creating a Walk with a Doc chapter in Berkeley. Had I not done the seemingly minor task of taking footage that day, I probably would not be writing this very essay. The bottom line is – take notice of everything that is going around you and the opportunities that may come your way. And if they don’t come, take notice of the things that you are doing and forge your own path to create something that you feel there is a need for in your community.

With that said, I invite you to come walk with us on Saturday, October 19^th in San Pablo Park in Berkeley. Dr. Janet Berreman will be speaking about the importance of physical activity and nutrition and Heart 2 Heart will be providing blood pressure screenings. In addition, we have invited Thalassemia Outreach at Children’s Hospital, Diabetes and Sports Health Camp (DASH), and 10x10 Wellness for Alameda County to speak to walkers about their respective health organizations. If you would like to volunteer or would like more information about this event and Walk with a Doc, feel free to e-mail me at wwad.berkeley@gmail.com. 

China's Lethal Air Pollution

By Penelope Chuah 

China’s economic performance and growth in the past ten years is unparalleled to the economic growth of any other country. Over the past decade, China has steadily climbed to the number two position in the world’s largest economies ranking, surpassing economic powerhouses including Germany and Japan. A factor behind this development can be attributed to the nation’s rapid urbanization. With rapid urbanization came technological advancements that produced large quantities of pollution. With the growing urban population, the number of automotives, factories, houses, skyscrapers, and other coal producing entities, the heavy blanket of pollution that covers most bustling cities in China will continue to grow denser.

In 2010 it was recorded that approximately 1.2 million deaths occurred as a result of air pollution in China (Atlantic Wire). As urban areas and industrialized cities become ever increasingly popular, pollution levels will proportionately increase. According to an article in the Bloomberg Businessweek, a group of researchers investigated the outcomes of the heavy polluted province of Shanxi. Over the course of ten years, researchers concluded that large amounts of “pesticides, industrial solvents, and especially polycrylic aromatic hydrocarbons, which are released into the air when fossil fuels are burned” (Larson) were found in the placentas of newborns with various birth defects. Researchers then studied the placenta of newborns without birth defects and noticed a significantly lower amount of chemicals and industrial solvents. This direct correlation between exposures to fossil fuels and birth defects is a serious health issue that is a result of excessive coal consumption. 

Another contribution to the rise in the air pollution index is cigarette smoke from China’s heavy tobacco use. According to a BBC News article, “because of a sharp increase in cigarette sales in the last 30 years, around 2,000 people a day are currently dying of smoking in China”. This shockingly high number reflects the troubling effects of China an increasingly heavily dependent smoking society. The article continues to further state, “by 2050, the researchers expect this number could rise to 8,000 a day- some three million people a year”. In regards to health concerns, smoking causes higher chances of lung cancer and various forms of respiratory diseases and problems. The combination of a heavy smoking population as well as the dependency on coal for energy, China’s environment is concernedly a worrisome place for health outcomes. While tremendous progress has been made in the healthcare sector in China, with an improved infant mortality rate in some areas and development of more advanced medical technology, China’s pollution index continues to skyrocket.

In what ways can this issue be addressed? Health education is an important aspect that needs attention with a focus on health precautions and increased awareness. BBC news states from a survey taken in China, approximately 60% of the survey takers did not regard smoking cigarettes as detrimental to their health. Furthermore, more stringent health safety regulations need to be enforced. Shanxi province, for example, represents an area that needs government intervention to enforce a cap on the amount of coal used and fuel emitted by factories and power plants. China is in the midst of a booming economy and a focus on a greener, cleaner environment will remain on the backburner for quite sometime.

China is a place of rich culture and incredible history. Large cities are transforming into cosmopolitan metropolises attracting massive tourism, business development, and global integration. It is a nation of tremendous success; it is often times considered the future. Its deadly air pollution, however, requires desperate attention. 

Sources:

http://www.theatlanticwire.com/global/2013/04/china-air-pollution-2013/63836/

http://www.businessweek.com/articles/2013-03-28/air-pollution-birth-defects-and-the-risk-in-china-and-beyond

http://news.bbc.co.uk/2/hi/health/216998.stm

What does Covered California mean for Californians?

By Penelope Chuah

Tremendous strides towards developing more affordable, accessible, and higher quality healthcare has taken place within the past three years; this year California is about to kick-off its new health market under Covered California.

These changes to the healthcare market all began with the momentous occasion in 2010 when “President Obama with the stroke of a pen, made health care for all Americans a right not a privilege” (Nancy Pelosi, Covered California Town Hall Forum). This monumental legislation called the Patient Protection and Affordable Care Act was designed to restructure the fractured American healthcare system that has consequently ranked the nation 37th in worldwide health performance. Changes to individual premiums as well as other state insurance policies will vary from state to state. In California, Covered California will offer people an online platform to appropriately choose an affordable and high quality health plan.

So what else exactly does this legislation mean for Californians? It means ensuring that both the insured and uninsured find plans well suited to their needs; it means allowing people to choose from 13 health plans presented by the Health Benefit Exchange; it means providing premium assistance targeted by income; and it means decreasing health disparities. 5.3 million represents the number of currently uninsured Californians or those who purchase health insurance on his or her own; this number, however, will decrease tremendously this October 1, 2013 when the California health insurance marketplace opens for enrollment. In the Covered California forum hosted at UCSF, Peter Lee, Executive Director of the California Health Benefit Exchange and Berkley graduate, stated Covered California’s mission: 1. Increase the number of insured Californians and decrease health disparities, 2. Increase healthcare quality, 3. Decrease healthcare costs. The new system will provide standard benefits designed to ensure that money does not become a deterrent of access to care. Rates will be determined by age, zip code, income, and household size. How can you access this new exchange? Covered California has created an easily navigable website to facilitate new users to the options available. This online marketplace offers people a clear layout of the various health plans offered and to which ones they may qualify. For those who already have health insurance, they will be able to keep their insurance and receive the new benefits and security provided by the Affordable Care Act.

The remaining few months of 2013 and the forthcoming months of 2014 provide a bright future for the ongoing health reform process. For more information and details about Covered California and how to enroll, please follow this link: http://www.coveredca.com/

Soda Consumption

By Melanie Tina Mascarenhas

As we all know, summer typically brings us days of cloudless skies and up to fifteen hours of warm sunshine. This beautiful weather often comes with temperatures in the upper 80’s and 90’s and often times surpasses 100 degrees for a week or two. With hotter days, hydration becomes an important issue that is easily overlooked in the no-school frenzy.

Summer is the time for beach bashes and BBQs, events where sugary drinks and alcohol abound but natural beverages can be scarce. Soda consumption spikes during the summer months because, let us face it, grabbing a chilled can of Coke is convenient and refreshing in the short term. In fact, in California 62% of adolescents aged 12-17 consume at least one soda per day and, on average, soda is the top caloric source in modern teen diets. A twenty ounce soda contains sixteen teaspoons of sugar that not only fail to quench thirst, but also do nothing to satisfy hunger and lead to the familiar “crash” in energy levels mere hours after consumption. Consequently, drinking soda only serves to add to our caloric intake, which eventually contributes to unhealthy weight gain over time. In addition to increasing obesity nationwide, soda consumption also raises the risk of developing diabetes and heart disease.

Now I am not saying that we should abandon sugary drinks entirely and subsist on water and milk from here onwards (though from a nutritional standpoint, that would be ideal). After all, there are some things that just are not complete if there is no fizzy drinks involved. What is a New Year’s Eve party without apple cider? And Superbowl Sunday simply would not be the same if our beverage options were restricted to…water. The idea is to eliminate excessive soda consumption in order to lead a healthier lifestyle. This means that instead of reaching for the two liter Dr. Pepper at the grocery store, grab a watermelon that you can blend into watermelon juice or a squeeze a bunch of carrots for a boost of Vitamin A with every carrot-y sip. There are countless possibilities that can replace the sugary drinks of our time without skimping on convenience and revitalizing tastiness. Here are a few of my favorites that you can try:

1. Citrus Water
A simple alternative to flavored water, citrus water is a quick way to jazz up plain filtered water for celebratory events or everyday use.
Making this is easy if you happen to have fruit trees and an herb garden in your backyard. If not, head over to the nearest Safeway and stock up on your favorite kinds of fruit (pretty much anything will work) and a couple of herbs to add some pleasant fragrance and you are all set.

To make the citrus version, slice up a lemon, a lime, and an orange into a two quart pitcher and gently press the slices with a wooden spoon to release a bit of the juice. Fill up the pitcher with ice and add water to the top along with some more citrus slices and you are done! If you are not a citrus fan, add 2 cups of any kind of fruit (strawberry, pineapple, blackberry, etc.) along with mint, sage, or rosemary if desired and follow with ice and water for an all-natural twist on water according to your preference.

2. Lassi
My personal obsession, lassi is a traditional Indian beverage that is a staple for my summer days. There are many varieties, the most popular in the U.S. being mango. The simplest kind, however is known as plain lassi and is still as mouth-wateringly delicious as all the others.

Lassi is wholly yogurt-based so be sure to have some plain yogurt on hand if you are planning to make it. All you need to do is put 2 cups of yogurt, one cup of ice, and a little bit of salt and sugar into a blender and blend away! The final product is a frothy, white liquid that is a delight to the senses.

3. Frozen Berry Smoothie
To be honest, I’m sure berry smoothies are supposed to be made with actual berries but fresh berries can be quite pricey. Plus going to the store can be a tad out of the way. The nice thing about frozen fruit is that you can keep the little packages in your freezer, break off how much you want to use, and save the rest for the next time you have a midnight craving for a homemade Jamba Juice.

For this smoothie, use half a pack of Trader Joe’s Berry Mix (containing blueberries, raspberries, and blackberries) or any kind of frozen berry mix, really. Put the berry mix into a blender with one freshly sliced banana for thickness. If you want to shoot for the health stars or would like some added crunch, add in a dash of flaxseed or a handful of chia seeds (I hear they’re extremely nutritious). Blend until desired smoothness is achieved. Because the berries were frozen, the smoothie should be cold already so you can enjoy it right away.

4.Avocado Shake
Now I know what you’re thinking: avocados? Avocados are for salads and sandwiches! Why would I want to drink them? Trust me on this, as long as you’re not allergic to avocados, this shake is one you’ll love. Containing almost 20 essential nutrients that help with everything from lowering blood cholesterol to reducing the risk of a variety of eye diseases, avocados are a highly valuable addition to any diet.
To get your fill of this little green fruit, simply slice up one avocado and put it in your blender along with a cup of milk, ice, and a tablespoon of sugar for added sweetness. Run the blender till the shake is reasonably smooth and drink up!

Sources:
http://digitalarchive.gsu.edu/cgi/viewcontent.cgi?article=1195&context=iph_theses
http://www.kickthecan.info/soda-facts
http://www.kickthecan.info/files/documents/ktc_facts_health_consequences_R1_1.pdf
http://www.hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet/