Potential article of interest on President Obama's Proposed Reform on Higher Education:
http://www.accreditedonlinecolleges.com/blog/2013/obamas-accreditation-reforms-on-higher-education/


 

Brown Fat: It's a Big Deal

Non-shivering thermogenesis is the process by which the body generates extra heat without shivering.  Shivering is a way for the body to use muscular contractions to generate heat, but non-shivering thermogenesis uses a completely different mechanism to accomplish the same goal: a specialized fat-burning tissue called brown fat.  Brown fat is brown rather than white because it's packed with mitochondria, the power plants of the cell.  Under cold conditions, these mitochondria are activated, using a specialized molecular mechanism called uncoupling* to generate heat.

The mechanism of brown fat activation has been worked out fairly well in rodents, which rely heavily on non-shivering thermogenesis due to their small body size.  Specialized areas of the hypothalamus in the brain sense body temperature (through sensors in the brain and body), body energy status (by measuring leptin and satiety signals), stress level, and probably other factors, and integrate this information to set brown fat activity.  The hypothalamus does this by acting through the sympathetic nervous system, which heavily innervates brown fat.  As an aside, this process works basically the same in humans, as far as we currently know.  Those who claim that rodent models are irrelevant to humans are completely full of hot air**, as the high degree of conservation of the hypothalamus over 75 million years of evolution demonstrates.

Two new studies concurrently published in the Journal of Clinical Investigation last week demonstrate what I've suspected for a long time: brown fat can be 'trained' by cold exposure to be more active, and its activation by cold can reduce body fatness.

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Zucchini: The Home Gardener's Worst Friend? With bonus garden-related rambling.

One of my main gardening goals has been to harvest more of something than I can eat, despite my limited gardening space here in the Emerald City.  I want the feeling of abundance that comes with having to preserve and give away food because I can't eat it all.

Enter zucchini.  My grandfather used to say that in New Jersey in summertime, you'd have to keep your car doors locked, otherwise the car would be full of zucchini the next time you got in!  In mid-May, I planted two starts from my local grocery store labeled "green zucchini", with no further information.  I put them in a bed that used to be a pile of composted horse manure, and that I had also cover cropped, mulched, fertilized, and loosened deeply with my broadfork.  They look pleased.

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#RoyalBaby Offers Public Health A Unique Opportunity To Advocate For Maternal and Child Health

As Catherine, Duchess of Cambridge, went into labor early yesterday morning, public health organizations and advocates took advantage of the opportunity to talk about maternal and child health.  Since much of the world was following the #RoyalBaby story, it made sense to make the connection to public health work.

Here are some of my favorite tweets and topics:

VACCINATIONS

 

 NEWBORN SCREENING

BREASTFEEDING

Andy's tweet was in response to this image from Oreo:

PRENATAL SMOKING

SUPPORT FOR NEW PARENTS

As I've noted in related posts, I hope these organizations are evaluating their communication strategies!

• Have they seen an increase in traffic to their websites and resources?
• Have they engaged a new audience by aligning with the #RoyalBaby news?
• What organizational resources are needed to develop communication plans that coordinate with timely global and pop culture news?
• What lessons learned can be applied to future communication efforts? 

What do you think?

• Are these types of communication strategies effective in reaching a broader audience?
• Are there other relevant public health tweets that you felt were creative and engaging?  Please share!!

The Genetics of Obesity, Part III

Genetics Loads the Gun, Environment Pulls the Trigger

Thanks to a WHS reader* for reminding me of the above quote by Dr. Francis Collins, director of the US National Institutes of Health**.  This is a concept that helps reconcile the following two seemingly contradictory observations:

1. Roughly 70 percent of obesity risk is genetically inherited, leaving only 30 percent of risk to environmental factors such as diet and lifestyle.
2. Diet and lifestyle have a large impact on obesity risk.  The prevalence of obesity has tripled in the last 30 years, and the prevalence of extreme obesity has increased by almost 10-fold.  This is presumably not enough time for genetic changes to account for it.

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Return to the Source Parkour Camp

For those who are interested in natural movement training, this summer my friend Rafe Kelley will be hosting an interesting three-day event near Bellingham, WA called "Return to the Source".  Rafe is skilled in a variety of movement disciplines and is the co-founder of the Seattle parkour gym Parkour Visions.  Parkour is a very fun sport that hones our natural ability to skillfully navigate physical obstacles, but it's usually done in an urban context.

The camp will take place from August 23-25.  Here's a description from the Parkour Visions site:

"This summer, return to the source of human movement with Parkour Visions as we explore the natural environment in and around Bellingham, WA. Rafe Kelley will introduce you to the benefits of training and playing in nature. You will learn how to adapt your technique and movement to moving effectively through woods, over rocks, and in trees during this unique, 3-day experience."

Watch this video if you want to see what you're in for.

Knowing Rafe, it will be fun and productive.  You can sign up through this page.

Everything I Need To Know About Public Health Preparedness, I Learned From "Sharknado"

If you were on twitter last night, you might have witnessed the phenomenon that was "Sharknado".  You take a corny Syfy disaster movie, add in Tara Reid and Ian Ziering (of 90's fame in "American Pie" and "Beverly Hills, 90210" respectively) and it becomes something great!

In the midst of a rare California hurricane, super tornadoes suck up sharks from the ocean and hurl them around the Los Angeles area.  There is flooding, wind, debris, and sharks swimming in the streets.

While the movie was outrageous (as expected), this tweet from the Red Cross got me thinking about its surprisingly relevant public health preparedness messages:

#1:  Always Be Prepared  
Over and over, the lead character Fin (Ian Ziering) tells his kids "Semper Paratus".  That is Latin for "always prepared".  That is the key to preparedness- as evidenced by FEMA's slogan on Ready.gov- "Prepare. Plan. Stay Informed".

#2:  Prepare For The Unexpected
Los Angeles is more well known for its earthquakes than its hurricanes.  In fact, the article "Is there science behind 'Sharknado'?", tells us that a hurricane has never hit Los Angeles and we must go back to 1858 to find a hurricane that hit southern California.  However, just because your town has never had a historic hurricane, tornado, or fire does not mean you should not prepare for one.  Everyone should have an emergency plan in place.  You never know!

#3:  Evacuate And Get To Higher Ground
After waves and flying sharks shattered the windows of Fin's beach bar in Santa Monica, they hightailed it out of there and drove to higher ground!  My only critique is that they drove through some very flooded streets.  Remember, "Turn Around, Don't Drown" is a National Weather Service campaign to warn people about the dangers of walking or driving a vehicle through flood waters.

#4:  Check On Friends And Family
Although April (Tara Reid) demanded that her ex-husband Fin leave her alone and that the storm was "just a little rain", he came anyway.  And good thing that he did!  Otherwise, she and daughter Claudia may have been eaten by the shark swimming in their pool or crushed when their house collapsed in the flooding.

#5:  Shop For The Emergency Supply Kit Essentials
While FEMA offers a great list of kit essentials, it was fun to watch the Sharknado crew add a few more creative items like chainsaws and bombs.  Whether or not you saw the movie, I highly recommend that you check out this GIF of Fin, a shark, and a chainsaw.

Tell Me What You Think:

• What was your favorite scene from Sharknado?
• What other public health preparedness lessons did you learn?

Pinning Public Health: A Spotlight on Hamilton County Public Health

On June 18, 2013 "How and Why Should We Pin Public Health?" became one of Pop Health's most popular blog posts.  So you can imagine my excitement to share a follow-up piece that spotlights the Pinterest work at the Hamilton County, Ohio Public Health Department! 

Today's post is written by Christy Cauley, M.Ed., an Electronic Communications Specialist, who is responsible for the department's social media strategy.  Hamilton County Public Health (HamCoHealth) was established in 1919 to serve more than 460,000 Hamilton County residents living outside the cities of Cincinnati, Norwood, Sharonville and Springdale. With a staff of more than 80, including sanitarians, plumbers, health educators, nurses and epidemiologists, Hamilton County Public Health strives to prevent disease and injury, promote wellness, and protect people from environmental hazards.  

I am very fortunate to work for a local public health department that understands the value of a strong social media presence. Hamilton County Public Health  has a strong presence on Facebook, Twitter and YouTube and now we’re expanding our presence on Google+ and Pinterest. The latter’s image-centered format poses many challenges to public health entities. After all, who wants to look at pictures of syphilis?

That simply means we have to get creative. Rather than pinning a picture of syphilis, I’ll pin a picture of a cute stuffed amoeba that represents syphilis. The photo still links to an article that lets everyone know there is a syphilis epidemic in Cincinnati and what they can do about it, but they are spared the sometimes graphic images that are associated with public health.

We also have to consider our audience. Our Pinterest audience is quite different from other social media outlets. For starters, there is a much stronger female presence on Pinterest. In fact, the vast majority of our followers are women. That affects our pins and our boards – we have a Women’s Health board for example. Our pins have much more to do with family health and safety than our other social media pages. We tend to focus on health, nutrition and fitness, things that matter more to women than men. We have many pins on Pinterest that do not make it to our Facebook or Google+ pages because the audience just isn’t right for it.

Growing our audience has been challenging on Pinterest. Few people outside the profession are really interested in public health until there is a reason to be interested – like an outbreak of West Nile Virus, for example. We take the usual steps – following others’ boards, liking, commenting and repinning when possible. But what we really want is interaction with our stakeholders on our own boards. We want to get our messages out and know that our audience is hearing them.

To help with that goal, we have “public” boards where we allow others to post to our boards (and we have been invited to do the same). This creates boards with people of similar interests who can share pins more easily. We are careful to include a disclaimer on these boards however, and we do monitor outside pins. Our public health and safety boards can only be pinned on by us, but our recipe and fitness boards are open for our followers to share their favorite pins and they do. We pin to a public board called Health Communication & Social Media from Raed Mansour, where social media and communications professionals can share their ideas. Before, our only interaction with these professionals was on Twitter.

Interestingly enough, the place where we receive the most interaction on Pinterest is one of the public boards we were invited to pin to – Cat World, a board by Joyce Egoodman. Yep, you read that right, Cat World. What does that have to do with public health, you ask? Not a lot, although we can connect pets to our emergency preparedness and heat safety topics quite easily. But, people who love cats are our stakeholders. Public health affects everyone, even our pets. And who doesn’t like cute cat pictures?

How it works is we will find the cutest cat picture on our following boards in the morning and repin it to Cat World with a message about public health or safety. That pin then gets repinned by anyone who likes the picture – not necessarily the message. In turn, our message gets disseminated all over Pinterest and it only took a few seconds of our time. Our Cat World pins get commented on, liked and repinned much more often than our other pins because that board has a wider audience (for now).

One of the Social Media for Public Health (#SM4PH) Twitter chat participants (@AmandaMPH) mentioned that there is a LOT of unhealthy dieting information on Pinterest and we have also found that to be the case. That’s one of the reasons it’s so important for health departments to have a presence on Pinterest, so we can put out accurate information that people can trust.

We’ve found that the image is as important as the message. As a result, we keep our messages short and sweet and we keep our pictures creative. For example, did you know Ryan Gosling is the poster boy for public health? There are hundreds, maybe even thousands of Ryan Gosling memes and many of them are public health centered. We try to utilize them on “Fun Friday” as much as possible.

Another small thing we do is change our board covers often. When new stakeholders visit our page, we want them to see a captivating image that makes them want to view the board, but we also want to make sure that the pin in question is toward the top of the board. I can’t tell you how many pages I’ve visited where I wanted to repin the board cover image, but once I clicked the board, it went on forever and the cover photo was nowhere to be found. We want our stakeholders to find things easily. It’s a small thing, but don’t underestimate its importance to the aesthetics of your page. And don’t neglect the description and category areas either.

We have also taken advantage of @PinGraphy, which allows us to schedule pins for certain times and days. When interaction matters so much and we do not have someone on social media on the weekends, this tool is invaluable. (We use HootSuite for scheduling our other social media sites.)

Getting our feet wet in Pinterest has been challenging. We have made a lot of changes to our boards since we started in response to feedback from users. We’re still learning, but we hope that Pinterest will be a valuable tool in spreading our messages about public health and safety issues in Hamilton County, Ohio and throughout the world.

BIG DATA IS COMING TO A CLOUD NEAR YOU!*

Star Trek: The Next Generation fans will wonder whether the two words Big Data are descriptors for a new sentient android of epic proportion, a supersized upgrade of Lieutenant Commander Data.   As an addicted trekkie, sadly I must quickly disabuse you.  Well, maybe I’m wrong.  There are people who consider that Big Data is every bit (?byte) as exciting as the USS Enterprise’s second officer.

Big Data refers to immense data sets that are collected in fields as diverse as astronomy and genomics.  As Wikipedia tells it, “as of 2012, every day 2.5 quintillion (2.5×10¹⁸) bytes of data were created”, so there is a lot of data about.  The dynamic of Big Data is the search for relationships among these data and teasing out correlations that may not be obvious from the constituent data sets that comprise it. Our technical capacity to search immense data repositories means that correlations can be found in a way never before possible. 

In their new book Big Data: a Revolution that will transform how we Live, Work and Think, Viktor Mayer-Schönberger an Internet governance academic from Oxford and Kenneth Cukier, the data editor of The Economist, recount an interesting example of how Big Data, collected by Google from the three billion search requests it receives each day was used to track influenza in the US 

Google took the 50 million ‘most common search terms used by Americans and compared the list with Centers for Disease Control (CDC) data on the spread of seasonal flu between 2003 and 2008’. After stupendous computer activity, they settled on 45 search terms that were strongly correlated with official figures.  These included many obvious terms such as flu, cough, medications for cough but others that were not so obviously linked.  ‘Unlike CDC, they could tell it in near real time, not a week or two after the fact.’   Although not without their critics and errors, Google flu trends are now available for many countries. http://google.about.com/od/experimentalgoogletools/qt/GoogleFluTrends.htm

Mayer-Schönberger and Cukier accept that there is no universally-accepted definition of Big Data, but rather see the term referring to ‘things one can do at a large scale that cannot be done at a smaller one, to extract new insights or create new forms of value, in ways that change markets, organisations, the relationship between citizens and government, and more.’

Our capacity to collect, link and analyse data electronically is growing exponentially.  Mayer-Schönberger and Cukier draw a parallel between the present and the era that followed the invention of the Guttenberg printing press around 1439.  In the half century starting 1453, they quote an estimate that eight million books were printed, ‘more than all the scribes of Europe had produced since the founding of Constantinople 1,200 years earlier.’ In 2003, following a decade of effort, the human genome was sequenced.  ‘Now… a single facility can sequence that much DNA in a day.’  And because Big Data includes all the data available, population samples will no longer be needed in the way they are today and the work of statisticians will be redefined.

There are many features of Big Data to ponder for medicine.  How will we practise with more information about correlation and less about causation? If Big Data shows that people who take regular exercise have better cancer survival, what will we advise our patients?  Is the correlation sufficient to advise them to exercise, even though the causal pathway is not known?  This will increase our need, and that of our patients, to live with uncertainty.   What meaning does privacy and even confidentiality have in this new age?  We should surely be thinking and discussing these things now.  

(Potential conflict of interest: SL’s son Nick leads Google France.)

*Previously published in MJA Insight on June 24, 2013

A Pop Health Book Review of “My Foreign Cities: A Memoir”

I cannot remember the last time I was so engrossed in a book that I looked up with shock to see the clock read 2:00am.  Well, that happened to me on both Friday night (when I started) and Saturday night (when I finished) the book “My Foreign Cities”.  The memoir chronicles the love story between author Elizabeth Scarboro and Stephen Evans.  In late high school/early college, their friendship grew into love and Elizabeth chose to be with Stephen, even though she knew his cystic fibrosis (CF) would limit his life expectancy (30 years old on average), impact her choices, and reduce their time together:

"In comparison to Stephen, most things would be there.  If I wanted him, I had to hurry up" (page 36).

While there were numerous public health topics of interest in this book, I was most struck by the strength, resilience, and creativity that Elizabeth brought to her role as a caregiver.  While the focus was on Stephen's health, we also learned how and when she needed to take care of herself.  Many of her words have stayed with me, so I'm weaving her eloquent quotes into this review.

Throughout the book, I was surprised by how she could both focus on the present and think about her future.  Even though she knew that future would not include Stephen at some point:

"Back then, this was my plan to get through Stephen's death: I'd have a life, a self, I wanted to continue after he was gone.  But I couldn't invent that on the spot- it would have to already be there, which meant I'd need to live it while he was here too" (page 79).

Because of this mindset, the reader gets to hear about the risks and adventures they took- both big and small.  The big being the trips to Mexico, Hawaii, Scotland, and Ireland- the moves to San Francisco, Boston, and back to San Francisco again- going to graduate school- and getting married.  The small being the clandestine escapes to the hospital roof for privacy during a long stay and their wonderful hikes around their homes in Denver and San Francisco.  Elizabeth's writing is so vivid that you can see the scenery, feel the air on your face, and sometimes hear Stephen's labored breathing.

When Stephen struggles with a dangerous addiction to his pain medication, we are reminded that caregivers deal with all the side effects and dangers that surround an illness- not just the disease itself.  Stephen managed to hide the addiction from Elizabeth for almost a year.  Their relationship and communication were challenged as she tried various solutions to the problem- locking up the medications, alerting his physicians. Elizabeth talks about how his withdrawal symptoms and subtle disclosures were often lost on her because she always viewed things within the larger context of CF:

"But that was the great thing, and the dangerous thing, about life-threatening illness- every other problem appeared like a sideshow when cast in its light" (page 108).

When Elizabeth battles depression during Stephen's recovery from a double lung transplant, we are reminded that caregivers have their limits and that self-care is incredibly important:

"And then I crashed.  Not in the way that Stephen might have, with none of the magnitude or danger, but in the way of a healthy person, slipping slowly, with the strong sense that it couldn't be happening, I could fix it if I just tried hard enough.  Maybe I crashed because I finally could, because Stephen was okay" (page 188).

During her recovery from depression and later- as Stephen's condition worsens, the reader is introduced to Elizabeth's amazing support network.  I can only hope that every caregiver has a group of friends/family like hers:

"Back home, my friends converged to take care of me, like incredibly skilled dancers, hiding the work of it, moving so seamlessly that I barely noticed the details, I just felt, underneath me, a solid floor" (page 273).

I would highly recommend this book to public health professionals, clinicians, patients, and caregivers.  While some parts are heartbreaking, the theme of resilience dominates.  We also get an inside view to patients and caregivers that should help us think about access to health care, quality of life, and the empowerment of patients.

I would also recommend this book because Stephen was one of us.  After college, he enrolled at the Harvard School of Public Health to pursue his interest in health care policy:

"Stephen was most concerned about how people without insurance would be managed, or worse, not taken into account at all.  He felt indebted to the California state system that covered CF, and he wanted to give back" (page 103).

I hope this book helps continue this legacy for Stephen.  I hope the book ignites conversation about access to care, coverage for the uninsured, and support for chronic illness patients, transplant patients, and their families.

Supplemental Information:

• My Foreign Cities: A Memoir- Facebook Page
• Pew Internet & American Life Project- New data on caregivers and how they use technology to find health information

The Genetics of Obesity, Part II

Rodents Lead the Way

The study of obesity genetics dates back more than half a century.  In 1949, researchers at the Jackson Laboratories identified a remarkably fat mouse, which they determined carried a spontaneous mutation in an unidentified gene.  They named this the "obese" (ob/ob) mouse.  Over the next few decades, researchers identified several other genetically obese mice with spontaneous mutations, including diabetic (db/db) mice, "agouti" (Avy) mice, and "Zucker" (fa/fa) rats.

At the time of discovery, no one knew where the mutations resided in the genome.  All they knew is that the mutations were in single genes, and they resulted in extreme obesity.  Researchers recognized this as a huge opportunity to learn something important about the regulation of body fatness in an unbiased way.  Unbiased because these mutations could be identified with no prior knowledge about their function, therefore the investigators' pre-existing beliefs about the mechanisms of body fat regulation could have no impact on what they learned.  Many different research groups tried to pin down the underlying source of dysfunction: some thought it was elevated insulin and changes in adipose tissue metabolism, others thought it was elevated cortisol, and a variety of other hypotheses.

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