CDC Conference 2013, Canberra, Australia - Day 2

 Day 2 of CDC 2013, the main themes were foodborne disease, vaccine preventable diseases and anti-microbial resistance.

Blogging CDC 2013 Canberra, Australia, Day 1

Blogging some highlights from the Australian CDC 2013 Conference - the peak biannual communicable disease surveillance conference in Australia. The presentations should be available on the website soon. Some highlights from the morning panel session was John Kaldor's (from Kirby Institute) comment that the decreased rate of viral warts in young men prior to the roll out of the male HPV vaccine suggests "that we probably don't need to vaccinate guys as the women have it covered".   Rosemary Lester, CHO of Victoria - but speaking as chair of the Communicable Disease Network of Australia described a vision of national surveillance out to 2020. Allan Cheng from University of Melbourne asked what were the barriers to a CDC i.e. a federal centre for disease control akin to the US CDC or European ECDC in Australia.  It was obvious that this was an uncomfortable question for some of the panelists.More highlights..

Randomness is lumpy

Randomness is lumpy. Can you imagine anything less random than a bunch of trees all growing in a matrix each 2 metre apart, perfectly 2 metres apart. Or, if you dropped a handful of jelly beans and each one fell, perfectly 3 cm apart from each other.  Unlikely, and not "random". So why are we so surprised in public health (and life in general) when we see a "cluster"  (a time space aggregation) - isn't this what we should expect to see?   But then if we believe there is a cause behind everything is anything truly random or do we just not the reason determining the outcome.   See this nice article at 3quarks daily for more.

Obesity, low vitamin D and bi-directional mendelian randomisation

Just when you think you cant sort out cause and effect in cross sectional data correlating low vitamin D levels with obesity  – along comes bi-directional mendelian randomisation in PLOS Medicine. Interesting, from a previous post,  that a big chunk of the Environmental Health 2013 conference is devoted to the mediation of  environmental exposures via genetic and epigenetic pathways.

Health Risk Assessment - the leading edge from NTP

The National Toxicology Program, part of the National Institute for Environmental Science of NIH is a great resource for human toxicological information. You can subscribe to the NIEHS newsletter Environmental Factor for updates.

The NTP Office of Health Assessment and Translation has just released a Draft OHAT Approach for Systematic Review and EvidenceIntegration for Literature-based Health Assessments – February 2013 – it provides a seven-step framework for conducting evaluations using principles of systematic review. I particularly like the way step 5 (Rate confidence in the body of evidence)  and Step 6 (Translate confidence ratings into evidence of health effects) are described in Figure 1. 

Reviewing my Journal Table of Contents Alerts

Its 2013 and time to review my journal table of contents alerts.  I have decided to reduce the number of journals I will follow and focus on higher quality journals.  I sed the journal impact factor to review top ranked journals in public health/enviromental health. I know there is controversy as to whether the impact factor is the best guide to the importance of  journal so I used the Thomson Reuters Journal Citation Reports which includes other metrics to fine tune my selection. Basically, impact factor was not so different to "Article Influence Score" for most of the public health/environmental health journals of interest - except for Annual Reviews in Public Health which is only ranked 5 in impact factor but number 2 in "Article Influence Score".   Here follows the journals dropped from the reading list in 2013, those added and those continued..

Willingness to Share Research Data Is Related to the Strength of the Evidence and the Quality of Reporting of Statistical Results

We all know we should - but now we have evidence to support open sharing of data. In the summer of 2005, Wicherts and colleagues contacted the corresponding authors of 141 papers that were published in American Psychological Association journals which contract authors to openly share their data after publication (as do PLOS One).  Although all corresponding authors had signed a statement that they would share their data for verification purposes, most authors failed to do so and the authors of papers with more statistical errors were less likely to share their data.

What's hot in Environmental Health - check the program

Although I won't make Environmental Health 2013 in Boston - just reading the program provides great insight into what's hot in environmental health at this important conference - climate change and health, low dose exposure to industrial chemicals, and genetic and epigenetic mediators of environmental diseases.

Port Waratah Coal Service Cancer Cluster

After the forum on the 8th, I received an emailed question about the PWCS cancer cluster.  Cancer clusters are often difficult to interpret.   I have pasted the essence of my response to the question below.

The media and public health: complexity, controversy and combat

Interesting responses received from both public health and media colleagues on my recent article.  Some print journalist colleagues took exception to it based on hearing a summary on radio but felt it was more balanced when they actually read the article.  Ironically, some institutional media relations folks wanted to be briefed on the implications of an article suggesting that institutions sometimes seek to over manage the media.

The article was a commentary on Melissa Sweet's very interesting paper:  Learning from journalists’ experiences of the H1N1 pandemic

Newcastle Air and Health Forum - Nov 8th

About 150 people attended the forum.  Community concern related mainly to the proposed coal loader and emissions from Kooragang Island. After the forum concern was raised that there is no monitoring of the extremely small particulates of 1 micron or less.  I made the point at the forum that the smaller particles probably have greater health impact than the larger particles between 2.5 and 10 microns. However, there is little benefit in monitoring for PM1s in the Hunter because we cannot interpret the results from such monitoring - Howard Bridgman made the point it is particularly difficult to even monitor PM1s. The powerpoint presentation is available here

On Retreat for 8 weeks

No blogging for a while - on retreat for 8 weeks.  Yes - that is a picture of the retreat centre!

Should we set a date for banning retail tobacco?

Had an article published in the Conversation - which has already attracted 83 comment in the first 48 hours - quite amazing.  The Conversation article was intended to highlight the article published the same day in Drug and Alcohol Review, and a website I set up to further promote discussion about the need for a ban on retail tobacco www.tobacco-ban-australia.org.

Environmental Health for Environmental Advocates Workshop

I conducted a workshop entitled “Environmental Health for Environmental Advocates” in association with the Tom Farrell Institute for the Environment on May 29^th, 2012.  The purpose of the workshop was to provide a forum in which an extended dialogue around environmental health science and risk assessment, primarily focusing on air pollution and health in the Hunter, could occur.

Flutracking at Skoll Global Threats Meeting in SFO

Myself and Stephen Clarke from Flutracking.net had the good fortune to be invited to the 1st International Conference on Self-reported Influenza-like Illness Surveillance hosted by the Skoll Foundation for Global Threats (a foundation set up by Jeff Skoll - former Ebay CEO) and the American Public Health Association.  Flutracking.net is the second oldest and second largest of the schemes internationally, next to the Dutch system.  We were able to learn a lot from the other surveillance systems.  It seems that Flutracking.net excels  in terms of growth of participants and weekly participation (ours is the shortest survey), however, the Dutch certainly do some very interesting analysis and we will exchange data with them to explore new analyses.  This conference has kicked off an international collaboration and we will attempt to standardise our systems to allow great inter-country comparisons.  Thanks to Jeff Skoll, Larry Brilliant and Mark Smolinski for hosting the event.

Presentation on Bhutan, GNH and Contemplative Practice

So I gave a seminar at GRIT (Group for Religious and Intellectual Traditions) at the Uni of Newcastle on Mayu 15 and they recorded it and loaded it up to Youtube.

Evidence of the fragmentation of public health perpsectives?

Plotinus, a "neoplatonist" believed that the ultimate good was a return to the "one" - the experience of the world in its holistic coherence, without fragmentation into silos and fragments defined by narrow human interests and perspectives.  I was reminded of this when I read two articles in the March, 2012 issue of the American Journal of Public Health - first

Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories by Susan E. Collins et al describing how providing housing to people with alcohol addiction problems, without requiring them to be abstinent of alcohol (as many welfare programs require) resulted in decreased alcohol use.  This was an example of ensuring the addiction did not stigmatise the user and further lower their living standards and reinforce their alcohol use.  

In the same issue, Michael Ong et al publish Estimates of Smoking-Related Property Costs in California Multiunit Housing in which they attempt (with a 22% response rate) to estimate the impact of smoking renters on property costs.  They calculate that "implementing statewide complete smoke-free policies may save multiunit housing property owners $18 094 254 annually."   

Contemplative Practice in Public Health Pilot

The evaluation of the 9 week Contemplative Practice in Public Health pilot I conducted with fellow public health practitioners is complete and available here.  What is of interest to me is how much the formal study and evaluation of something that is "alive" loses its freshness when you seek to quantify, categorise, or label it.  The evaluation is very positive overall but it does not really capture the richness of the informal feedback shared in hallways and over lunches.  We will continue the program this year with a slightly longer program of about 12 weeks - participants felt they needed more time on more challenging issues such as interdepence and considering our own mortality (who doesnt!).  Another interesting piece of feedback was that participants wanted to continue the focus on active contemplation of ethical or moral challenges rather than passive meditation - which aligns with the programs theme of "examining reality - not relaxation".

Micro-inequities in public health

Interest in inequalities in health seems to come in cycles in public health literature and activity.  There was a peak with the work of Douglas Black of the Black Report in 1980, Margaret  Whiteheads "The Health Divide in 1987  and then Marmot but its  not clear that the enthusiasm is being maintained.  It is difficult to turn around health inequalities brought about by societal structures without reforming social structures and that work is more often undertaken by revolutionaries manning barricades than public health practitioners.

I was interested to come across the concept of micro-inequities as described by Mary Rowe from MIT - tiny almost unnoticeable biases that when accumulated in systems and by people subject to the tiny biases that  eventually have a huge system impact.  Its kind of like the way cornflake boxes leave the factory with an even distribution of flake size throughout the package but thanks to multiple little road dips and bumps traversed by delivery trucks and forklifts and shelf packing, somehow, all the small cornflakes end up at the bottom of the package.  Not so easy to control subtle effects like that in society, maybe that requires a mass cognitive revolution.

An amoral editorial on decision aids for screening in BMJ

The BMJ just published my rapid response to an editorial on decision aids for screening - such as bowel cancer screening.  I was surprised that the BMJ (the journal I would probably choose to have on a desert island if only allowed one journal) published an editorial that was blind to the ethical issues associated with public health screening. My response is pasted below or you can read it in the BMJ.