E-News May 2006

Please send items of interest for the E-News -- and any other feedback -- to E-News editor Dave Cundiff, MD, MPH. Thanks!

(There are several other Hiltons nearby. We're at the Hilton Chicago, 720 South Michigan Avenue! Directions, and other information about the hotel, can be found at http://www.chicagohilton.com/hotels_hiltonchicago.aspx. A map of the third floor, showing the Williford room, is at http://www.hilton.com/en/hi/hotels/floorplans.jhtml?ctyhocn=CHICHHH&floor=3&tab=reception.)

From 4:30 pm to 5:30 pm, we will hold a Business Meeting, including elections of officers and trustees, and consideration of proposed bylaws amendments on outside business and on succession planning.

At 5:30 pm, we will share a presentation on "The AMA and Public Health" by MICHAEL D. MAVES, MD, MBA, Executive Vice President and Chief Executive Officer of the AMA. Dr. Maves' presentation, including questions and answers, is scheduled from 5:30 pm to 6:00 pm.

From 6:00 pm to 8:00 pm, we will share a presentation from the AAPHP's Preventive Services ToolKit (PSTK) project. Dave Cundiff, MD, MPH, from the PSTK faculty team, will present the team's work on "Implementing Preventive Services: Tricks of the Trade". Category 1 CME has been applied for. We plan to serve pizza and soft drinks during the PSTK presentation.

We regret the short notice for this meeting. We hope as many members as possible can attend.

2) Google Scholar link on AAPHP Web Site:

AAPHP Webmaster Kim Buttery, MD, MPH has linked AAPHP's home page with "Google Scholar" -- which searches a wide range of scholarly publications, not just the standard medical journals. This is a convenient way to begin all of your on-line scientific inquiries.

To use Google Scholar directly, go to http://www.aaphp.org and type your search term(s) directly into the "Google Scholar" box at the top of the page. Click the "Search" button (or, in most browsers, just hit the "Return/Enter" key) and begin using your search results.

We also have "RSS" feeds available through AAPHP's Web site. A future E-News will discuss the use of this feature.

We're grateful for Dr. Buttery's work to make AAPHP's Web site the best it can be. Please use the site, give us feedback, and tell your colleagues about it!

3) AAPHP's New Contact Information:

Because our prior contractor has been unable to provide the promised level of service, AAPHP has new contact information effective immediately.

AAPHP's postal address is now 3433 Kirchoff Road, Rolling Meadows IL 60008-1842. Our telephone number is (847) 371-1502 and our fax number is (847) 255-0559. AAPHP's E-mail address will be aaphp@reachone.com. The Web site will continue at http://www.aaphp.org.

Please update your contact information for us. We should have our Web site updated with the new information within a few days. Thanks for your understanding and support!

4) Notes Washed Up in a Bottle:

AAPHP member Donald S. MacCorquodale, MD, MSPH has published six issues of "Notes Washed Up in a Bottle" since our last E-News.

2006-03-08 (http://www.aaphp.org/bottle/2006/mar8.html):

A randomized Women's Health Initiative trial of low-fat diets found a not-quite-significant 9% reduction in invasive breast cancer. The TYPE of fat isn't discussed.

Observational studies in the Nurses Health Study III (NHS II) looked at breast cancer risk on a gradient between purely "Western" diets and purely "prudent" diets. This study showed neither a consistent nor a significant relationship between the type of diet and the risk of breast cancer. (A non-significant association between the "Western" diet and breast cancer was seen in never-smokers, while a not-quite-significant association between the "prudent" diet and breast cancer was seen in ever-smokers. )

Low levels of "job control" were associated with drug dependence in a recent study, most of whose subjects were young African-Americans.

2006-03-20 (http://www.aaphp.org/bottle/2006/Mar20.html):

A recent study in Epidemiology suggests that racial differences in preterm delivery may be mediated, at least partly, by differences in job control, job satisfaction, and the degree of increase in blood pressure in response to psychological stress. These findings support the hypothesis that psychosocial stresses may produce much or all of the observed racial disparity in preterm delivery, and they suggest possible biologic mechanisms by which these stresses may damage health.

Another study, based on "job-exposure matrix" analysis, provides additional evidence linking hydrazine with lung cancer.

A case-control study finds no statistically significant relationship between cellular phone use and either glioma or meningioma. Among persons who used cellular phones for ten or more years, a non-significant increased risk was found for glioma (OR 2.20; 95% CI 0.94 to 5.11). Dr. MacCorquodale notes that while controversy persists, well-designed studies in this area have been "remarkably consistent" in demonstrating no association between mobile phone use and brain cancer.

2006-04-01 (http://www.aaphp.org/bottle/2006/apr1.html):

A new case-control study appears to support previous suggestions that MODERATE alcohol consumption (15-30 grams per day, averaged over an adult lifetime) is positively associated with breast cancer, while higher and lower levels of alcohol consumption are not. This effect is primarily seen among women with body mass index (BMI) less than 25.

In an observational study, remission of mothers' depression was associated with better mental health of their children.

Genetic mutations that lower human low density lipoprotein (LDL) levels throughout the lifespan are estimated to lower coronary heart disease (CHD) rates by 40%. Equivalent LDL lowering with HMG-CoA reductase inhibitors ("statin" drugs) for five years yields much less benefit. Whenever feasible, coronary disease prevention strategies should focus on lifelong diet changes, not late-stage pharmacologic interventions.

2006-04-29 (http://www.aaphp.org/bottle/2006/apr29.html):

After adjustment for other cancer risk factors, cohort studies in Sweden show no association (in either direction) between coffee consumption and colorectal cancer. This is consistent with similar U.S. studies.

A cohort study of selected categories of Vietnam-era veterans (those who entered the U.S. Army between 1965 and 1971, served only one term of enlistment with at least 16 weeks of active duty, earned a military occupation specialty, and had a pay grade no higher than E5 on discharge) showed that PTSD symptoms were more likely to be seen among members of socially disadvantaged groups and among those who entered the military at a younger age. PTSD symptoms were associated with increased rates of overall mortality. (Dr. MacCorquodale notes that because of the strict inclusion criteria, it is difficult to draw any general conclusions from this study.)

The National Center for Health Statistics (NCHS) has released selected findings from the 2004 preliminary mortality data for the United States at http://www.cdc.gov/nchs. The estimated age-adjusted death rate was 801 per 100,000 U. S. standard population, a new low, and it is 3.8 percent lower than the 2003 rate of 832.7. Improvement is seen in all the sex, race, and Hispanic origin groups described in the report. Life expectancy at birth in 2004 reached a record high of 77.9 years. The difference between male and female life expectancy was 5.2 years in 2004, the smallest difference since 1946. The difference between white and black life expectancy in 2004 has decreased to 5.0 years.

2006-05-17 (http://www.aaphp.org/bottle/2006/may17.html):

The difference between "cohort" and "period" life tables is briefly explained. Dr. MacCorquodale discusses selected findings from the U.S. period life tables for 2003.

A recent report on diagnostic tests suggests that the standard measures of "sensitivity" and "specificity" are, in most cases, calculated on the basis of a very small sample size. The authors suggest that these statistics cannot usually be viewed as precise, unless they are based on a large enough sample size. Sensitivity and specificity analysis for subgroups must also be based on a sufficiently large sample, if the results are intended to be statistically meaningful.

The vast majority of visual impairments in U.S. adolescents and adults could be compensated if the impaired people had access to refractive services and took advantage of them. Testing each person with his or her corrective lenses, the NHANES 1999-2000 surveyors found that 6.4% of respondents had visual impairment. The majority of these could achieve good corrected visual acuity using refractive correction. Writing in JAMA, the investigators suggest that “health care access and resources may be important barriers to consider in addressing the need for refractive correction of visual impairment."

A recent article in the New England Journal of Medicine notes successes in Brazil's HIV/AIDS prevention and treatment programs. These programs feature condom promotion and syringe exchange, and acknowledge prostitutes as "partners" in HIV prevention. (Prostitution is legal in Brazil.) Affordable HIV treatment was facilitated by Brazil's late entry into international patent-recognition treaties, allowing Brazilian firms to produce antiretroviral drugs whose patents were registered before 1996. This array of measures appears to have been very successful.

2006-05-27 (http://www.aaphp.org/bottle/2006/may27.html):

This issue summarizes and discusses findings about the health of U.S. adults based on the 2004 National Health Interview Survey. Among the many findings reviewed: 58% of American adults have smoked fewer than 100 cigarettes in their lifetimes (never-smokers); 21% are former smokers; and 21% are current smokers. This varies by race. About 11% of Asian-American adults were current smokers, compared with 20% of African-American adults, 21% of European-American adults, and 29% of American Indian and Alaska Native adults. Asian-Americans report much better health in a wide variety of areas.

Dr. MacCorquodale's "Notes Washed Up in a Bottle" communications since 2002 are listed at http://www.aaphp.org/bottle/allnotes.htm. We appreciate his faithful service!

5) Bylaws Proposals:

Kevin M. Sherin, MD, MPH, CPE has submitted proposals for bylaws amendments. These proposals will be discussed and decided at the 2006-06-11 General Membership Meeting.

Each of these would be a new section or subsection of the bylaws:

PROPOSED NEW SECTION V.5: "Any conduct of business or business contact with outside entities, on behalf of the Association, will be limited to the executive committee."

PROPOSED NEW SUBSECTION VI.4 (presumably VI.F.4 -- DRC): "In the event that the President-elect is unable to serve as President, the current President shall continue to serve for one year until the Vice President is prepared to serve the second year of the term of President, or the Vice President shall serve as President in the event that adequate preparation has already occurred."

PROPOSED NEW SUBSECTION VI.5 (presumably VI.F.5 -- DRC): "In the event that the Vice President succession plan is invoked, a second Vice President or a new Vice President shall be elected at the Annual Membership Meeting depending on succession needs and timing."

Comments on these proposed changes may be sent to Dr. Sherin, AAPHP's Vice President and Bylaws Commmittee chairman, using the E-mail link on the bylaws page at http://www.aaphp.org/bylaws/Bylaws_2005_revdec05.htm.

6) Essential Nutrients for a Healthy Humanity:

Massachusetts General Hospital emergency physician Thomas Burke, MD writes in his old hometown newspaper, "The necessary nutrients for a healthy humanity can be broken down into four main components: political stability and peace, economic distribution, education, and available and accessible health care." He defines health as increasingly a global issue, in which we cannot afford to ignore unnecessary death and disability anywhere in the world, and he gives examples.

Dr. Burke's full column is currently available in ad-supported format at http://www.theolympian.com/apps/pbcs.dll/article?AID=/20060515/LIVING0301/60515018&SearchID=73245849872221. It is also currently available at the Web site that Dr. Burke shares with his colleague Joe Pellicer, MD, at http://www.notesfromtheer.com/most_recent.php?action=article&news_id=5.

AAPHP has struggled for the last several months, for two unrelated reasons. First, our contractor's staff turnover in January 2006 caused significant disruptions to our membership processing and communications processes. Second, your Secretary's non-AAPHP job commitments have made it impossible to publish the E-News at last year's levels.

Correction plans for the first situation are being implemented in early June. I'll also do what I can to increase the E-News frequency and maintain quality. Many of you have thanked us for the E-News and we want to serve you as well as we can. (Volunteers are welcome.)

I'll try to include a full "member update", with acknowledgments of all new and renewing members, in the next E-News issue. This may require review of multiple data sources, so please be patient. Thanks to AAPHP members for your understanding and support!

Dave Cundiff, MD, MPH (cundiff@reachone.com)

AAPHP Secretary and E-News Editor

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