Podcasts about am j public health

Most commonly the challenge is gaining lean muscle. Doing all the things but can't seem to gain muscle? Then tune in and go through this like a check list of 12 strength training mistakes in menopause that could be the reason. It just takes one. But if there are multiple, it's compounded and in this case, not interest but penalty! Join us at Metabolism Makeover 2.0 to support your journey avoiding the 12 strength training mistakes in menopause. Overworking Small Muscle Groups [00:02:20] You need fewer of these small muscle group-focused exercises in your routine if you prioritize the major muscles like chest (pectoralis) and back (trapezius and Latissimus Dorsi). If the secondary (biceps and triceps) muscles are going to get a workout most of the time, these will rob you of time and energy that is better spent on major muscles if you aren't getting in the adequate volume there. Skipping the Warmup [00:06:40] Nearly a decade ago, I began sharing the fact that if you skip the warmup, you also miss an opportunity to increase total energy expenditure during a workout. It's not only about injury prevention. There's an increased blood circulation, improved energy expenditure, mobility and you can work closer to your capacity. If fitness and longevity are truly goals, “exercising” is not the same as working at your capacity and safely, sanely raising the roof on your fitness level so that age doesn't automatically result in slowing down or gaining weight. Not Resting Between Sets Long Enough Before [00:13:10] Rapidly moving from one exercise to the next, was yesterday. The “metabolic conditioning workouts” are a nice anomaly, a change in pace. Rest between sets of strength training. Reach complete muscle fatigue or within 2 reps of it. If you do HIIT, separate the sessions so you get the best benefit from it and from strength. If you are not getting stronger, not increasing muscle, and these are your goals (in order, perhaps to improve body fat % ultimately), it's a “how” you're doing it problem. Plan Your Routine to Avoid 12 Strength Training Mistakes in Menopause No Organized Plan [00:17:30] You either default to using what's available at the gym or doing the same exercises in the same sequence every time. If you're not careful you won't change the stimulus (by changing the sequence and sets/rep combination) and may also not be getting enough sets per muscle group in each week. It doesn't mean that all sets for a muscle group must be all the same exercise. A super set of 6 different exercises for the triceps works. The next workout you may just do 3 and you're still covered… if you planned it that way. Not Sleeping Enough or Not Changing the Workout When You Don't Sleep [00:20:50] The sleep you get will determine the benefit you get from exercise. If you don't prioritize, your workouts will suffer too. You're also at risk for injury, not only because your body isn't fully doing the repair job or releasing testosterone and growth hormone in deep cycles of sleep as it should, but because coordination suffers. Treating Soreness or Worn Out an Indication of “Good Workout” [00:22:40] When you work muscles, it's normal to feel sore, even if you're extremely fit. Some muscles like quads and glutes are used to a lot of activity and tend to get sore less often. But there are two genes associated with soreness and you may either be predisposed to be sore or not. It's not a good indication of whether you worked hard enough. If you reached muscle fatigue or came close, you gave the muscle enough stimulus. The first sign of poor recovery was soreness after workouts, the second was reduced performance during workouts. 12 Strength Training Mistakes in Menopause to Avoid and Nurture Your Body Dependence on Supplements and Negating Balanced Whole Food Meals. [00:27:00] If you're all too willing to jump to EAAs, or BCAAs but won't eat regular meals that result in satiety, chances are your lack of micro and macronutrients will catch up with you. “Food first”, then allow supplements to take you the rest of the way. I don't like to “count” calories on a regular basis but a snapshot is very helpful for checking in. Often for knowing when you're eating too little. Taking Too Much Advice (or Too Little From Too Many People) [00:30:20] It often takes even gurus a while to come around. You have to love Vonda Wright and Mary Haver sharing their own menopause journeys. We need more women like them. They're open about not knowing what they didn't know about menopause, as physicians and women. You have at your fingertips access to women who learned the hard way, so you don't have to. Just don't jump in the middle. You need an onramp. Ignoring Nutrition Needs. [00:32:30] The talk is “calorie deficit.” Yet, 80% of women in our community under-eat for their mere existence (resting metabolic rate) and then try to put their foot on the accelerator for exercise causing a bigger caloric deficit. Then they stay there for years, under-fed and under-fueled (processed food, diet food), the metabolism will come to a halt, along, potentially with adrenal and thyroid function. Figure your calorie needs. Use an app to track your actual intake for 3-5 days. 12 Strength Training Mistakes in Menopause That Hinder Your Progress Thinking Small, Skinny, or Numbers That Don't Matter Instead of That Do [00:36:20] Your size and your weight on the scale do not tell the story of your fitness and health. Though they might hint at your likelihood of sarcopenia and osteoporosis, fall and fracture risk. When women focus on weight or size they sacrifice muscle. When they lose muscle, they lose strength, longevity and independence. A woman who has her ideal weight or size is constantly thinking about it and a step away from a fall or fracture. A fracture that results in bedrest, weakness and loss of more muscle. The beginning of the end. Those falls are not devastating just because of the breaks, but because of brain bleeds or other internal damage. Too Heavy to Start [00:38:20] The first 6-8 weeks, and up to 12, of a resistance training program, the benefits are due to the neural connection. That isn't rushed by going heavy. But loads too great for your ligaments, tendons and joints or muscles can cause weakness, undue soreness, and a weak foundation leading to injury. We, in the fitness industry, need to be more careful. We have sometimes lost our way in regard to where to START, and how and at what pace to PROGRESS. You Add Something But Don't Remove Something Else [00:40:30] I've experienced this temptation myself. When I started training for triathlons at 40, I was compelled to figure out how to run even while I was adding biking or swimming to my schedule. I soon realized I was sabotaging the quality of every workout and just putting those “junk miles.” A woman will lose muscle because of the added stress, inability to recover. That's an extreme example, but if you're adding and never subtracting/replacing, you're probably going to experience similar results. References for the 12 Strength Training Mistakes in Menopause: For dropping in the references.. Ideally just the single line link.. Vs long for the podcasts and posts - however if the research is really: within last 10 years, features female subjects.. Then it should be added to the research document. Nothing else should ever be used in our content. #1 Cheng AJ, Jude B, Lanner JT. Intramuscular mechanisms of overtraining. Redox Biol. 2020 Aug;35:101480. doi: 10.1016/j.redox.2020.101480. Epub 2020 Feb 26. PMID: 32179050; PMCID: PMC7284919. #2 Afonso J, Brito J, Abade E, Rendeiro-Pinho G, Baptista I, Figueiredo P, Nakamura FY. Revisiting the 'Whys' and 'Hows' of the Warm-Up: Are We Asking the Right Questions? Sports Med. 2024 Jan;54(1):23-30. doi: 10.1007/s40279-023-01908-y. Epub 2023 Sep 2. PMID: 37658965; PMCID: PMC10798919. #3 https://pubmed.ncbi.nlm.nih.gov/19691365/#:~:text=Conversely%2C some experiments%20have%20a demonstrated,be%20safer%20and%20more%20reliable #4 Hughes SL, Seymour RB, Campbell RT, Whitelaw N, Bazzarre T. Best-practice physical activity programs for older adults: findings from the national impact study. Am J Public Health. 2009 Feb;99(2):362-8. doi: 10.2105/AJPH.2007.131466. Epub 2008 Dec 4. PMID: 19059858; PMCID: PMC2622796 #4 Brickwood KJ, Ahuja KDK, Watson G, O'Brien JA, Williams AD. Effects of Activity Tracker Use With Health Professional Support or Telephone Counseling on Maintenance of Physical Activity and Health Outcomes in Older Adults: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2021 Jan 5;9(1):e18686. doi: 10.2196/18686. PMID: 33399541; PMCID: PMC7815450. #5 https://www.somnologymd.com/2024/09/sleep-womens-health/ #6 Romero-Parra N, Maestre-Cascales C, Marín-Jiménez N, Rael B, Alfaro-Magallanes VM, Cupeiro R, Peinado AB. Exercise-Induced Muscle Damage in Postmenopausal Well-Trained Women. Sports Health. 2021 Nov-Dec;13(6):613-621. doi: 10.1177/19417381211014134. Epub 2021 May 27. PMID: 34039086; PMCID: PMC8558998. #6 https://sheffieldphysiotherapy.co.uk/muscle-soreness-mean-youve-effective-workout/ #7 & #9 Erdélyi A, Pálfi E, Tűű L, Nas K, Szűcs Z, Török M, Jakab A, Várbíró S. The Importance of Nutrition in Menopause and Perimenopause-A Review. Nutrients. 2023 Dec 21;16(1):27. doi: 10.3390/nu16010027. PMID: 38201856; PMCID: PMC10780928. #7 Lentjes MAH. The balance between food and dietary supplements in the general population. Proc Nutr Soc. 2019 Feb;78(1):97-109. doi: 10.1017/S0029665118002525. Epub 2018 Oct 30. PMID: 30375305; PMCID: PMC6366563 #10 Martinez, B.P., Batista, A.K.M.S., Gomes, I.B. et al. Frequency of sarcopenia and associated factors among hospitalized elderly patients. BMC Musculoskelet Disord 16, 108 (2015). https://doi.org/10.1186/s12891-015-0570-x #10 Sakuma, Kunihiro, Yamaguchi, Akihiko, Sarcopenic Obesity and Endocrinal Adaptation with Age, International Journal of Endocrinology, 2013, 204164, 12 pages, 2013. https://doi.org/10.1155/2013/204164 #11 Kraemer WJ, Ratamess NA. Fundamentals of resistance training: progression and exercise prescription. Med Sci Sports Exerc. 2004 Apr;36(4):674-88. doi: 10.1249/01.mss.0000121945.36635.61. PMID: 15064596 #12 Caplin A, Chen FS, Beauchamp MR, Puterman E. The effects of exercise intensity on the cortisol response to a subsequent acute psychosocial stressor. Psychoneuroendocrinology. 2021 Sep;131:105336. doi: 10.1016/j.psyneuen.2021.105336. Epub 2021 Jun 18. PMID: 34175558. #12 Woods NF, Mitchell ES, Smith-Dijulio K. Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study. Menopause. 2009 Jul-Aug;16(4):708-18. doi: 10.1097/gme.0b013e318198d6b2. PMID: 19322116; PMCID: PMC2749064. https://pmc.ncbi.nlm.nih.gov/articles/PMC2749064/#:~:text=Early laboratory studies of hot,in our earlier report5. Resources: 5 Day Flip: https://www.flippingfifty.com/5-day-challenge-new/ Lunges: Love 'em or Leave 'em https://www.flippingfifty.com/lunges-muscles-squats-variations-benefits Protein Products: https://www.flippingfifty.com/protein Other Episodes You Might Like: How to Exercise with High or Low Cortisol in Menopause: https://www.flippingfifty.com/high-or-low-cortisol-in-menopause 8 Strength Training Mistakes Wasting Your Time (fix them): https://www.flippingfifty.com/8-strength-training-mistakes Fit or Fat? Training and Measuring Fitness in Menopause: https://www.flippingfifty.com/measuring-fitness-in-menopause

In this episode, Matt and Lauren speak with Dr. Tiffany Kindratt whose research focuses on examining health outcomes among the Middle Eastern and North African (MENA) population, a group that was – until recently – categorized as “white” by the US government despite. Evidence showing their health and lived experiences are different. We'll get into a recent American Journal of Public Health article authored by Dr. Kindratt that that examines how cognitive difficulties differ among the MENA population when compared with other racial and ethnic categories. Faculty Profile: Tiffany Kindratt, PhD, MPH Health Survey Research (HSR) Lab @ University of Texas at Arlington American Community Survey (ACS) AJPH Article: Kindratt TB, Smith A. Cognitive Difficulty in Middle Eastern and North African Adults Living in the United States Compared With Other Racial and Ethnic Categories, 2017-2021. Am J Public Health. 2024 Nov;114(11):1265-1274. doi: 10.2105/AJPH.2024.307803. PMID: 39357001; PMCID: PMC11447784. The transcript for this episode can be found here.You can subscribe to Minding Memory on Apple Podcasts, Spotify, or wherever you listen to podcasts. Hosted on Acast. See acast.com/privacy for more information.

Welcome to Episode 37 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 37 of “The 2 View” – Pitfalls in Managing Pain in the ED with Sergey M. Motov, MD, FAAEM. Segment 1 Bachhuber MA, Hennessy S, Cunningham CO, Starrels JL. Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996-2013. Am J Public Health. 2016;106(4):686-688. doi:10.2105/AJPH.2016.303061. https://pubmed.ncbi.nlm.nih.gov/26890165/ Bijur PE, Kenny MK, Gallagher EJ. Intravenous morphine at 0.1 mg/kg is not effective for controlling severe acute pain in the majority of patients. Ann Emerg Med. 2005;46(4):362-367. doi:10.1016/j.annemergmed.2005.03.010. https://pubmed.ncbi.nlm.nih.gov/16187470/ Evoy KE, Covvey JR, Peckham AM, Ochs L, Hultgren KE. Reports of gabapentin and pregabalin abuse, misuse, dependence, or overdose: An analysis of the Food And Drug Administration Adverse Events Reporting System (FAERS). Res Social Adm Pharm. 2019;15(8):953-958. doi:10.1016/j.sapharm.2018.06.018. https://pubmed.ncbi.nlm.nih.gov/31303196/ Kim HS, McCarthy DM, Hoppe JA, Mark Courtney D, Lambert BL. Emergency Department Provider Perspectives on Benzodiazepine-Opioid Coprescribing: A Qualitative Study. Acad Emerg Med. 2018;25(1):15-24. doi:10.1111/acem.13273. https://pubmed.ncbi.nlm.nih.gov/28791786/ Li Y, Delcher C, Wei YJ, et al. Risk of Opioid Overdose Associated With Concomitant Use of Opioids and Skeletal Muscle Relaxants: A Population-Based Cohort Study. Clin Pharmacol Ther. 2020;108(1):81-89. doi:10.1002/cpt.1807. https://pubmed.ncbi.nlm.nih.gov/32022906/ Peckham AM, Evoy KE, Covvey JR, Ochs L, Fairman KA, Sclar DA. Predictors of Gabapentin Overuse With or Without Concomitant Opioids in a Commercially Insured U.S. Population. Pharmacotherapy. 2018;38(4):436-443. doi:10.1002/phar.2096. https://pubmed.ncbi.nlm.nih.gov/29484686/ Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016;111(7):1160-1174. doi:10.1111/add.13324. https://pubmed.ncbi.nlm.nih.gov/27265421/ Suvada K, Zimmer A, Soodalter J, Malik JS, Kavalieratos D, Ali MK. Coprescribing of opioids and high-risk medications in the USA: a cross-sectional study with data from national ambulatory and emergency department settings. BMJ Open. 2022;12(6):e057588. Published 2022 Jun 16. doi:10.1136/bmjopen-2021-057588. https://pubmed.ncbi.nlm.nih.gov/35710252/ Segment 2 Caplan M, Friedman BW, Siebert J, et al. Use of clinical phenotypes to characterize emergency department patients administered intravenous opioids for acute pain. Clin Exp Emerg Med. 2023;10(3):327-332. doi:10.15441/ceem.23.018. https://pubmed.ncbi.nlm.nih.gov/37092185/ Connors NJ, Mazer-Amirshahi M, Motov S, Kim HK. Relative addictive potential of opioid analgesic agents. Pain Manag. 2021;11(2):201-215. doi:10.2217/pmt-2020-0048. https://pubmed.ncbi.nlm.nih.gov/33300384/ Fassassi C, Dove D, Davis A, et al. Analgesic efficacy of morphine sulfate immediate release vs. oxycodone/acetaminophen for acute pain in the emergency department. Am J Emerg Med. 2021;46:579-584. doi:10.1016/j.ajem.2020.11.034. https://pubmed.ncbi.nlm.nih.gov/33341323/ Irizarry E, Cho R, Williams A, et al. Frequency of Persistent Opioid Use 6 Months After Exposure to IV Opioids in the Emergency Department: A Prospective Cohort Study. J Emerg Med. Published online March 14, 2024. doi:10.1016/j.jemermed.2024.03.018. https://pubmed.ncbi.nlm.nih.gov/38821847/ Sapkota A, Takematsu M, Adewunmi V, Gupta C, Williams AR, Friedman BW. Oxycodone induced euphoria in ED patients with acute musculoskeletal pain. A secondary analysis of data from a randomized trial. Am J Emerg Med. 2022;53:240-244. doi:10.1016/j.ajem.2022.01.016. https://pubmed.ncbi.nlm.nih.gov/35085877/ Wightman R, Perrone J, Portelli I, Nelson L. Likeability and abuse liability of commonly prescribed opioids. J Med Toxicol. 2012;8(4):335-340. doi:10.1007/s13181-012-0263-x. https://pubmed.ncbi.nlm.nih.gov/22992943/ Segment 3 Anshus AJ, Oswald J. Erector spinae plane block: a new option for managing acute axial low back pain in the emergency department. Pain Manag. 2021;11(6):631-637. doi:10.2217/pmt-2021-0004. https://pubmed.ncbi.nlm.nih.gov/34102865/ Chauhan G, Burke H, Srinivasan SK, Upadhyay A. Ultrasound-Guided Erector Spinae Block for Refractory Abdominal Pain Due to Acute on Chronic Pancreatitis. Cureus. 2022;14(11):e31817. Published 2022 Nov 23. doi:10.7759/cureus.31817. https://pubmed.ncbi.nlm.nih.gov/36579238/ Dove D, Fassassi C, Davis A, et al. Comparison of Nebulized Ketamine at Three Different Dosing Regimens for Treating Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind Clinical Trial. Ann Emerg Med. 2021;78(6):779-787. doi:10.1016/j.annemergmed.2021.04.031. https://pubmed.ncbi.nlm.nih.gov/34226073/ Elkoundi A, Eloukkal Z, Bensghir M, Belyamani L, Lalaoui SJ. Erector Spinae Plane Block for Hyperalgesic Acute Pancreatitis. Pain Med. 2019;20(5):1055-1056. doi:10.1093/pm/pny232. https://pubmed.ncbi.nlm.nih.gov/30476275/ Finneran Iv JJ, Gabriel RA, Swisher MW, Berndtson AE, Godat LN, Costantini TW, Ilfeld BM. Ultrasound-guided percutaneous intercostal nerve cryoneurolysis for analgesia following traumatic rib fracture -a case series. Korean J Anesthesiol. 2020 Oct;73(5):455-459. doi: 10.4097/kja.19395. Epub 2019 Nov 5. PMID: 31684715; PMCID: PMC7533180. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533180/ Finneran JJ, Swisher MW, Gabriel RA, et al. Ultrasound-Guided Lateral Femoral Cutaneous Nerve Cryoneurolysis for Analgesia in Patients With Burns. J Burn Care Res. 2020;41(1):224-227. doi:10.1093/jbcr/irz192. https://pubmed.ncbi.nlm.nih.gov/31714578/ Gabriel RA, Finneran JJ, Asokan D, Trescot AM, Sandhu NS, Ilfeld BM. Ultrasound-Guided Percutaneous Cryoneurolysis for Acute Pain Management: A Case Report. A A Case Rep. 2017;9(5):129-132. doi:10.1213/XAA.0000000000000546. https://pubmed.ncbi.nlm.nih.gov/28509777/ Herring AA, Stone MB, Nagdev AD. Ultrasound-guided abdominal wall nerve blocks in the ED. Am J Emerg Med. 2012;30(5):759-764. doi:10.1016/j.ajem.2011.03.008. https://pubmed.ncbi.nlm.nih.gov/21570238/ Kampan S, Thong-On K, Sri-On J. A non-inferiority randomized controlled trial comparing nebulized ketamine to intravenous morphine for older adults in the emergency department with acute musculoskeletal pain. Age Ageing. 2024;53(1):afad255. doi:10.1093/ageing/afad255. https://pubmed.ncbi.nlm.nih.gov/38251742/ Mahmoud S, Miraflor E, Martin D, Mantuani D, Luftig J, Nagdev AD. Ultrasound-guided transverse abdominis plane block for ED appendicitis pain control. Am J Emerg Med. 2019;37(4):740-743. doi:10.1016/j.ajem.2019.01.024. https://pubmed.ncbi.nlm.nih.gov/30718116/ McCahill RJ, Nagle C, Clarke P. Use of Virtual Reality for minor procedures in the Emergency Department: A scoping review. Australas Emerg Care. 2021;24(3):174-178. doi:10.1016/j.auec.2020.06.006. https://pubmed.ncbi.nlm.nih.gov/32718907/ Nguyen T, Mai M, Choudhary A, et al. Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial. Ann Emerg Med. Published online May 2, 2024. doi:10.1016/j.annemergmed.2024.03.024. https://pubmed.ncbi.nlm.nih.gov/38703175/ Sikka N, Shu L, Ritchie B, Amdur RL, Pourmand A. Virtual Reality-Assisted Pain, Anxiety, and Anger Management in the Emergency Department. Telemed J E Health. 2019;25(12):1207-1215. doi:10.1089/tmj.2018.0273. https://pubmed.ncbi.nlm.nih.gov/30785860/ Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

AJPH Editors Vickie Mays and Alfredo Morabia interview Tamara Rushovich (Harvard), lead author of "US Voting Rights Act Impact on Black and Black vs. White Infant Death Rates in Jim Crow States, 1959–1980 and 2017–2021" (Am J Public Health. 2024; 114(3): 300–308), and Jesse H. Rhodes (UMass Amherst). We discuss the definition of "Jim Crow Laws" and states, the public health effects of the 1965 Voting Rights Act, and its impact on infant mortality. We also explore whether current Supreme Court decisions are eroding voting rights and how to defend them. Podcast producer: Troels Drasbech. Journal Assistant: Keira McCarthy.

איך זה שב-2024, עם כל הידע שקיים, אתם עדיין מתקשים למצוא את הדיאטה שנכונה לכם, וגם אם נראה שמצאתם – קשה לכם להתמיד בה???   בפרק 91 בפודקאסט אני חושפת לכם את הכישלון המוצלח ביותר בעת שלנו: כישלון הדיאטות. לא כי הן לא עובדות! אלא כי מה שקורה לנו בתוכן – יכול להזיק לא פחות מאשר להועיל.   אז מה עושים? מוותרים על הכל ול***זל עם הבריאות? לא! כי אפשר בכל זאת ליצור שלום בחזרה עם הבריאות, הגוף והמשקל שלנו, ובדיוק על כך אני מדברת בפרק.   לחצו כאן להדרכה חינם – איך יוצרים לבד תפריט שבאמת אפשר לעמוד בו  לחצו כאן לפרטים על טיפולים תזונתיים ורגשיים במרכז שלי   עקבו אחריי לעוד המון מידע חינמי: אינסטגרם: https://www.instagram.com/rutifink/ טיק-טוק: https://www.tiktok.com/@rutifink פייסבוק: https://www.facebook.com/fink.ruti יוטיוב: https://www.youtube.com/@rutifink לקבלת מייל בכל פעם שיוצא פרק חדש של הפודקאסט: http://rutifink.vp4.me/podcast   רפרנסים: Mauldin K, May M, Clifford D. The consequences of a weight-centric approach to healthcare: A case for a paradigm shift in how clinicians address body weight. Nutr Clin Pract. 2022;37:1291-1306. Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost AT, Gulliford MC. Probability of an obese person attaining normal body weight: cohort study using electronic health records. Am J Public Health. 2015;105:e54‐e59 Pélissier L et al. Is dieting a risk for higher weight gain in normal-weight individual? A systematic review and meta-analysis. Br J Nutr. 2023 Jan 16:1-23 Tomiyama AJ, Ahlstrom B, Mann T. Long‐term effects of dieting: is weight loss related to health? Soc Personal Psychol Compass. 2013;7:861‐877 Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013 Jul 11;369(2):145-54. Memon AN, Gowda AS, Rallabhandi B, Bidika E, Fayyaz H, Salib M, Cancarevic I. Have Our Attempts to Curb Obesity Done More Harm Than Good? Cureus. 2020 Sep 6;12(9):e10275 Cameron JD, Goldfield GS, Doucet É. Appetite. 2012;58:978‐981. Thaiss CA, Itav S, Rothschild D, et al. Nature. 2016;540:544‐551. Zou, Huajie, et al. Journal of diabetes investigation  2021: 625-632.‏ Lee, Dong Hoon, et al. Cancer Causes & Control 2021: 1029-1038.‏ Zou, Huajie, et al. Frontiers in endocrinology (2019): 728.‏ Massey, Robert J., et al. Cardiovascular Diabetology 22.1 (2023): 1-12.‏ Rossi AP, Rubele S, Calugi S, et al. Obesity. 2019;27:1068–1075 Polivy J. Psychological consequences of food restriction. J Am Diet Assoc. 1996;96(6):589-92; quiz 593-4. Herman CP, Polivy J, Esses VM. The illusion of counter-regulation.. Appetite. 1987;9:161–169. Knight LJ, Boland FJ. Restrained eating: an experimental disentanglement of the disinhibiting variables of perceived calories and food type. J Abnorm Psychol. 1989 Nov;98(4):412-20 Patton GC, Selzer R, Coffey C, Carlin JB, Wolfe R. Onset of adolescent eating disorders: population based cohort study over 3 years. BMJ. 1999;318:765–768. Emmer C, Bosnjak M, Mata J. The association between weight stigma and mental health: A meta-analysis. Obesity Reviews. 2020; 21:e12935 Puhl, RM et al. Weight stigma as a psychosocial contributor to obesity. American Psychologist 2020;75(2):274–289  

Fettföraktet inom vården är utbrett och illavarslande. Över hälften rapporterar att ha blivit utsatt för någon form av viktdiskriminering inom vården. Kanske är du en av dem? Viktstigmatiseringen har ökat med 66% senare år och det är en accepterad form av diskriminering, till skillnad från rasism och homofobi. Det är inget vi heller ska skoja bort eftersom det ökar risken att dö i förtid med 60%. Tjocka människor undviker vård fram till den dag symptomen blir så överväldigande att det inte längre går att blunda.I detta avsnitt av podden Matfrihet möter vi överläkaren Johanna Skoglösa som arbetar med mag- och tarmsjukdomar. I hennes yrkesroll möter hon patienter med fettlever som ofta är tjocka. Jag och Johanna pratar om hur man kan möta patienter på ett respektfullt sätt, varför det är mer intressant att prata om hälsosamma vanor än om BMI och varför det är så lönlöst att banta.Gratis resurser att kickstarta Matfriheten: https://www.matfri.se/gratis-resurserKöp min bok här: https://peopleandstories.se/products/matfrihet-bli-fri-fran-halsoatning-och-matangest-med-intuitivt-atandeGlöm inte att prenumerera på podden!Källor i introthttps://journalofethics.ama-assn.org/article/weight-bias-health-care/2010-04Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health. 2010 Jun;100(6):1019-28. doi: 10.2105/AJPH.2009.159491. Epub 2010 Jan 14. PMID: 20075322; PMCID: PMC2866597.Sutin AR, Stephan Y, Terracciano A. Weight Discrimination and Risk of Mortality. Psychol Sci. 2015 Nov;26(11):1803-11. doi: 10.1177/0956797615601103. Epub 2015 Sep 29. PMID: 26420442; PMCID: PMC4636946.Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015 Apr;16(4):319-26. doi: 10.1111/obr.12266. Epub 2015 Mar 5. PMID: 25752756; PMCID: PMC4381543. Hosted on Acast. See acast.com/privacy for more information.

The United States is in the midst of an overdose crisis that's been exacerbated by the COVID-19 pandemic and increased toxicity of the drug supply, largely a result of adulterants like fentanyl and other synthetic opioids. In 2021, the number of deaths in New York State alone surged to more than 5,800 individuals – an average of nearly 16 people every day. Scaling up harm reduction interventions has helped avert thousands of overdose-related deaths, but the persistent predominance of fentanyl continues to fuel mortality. To complement existing interventions, colleagues in Canada and elsewhere around the globe have pointed to providing “safer supply,” or an alternative to the unregulated, toxic drug supply as a potential solution to prevent overdose-related deaths and address the needs of people for whom current treatment models do not work or are not a good fit. Although not intended as a standalone treatment for substance use disorder, this novel approach is showing promise in addressing the growing morbidity and mortality surrounding the current drug supply. This episode will introduce safer supply as a harm reduction approach to support and engage people who use drugs. Disclaimer: Safer supply is not legal or authorized in the United States under current FDA and DEA regulations.  Related Content: New York State Office of Addiction Services and Supports Harm Reduction: https://oasas.ny.gov/harm-reduction Government of Canada Safer Supply: https://www.canada.ca/en/health-canada/services/opioids/responding-canada-opioid-crisis/safer-supply.html British Columbia Centre on Substance Use, Provincial Clinical Guidelines for Opioid Use Disorder: https://www.bccsu.ca/opioid-use-disorder/ The National Harm Reduction Coalition: https://harmreduction.org/ Haines M, O'Byrne P. Safer opioid supply: qualitative program evaluation. Harm Reduct J. 2023 Apr 20;20(1):53. doi: 10.1186/s12954-023-00776-z. PMID: 37081500; PMCID: PMC10117245 Tyndall M. A safer drug supply: a pragmatic and ethical response to the overdose crisis. CMAJ. 2020 Aug 24;192(34):E986–7. doi: 10.1503/cmaj.201618. PMCID: PMC7840515 McNeil R, Fleming T, Mayer S, Barker A, Mansoor M, Betsos A, Austin T, Parusel S, Ivsins A, & Boyd J. Implementation of safe supply alternatives during intersecting COVID-19 and overdose health emergencies in British Columbia, Canada 2021. Am J Public Health. 2022;112(S151_S158). doi: 10.2105/AJPH.2021.306692 Dr. Eric Kutscher Mount Sinai profile: https://profiles.mountsinai.org/eric-kutscher CEI toll free line for NYS providers: 866-637-2342 https://ceitraining.org/

The Hawk's Nest Tunnel Disaster involved thousands of workers being exposed to silica dust, and many continued to get sick and die for years after the tunnel was finished. The project was run with total disregard for workers' lives and safety. Research: Investigation Relating to Health Conditions of Workers Employed in the Construction and Maintenance of Public Utilities : hearings before the United States House Committee on Labor, Seventy-Fourth Congress, second session, on Jan. 16, 17, 20-22, 27-29, Feb. 4, 1936.” https://play.google.com/books/reader?id=OhHRhNWDGi4C&pg=GBS.PA1&hl=en Cherniack, Martin G. "Hawks Nest Tunnel Disaster." e-WV: The West Virginia Encyclopedia. 14 March 2023. Web. 08 August 2023. Cherniack, Martin. “The Hawk's Nest Incident: America's Worst Industrial Disaster.” Yale University Press. 1986. Crandall, William “Rick” and Richard E. Crandall. “Revisiting the Hawks Nest Tunnel Incident: Lessons Learned from an American Tragedy.” Journal of Appalachian Studies , Fall 2002, Vol. 8, No. 2 (Fall 2002). Via JSTOR. https://www.jstor.org/stable/41446542 Georgius Agricola “De re metallica.” Translated by Herbert Clark Hoover and Lou Henry Hoover. The Mining Magazine. 1912. https://archive.org/details/georgiusagricola00agririch Harrington, D. and Sara J. Davenport. “Review of the Literature on the Effects of Breathing Dusts, With Special Reference to Silicosis.” United States Bureau of Mines. House of Representatives Subcommittee Report. “Congressional Record: Proceedings and Debates of the Second Session of the Jordan, Jennifer. “Hawks' Nest.” From the West Virginia Historical Society Quarterly, 12:2(April 1998): 1-3. https://archive.wvculture.org/history/wvhs/wvhs122.html Lancianese, Adelina. “Before Black Lung, The Hawks Nest Tunnel Disaster Killed Hundreds.” Weekend Edition Sunday. NPR. 1/20/2019. https://www.npr.org/2019/01/20/685821214/before-black-lung-the-hawks-nest-tunnel-disaster-killed-hundreds Marcus, Irwin M. “The Tragedy at Gauley Bridge.” Negro History Bulletin , April, 1976, Vol. 39, No. 4 (April, 1976). Via JSTOR. https://www.jstor.org/stable/44175749 Quail, M. Thomas. “Special Report.” Journal of Environmental Health , January/February 2017, Vol. 79, No. 6. Via JSTOR. https://www.jstor.org/stable/10.2307/26330599 Rosner D, Markowitz G. A Short History of Occupational Safety and Health in the United States. Am J Public Health. 2020 May;110(5):622-628. doi: 10.2105/AJPH.2020.305581. Epub 2020 Mar 19. PMID: 32191514; PMCID: PMC7144431. Rosner, David and Gerald Markowitz. “Workers, Industry, and the Control of Information: Silicosis and the Industrial Hygiene Foundation.” Journal of Public Health Policy. 16, No. 1 (Spring, 1995). Via JSTOR. https://www.jstor.org/stable/3342976 Rukeyser, Muriel. “The Book of the Dead.” With an introduction by Catherine Venable Moore. West Virginia University press. 2018. Seventy- Fourth Congress of the United States of America. Vol. 80, pt. 5. Washington: GPO, 1936.” From West Virginia Archives and History. https://archive.wvculture.org/hiStory/disasters/hawksnesttunnel04.html Spencer, Howard W. “The Historic & Cultural Importance of the Hawks Nest Disaster.” PSJ Professional Safety. February 2023. https://www.assp.org/docs/default-source/psj-articles/vpspencer_0223.pdf?sfvrsn=afa39647_0 Stafnaker, C. Keith. “Hawk's Nest Tunnel: A Forgotten Tragedy in Safety's History.” Professional Safety. October 2006. Wills, Matthew. “Remembering the Disaster at Hawks Nest.” JSTOR Daily. 10/30/2020. https://daily.jstor.org/remembering-the-disaster-at-hawks-nest/ See omnystudio.com/listener for privacy information.

CDC BMI: https://www.cdc.gov/healthyweight/assessing/bmi/index.htmlAdult BMI: https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.htmlHenry Blackburn , David Jacobs, Jr, Commentary: Origins and evolution of body mass index (BMI): continuing saga, International Journal of Epidemiology, Volume 43, Issue 3, June 2014, Pages 665–669, https://doi.org/10.1093/ije/dyu061  AJCN: https://www.sciencedirect.com/science/article/pii/S000291652200627XBMI for Practitioners: https://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdfAPA Weight Stigma: https://www.apa.org/monitor/2022/03/news-weight-stigmaPuhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health. 2010;100(6):1019-1028. doi:10.2105/AJPH.2009.159491  -------------------------------------------------------------- Felicia Porrazza is a registered and licensed dietitian with a masters degree in dietetics administration, an ACSM certified personal trainer, National Board Certified Health & Wellness Coach, college nutrition faculty instructor, and owner of Porrazza Nutrition LLC and My Dietitian Journey. In her private practice, she works one-on-one with clients to help them develop an understanding of healthy eating and fitness. She specializes in combining plant-based eating with fitness programs, specifically targeting beginner strength-training. Felicia has been a mentor to Dietitians starting their own private practice and a dietetic internship preceptor for Dietetic students. Disclaimer: Information provided is not intended to constitute legal or medical advice. All information is for general educational purposes only.

This week we're joined by personal trainer and functional strength coach Theresa Racicot, who has been helping train circus artists since 2002 (that's before the first pole studio even opened, depending on how you measure it!). We cover a lot in this episode, including discussing hypermobility, functional strength & diet culture. You can find Theresa and Reimagym at https://reimagym.com/, on TikTok, Instagram and YouTube. Also some citations for some of the things I mention: - Co-incidence of neurodivergence & hypermobility: Csecs & Et al (2022) Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain, Front. Psychiatry, 02 February 2022 Sec. Psychological Therapy and Psychosomatics Volume 12 https://www.frontiersin.org/articles/10.3389/fpsyt.2021.786916/full?field=&journalName=Frontiers_in_Psychiatry&id=786916 - On the incidence of weight re-gain: Hall KD, Kahan S. Maintenance of Lost Weight and Long-Term Management of Obesity. Med Clin North Am. 2018 Jan;102(1):183-197. doi: 10.1016/j.mcna.2017.08.012. PMID: 29156185; PMCID: PMC5764193. - On body size not being indicative of health: Bombak A. Obesity, health at every size, and public health policy. Am J Public Health. 2014;104:e60–e67. - On epigenetic factors & body size (I'd recommend starting with Section 3) Mahmoud AM. An Overview of Epigenetics in Obesity: The Role of Lifestyle and Therapeutic Interventions. Int J Mol Sci. 2022 Jan 25;23(3):1341. doi: 10.3390/ijms23031341. PMID: 35163268; PMCID: PMC8836029. The Evidence-Based Pole Podcast aims to help pole dancers feel better on and off the pole by talking with experts and diving into relevant scientific research to find evidence-based insights we can apply to our pole journeys. It's a production of Slink Through Strength, the inclusive, evidence-based online pole studio, which can be found online at http://slinkthroughstrength.com/. #poledance #physicaltherapy #evidencebasedpractice --- Support this podcast: https://podcasters.spotify.com/pod/show/rosy-boa/support

פרק 75 ממשיך את הבעיטה בכל מה שידעתם עד עכשיו על ירידה במשקל (שהתחלנו בפרק 74) ומדבר על הנושא שרבים מתעלמים ממנו: היחסים הסבוכים שלנו עם הגוף שלנו, במיוחד אלה מאיתנו שהם עם גוף גדול יותר מהאחרים. בפרק היום אנחנו יוצאים מהבנאליות הניו-אייג'ית של "אהבה לגוף" ומדברים תכלעס: מה המחקר אומר: האם חיוביות כלפי הגוף מועילה או מזיקה לשמירה שלנו על המשקל? ואיך מיישמים את המחקרים האלה בפועל מול האכילה שלכם?   מה עוד בפרק? האם קבלה של הגוף מחייבת בהכרח הסכמה להמשיך להיות במשקל גבוה? המלכודת בדיאטה של מי שלא מרוצה מהגוף שלו כרגע, ואיך לצאת ממנה? מה זה אומר בכלל "להקשיב לגוף?" (לא מה ששמעתם עד כה) איך מפסיקים את המלחמה בגוף ועדיין מגיעים לתוצאות שאנחנו רוצים? ועוד ועוד...   לרישום להדרכה "איך יוצרים את התפריט המושלם שכן ניתן לעמוד בו" לחצו כאן: https://rutifink.vp4.me/menu למדריך חינם "איך להשתלט על נשנשת הערב בלי כוח רצון" לחצו כאן: https://rutifink.vp4.me/night   עקבו אחריי לעוד המון מידע חינמי: אינסטגרם: https://www.instagram.com/rutifink/ טיק-טוק: https://www.tiktok.com/@rutifink פייסבוק: https://www.facebook.com/fink.ruti יוטיוב: https://www.youtube.com/@rutifink לקבלת מייל בכל פעם שיוצא פרק חדש של הפודקאסט: http://rutifink.vp4.me/podcast   רפרנסים: Mauldin K, May M, Clifford D. The consequences of a weight-centric approach to healthcare: A case for a paradigm shift in how clinicians address body weight. Nutr Clin Pract. 2022;37:1291-1306.   Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost AT, Gulliford MC. Probability of an obese person attaining normal body weight: cohort study using electronic health records. Am J Public Health. 2015;105:e54‐e59   Abramowitz MK, Hall CB, Amodu A, Sharma D, Androga L, Hawkins M. Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study. PLoS One. 2018;13(4):e0194697   Zou, Huajie, et al. "Association between weight cycling and risk of developing diabetes in adults: A systematic review and meta‐analysis." Journal of diabetes investigation  2021: 625-632.‏   Lee, Dong Hoon, et al. "Association between weight cycling and risk of kidney cancer: a prospective cohort study and meta-analysis of observational studies." Cancer Causes & Control 2021: 1029-1038.‏   Zou, Huajie, et al. "Body-weight fluctuation was associated with increased risk for cardiovascular disease, all-cause and cardiovascular mortality: a systematic review and meta-analysis." Frontiers in endocrinology (2019): 728.‏   Massey, Robert J., et al. "Weight variability and cardiovascular outcomes: a systematic review and meta-analysis." Cardiovascular Diabetology 22.1 (2023): 1-12.‏   Weight cycling as a risk factor for low muscle mass and strength in a population of males and females with obesity. Rossi AP, Rubele S, Calugi S, et al. Obesity. 2019;27:1068–1075   Memon AN, Gowda AS, Rallabhandi B, Bidika E, Fayyaz H, Salib M, Cancarevic I. Have Our Attempts to Curb Obesity Done More Harm Than Good? Cureus. 2020 Sep 6;12(9):e10275   Polivy J. Psychological consequences of food restriction. J Am Diet Assoc. 1996;96(6):589-92; quiz 593-4.   Herman CP, Polivy J, Esses VM. The illusion of counter-regulation.. Appetite. 1987;9:161–169.    

אני אומרת הכי בכנות – זה פרק חובה לכל אחד ואחד! הפרק הזה יבעט לכם בכל מה שידעתם עד עכשיו על ירידה במשקל ויהפוך לכם את הקערה על פיה בצורה שלא שמעתם בעבר. כי אם אתם בטוחים שהמשקל שלכם פוגע בבריאות שלכם, שחייבים לאבד במשקל כדי לשפר את הבריאות, ושכל מה שעומד בינכם לבין שלום עם הגוף הוא המשקל שלכם – אתם הולכים להיות מאווווווד מופתעים!   עוד בפרק: האם האמונות ה-לכאורה-מדעיות שחייבים לרדת במשקל כדי לשפר את הבריאות כל כך מבוססות כמו שכולם מאמינים להן? האם לעודד את עצמינו לרדת במשקל עוזר לנו או שיש לזה נזק קצר וארוך טווח? מה הסיכוי האמיתי שלכם לשמור על כל סוג של דיאטה (וזה כולל צום לסירוגין וקיטו!)? האם באמת יש הבדל בין דיאטה לבין "אורח חיים בריא"? מה הפתרונות האמיתיים לאתגרי המשקל והבריאות שלכם? ועוד ועוד...   לרישום להדרכה "איך יוצרים את התפריט המושלם שכן ניתן לעמוד בו" לחצו כאן: https://rutifink.vp4.me/menu למדריך חינם "איך להשתלט על נשנשת הערב בלי כוח רצון" לחצו כאן: https://rutifink.vp4.me/night   עקבו אחריי לעוד המון מידע חינמי: אינסטגרם: https://www.instagram.com/rutifink/ טיק-טוק: https://www.tiktok.com/@rutifink פייסבוק: https://www.facebook.com/fink.ruti יוטיוב: https://www.youtube.com/@rutifink לקבלת מייל בכל פעם שיוצא פרק חדש של הפודקאסט: http://rutifink.vp4.me/podcast   רפרנסים: Mauldin K, May M, Clifford D. The consequences of a weight-centric approach to healthcare: A case for a paradigm shift in how clinicians address body weight. Nutr Clin Pract. 2022;37:1291-1306.   Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost AT, Gulliford MC. Probability of an obese person attaining normal body weight: cohort study using electronic health records. Am J Public Health. 2015;105:e54‐e59   Abramowitz MK, Hall CB, Amodu A, Sharma D, Androga L, Hawkins M. Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study. PLoS One. 2018;13(4):e0194697   Zou, Huajie, et al. "Association between weight cycling and risk of developing diabetes in adults: A systematic review and meta‐analysis." Journal of diabetes investigation  2021: 625-632.‏   Lee, Dong Hoon, et al. "Association between weight cycling and risk of kidney cancer: a prospective cohort study and meta-analysis of observational studies." Cancer Causes & Control 2021: 1029-1038.‏   Zou, Huajie, et al. "Body-weight fluctuation was associated with increased risk for cardiovascular disease, all-cause and cardiovascular mortality: a systematic review and meta-analysis." Frontiers in endocrinology (2019): 728.‏   Massey, Robert J., et al. "Weight variability and cardiovascular outcomes: a systematic review and meta-analysis." Cardiovascular Diabetology 22.1 (2023): 1-12.‏   Weight cycling as a risk factor for low muscle mass and strength in a population of males and females with obesity. Rossi AP, Rubele S, Calugi S, et al. Obesity. 2019;27:1068–1075   Memon AN, Gowda AS, Rallabhandi B, Bidika E, Fayyaz H, Salib M, Cancarevic I. Have Our Attempts to Curb Obesity Done More Harm Than Good? Cureus. 2020 Sep 6;12(9):e10275   Polivy J. Psychological consequences of food restriction. J Am Diet Assoc. 1996;96(6):589-92; quiz 593-4. Herman CP, Polivy J, Esses VM. The illusion of counter-regulation.. Appetite. 1987;9:161–169.    

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: November 9, 2017 With the ongoing opioid crisis, not only those using opiates are affected. There has been an exponential rise in the incidence of neonatal abstinence syndrome--the multiorgan dysfunction experienced by newborns of mothers who are using opioid products and other substances. This week, we discuss the manifestations and ramifications of this disease, with a short commentary on the implications of this global epidemic. Produced by James E Siegler. Music by Little Glass Men, Jason Shaw, and Chris Zabriskie. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. This is no excuse to give your irritable baby opiates in their applesauce. REFERENCES Hagan H, McGough JP, Thiede H, Weiss NS, Hopkins S, Alexander ER. Syringe exchange and risk of infection with hepatitis B and C viruses. Am J Epidemiol 1999;149(3):203-13. PMID 9927214 Hudak ML, Tan RC; Committee On Drugs; Committee On Fetus And Newborn; American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics 2012;129(2):e540-60. PMID 22291123 Jarlenski M, Barry CL, Gollust S, Graves AJ, Kennedy-Hendricks A, Kozhimannil K. Polysubstance use among us women of reproductive age who use opioids for nonmedical reasons. Am J Public Health 2017;107(8):1308-10. PMID 28640680 Kocherlakota P. Neonatal abstinence syndrome. Pediatrics 2014;134(2):e547-61. PMID 25070299 McQueen K, Murphy-Oikonen J. Neonatal abstinence syndrome. N Engl J Med 2016;375(25):2468-79. PMID 28002715 Vlahov D, Des Jarlais DC, Goosby E, et al. Needle exchange programs for the prevention of human immunodeficiency virus infection: epidemiology and policy. Am J Epidemiol 2001;154(12 Suppl):S70-7. PMID 11744532 Wodak A, Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse 2006;41(6-7):777-813. PMID 16809167  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Join our Miami Trauma team including Drs. Urréchaga, Neeman, and Rattan as they dive into the literature regarding a topic that has become all too common to the US news cycle- gun violence. They will go over a recent paper from JAMA and include other important literature while trying to understand this complex problem that has been grappling US public policy.  Quick Hits: 1.     Firearm injury is the leading cause death in the US among ages 1-19 2.     For every person killed violently by someone else with a firearm, there are 3 survivors.  3.     Gun ownership triples the risk of homicide 4.     Permit laws and preventing people convicted of a violent crime from owning a firearm decrease firearm-related death and have a positive ripple effect even outside state borders. In short, for effective reductions of firearm-related injury and death, federal legislation will be more effective than state-by-state References 1.     Liu, Y, Siegel, M, Sen, B. Association of State-Level Firearm-Related Deaths With Firearm Laws in Neighboring States. JAMA Network Open. 2022;5(11):e2240750. doi:10.1001/jamanetworkopen.2022.40750 2.     Goldstick, JE, Cunningham, RM, Carter, PM. Current Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2022 May 19;386(20):1955-1956. doi: 10.1056/NEJMc2201761.  3.     Kellermann, AL, Rivara, FP, Rushforth, NB, Banton, JG, Reay, DT, Francisco, JT, Locci, AB, Prodzinski, J, Hackman, BB, Somes, G. Gun Ownership as a Risk Factor for Homicide in the Home. N Engl J Med 1993; 329:1084-1091. DOI: 10.1056/NEJM199310073291506 4.     Liu Y, Siegel, M, Sen, B. Neighbors do matter: between-state firearm laws and state firearm-related deaths in the US, 2000-2017. Am J Prev Med. 2020;59(5):648-657. doi:10.1016/j.amepre.2020.06.022 5.     Siegel, M, Pahn, M, Xuan, Z, et al. Firearm-related laws in all 50 US states,1991-2016. Am J Public Health.2017; 107(7):1122-1129. doi:10.2105/AJPH.2017.303701 6.     Kalesan, B, Mobily, ME, Keiser, O, Fagan, J, Galea, S. Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. Lancet. 2016 Apr 30;387(10030):1847-55. doi: 10.1016/S0140-6736(15)01026-0. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Journal Review episodes here: https://behindtheknife.org/podcast-series/journal-review/

Podcast #9 Looking Ahead in an Unfinished Journey References: Kindig DA. 2015. Can There Be Political Common Ground for Improving Population Health? Milbank Q 93(1):24–27. Kindig DA. 2007. Understanding Population Health Terminology. Milbank Q 85(1):139-161. Kindig D, Nobles J, Zidan M. 2018. Meeting the Institute of Medicine's 2030 US Life Expectancy Target. Am J Public Health108(1):87-92. McCullough JM, Speer M, Magnan S, Fielding JE, Kindig D, Teutsch SM. 2020. Reduction in US Health Care Spending Required to Meet the Institute of Medicine's 2030 Target. Am J Public Health 110(12):1735-1740. Hughes-Cromwick P, Kindig D, Magnan S, Gourevitch M, Teutsch 2021. The Reallocationists Versus the Direct Allocationists. Health Affairs Forefront. August 6. https://www.healthaffairs.org/do/10.1377/forefront.20210729.55316 Kindig D. 2022. The Promise of Population Health: A Scenario for the Next Two Decades. NAM Perspectives. Commentary, National Academy of Medicine. Washington, DC. https://doi.org/10.31478/202203a Kindig D. 2020. A Population Health Boot Camp. https://iaphs.org/a-population-health-boot-camp/ Wagstaff A. 2002. Inequality aversion, health inequalities and health achievement. J Health Econ 21(4):627–41. https://pubmed.ncbi.nlm.nih.gov/12146594/

Podcast #5 Picking Up Steam 2006-2014 County Health Rankings Model Dave tells us about how the population health idea began to catch on, in scholarship as well as in the County Health Rankings, Federal Medicare and Medicaid. The momentum continued in his blog and the founding of the Institute of Medicine Roundtable on Population Health Improvement …saying to Robert Wood Johnson  “…they couldn't say no”. References: Kindig DA, Asada Y, Booske B. 2008. A Population Health Framework for Setting National and State Health Goals. JAMA 299(17):2081-2083. Kindig D. 2008. Beyond the Triple Aim: Integrating the Nonmedical Sectors. Health Affairs Blog May 19. https://www.healthaffairs.org/do/10.1377/forefront.20080519.000393/full/ Peppard PE, Kindig DA, Dranger E, Jovaag A, Remington PL. 2008. Ranking Community Health Status to Stimulate Discussion of Local Public Health Issues: The Wisconsin County Health Rankings. Am J Public Health 98(2):209-212. Kindig DA, Booske BC, Remington PL. 2010. Mobilizing Action Toward Community Health (MATCH): Metrics, Incentives, and Partnerships for Population Health. Prev Chronic Dis 7(4). https://www.cdc.gov/pcd/collections/pdf/PCD_MATCH_2010_web.pdf Kindig D. Feb 3, 2017. https://iaphs.org/improving-population-health-continuing-journey/ Kindig D. 2011-2014. Improving Population Health: Ideas and Action. Electronic blog collection (43 posts). https://uwphi.pophealth.wisc.edu/wp-content/uploads/sites/316/2018/03/blog-collection-final-2014-04-05.pdf 7. The Roundtable on Population Health Improvement. National Academies of Sciences, Engineering and Medicine. https://www.nationalacademies.org/our-work/roundtable-on-population-health-improvement

Vaccine development is considered one of the greatest achievements of public health and medical science with millions of lives saved worldwide from many once-deadly infectious diseases.  Fortunately, most parents readily accept all vaccines recommended by the American Academy of Pediatrics (AAP).  However, vaccine hesitancy is becoming increasingly prevalent. Pediatric Resident, Dr. Caroline Fu, joins Associate Professor of Pediatrics at MCG, Dr. Donna Moore, to discuss childhood vaccine hesitancy.  After listening to this podcast, learners should be able to: 1. Recognize the public health concerns of childhood vaccination refusal and delays. 2. Understand common objections and concerns about vaccines and know how to dispel misconceptions. 3. Utilize communication strategies for counseling vaccine hesitant parents. 4. Know how to access reputable resources to provide parents who would like additional resources. 5. Explain the few true medical contraindications to vaccines vs. religious or philosophical objections. 6. Review tips on how to approach parents who continue to refuse vaccines despite extensive counseling. FREE CME Credit (requires free sign-up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=11406  References:  Wolfe, RM and Sharp, LK.  Anti-Vaccinationists Past and Present.  BMJ.  2002; 325:430.  AAP COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE, AAP COMMITTEE ON INFECTIOUS DISEASE, AAP COMMITTEE ON STATE GOVERNMENT AFFAIRS, AAP COUNCIL ON SCHOOL HEALTH, AAP SECTION ON ADMINISTRATION AND PRACTICE MANAGEMENT.  Medical versus Nonmedical Immunization Exemptions for Child Care and School Attendance.  2016; 138 (3): e20162145  Edwards KM, Hackell JM, AAP THE COMMITTEE ON INFECTIOUS DISEASES, THE COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE.  Countering Vaccine Hesitancy.  Pediatrics.  2016; 138(3): e20162146  Natbony, J and Genies, M. Vaccine Hesitancy and Refusal in Brief.   Pediatrics in Review.  2016; 40.1(22-3)  Smith, M.  Vaccine Safety: Medical Contraindications, Myths, and Risk Communication.  Pediatrics in Review.  2015; 36:6 (227-236).  Healy, MC and Pickering, LK.  How to Communicate with Vaccine-Hesitant Parents.  2011; 127:S127-S133.  McKee, C and Bohannon, K.  Exploring the Reasons Behind Parental Refusal of Vaccines.  Journal of Pediatric Pharmacology and Therapeutics.  2016; 1:2 (104-9).  Wombwell E, Fangman MT, Yoder AK, and Spero DL.  Religious Barriers to Measles Vaccination.  Journal of Community Health.  2015; 40:597-604.  Singh, K and Mehta, S.  The clinical development process for a novel preventative vaccine: An overview.  Journal of Postgraduate Medicine. 2016; 62(1): 4-11.    Girotto, J.  What does full FDA Approval Mean for a Vaccine already authorized for emergency use?  UConn Today.  August 19, 2021. https://today.uconn.edu/2021/08/what-does-full-fda-approval-mean-for-a-vaccine-already-authorized-for-emergency-use/  Quinn SC, Jamison AM, Freimuth V.  Communicating effectively about emergency use authorization and vaccines in the COVID-19 pandemic.  Am J Public Health.  2021; 111(3):355-358.  JD Grabstein. What the World Teaches, Applied to Vaccines and Immunoglobulins. Vaccine.  2013 April 12;31(16):2011-23.doi: 10.1016/j.vaccine.2013.02.026. Epub 2013 Feb 26.  World Health Organization. Ten health issues who will tackle this year. 2019.  https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 Resources for parents and providers  CDC provider resources for conversation with vaccine hesitant parents: https://www.cdc.gov/vaccines/hcp/conversations/index.html https://www.cdc.gov/vaccines/parents/index.html (CDC vaccines for parents resource)  https://www.cdc.gov/vaccines/pubs/pinkbook/index.html (PinkBook CDC)  https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hepb.html (Advisory Committee on Immunization Practices; contraindications and precautions for vaccines)  https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/thimerosal-and-vaccines#cstat https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-ingredients CHOP vaccine ingredients   https://www.chop.edu/centers-programs/vaccine-education-center/resources/vaccine-and-vaccine-safety-related-qa-sheets CHOP Vaccine safety q and a  https://www.vaccinesafety.edu/Religion.htm https://downloads.aap.org/DOPCSP/SOID_RTV_form_01-2019_English.pdf AAP Refusal to Vaccinate Form - English  https://downloads.aap.org/DOPCSP/SOID_RTV_form_01-2019_Spanish.pdf AAP Refusal to Vaccinate Form - Spanish  https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html COVID vaccine tracker (details the vaccine trials and approval process).   

Common Collagen Claims (taken from actual websites selling collagen supplements): “improves skin elasticity,” “support bone and joint health,” “strengthen hair, skin, and nails,”  “may benefit the bodies cellular structure,” “support healthy skin, bone, and joints.” “will feed your skin health” “will improve nail appearance and strength” “lead to a noticeable hair thickness” Collagen as a supplement is not regulated by the Drug division of The Food and Drug Administration If you look at the bottom of the websites, or on the bottles, you will see a disclaimer that the claims “have not been evaluated by the U.S. Food and Drug Administration. ” More telling is “these products are not intended to treat, diagnose, cure, or prevent any disease.” Such a disclaimer is provided by the lawyers because if one claims to cure, treat, or diagnose an actual medical condition then it must have passed a rigorous FDA approval. To be clear, there have been no FDA studies that show collagen as a supplement treats any disease. Supplements commonly will use “support xyz health” – where you can fill in the blank with hair, nails, joints, skin – in the case of collagen. One of the main issues with supplements is “If the composition and quality of ingredients cannot be reliably ensured, the validity of research on dietary supplements is questionable. Moreover, the health of the US public is put at risk.” Starr RR. Too little, too late: ineffective regulation of dietary supplements in the United States. Am J Public Health. 2015;105(3):478-485. doi:10.2105/AJPH.2014.302348 As such, even when you look at the studies which promote collagen, or collagen byproducts, they do not meet the most basic of studies which are done to evaluate pharmaceuticals. In order to have an evaluation of a pharmaceutical you must have three phases in the trial: phase one is determining the dose for safety. While the supplement industry is happy if you think all supplements are good and all pharmaceuticals are evil – everything, every drug, every chemical from water to salt to formaldehyde has a toxic dose phase two is to test the drug for efficacy and side effects. Some people will react poorly to a supplement just as they will a drug. WE need to know what those side effects are. With a supplement people who don't feel well often just stop it – or, like my cousin, die (yes, I had a cousin who died from a supplement). phase three testing is to determine if there is truly efficacy, what is the effectiveness and what is the safety. phase four is post-marketing surveillance in the public because even though you have gone through trials with a number of phases and under strict supervision when a drug is released to the public you have the chance to see millions of reactions. Thalidomide, for example, was released in Europe and even had two drug trials in the United States but was NEVER approved in the United States by the FDA because of insufficient data. Vioxx was a drug used worldwide and was taken off the market in 2004 because of the risk of a fatal heart attack, but was taken off after it had passed multiple drug tests previously. FDA testing is rigorous and specific, with the highest standards in the world. Collagen has NEVER had such rigorous testing performed. These tests have not risen to the level and in 2022 one report noted “More research is needed to establish knowledge of the effects and physiologic mechanism of collagen supplementation. Dermatologists should be aware of the unsubstantiated proclamations of collagen made by companies and in social media, as well as what evidence is established thus far, to be equipped to discuss collagen supplementation with patients.” Rustad AM, Nickles MA, McKenney JE, Bilimoria SN, Lio PA. Myths and media in oral collagen supplementation for the skin, nails, and hair: A review. J Cosmet Dermatol. 2022 Feb;21(2):438-443. doi: 10.1111/jocd.14567. Epub 2021 Oct 25. PMID: 34694676. One of the most...

An immersive reading of excerpts from the short story ‘Iron Routine' by Zitkála-Šá with reflection on healthcare disparities, authority and antagonists. Excerpts‘Iron Routine' by Zitkála-ŠáA paleface woman, with a yellow-covered roll book open on her arm and a gnawed pencil in her hand, appeared at the door. Her small, tired face was coldly lighted with a pair of large gray eyes.She stood still in a halo of authority, while over the rim of her spectacles her eyes pried nervously about the room. Having glanced at her long list of names and called out the first one, she tossed up her chin and peered through the crystals of her spectacles to make sure of the answer "Here."Relentlessly her pencil black-marked our daily records if we were not present to respond to our names, and no chum of ours had done it successfully for us. No matter if a dull headache or the painful cough of slow consumption had delayed the absentee, there was only time enough to mark the tardiness. It was next to impossible to leave the iron routine after the civilizing machine had once begun its day's buzzing; and as it was inbred in me to suffer in silence rather than to appeal to the ears of one whose open eyes could not see my pain, I have many times trudged in the day's harness heavy-footed, like a dumb sick brute.Once I lost a dear classmate. I remember well how she used to mope along at my side, until one morning she could not raise her head from her pillow. At her deathbed I stood weeping, as the paleface woman sat near her moistening the dry lips. Among the folds of the bedclothes I saw the open pages of the white man's Bible. The dying Indian girl talked disconnectedly of Jesus the Christ and the paleface who was cooling her swollen hands and feet.I grew bitter, and censured the woman for cruel neglect of our physical ills. I despised the pencils that moved automatically, and the one teaspoon which dealt out, from a large bottle, healing to a row of variously ailing Indian children. I blamed the hard-working, well-meaning, ignorant woman who was inculcating in our hearts her superstitious ideas. ReferenceAmerican Indian Stories: https://www.gutenberg.org/ebooks/10376 Thierry J, Brenneman G, Rhoades E, Chilton L. History, law, and policy as a foundation for health care delivery for American Indian and Alaska native children. Pediatr Clin North Am. 2009 Dec;56(6):1539-59.Rhoades ER, Rhoades DA. The public health foundation of health services for American Indians & Alaska Natives. Am J Public Health. 2014 Jun;104 Suppl 3(Suppl 3):S278-85. doi: 10.2105/AJPH.2013.301767. Epub 2014 Apr 23. https://www.ihs.gov/newsroom/factsheets/disparities/ Accessed 1.17.22Kovich H. Rural Matters - Coronavirus and the Navajo Nation. N Engl J Med. 2020 Jul 9;383(2):105-107. doi: 10.1056/NEJMp2012114. Epub 2020 Apr 24.

Natural disasters are increasing in intensity and severity and companion animals are often adversely impacted however they have not been included in evacuation plans historically, so communities and rescue organizations need to work together to provide adequate resources for companion animal owners in preparation for disasters. Episode Hosts: Michelle Ledru, Megan Sekiya Course Coordinators & Podcast Ringmasters: Colleen Duncan, Molly Carpenter, Treana Mayer Audio Engineer: Ethan Fagre Special Guests: Dr. Ragan Adams, Erik Thompson Episode Notes In the most recent IPCC report, it was stated that extreme weather events are becoming more frequent and severe. Humans and animals alike will be negatively impacted by these natural disasters. In Hurricane Katrina, Snowball, a little dog that could not get on the evacuation bus with his child owner spurred the PETS act. This act states that FEMA will only provide funds to organizations that include plans for the rescue and essential needs of animals. This episode covers the progress that's been made in disaster planning since the PETS act was implemented and how you can be prepared for a natural disaster before it hits your area. References Chadwin R. Evacuation of Pets During Disasters: A Public Health Intervention to Increase Resilience. Am J Public Health. 2017;107(9):1413-1417. doi:10.2105/AJPH.2017.303877 Farmer A. K. and DeYoung S. E. The Pets of Hurricane Matthew: Evacuation and Sheltering with Companion Animals. Anthrozoös. 2019; 32(3):419-433. DOI: 10.1080/08927936.2019.1598661 Glassey S. Did Harvey Learn from Katrina? Initial Observations of the Response to Companion Animals during Hurricane Harvey. Animals. 2018; 8(4):47. https://doi.org/10.3390/ani8040047 Hoegh-Guldberg, O., D. Jacob, M. Taylor, M. Bindi, S. Brown, I. Camilloni, A. Diedhiou, R. Djalante, K.L. Ebi, F. Engelbrecht, J. Guiot, Y. Hijioka, S. Mehrotra, A. Payne, S.I. Seneviratne, A. Thomas, R. Warren, and G. Zhou, 2018: Impacts of 1.5ºC Global Warming on Natural and Human Systems. In: Global Warming of 1.5°C. An IPCC Special Report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty [Masson-Delmotte, V., P. Zhai, H.-O. Pörtner, D. Roberts, J. Skea, P.R. Shukla, A. Pirani, W. Moufouma-Okia, C. Péan, R. Pidcock, S. Connors, J.B.R. Matthews, Y. Chen, X. Zhou, M.I. Gomis, E. Lonnoy, T. Maycock, M. Tignor, and T. Waterfield (eds.)]. In Press.

In keeping with this month's spooky theme, here are the TRUE EVENTS that inspired Wes Craven's classic horror film, A Nightmare on Elm Street. SOURCEShttps://www.nytimes.com/1981/05/10/us/nightmares-suspected-in-bed-deaths-of-18-laotians.htmlSudden death in sleep of Laotian-Hmong refugees in Thailand: a case-control study; R G Munger; Am J Public Health. 1987 September; 77(9): 1187–1190.Refugee Stress and Folk Beliefs: Hmong Sudden Deaths; Shelley R. Adler https://moodle.swarthmore.edu/pluginfile.php/80112/mod_resource/content/0/Adler-_Hmong_Sudden_Deaths.pdfhttps://www.theatlantic.com/health/archive/2011/09/the-dark-side-of-the-placebo-effect-when-intense-belief-kills/245065/https://www.cdc.gov/mmwr/preview/mmwrhtml/00001278.htmhttps://www.vulture.com/2014/10/nightmare-on-elm-street-oral-history.html

Content warning: today's episode discusses domestic violence. We also appreciate your patience with this episode as we know it is a few weeks behind our usual schedule! Thank you all for your support. Short SMOA listener story: bit.ly/smoasurvey In this episode, Anna Mullany discusses the interrelationship between domestic abuse, capitalism and political economy, patriarchy, and the teaching of social medicine. She discusses the history of the anti-domestic violence movement, the violence of the state, the rise of the carceral state, and the 'social problem apparatus.' She also shares stories from students learning about structural violence and social medicine in the classroom. In combining the micro and macro, she points a way towards emancipation for all. Anna Mullany is a 4th year doctoral student at the School of Public Health and Health Sciences at the University of MA Amherst. The focus of her doctoral work is on rural intimate partner violence and social services. Taking a political economic perspective, she looks at how the structural determinants of health determine people's wellbeing and daily lives within capitalism. She is committed to investigating how we create a truly equitable world in which health for all is a reality. She teaches courses on "Health Communication" and "Population Health and Imperialism" to undergraduates in the Public Health Department at UMass Amherst. Additionally, she is on faculty with the Spark Teacher Education Institute in Brattleboro, VT. Prior to her doctoral studies she worked for 6 years at the Women's Freedom Center in Brattleboro, VT – a crisis center responding to intimate partner violence. Anna also serves as a one of the hosts of Indigo Radio, a weekly radio show on the Brattleboro Community Radio Station WVEW, broadcasts of which focus on connecting local and global issues. Recommended Resources: Harvey M. How Do We Explain the Social, Political, and Economic Determinants of Health? A Call for the Inclusion of Social Theories of Health Inequality Within U.S.-Based Public Health Pedagogy. Pedagogy in Health Promotion. 2020;6(4):246-252. bit.ly/3iNgzNX Gimenez, M. Capitalism and the Oppression of Women: Marx Revisited. Science & Society, 2005;69(1), 11-32. bit.ly/3kTxbGA Waitzkin, H. "The Social Origins of Illness: A Neglected History" in The Second Sickness: Contradictions of Capitalist Health Care (Lanham, MD: Rowman & Littlefield, 2000). bit.ly/3eUsJU5 Brown TM, Fee E. Rudolf Carl Virchow: medical scientist, social reformer, role model. Am J Public Health. 2006;96(12):2104-5. bit.ly/3x5cObK Indigo Radio, bit.ly/3kU4iu3 Spark Teacher Education, bit.ly/3BBRcr7

This episode is the first in a set of six Coffee and Science conversations on Assistance—health care sector activities that aim to reduce social risk by providing or linking patients with relevant social services. Nadia Islam, PhD, an associate professor in the Department of Population Health at NYU Langone, speaks with Maria Lemus, the executive director of Visión y Compromiso, an organization created and led by promotores that supports work to improve both individual and community wellbeing. Nadia and Maria explore the potential risks and benefits of formalizing roles for community health workers and promotores in the health care sector's social care workforce.Recommended references: Visión y Compromiso. Key Workforce Priorities for the Community Transformation Model. 2017. Islam N, Shapiro E, Wyatt L, Riley L, Zanowiak J, Ursua R, et al. Evaluating community health workers' attributes, roles, and pathways of action in immigrant communities. Prev Med. 2017. Islam N, Rogers ES, Schoenthaler A, Thorpe LE, Shelley D. A cross-cutting workforce solution for implementing community–clinical linkage models. Am J Public Health. 2020. Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 — Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020.

Summary by Gina: In this podcast, I will share some public understanding of AIDS. And the common misconception—the stigma of AIDS and its causes are the major focus. In this process, the differences between China and the United States in this social problem will be compared, so as to better understand the impact of this problem on AIDS patients and put forward corresponding measures. In addition, the inclusion of interview clips not only strengthens the persuasive force of the explanation but also makes the audience feel the importance of the issue more directly. References 曹越, 黄笛, 刘小平, 郭昫澄, 李十月, 燕虹, 孟详喻, 方程, 曾宪涛. (2018). 中国医务人员艾滋病污名现状 meta 分析. 中国公共卫生, 34(8), 1182–1186. 段文杰, 李玉梅, 何啊龙, & 吴桐. (2021). 基于未感染者与感染者双重视角的艾滋病污名.心理科学进展, 29(2), 323.高晓虹. 中国新闻传播研究 2016 (上). BEIJING BOOK CO. INC., 2017. Bazzi, A. R., Drainoni, M. L., Biancarelli, D. L., Hartman, J. J., Mimiaga, M. J., Mayer, K. H., & Biello, K. B. (2019). Systematic review of HIV treatment adherence research among people who inject drugs in the United States and Canada: evidence to inform pre-exposure prophylaxis (PrEP) adherence interventions. BMC public health, 19(1), 1-10. Blake, Turan, J. M., Atkins, G., Kempf, M. -C., Clay, O. J., Raper, J. L., & Turan, B. (2017). Interpersonal mechanisms contributing to the association between HIV-related internalized stigma and medication adherence. AIDS and Behavior, 21(1), 238–247 Galindo, G. R. (2013). A loss of moral experience: Understanding HIV-related stigma in the New York City House and Ball Community. Am J Public Health, 103(2), 293–299 Katz, I. T., Ryu, A. E., Onuegbu, A. G., Psaros, C., Weiser, S. D., Bangsberg, D. R., & Tsai, A. C. (2013). Impact of HIV-related stigma on treatment adherence: Systematic review and meta-synthesis. Journal of the International AIDS Society, 16, 18640 Pantelic, Marija, Laurel Sprague, and Anne L. Stangl. (2019). "It's not “all in your head”: critical knowledge gaps on internalized HIV stigma and a call for integrating social and structural conceptualizations." BMC infectious diseases, 19(1), 1-8. World Health Organization. 2020, "Number of people (allages) living with HIV: Estimates by WHO Region". Retrieved April 4, 2020 from https://apps.who.int/gho/data/view.main.22100WHO?lang=en

Are you concerned about the long term impact of some of the pandemic “safety” measures? Feeling more disconnected from nature than ever? Tune in to hear Ali and Becki discuss why the microbiome matters, how our current industrialized society may be doing damage and how getting in the dirt can help!    In this episode, Ali and Becki unpack how disconnection and social isolation can actually drive imbalance in the body and harm to our microbiome. Learn how masking and overuse of disinfectants can contribute to sterility and how we are already set up for dysbiosis via our disconnect from the natural world. Plus learn about emerging research in the area of the “Microbioscape” or the interaction between our microbiome and environment and how getting in nature can help you to reconnect on a whole body level!    Also in this episode: YouTube Videos:All About Probiotics Signs of Dysbiosis & How to Do a Probiotic Challenge Beat the Bloat Gut Cleanse 5 Ways to Cope with a Gut Cleanse Podcast Episodes:Episode 22: Candida Albicans Episode 60: Dysbiosis and the Microbiome Episode 87: The Gut Brain Axis Episode 131 Candida and SIBO Deep Dive Episode 174: The Dysbiosis Disease Connection Episode 198: So You're On An Antibiotic Episode 210: Herxheimer Reactions and Coping with a Cleanse Why the Microbiome Matters Why Disconnection Drives DiseaseSafer Cleaning Products: Branch Basics use code ALIMILLERRD Wine without Glyphosate: Dry Farms Wine use this link to get a penny bottle! Masks and the Microbiome How the Microbiome Influences Gene Expression The Importance of Nature to our Microbiome Prebiotics and Short Chain Fatty Acids Do We Still Need to Take Probiotics?Probiotic Challenge Restore Baseline Probiotic  Targeted Strength Probiotic Beat the Bloat Updates - Get the Ebook for $1.99 with code BEATTHEBLOAT Beat the Bloat Bundle Studies Discussed: Robinson JM, Jorgensen A. Rekindling old friendships in new landscapes: the environment-microbiome-health axis in the realms of landscape research. People Nat. 2020;2:339-349. doi:1002/pan3.10082 Dong TS, Gupta A. Influence of early life, diet, and the environment on the microbiome. Clin Gastroenterol Hepatol. 2019;17(2):231-242. doi:1016/j.cgh.2018.08.067 Tasnim N, Abulizi N, Pither J, Hart MM, Gibson DL. Linking the gut microbial ecosystem with the environment: does gut health depend on where we live? Front Microbiol. 2017;8:1935. doi:3389/fmicb.2017.01935 Ruokolainen L, von Hertzen L, Fyhrquist N, et al. Green areas around homes reduce atopic sensitization in children. Allergy. 2015;70(2):196-202. doi:1111/all.12545 Hanski, I, von Hertzen L, Fyhrquist N, et al. Environmental biodiversity, human microbiota, and allergy are interrelated. Proc Natl Acad Sci U S A. 2012;109(21):8334-8339. doi:1073/pnas.1205624109 Maier J, Jette S. Promoting nature-based activity for people with mental illness through the US “Exercise Is Medicine” initiative. Am J Public Health.2016;106(5):796-799. doi:2105/ajph.2016.303047   Sponsors for This Episode: This episode is sponsored by the Naturally Nourished supplement line: these pure, potent and effective formulas have been hand selected to deliver profound health benefits. We price our formulas 2-5% below market industry standard and competitors and guarantee that our products will always be third party assessed to ensure they are free of mold, toxins, contaminants, and contain the stated active ingredients in dosages noted.  Use code ALI15 for 15% off your first Naturally Nourished Supplement Order!    This episode is also sponsored by FOND Bone Broth Tonics, Your Sous Chef in a Jar. FOND is slow simmered and lovingly tended from simmer to seal. They partner with organic farms and hand-pick and pair ingredients to optimize absorption and taste. Use code ALIMILLERRD to save at fondbonebroth.com.  

Today's episode discusses our prison system and how it not only affects the person going to prison but also the entire community. Dr. Des and Ms. Tae discuss how increased incarceration rates have led to an increase in teenage pregnancy's and sexually transmitted infections in black and brown communities. They also dive into the current system and how there is a need for more programs to assist the incarcerated and their loved ones with a smooth transition back into society. The article mentioned in this episode: James C. Thomas, PhD, MPH, and Elizabeth Torrone, MSPH. Incarceration as Forced Migration: Effects on Selected Community Health Outcomes. Am J Public Health. 2006;96:1762–1765. doi:10.2105/AJPH.2005.081760. Join DA Health Connect & Black Girls Do Public Health on February 25th at 7pm, as we dive into topics discussed on the DA Health Connect Podcast! The Public Health Run Down is a time to share your opinion, and jump in the conversation to increase health equity within everything we do! Register Here--->https://famu.zoom.us/meeting/register/tJEsceisrTkjHdekJe5A1y9DYYteCbeQGt_h Space is limited so sign up asap! See you February 25th at 7pm!!!! Make sure you follow us on Clubhouse, Instagram, and Facebook, where we talk more about this episode & give some tips to continue the conversation about Health Equity. [ https://instagram.com/dahealthconnect ] [Clubhouse: @DrDes & @ar.taee] Do not forget to subscribe, rate, follow, and share this podcast! Please leave us your thoughts in the comments section as well!

Dr. Toyin Ajayi, Co-founder and Chief Health Officer at Cityblock Health speaks with Dr. Monica Peek, associate professor of General Internal Medicine at the University of Chicago. This conversation is the second in a series focused on health care sector efforts to increase Awareness about both patient and community-level social conditions. Drs. Ajayi and Peek discuss concerns structurally marginalized people may have in spaces like health care in and outside the context of social risk screening and explore ways health care organizations can earn trust and build rapport with patients of color.Recommended references: Peek ME, Odoms-Young A, Quinn MT et al. Racism in healthcare: Its relationship to shared decision-making and health disparities: A response to Bradby. Soc Sci Med. 2010;71:13-17. Peek ME, Nunez-Smith M, Drum M, Lewis TT. Adapting the Everyday Discrimination Scale to medical settings: Reliability and validity testing in a sample of African-American patients. Ethn Dis. 2011;21(4):502-9. Peek ME, Lopez F, Williams HS et al. Development of a conceptual framework for understanding Shared Decision-Making among African-American LGBT patients and their clinicians. J Gen Intern Med. 2016;31(6):677-87. Tung EL, Johnson TA, O'Neal Y, Steenes AM, Caraballo G, Peek ME. Experiences of Community Violence Among Adults with Chronic Conditions: Qualitative Findings from Chicago. J Gen Intern Med. 2018;33(11): 1913-1920. Tung EL, Cagney K, Hawkley L, Peek ME. Social Isolation, Loneliness, and Violence Exposure in Urban Adults. Health Affairs. 2019;10;2670-2678. Peek ME, Vela MD, Chin MH. Practical lessons for teaching about race and racism: Successfully leading free, frank and fearless discussions. Acad Med. 2020;95:S139–S144. Peek ME, Simons R, Parker WF et al. Our Collective Obligation: An Action Plan for Mitigating COVID-19 Disparities. Am J Public Health. Persad G, Peek ME, Emanuel EJ. Fairly Prioritizing Groups for COVID-19 Vaccine Access. JAMA. 2020;324(16):1601-2.

 Dr. Anand Shah, Vice President of Social Health at Kaiser Permanente speaks with Dr. Stacy Lindau, tenured professor at the University of Chicago, founder of NowPow, and president of MAPSCorps. This conversation is the first of several conversations about health care sector efforts to increase Awareness about both patient and community-level social conditions. Dr. Shah and Dr. Lindau share why whole person care matters to them personally and delve into the opportunities and challenges to taking social risk screening to scale. Some references mentioned by our speakers in this episode:  SIREN Coffee & Science Episode 0  NASEM. Integrating Social Care into the Delivery of Health Care. 2019.  CMS 2021 E&M code changes related to social determinants of health  Gottlieb LM, Hessler D, Long D, et al. Effects of social needs screening and in-person service navigation on child health: a randomized clinical trial. JAMA Pediatr. 2016:e162521.  Tong ST, Liaw WR, Kashiri PL, et al. Clinician experiences with screening for social needs in primary care. J Am Board Fam Med. 2018;31(3):351-363.  Lindau ST, Makelarski JA, Abramsohn EM, et al. CommunityRx: A real-world controlled clinical trial of a scalable, low-intensity community resource referral intervention. Am J Public Health. 2019:e1-e7.  Wilson JMG, Jungner G, World Health Organization. Principles and practice of screening for disease. 1968.  Dr. Lindau's disclosure statement: Under the terms of Grant Number 1C1CMS330997-01-00 (Lindau, PI) from the Department of Health and Human Services, Centers for Medicare & Medicaid Services we were expected to develop a sustainable business model which will continue and support the model that we tested after award funding ends. I am the founder and owner of a social impact company NowPow, LLC and president of MAPSCorps, 501(c)(3). Neither the University of Chicago nor UChicago Medicine is endorsing or promoting NowPow or its business, products, or services. I will not discuss off label use or investigational use in my presentation. 

Diana M. Martinez, MD, conducts a Masterclass on marijuana’s effects on psychiatric disorders. Dr. Martinez, a professor of psychiatry at Columbia University, New York, specializes in addiction research. She disclosed receiving medication (cannabis) from Tilray for one study and has no other financial relationships with this company. Take-home points The use of cannabis, recreationally and medically, has been a controversial topic for ages, and the classification of cannabis as a schedule I controlled substance has made it all the more difficult to research and meaningfully understand its harms and benefits. Based on information from the National Academies of Sciences publication Health Effects of Marijuana: An Evidence Review and Research Agenda, Dr. Martinez presents a sweeping overview of the role of cannabis in two domains: Its ability to worsen psychiatric symptoms, and its role in causing psychiatric disorders. The cannabis plant has 100 cannabinoids. The two most commonly studied are tetrahydrocannabinol (THC), which creates the "high," and cannabidiol (CBD), which does not create a high and has many subjective effects. Cannabis is researched and used in several forms, including the smoked plant or flower form, and prescription cannabinoids based on THC – namely dronabinol (Marinol), nabilone (Cesamet), and CBD. Research suggests that both benefits and risks are tied to using cannabis and cannabinoids. Clinicians should have rational discussions with their patients about the use of cannabis. If patients are no longer responding to psychiatric treatment, and the clinician wants to talk about their cannabis use, it is important to understand the common reasons patients use cannabis, including for chronic pain, anxiety, and insomnia. Benefits There is substantial evidence supporting the use of cannabis and cannabinoids for the treatment of chronic pain. Most studies evaluated the smoked or vaporized form. Research suggests a dose of 5-20 mg of oral THC is about as effective as 50-120 mg of codeine, although there are few head-to-head studies to reinforce this finding. Cannabis will likely have a role in the pain treatment armamentarium. The risks of use include intoxication and development of an addiction. Cannabinoids may have a role in achieving abstinence from addiction to cannabis and other substances. THC in the form of cannabinoids shows some promise for its use in disorders such as PTSD and obsessive-compulsive disorder, but larger controlled studies are needed. In addition, cannabinoids have an effect when combined with other behavioral interventions, such as exposure therapy. Risks There is substantial evidence that cannabis has a moderate to large association with increased risk of developing psychotic spectrum disorders in a dose-dependent fashion, particularly in patients who are genetically vulnerable. Moderate evidence suggests that cannabis causes increased symptoms of mania and hypomania in people with bipolar disorder who use it regularly. Cannabis can cause addiction. About 9% of people who use it will develop a substance use disorder, and the risk of developing a substance use disorder increases to 17% in people who start using cannabis in their teenage years. Frequent cannabis use is associated with withdrawal symptoms, such as irritability, sleep problems, cravings, decreased appetite, and restlessness. References National Academies of Sciences, Engineering, and Medicine. Health Effects of Marijuana: An Evidence Review and Research Agenda. Washington, DC: National Academies Press, 2017. Whiting PF et al. JAMA. 2015;313(24):2456-73. Fischer B et al. Am J Public Health. 2017 Jul 12. doi: 10.2105/AJPH.2017.303818. *  *  * Show notes by Jacqueline Posada, MD, associate producer of the Psychcast; assistant clinical professor in the department of psychiatry and behavioral sciences at George Washington University, Washington; and staff physician at George Washington Medical Faculty Associates, also in Washington. Dr. Posada has no conflicts of interest. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com  

Given the COVID-19 pandemic there is an urgent need for us to better understand how scientific evidence generated in epidemiologic research gets translated into information that can be used to create public health policy. In this episode of SERious Epidemiology, we talk with Dr. Laura Rosella about data driven public health, the role of epidemiology in public health, and more broadly, the importance of knowledge translation for epidemiologists. After listening to this podcast, if you are interested in learning more about the intersection of epidemiology and public health some resources are included below: How’s my flattening: A centralized data analytics and visualization hub monitoring Ontario's response to COVID-19 Link: howsmyflattening.ca Definitions of epidemiology, including references to the definition Dr. Rosella mentioned from McMahon and Pugh’s epidemiology textbook (1970): Frérot M, Lefebvre A, Aho S, Callier P, Astruc K, Aho Glélé LS. What is epidemiology? Changing definitions of epidemiology 1978-2017. PLoS One. 2018;13(12):e0208442. doi:10.1371/journal.pone.0208442 Terris, M. Approaches to an Epidemiology of Health. Am J Public Health. 1975; 65(10) https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.65.10.1037#:~:text=Introduction,.%221I%20This%20definition%20repre%2D The use of scientific evidence for public health decision making: Rosella LC, Wilson K, Crowcroft NS, Chu A, Upshur R, Willison D, Deeks SL, Schwartz B, Tustin J, Sider D, Goel V. Pandemic H1N1 in Canada and the use of evidence in developing public health policies--a policy analysis. Soc Sci Med. 2013 Apr;83:1-9. doi: 10.1016/j.socscimed.2013.02.009. Agent-based modeling Tracy M, Cerdá M, Keyes KM. Agent-Based Modeling in Public Health: Current Applications and Future Directions. Annu Rev Public Health. 2018 Apr 1;39:77-94. doi: 10.1146/annurev-publhealth-040617-014317. Additional info on agent-based modeling: https://www.publichealth.columbia.edu/research/population-health-methods/agent-based-modeling  

The COVID-19 pandemic laid bare the racial health disparities in the United States, with markedly increased mortality especially among Blacks and Native Americans. In this episode, Tony Breu and I discuss the conception of race, racism, and the social determinants of health through three historic plagues in the United States -- from yellow fever in New Orleans, to poliomyelitis, and finally the early days of HIV/AIDS -- and what lessons we can draw for COVID-19. Along the way, we’ll discuss the unique social capital afforded by acclimation, immunity passports, the concept of the “original antigenic sin,” and constitutionalism and eugenics. This presentation was performed live at the annual meeting of the Massachusetts American College of Physicians, and is only lightly edited.   SOURCES:   Monath TP, Yellow fever: an update. Lancet Infect Dis. 2001 Aug;1(1):11-20. doi: 10.1016/S1473-3099(01)00016-0. Kallas EG, D'Elia Zanella LGFAB, Moreira CHV, Buccheri R, Diniz GBF, Castiñeiras ACP, Costa PR, Dias JZC, Marmorato MP, Song ATW, Maestri A, Borges IC, Joelsons D, Cerqueira NB, Santiago E Souza NC, Morales Claro I, Sabino EC, Levi JE, Avelino-Silva VI, Ho YL. Predictors of mortality in patients with yellow fever: an observational cohort study. Lancet Infect Dis. 2019 Jul;19(7):750-758. doi: 10.1016/S1473-3099(19)30125-2. Epub 2019 May 16. Erratum in: Lancet Infect Dis. 2019 Nov;19(11):e370. PMID: 31104909. Blake LE, Garcia-Blanco MA. Human genetic variation and yellow fever mortality during 19th century U.S. epidemics. mBio. 2014 Jun 3;5(3):e01253-14. doi: 10.1128/mBio.01253-14. PMID: 24895309; PMCID: PMC4049105. Jelili Ojodu, MPH1, Mary M. Hulihan, MPH2, Shammara N. Pope, MPH2, Althea M. Grant, PhD2,, MMWR, Incidence of Sickle Cell Trait — United States, 2010. IthaMaps, Haemoglobin Epidemiology. https://www.ithanet.eu/db/ithamaps?country=GR Serjeant GR, The natural history of sickle cell disease. Cold Spring Harb Perspect Med. 2013 Oct; 3(10): a011783. Hamosh A, FitzSimmons SC, Macek M Jr, Knowles MR, Rosenstein BJ, Cutting GR. Comparison of the clinical manifestations of cystic fibrosis in black and white patients. J Pediatr. 1998 Feb;132(2):255-9. doi: 10.1016/s0022-3476(98)70441-x. PMID: 9506637. Gershman KD et al, Yellow Fever Vaccine & Malaria Prophylaxis Information, by Country. CDC.  Kofler N and Baylis F, Ten reasons why immunity passports are a bad idea. Nature 21 May 2020. NASEM, National Academies Release Framework for Equitable Allocation of a COVID-19 Vaccine for Adoption by HHS, State, Tribal, Local, and Territorial Authorities. Schmidt H et al, Covid-19: how to prioritize worse-off populations in allocating safe and effective vaccines.BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3795 (Published 05 October 2020). Siegal FP, Lopez C, Hammer GS, Brown AE, Kornfeld SJ, Gold J, Hassett J, Hirschman SZ, Cunningham-Rundles C, Adelsberg BR, et al. Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. N Engl J Med. 1981 Dec 10;305(24):1439-44. doi: 10.1056/NEJM198112103052403. PMID: 6272110. Lushniak BD, Surgeon General’s Perspectives. Public Health Rep. 2014 Mar-Apr; 129(2): 112–114. Booske BC et al, “Different Perspectives For Assigning Weights to Determinants of Health,” University of Wisconsin Population Health Institute.  Marc LG et al,HIV among Haitian-born persons in the United States, 1985–2007, AIDS. Author manuscript; available in PMC 2011 Aug 24. Rogers N, Race and the Politics of Polio: Warm Springs, Tuskegee, and the March of Dimes. Am J Public Health. 2007 May; 97(5): 784–795. Curran JW and Jaffe HW, AIDS: the Early Years and CDC’s Response. MMWR. Olivarius Kathryn, Immunity, Capital, and Power in Antebellum New Orleans. The American Historical Review, Volume 124, Issue 2, April 2019, Pages 425–455,

Richard Balon, MD, returns to the Psychcast, this time to conduct a Masterclass on the impact of marijuana use on patients, particularly adolescents. Dr. Balon is professor of clinical psychiatry and anesthesiology and associate chair of education at Wayne State University in Detroit. He has no disclosures. Take-home points Marijuana remains a controversial topic as potential legalization looms large in public policy and various groups espouse the positive benefits of marijuana. Current marijuana formulations are more potent than formulations used in previous years. Formulations used today have a higher tetrahydrocannabinol content, with up to 80% THC content achieved through artificial selection. Clinicians are rightly concerned about the well-established negative effects of marijuana on specific populations, particularly adolescents. They also worry about the effect of marijuana on brain development, which could affect educational outcomes, and the significant risk of developing psychosis and/or schizophrenia after using marijuana. Newer research on marijuana use is also suggesting other negative health outcomes, including a potential link between marijuana use and an increased risk of developing various types of cancer. Summary Research over the past 20 years has elucidated the negative effects of marijuana on brain health and development. Marijuana use undermines cognitive function, including executive function and educational outcomes. Longitudinal and twin studies show a decline in the IQ of adolescents who have used marijuana. This is congruent with other established research and public health guidelines urging individuals to avoid the use of psychoactive drugs before the brain finishes maturing at approximately age 25 years. In 2016, Nora D. Volkow, MD, director of the National Institute on Drug Abuse, and other leading investigators in the field published a review of the literature discussing the impact of marijuana cognitive capacity, amotivational syndrome, and the risk of psychosis. Ample evidence based on neuropsychological testing demonstrates a negative impact of marijuana on learning and working memory. Cannabis amotivational syndrome manifests as apathy, reduced concentration, and an inability to follow routines or master new material. Evidence demonstrates that long-term heavy cannabis use is associated with educational underachievement and impaired motivation. Marijuana use is considered a preventable risk factor for the development of psychosis and schizophrenia. Any use of marijuana is estimated to double the risk of schizophrenia, accounting for 8%-14% of cases, and those at greatest risk include adolescents who start at an early age, engage in heavy use, and use high-potency THC. There is limited evidence about the effect of marijuana on PTSD, and a study using a large Veterans Affairs database suggests that marijuana may worsen PTSD symptoms and increase the risk of violence. A well-established physical outcome of heavy cannabis use is cannabis hyperemesis, defined as recurrent nausea, vomiting, and cramping abdominal pain tied to marijuana use. The symptoms may improve temporarily by taking a hot shower or bath. Though more research is required, low-strength evidence suggests that regular marijuana use may be associated with development of testicular germ cell tumors. The association of marijuana use with lung and oral cancer is unclear, partly because marijuana smokers often also smoke cigarettes. Given that we know the smoke in cigarettes is a major risk factor for heart disease, the same concerns must be investigated for individuals who smoke only marijuana. References Fischer B et al. Am J Public Health. 2017 Jul 12;107(8):e1-12. Volkow ND et al. JAMA Psychiatry. 2016;73(3):292-7. Lorenzetti V et al. Eur Neuropsychopharmacol. 2020 Jul;36:169-80. Fried P et al. CMAJ. 2002 Apr 2;166(7):887-91. Meier MH et al. Addiction. 2017 Jul;113:257-65. McAlaney J et al. Eur Addict Res. 2020 May 6;1-8. Ben Amar M, Potvin S. J Psychoactive Drugs. 2007;39:131-42. Wilkinson ST et al. J Clin Psychiatry. 2015 Sep;76(9):1174-80. Steenkamp MM et al. Depress Anxiety. 2017 Mar;34(3):207-16. Chocron Y et al. BMJ. 2019;366:l4336. Ghasemiesfe M et al. JAMA Netw Open. 2019;2(11):e1916318. Show notes by Jacqueline Posada, MD, who is associate producer of the Psychcast and consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va. Dr. Posada has no conflicts of interest. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com

Part 2 of this series explores how we began to measure antibody levels and how serotherapy evolved and was used to investigate multiple diseases (I’m looking at you, pneumonia). We’ll also learn how advances in laboratory techniques like electrophoresis paved the way for a better understanding of the antibody. Intro :11 In this episode :15 Recap of Part 1 :22 In this episode :53 The mechanism of action was theoretical 2:30 The story of convalescent serum 6:22 Pneumonia: “The captain of the men of death” 6:58 How culturing was done then 10:56 A big break: Isolating the antibody 14:26 A 30,000-foot look at pneumonia 17:13 Type 1 pneumonia trials 20:20 1918 influenza pandemic 23:31 Measles 27:59 The story of the antibody 30:30 More fun naming conventions 35:25 Cone fractionation 38:35 Quick summary 42:20 Thanks for listening! 44:27 Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Black CA. Immunol Cell Biol. 1997;doi: 10.1038/icb.1997.10. Bullowa JGM. JAMA. 1928;90:1354-1358. Cecil RL, Sutliff WD. JAMA. 1928;91:2035-2042. Felton LD. Boston Med Surg J. 1924;190:819-825. Hooper JA. LymphoSign Journal. 2015;2 181-194. Luke TC, et al. Ann Intern Med. 2006;145:599-609. McGuire LW, Redden WR. Am J Public Health. 1918. 741-744. McKhann CF, Chu FT. Am J Dis Child. 1933;45:475-479. Podolsky SH. Am J Public Health. 2005;95:2144-2154. Podolsky SH. J R Soc Med. 2009;102:203-207. Tiselius A, Kabat EA. J Exp Med. 1939;69:119-131.

Michelle Morse (@michellemorse) discusses race and antiracism in medicine. Beginning with Camara Jones' metaphor of the Gardener's Tale, she helps to imagine how medicine can work for the good of all and how medicine can move past its entanglements with racist ways of thinking and acting. Michelle Morse MD MPH is a physician, organizer, and social medicine leader who has cofounded EqualHealth, the Social Medicine Consortium, and three residency programs at the Mirebalais University Hospital. She is an assistent professor at Harvard Medical School, a Robert Wood Johnson Health Policy Fellow, and is currently working on the global Campaign Against Racism. Her recommended resources: Jones, C. P. (2000). Levels of racism: A theoretic framework and a gardener's tale. American Journal of Public Health, 90(8), 1212–1215. https://doi.org/10.2105/AJPH.90.8.1212. PDF. Jones CP, Truman BI, Elam-Evans LD, et al. Using "socially assigned race" to probe white advantages in health status. Ethn Dis. 2008;18(4):496-504. PDF. Ford CL, Airhihenbuwa CO. Critical Race Theory, race equity, and public health: toward antiracism praxis. Am J Public Health. 2010;100 Suppl 1(Suppl 1):S30-S35. doi:10.2105/AJPH.2009.171058. PDF. Tsai J, Ucik L, Baldwin N, Hasslinger C, George P. Race Matters? Examining and Rethinking Race Portrayal in Preclinical Medical Education. Acad Med. 2016;91(7):916-920. doi:10.1097/ACM.0000000000001232. Full text. Jee-Lyn García J, Sharif MZ. Black Lives Matter: A Commentary on Racism and Public Health. Am J Public Health. 2015;105(8):e27-e30. doi:10.2105/AJPH.2015.302706. Full text.

Derek M. Griffith, PhD, joints host Lorenzo Norris, MD, to discuss different ways to look at men’s health within the context of COVID-19. Dr. Griffith is founder and director of the Center for Research on Men’s Health at Vanderbilt University, Nashville, Tenn. He also serves as professor of medicine, health, and society at the university. Neither Dr. Griffith nor Dr. Norris have disclosures. And do not miss Renee Kohanski, MD, who offers a message of hope in the “Dr. RK” segment. Take-home points The confluence of the COVID-19 pandemic, the death of civil rights leader Rep. John Lewis, and the death of Herman Cain from COVID-19 requires us to reflect on race, gender, personal identity, and our own vulnerability. Sometimes denial in the form of thinking “that won’t happen to me” is a trope within masculinity, especially black masculinity, and can lead to men delaying preventive treatments and interventions, which makes them more vulnerable to excess morbidity and mortality from preventable diseases. Some research suggests that men are more likely to suffer severe effects of COVID-19 than women. Personal preference and agency are hallmarks of the American ethos, and those attitudes made it difficult to accept new and challenging information during the beginning of the COVID-19 pandemic. Ironically, this fierce autonomy is celebrated and demonized in the male identity and will have an effect on their behavior in the environment. In terms of mental health, we must consider how schemas influence behavior, and one’s ability to take in and act on relevant information. Any singular lens is limited when discussing an issue as complex as the current pandemic. Many perspectives must be examined if we are to work toward an effective solution. While society is examining COVID-19 morbidity and mortality through the lens of race, we may miss other essential perspectives, such as place, gender, age, etc. In a situation such as the COVID-19 pandemic, we must manage complexity by asking the hard questions. Dr. Norris asked Dr. Griffith to identify what factor in the pandemic we are missing from our current perspectives. Dr. Griffith suggested that our society continues to assume that we know more about COVID-19 than we actually know. Several times throughout the pandemic, we have assumed that we have it “figured out,” only to be shown that the SARS-CoV-2 virus is more unpredictable than we realize. Race, gender, age, and health disparities also will be at play when it comes time to test and administer a COVID-19 vaccine. References Griffith DM et al. Prev Chronic Dis. 2020;17:E63. Griffith DM et al. The COVID-19 elephant and the blind men of race, place, and gender. Gender & COVID-19.org. 2020 Jul 26. Elder K and Griffith DM. Am J Public Health. 2016 Jul;106(7):1157. doi: 10.2105/AJPH.2016.303237. Peters JW. Will Herman Cain’s death change Republican views on the virus and masks? New York Times. 2020 Jul 30. Cain H. This is Herman Cain!: My Journey to the White House. New York: Threshold Editions, 2011. Sharma G et al. JACC Case Rep. 2020 Jul 15;2(9):1407-10. Baker P et al. Lancet. 2020 Jun;395(10241):1886-8. Indini A et al. Crit Rev Oncol Hematol. 2020 Sep;153:103059. Chowkwanyun M and Reed AL. Racial disparities and COVID-19 – Caution and context. N Engl J Med. 2020 Jul 16;383:201-3. Centers for Disease Control and Prevention. Health equity considerations and racial and ethnic minority groups. Updated 2020 Jul 24. Show notes by Jacqueline Posada, MD, who is associate producer of the Psychcast and consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va. Dr. Posada has no conflicts of interest. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com

COVID-19 has brought up the use of the old remedy convalescent serum. What is it? Did it work? This series walks us through the history of the serum, how it was discovered, how it was first used, and how it inspired the field of immunology. Intro :11 In this episode :15 A quick tale :20 Outline of these three episodes 2:51 Quick definitions 3:50 How it all began 7:16 A solo paper on diphtheria 12:57 A trial of children 17:07 Giving fluids from a horse 21:57 What happened with tetanus? 25:12 Switching gears to our understanding of antibodies 27:09 The next target: snakes 29:17 The plague 32:00 Summary of Part 1, what’s next 39:05 Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Butler T. Clin Microbiol Infect. 2014;20:202-209. Crum FS. Am J Public Health. 1917;7:445. Eibl MM. Immunol Allergy Clin North Am. 2008;28:737-764, viii. Graham BS, Abrosino DM. Curr Opin HIV AIDS. 2015;10:129-134. Grundbacher FJ. Immunol Today. 1992;13:188-190. Hawgood BJ. Toxicon. 1999;37:1241-1258. Kantha SS. Keio J Med. 1991;40:35-39. Kaufmann SHE. mBio. 2017;8:e00117-17. Klass, Perri. “An Apocryphal Christmas Miracle.” The New York Times, The New York Times, 23 Dec. 2019, www.nytimes.com/2019/12/23/well/family/diphtheria-antitoxin-Christmas-miracle.html. Lindenmann J. Scand J Immunol. 1984;19:281-285. Meyer KF, et al. Ann N Y Acad Sci. 1952;55:1228-1274. Ramon G. Bull Soc Centr Med Vet. 1925;101:227-234. von Behring, Emil. Geschichte der Diphtherie (mit besonderer Berücksichtigung der Immunitätslehre). Leipzig, Germany, Thieme, 1893. von Behring E. Ueber das Zustandekommen der Diphtherie-Immunität und der Tetanus-Immunität bei Thieren. German Medical Weekly; 1890.

Roger S. McIntyre, MD, returns the Psychcast, this time to talk with host Lorenzo Norris, MD, about the mental health hazards of COVID-19 and what clinicians can do to help protect patients. Dr. McIntyre is professor of psychiatry and pharmacology, and head of the mood disorders psychopharmacology unit at the University Health Network at the University of Toronto. He disclosed receiving research or grants from the Stanley Medical Research Institute and the CIHR/GACD/National Natural Science Foundation of China. Dr. McIntyre also disclosed receiving consultation/speaker fees from several pharmaceutical companies. Dr. Norris has no disclosures.  Take-home points Uncertainty tied to the COVID-19 pandemic threatens to undermine mental health and exacerbate problems for those with mental illness. U.S. suicide rates, which were already rising after the Great Recession of 2007-2009, are likely to climb further because of the impact of COVID-19. Clinicians can take steps to prevent some of the negative mental health outcomes tied to the pandemic. Summary COVID-19 presents a triple threat to patients' mental health. The fear of viral infection is a mental health hazard. The financial shock that COVID-19 has had on the economy has not been seen since the Great Depression. Links between suicide and unemployment are powerful. In a study published in World Psychiatry, McIntyre and colleagues found associations between COVID-19 and major depression, PTSD, binge alcohol use, and substance use disorders. French social scientist Emile Durheim, PhD described the link between suicide and unemployment. Quarantining affects mental health, and there is nothing like COVID-19 in the history books. The Toronto experience with severe acute respiratory syndrome in 2003 offers lessons about the devastating impact of quarantining on mental health. “Deaths of despair” in the form of suicides have been on the increase in the United States. From the Great Recession, researchers found that for every 1% increase in unemployment, there is a commensurate 1% increase in suicide. U.S. unemployment stood at 8%-9% during the Great Recession, and now those percentages are much higher. Dr. McIntyre and his team projected that an unemployment rate of 14%-20% would lead to an additional 8,000-10,000 suicides could occur each year for the next 2 years. That’s in addition to the current number of approximately 50,000 suicides annually. Express Scripts, a pharmacy benefits manager, recently reported a 40% increase in prescriptions for anxiety-related medications. This suggests that people are distressed. Clinicians should take an aspirational approach to addressing these issues by pivoting to virtual platforms to increase patients’ access to care. Create medical homes that are HIPAA compliant. Look toward evidence-based models such as those found in Japan. That country found that, for every 0.2% increase in GDP spending on mental health care right after the Great Recession, the suicide rate fell by 1%. Encourage patients to structure the day and avoid consuming too much news or participating on social media. Two studies conducted in China found that people who spent more than 2-3 hours a day on news consumption were more likely to report clinical levels of depression, anxiety, and insomnia. Social media consumption has been associated with many adverse mental health outcomes, including loneliness. People who spent more than 3 hours a day were more likely to experience depression. Support programs for small-business people; jobs enhance resilience. Target the “basics” of self-care, such as getting enough sleep and engaging with others. References McIntyre RS, Lee Y. Psychiatry Res. 2020 May 19. doi: 10.1016/j.psychres.2020.113104. McIntyre RS, Lee Y. World Psychiatry. 2020 Jun;19(2):250-1. Shanahan L et al. Am J Public Health. 2012 Jun;109(6):854-8. Kang S, Chua HC. CMAJ. 2004 Mar 2;170(5):811-2. Express Scripts. America’s State of Mind Report. 2020 Apr 16. Lee Y et al. Psychiatry Clin Neurosci. 2020 Jul 1. doi: 10.1111/pch.13101. Hao F et al. Brain Behav Immun. 2020 Jul;87:100-6. Tan W et al. Brain Behav Immun. 2020 Jul;87:84-92. Wang C et al. Brain Behav Immun. 2020 Jul;87:40-8. Harvey SB et al. Am J Psychiatry. 2018 Jan 1;175(1):28-36. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com

Special guest Dr. Seema Yasmin (@DoctorYasmin) focuses on racial disparities in healthcare, their origins, and the severe impact on  COVID-19 patients of color. This NACE COVID-19 Update was recorded live during the Emerging Challenges in Primary Care May 30, 2020 virtual symposium. Seema Yasmin, MB BChirDirector, Stanford Health Communication InitiativeClinical Assistant Professor, Stanford UniversitySchool of MedicineStanford, CAFacultyNeil Skolnik, MD Professor of Family and Community Medicine Sidney Kimmel Medical College Thomas Jefferson UniversityPhiladelphia, PA Seema Yasmin, MB BChirDirector, Stanford Health Communication InitiativeClinical Assistant Professor, Stanford UniversitySchool of MedicineStanford, CAThis activity is not certified for CME/CE creditReferencesAPM Research Lab Staff. THE COLOR OF CORONAVIRUS:COVID-19 Deaths by race and ethnicity in the U.S., May 27, 2020 APM Research Lab.Braun L. Breathing race into the machine: the surprising career of the spirometer from plantation to genetics. Minneapolis: University of Minnesota Press, 2014.Chowkwanyun, Merlin,Reed, Adolph L. Racial Health Disparities and Covid-19 — Caution and Context. New England Journal of Medicine, May 6, 2020. Edwards, Erika. African Americans 'disproportionately affected' by coronavirus, CDC report finds. NBC News, April 8 2020. Geronimus AT, Hicken M, Keene D, Bound J. "Weathering" and age patterns of allostatic load scores among blacks and whites in the United States. Am J Public Health. 2006;96(5):826‐833. doi:10.2105/AJPH.2004.060749Molina N. Fit to be citizens? Public health and race in Los Angeles, 1879-1939. Berkeley: University of California Press, 2006.Roberts SK. Infectious fear: politics, disease, and the health effects of segregation. Chapel Hill: University of North Carolina Press, 2009.Strings, S. It's Not Obesity, It's SlaveryThe New York Times, May 25, 2020Wen, Leana S.  Four concepts to assess your personal risk as the U.S, . Wen, Leana S, 100,000 deaths later, there are no more excuses, The Washington Post, May 21, 2020. Yasmin, Seema, How Medicine Perpetuates the Fallacy of Race, Medscape, March 11, 2020. 

This week special guest Dr. Seema Yasmin (@DoctorYasmin) joins Dr. Leana Wen (@DrLeanaWen) and Moderator Dr. Neil Skolnik (@NeilSkolnik) for the Update.  Dr Wen provides a  public health update and presents four concepts for evaluating your risk of infection as practices reopen their doors. Dr Yasmin Dr. Yasmin's focuses on racial disparities in health care and the impact on  COVID-19 patients and practice. This NACE COVID-19 Update was recorded live during the Emerging Challenges in Primary Care May 30, 2020 virtual symposium. Be sure to read Dr Wen's and Dr Yasmin recent articles listed in the References at the end of this summary. FacultyNeil Skolnik, MD Professor of Family and Community Medicine Sidney Kimmel Medical College Thomas Jefferson UniversityPhiladelphia, PA Leana S. Wen, MD, MSc Visiting Professor, Health Policy and Management Distinguished Fellow, Fitzhugh Mullan Institute for Health Workforce Equity George Washington University School of Public Health Washington, DCSeema Yasmin, MDDirector, Stanford Health Communication InitiativeClinical Assistant Professor, Stanford UniversitySchool of MedicineStanford, CAThis activity is not certified for CME/CE credit.ReferencesAPM Research Lab Staff. THE COLOR OF CORONAVIRUS:COVID-19 Deaths by race and ethnicity in the U.S., May 27, 2020 APM Research Lab.Braun L. Breathing race into the machine: the surprising career of the spirometer from plantation to genetics. Minneapolis: University of Minnesota Press, 2014.Chowkwanyun, Merlin,Reed, Adolph L. Racial Health Disparities and Covid-19 — Caution and Context. New England Journal of Medicine, May 6, 2020. Edwards, Erika. African Americans 'disproportionately affected' by coronavirus, CDC report finds. NBC News, April 8 2020. Geronimus AT, Hicken M, Keene D, Bound J. "Weathering" and age patterns of allostatic load scores among blacks and whites in the United States. Am J Public Health. 2006;96(5):826‐833. doi:10.2105/AJPH.2004.060749Molina N. Fit to be citizens? Public health and race in Los Angeles, 1879-1939. Berkeley: University of California Press, 2006.Roberts SK. Infectious fear: politics, disease, and the health effects of segregation. Chapel Hill: University of North Carolina Press, 2009.Strings, S. It's Not Obesity, It's SlaveryThe New York Times, May 25, 2020Wen, Leana S.  Four concepts to assess your personal risk as the U.S, . Wen, Leana S, 100,000 deaths later, there are no more excuses, The Washington Post, May 21, 2020. Yasmin, Seema, How Medicine Perpetuates the Fallacy of Race, Medscape, March 11, 2020. 

⟩⟩ Emotionaler Schmerz (z.B.: Trauer, Einsamkeit, Ablehnung) ist für viele Menschen kein angenehmes Gefühl. Im Gegenteil: wir tun oft alles, um diesem Gefühl komplett aus dem Weg zu gehen. Auf eine gewissen Weise ist sogar unser gesamtes (reaktives) Enneagramm-Muster dienlich, um uns vor emotionalem Schmerz zu bewahren. Wir wollen darüber sprechen (inkl. einiger Studien) wie diese Emotionswelt unseren Körper physisch verändert, welche Relevanz sie für uns hat und wie wir am besten damit umgehen können. --- Quellen: - How your emotions change the shape of your heart | Sandeep Jauhar -- https://youtu.be/mwoLhdHRt_0 - Hidden Brain — You 2.0: The Empathy Gym — July 29, 20193:00 PM ET https://www.npr.org/2019/07/22/744195502/you-2-0-the-empathy-gym — https://www.npr.org/transcripts/744195502 - Hidden Brain — ep. 68 „Schadenfacebook“ — https://www.npr.org/templates/transcript/transcript.php?storyId=524005057 - Hidden Brain — Looking Back - https://www.npr.org/2018/06/21/622298227/radio-replay-looking-back - Francesco Pelliccia, Juan Carlos Kaski, Filippo Crea, and Paolo G. Camici. Pathophysiology of Takotsubo Syndrome. Originally published13 Jun 2017https://doi.org/10.1161/CIRCULATIONAHA.116.027121 — https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.116.027121 - Christian Templin, Jürgen Hänggi, Carina Klein, Marlene S Topka, Thierry Hiestand, Rena A Levinson, Stjepan Jurisic, Thomas F Lüscher, Jelena-Rima Ghadri, Lutz Jäncke. Altered limbic and autonomic processing supports brain-heart axis in Takotsubo syndrome. European Heart Journal, Volume 40, Issue 15, 14 April 2019, Pages 1183–1187, https://doi.org/10.1093/eurheartj/ehz068 — https://academic.oup.com/eurheartj/article/40/15/1183/5366976/ - Aron, Arthur, Helen Fisher, Debra J. Mashek, Greg Strong, Haifang Li, and Lucy L. Brown. Reward, motivation, and emotion systems associated with early-stage intense romantic love. J Neurophysiol 94: 327–337, 2005; doi:10.1152/jn.00838.2004 — http://web.mit.edu/fustflum/documents/papers/love.pdf - Hsu, D. T., Sanford, B. J., Meyers, K. K., Love, T. M., Hazlett, K. E., Wang, H., … Zubieta, J.-K. (2013). Response of the μ-opioid system to social rejection and acceptance. Molecular Psychiatry, 18(11), 1211–1217. doi:10.1038/mp.2013.96 — http://sci-hub.tw/10.1038/mp.2013.96 - Starr CJ, Sawaki L, Wittenberg GF, et al. Roles of the insular cortex in the modulation of pain: insights from brain lesions. J Neurosci. 2009;29(9):2684–2694. doi:10.1523/JNEUROSCI.5173-08.2009 — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748680/ - Eisenberger NI. The pain of social disconnection: examining the shared neural underpinnings of physical and social pain. Nat Rev Neurosci. 2012 May 3;13(6):421-34. doi: 10.1038/nrn3231. — https://www.ncbi.nlm.nih.gov/pubmed/22551663 — http://icpla.edu/wp-content/uploads/2016/10/Eisenberger-N.-The-Pain-of-Social-Disconnection-Examining-the-shared-neural-underpinnings-of-physical-and-social-pain.pdf - Eisenberger NI. The neural bases of social pain: evidence for shared representations with physical pain. Psychosom Med. 2012;74(2):126–135. doi:10.1097/PSY.0b013e3182464dd1 -- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273616/ - Segerstrom, S. C., & Miller, G. E. (2004). Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry. Psychological Bulletin, 130(4), 601–630. doi:10.1037/0033-2909.130.4.601 — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361287/ - Cannon WB. "Voodoo" death. American Anthropologist, 1942;44(new series):169-181. Am J Public Health. 2002 Oct;92(10):1593-6; discussion 1594-5. PMID: 12356599. PMC1447285. DOI: 10.2105/ajph.92.10.1593 https://doi.org/10.1525/aa.1942.44.2.02a00010 --- ⟩⟩ Fragen und Anregungen zum Podcast: podcast@enneagramgermany.de

Drs. Sheryl Heron and Camara Phyllis Jones join us to discuss race and how it affects our practice in the ED.   Objectives:  Debunk misunderstandings about the biological basis of race Analyze the relationship between race, social determinants of health, and health outcomes Discuss interventions that work to improve racial health disparities Predict how race may play a role in current policy and public health problems   Take-home points:  Race is a social, not biological, construction  Ancestry is poor marker genetics, and race a poor indicator of ancestry Racial health disparities are driven by racial disparities in social determinants of health Residential segregation is a large driver of disparities in SDH Working deliberately to treat racial groups similarly on individual and population levels is necessary to ameliorating racial health disparities   Additional resources:    Allegories on Race and Racism. Camara Jones, TEDxEmory https://www.youtube.com/watch?v=GNhcY6fTyBM   Cohan D, Racist Like Me — A Call to Self-Reflection and Action for White Physicians. N Engl J Med 2019; 380:805-807   Jones CP. Levels of Racism: A Theoretical Framework and a Gardener’s Tale. Am J Public Health 2000; 90:1212-1215    Williams DR, American A, Wyatt R. Racial Bias in Health Care and Health Challenges and Opportunities. JAMA 2015;314(6):555–6   Washington, HA. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.  Harlem Moon an imprint of DoubleDay Publishing 2007   Guests:   Sheryl L. Heron, MD, MPH, FACEP Sheryl Heron is a Professor and Vice Chair of Administrative Affairs in Emergency Medicine and an Assistant Dean of Medical Education and Student Affairs at Emory University. While her accomplishments are too numerous to list, her 20 year career in emergency medicine, academia and public health, has led to national recognition as an expert on diversity and inclusion in medicine. Dr. Heron has also lectured and published extensively on diversity and inclusion in medicine. Most recently, she served as co-editor of the textbook, Diversity and Inclusion in Patient Care.   Camara Phyllis Jones, M.D., M.P.H., Ph.D Jones is a former president of the American Public Health Association and Adjunct Professor at the Morehouse School of Medicine and Emory Rollins School of Public Health. She has also served as the Research Director on Social Determinants of Health and Equity in the Division of Adult and Community Health at the CDC. As a family physician and epidemiologist, Dr. Jones’s work focuses on the impacts of racism on the health and well-being of the nation. From TED talks to National Symposia, Dr. Jones’ allegorical pedagogy has elevated the national dialogue on race and health.   Contributors: John Lewis Dan Gingold Sean Schnarr Jenny Tsai

  Show Notes Jack Rozel, MD, returns to the MDedge Psychcast to discuss gun violence and a new report from the National Council for Behavioral Health. In episodes 29 and 33, Dr. Rozel talked with Lorenzo Norris, MD, host of the MDedge Psychcast and editor in chief of MDedge Psychiatry, about this topic in the wake of the shooting last year at the Tree of Life synagogue in Pittsburgh.  Dr. Rozel is medical director of resolve Crisis Services at the Western Psychiatric Institute and Clinic of the University of Pittsburgh. He also is president-elect of the American Association for Emergency Psychiatry and a member of the National Council. Dr. Rozel can be found on Twitter @ViolenceWonks. Later, Renee Kohanski, MD, discusses betrayal in the context of Erik Erikson’s conceptualization of trust vs. mistrust. Dr. Kohanski, a member of the MDedge Psychiatry Editorial Advisory Board, is a psychiatrist in private practice in Mystic, Conn. Show notes by Jacqueline Posada, MD, consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va.   Gun violence in the United States Mass violence with guns is a distinctly American problem occurring with greater frequency and severity in the United States, compared with other countries. The United States has a broad swath of firearm violence: Deaths by suicide account for 60% of gun deaths, and the remaining 40% are deaths by homicide. 1%-2% of homicides are completed in mass shootings, which are defined as an event in which a gunman indiscriminately shoots four or more people. Firearm homicides have been trending downward, while mass shootings have increased. Mass shootings might be influenced by media coverage; media exposure about mass shootings can incite possible perpetrators. Mass shootings are shown to cluster in ways similar to suicide contagion. Responses to mass shootings/violence The National Council for Behavioral Health addresses mass violence by releasing a new report: The report, called “Mass Violence in America: Causes, Impacts and Solutions,” was written by a group of 30 multidisciplinary experts, including Dr. Rozel. It was released in response to stigma and incorrect messages linking psychiatric diagnoses to mass violence. The report reviews models aimed at preventing violence and understanding threat assessment. Predicting violence and diffusing threats Pathway to violence is a model for predicting mass violence generated by data and analysis of violent acts by the Los Angeles Police Department, U.S. Capitol Police, U.S. Marshals Service, and the U.S. Secret Service. Grievances: Violence often starts with a grievance. Clinicians might be familiar with patients who are “grievance collectors” and do not get along with any person, whether at work, family, or society at large. The pivot: A transition from simply having a grievance to violent ideation and wanting vengeance through violence. Psychiatrists certainly will see people who express violent fantasies. Perpetrators of violence shift from fantasy into research about planning and preparing to attack. Clinicians want to identify the point at which people feel aggrieved and should become most concerned when these people begin to get certain fixations. Preparation: The person will start to acquire weapons and tactical clothing; probe into vulnerabilities of their targets, conduct “test attacks”; and eventually carry out the final attacks. Identification: The grievance stage is the most effective place to intervene, once the identification has been made, and potentially diffuse a violent outcome. The United States holds a unique position when it comes to gun ownership, violence The United States is one of the three countries in the world that allow citizen access to firearms in their constitutions. With 393 million civilian-held firearms, the United States has more civilian-owned firearms than the next 39 countries combined. India, which has 70 million civilian-held firearms, ranks No. 2. Regardless of what happens with gun control following each mass shooting, the guns already are out there in civilian hands. Behavioral health clinicians must talk with patients about firearms safety. A person living in the United States is 10 times more likely to die of firearm-related suicide and 25 times more likely to die of firearm-related homicide, compared with people living in other economically developed countries. Components of proposed legislation that could reduce gun violence: Increasing mental health access: Violent acts can be attenuated through access to mental health with anger-management classes and interventions at emotional regulation. Implementing universal background checks for gun purchases. Currently, this policy varies from state to state. Requiring a background check to obtain a concealed carry permit. Testing competency/shooting ability with guns before giving a permit. Increasing access to gun violence restraining orders, also called gun violence prevention orders. The restraining orders are aimed at temporarily stopping people who pose a threat to themselves or others by buying or possessing a firearm. The number needed to treat to prevent suicide with this type of restraining order is 11-20.  Education and research that could address the problem Research about the pathway to violence model and threat assessment can be used to create training for the array of professions that touch on violence – such as police, gun stores, teachers, and health care professionals. Training can focus on de-escalation and recognition of individuals at risk of perpetuating violence against themselves and others. Training for health care professionals should not be limited to just a psychiatry rotation, but also in emergency medicine and primary care, since gun violence affects patients within every field. Research into firearm violence prevention is incredibly underfunded, primarily because of the restrictions embedded in the Dickey Amendment. Named for the late Rep. Jay Dickey of Arkansas, the provision specifies that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” This amendment remains a huge obstacle to any group seeking to research gun violence. References Lankford A. Do the media unintentionally make mass killers into celebrities? An assessment of free advertising and earned media value. Celebr Stud. 2018;9(3):340-54. Knoll IV JL and GD Annas. Mass shootings and mental illness. In: Gold LH and RI Simon (eds). Gun Violence and Mental Illness. Arlington, Va.: American Psychiatric Association Publishing, 2016. Silver J et al. Foreshadowing targeted violence: Assessing leakage of intent by public mass murderers. Aggress Violent Behav. 2018;38:94-100. Metzl JM and KT MacLeish. Mental illness, mass shootings, and the politics of American firearms. Am J Public Health. 2015;105(2):240-9. Swanson JW et al. Gun violence, mental illness, and laws that prohibit gun possession: Evidence from two Florida counties. Health Aff (Millwood). 2016 Jun 1;35(6):1067-75. Van Dorn R et al. Mental disorder and violence: is there a relationship beyond substance use? Soc Psychiatry Psychiatr Epidemiol. 2012;47(3):487-503. Rahman T et al. Anders Breivik: extreme beliefs mistaken for psychosis. J Am Acad Psychiatry Law. 2016;44(1):28-35. National Council for Behavioral Health. Mass violence in America: Causes, impacts, and solutions. 2019 Aug. Mass shooters and murderers: Motives and paths. National Collaborating Centre for Mental Health. Violence and aggression: Short-term management in mental health, health and community settings.2019 Apr 1. Betz ME and GJ Wintemute. Physician counseling on firearm safety: A new kind of cultural competence. JAMA. 2015;314(5):449-50. District of Columbia v. Heller (2008). Rostron A. The Dickey amendment on federal funding for research on gun violence: A legal dissection. Am J Public Health. 2018 Jul;108(7):865-7. “More research could help prevent gun violence in America.” Rand Review. 2018 Jul 10.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych    

The first wave of the opioid crisis began in 1991 when physicians began to overprescribe narcotic analgesics for pain. Eventually, addiction led to abuse and the fatality rates began to climb. In response, the US government cracked down on narcotic prescriptions--leading a surge in the price of medical grade opioids. By 2010, the cost of pharmacologic opiates was unaffordable, and users reverted back to the (now cheaper) alternative, heroin. 2013 marked the third wave of the opioid crisis, whereby synthetic, high-potency opiates like fentanyl and carfentanyl were being infused into other opiate products. With each wave, the world witnessed a spike in the number of opioid-related deaths, and thus far, our solutions have only led to new problems. But there is more to the opioid crisis than the effect of opioids on the voluntary user. In 2017, we released a show highlighting the clinical consequences and management of opioid dependence on infants born to mothers who had used opioids during their pregnancy. This week, we have remastered the 2017 program and included an update at the end. Produced by James E. Siegler. Music courtesy of Little Glass Men, Jason Shaw, and Chris Zabriskie. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES McQueen K and Murphy-Oikonen J. Neonatal Abstinence Syndrome. The New England journal of medicine. 2016;375:2468-2479. Vlahov D, Des Jarlais DC, Goosby E, Hollinger PC, Lurie PG, Shriver MD and Strathdee SA. Needle exchange programs for the prevention of human immunodeficiency virus infection: epidemiology and policy. American journal of epidemiology. 2001;154:S70-7. Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014;134:e547-61. Hagan H, McGough JP, Thiede H, Weiss NS, Hopkins S and Alexander ER. Syringe exchange and risk of infection with hepatitis B and C viruses. American journal of epidemiology. 1999;149:203-13. Wodak A and Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006;41:777-813. Jarlenski M, Barry CL, Gollust S, Graves AJ, Kennedy-Hendricks A and Kozhimannil K. Polysubstance Use Among US Women of Reproductive Age Who Use Opioids for Nonmedical Reasons. Am J Public Health. 2017;107:1308-1310. Hudak ML, Tan RC, Committee On D, Committee On F, Newborn and American Academy of P. Neonatal drug withdrawal. Pediatrics. 2012;129:e540-60. Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM and Patrick SW. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004-2014. Pediatrics. 2018;141. MacMillan KDL, Rendon CP, Verma K, Riblet N, Washer DB and Volpe Holmes A. Association of Rooming-in With Outcomes for Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis. JAMA Pediatr. 2018;172:345-351. Gomez-Pomar E and Finnegan LP. The Epidemic of Neonatal Abstinence Syndrome, Historical References of Its' Origins, Assessment, and Management. Front Pediatr. 2018;6:33.

Florence Nightingale stands as one of the most important reformers of 19th century medicine -- a woman whose belief in the power of reason and statistical thinking would critically shape the both the fields of epidemiology and nursing. This episode discusses the fascinating story of Nightingale’s legacy -- how modern nursing was born out of the horrors of war, medical theories about poisonous air, the outsize influence of the average man, the first graph in history, and how a woman who died over a century ago presciently foresaw some of the most important scientific and social issues in medicine that are still with us today. Plus, a new #AdamAnswers about the doctor-nurse relationship.   Sources:   Beyersmann J and Schrade C, Florence Nightingale, William Farr and competing risks, Journal of the Royal Statistical Society: Series A (Statistics in Society) Volume 180, Issue 1 Fagin CM, Collaboration between nurses and physicians: no longer a choice. Academic Medicine. 67(5):295–303, May 1992. Fee E and Garofalo ME, Florence Nightingale and the Crimean War, Am J Public Health. 2010 September; 100(9): 1591. Garofalo ME and Fee E, Florence Nightingale (1820–1910): Feminism and Hospital Reform. Am J Public Health. 2010 September; 100(9): 1588. Halliday Stephen, Death and miasma in Victorian London: an obstinate belief. BMJ. 2001 Dec 22; 323(7327): 1469–1471. Hardy A, The medical response to epidemic disease during the long eighteenth century. Epidemic Disease in London, ed. J.A.I. Champion (Centre for Metropolitan History Working Papers Series, No.1, 1993): pp. 65-70. Jahoda G, Quetelet and the emergence of the behavioral sciences. Springerplus. 2015; 4: 473. Keith JM, Florence Nightingale: statistician and consultant epidemiologist. Int Nurs Rev. 1988 Sep-Oct; 35(5):147-50. Kopf EW, Florence Nightingale as statistician.. Res Nurs Health. 1978 Oct; 1(3):93-102. Kramer M, Schmalenberg C. Securing “good” nurse–physician relationships. Nurs Manage 2003;34(7):34-8. McDonald L Florence Nightingale and the early origins of evidence-based nursing Evidence-Based Nursing 2001;4:68-69. McDonald L, Florence Nightingale, statistics and the Crimean War, J. R. Statist. Soc. A (2014)177, Part 3, pp. 569–586. McDonald L, Florence Nightingale at First Hand, London and New York: Continuum, 2010. Oyler L, “It’s Really Sickening How Much Florence Nightingale Hated Women,” Vice Broadly, retrieved online at https://broadly.vice.com/en_us/article/kb4jd3/its-really-sickening-how-much-florence-nightingale-hated-women “Rank for Nurses,” The American Journal of Nursing, Vol. 20, No. 3 (Dec., 1919), pp. 241-24. Rowen L, The Medical Team Model, the Feminization of Medicine, and the Nurse's Role. AMA Journal of Ethics, Virtual Mentor. 2010;12(1):46-51. Soine AH, From Nursing Sisters to a Sisterhood of Nurses: German Nurses and Transnational Professionalization, 1836-1918, Published Dissertation, August 2009. Stein LI. The doctor–nurse game. Arch Gen Psychiatry 1967;16(6):699-703. Stein LI, et al. The doctor–nurse game revisited. N Engl J Med 1990;322(8):546-9. Young D A B. Florence Nightingale's fever BMJ 1995; 311 :1697.

Mari and MD sit down to talk about marriage equality, its history from Ancient Rome to today, and its influence on mental health. Follow us on Twitter: http://twitter.com/bi_positive 
Follow us on Tumblr: http://bipositivepodcast.tumblr.com
 Follow us on iTunes: https://itunes.apple.com/podcast/bipositive/id1351323613?mt=2 Email us at bipositivepodcast@gmail.com Sources: Marriage equality and mental health Am J Public Health. 2015 June; 105(6): 1101–1105. Published online 2015 June. doi:  [10.2105/AJPH.2015.302589] PMCID: PMC4431106 PMID: 25880959 Ben Lennox Kail, PhD, Katie L. Acosta, PhD, and Eric R. Wright, PhD Journal of Marriage and Family Volume 80, Issue 2 Brief Report Legal Marriage, Unequal Recognition, and Mental Health Among Same‐Sex Couples Allen J. LeBlanc David M. Frost Kayla Bowen First published: 08 January 2018 https://doi.org/10.1111/jomf.12460 Am J Public Health. 2013 February; 103(2): 339–346. Published online 2013 February. doi:  [10.2105/AJPH.2012.301113] PMCID: PMC3558785 PMID: 23237155 Richard G. Wight, PhD, MPH, Allen J. LeBlanc, PhD, and M. V. Lee Badgett, PhD

There is a lot of talk amongst medical professionals and the media about sitting being the new smoking. Is that true? How would we compare that? Even if that is not EXACTLY true, what's the harm if it scares people into moving more? This article is open access at the time this episode was released so click the link below to download! Evaluating the Evidence on Sitting, Smoking, and Health: Is Sitting Really the New Smoking? Vallance JK, Gardiner PA, Lynch BM, D'Silva A, Boyle T, Taylor LM, Johnson ST, Buman MP, Owen N. Am J Public Health. 2018 Sep 25:e1-e5. doi: 10.2105/AJPH.2018.304649. [Epub ahead of print] Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission

With the ongoing opioid crisis, not only those using opiates are affected. There has been an exponential rise in the incidence of neonatal abstinence syndrome--the multi-organ dysfunction experienced by newborns of mothers who are using opioid products and other substances. This week, we discuss the manifestations and ramifications of this disease, with a short commentary on implications of this global epidemic. Produced by James E. Siegler. Music by Little Glass Men, Jason Shaw, and Chris Zabriskie. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. This is no excuse to give your irritable baby opiates in their applesauce. REFERENCES McQueen K and Murphy-Oikonen J. Neonatal Abstinence Syndrome. The New England journal of medicine. 2016;375:2468-2479. Vlahov D, Des Jarlais DC, Goosby E, Hollinger PC, Lurie PG, Shriver MD and Strathdee SA. Needle exchange programs for the prevention of human immunodeficiency virus infection: epidemiology and policy. American journal of epidemiology. 2001;154:S70-7. Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014;134:e547-61. Hagan H, McGough JP, Thiede H, Weiss NS, Hopkins S and Alexander ER. Syringe exchange and risk of infection with hepatitis B and C viruses. American journal of epidemiology. 1999;149:203-13. Wodak A and Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006;41:777-813. Jarlenski M, Barry CL, Gollust S, Graves AJ, Kennedy-Hendricks A and Kozhimannil K. Polysubstance Use Among US Women of Reproductive Age Who Use Opioids for Nonmedical Reasons. Am J Public Health. 2017;107:1308-1310. Hudak ML, Tan RC, Committee On D, Committee On F, Newborn and American Academy of P. Neonatal drug withdrawal. Pediatrics. 2012;129:e540-60.  

The United States is in the midst of an epidemic of addiction and overdose deaths due to opiate painkillers. Its causes are varied, but there’s no question that physicians share a large part of the blame. Little discussed is that this is actually the second time this has happened. Almost a century ago, a remarkably similar epidemic struck the country. In this episode, called “The First Opiate Epidemic,” I discuss what happened, the parallels to today, and the lessons we can learn from our forebearers. Learn about all this and a new #AdamAnswers in this month’s Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!   Sources:   Courtwright DT. Dark Paradise: A History of Opiate Addiction in America. Harvard University Press, 2001. Meldrum ML, “The ongoing opiod prescription epidemic: historical context,” Am J Public Health. 2016 August; 106(8): 1365–1366. Courtwright DT, “Preventing and treating narcotic addiction -- a century of federal drug control,” N Engl J Med 2015; 373:2095-2097. Adams JFA, “Substitutes for opium in chronic diseases,” Boston Med Surg J 1889; 121:351-356. Macht DI, “The history of opium and some of its preparations and alkaloids,” JAMA. 1915;LXIV(6):477-481. Hamilton GR and Baskett TF, “In the arms of Morpheus: the development of morphine for postoperative pain relief,” Can J Anesth. 2000;47:4, 367-374. Weiner JP, “A shortage of physicians or a surplus of assumptions?” Health Aff January 2002 vol. 21 no. 1 160-162. Gudbranson BA et al, Reassessing the Data on Whether a Physician Shortage Exists. JAMA. 2017;317(19):1945-1946. Kirch DG and Petelle K, Addressing the Physician Shortage: The Peril of Ignoring Demography. JAMA. 2017;317(19):1947-1948.  

Nesse episódio do NeuroPod vamos elucidar a relação entre Zika e Microcefalia em 5 perguntas-chave. Também teremos a entrevista exclusivíssima com a neurocientista Patricia P. Garcez, professora da UFRJ, especialista em microcefalia e pioneira nos estudos com Zika. Link para o Lattes da prof. Patricia P. Garcez: http://lattes.cnpq.br/7284551536353300 Referências bibliográficas do episódio: 1.        Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico. Vol 47 número 14, semana epidemiológica 8; 2016. 2.        Centro de Operações de Emergências emSaúde Pública sobre Microcefalias COES. MONITORAMENTO DOS CASOS DEMICROCEFALIA NO BRASIL. Vol 19. SE 12; 2016. 3.        Paixão ES, Barreto F, da Glória TeixeiraM, da Conceição N. Costa M, Rodrigues LC. History, Epidemiology, and ClinicalManifestations of Zika: A Systematic Review. Am J Public Health.2016;106(4):606-612. doi:10.2105/AJPH.2016.303112. 4.        Zanluca C, de Melo VCA, Mosimann ALP, dosSantos GIV, dos Santos CND, Luz K. First report of autochthonous transmissionof Zika virus in Brazil. Mem Inst Oswaldo Cruz. 2015;110(4):569-572.doi:10.1590/0074-02760150192. 5.        Instituto Nacional de Salud. Boletín EpidemiológicoSemanal. Vol Semana 5; 2016. Colômbia 6.        Instituto Nacional de Salud. Boletín EpidemiológicoSemanal. 2016; Semana 11. Colômbia 7.        Cruz R. Dados preliminares confirmam apresença do Zika vírus em Sergipe. Portal da saúde.http://saude.se.gov.br/index.php/2016/03/11/dados-preliminares-confirmam-a-presenca-do-zika-virus-em-sergipe/.Published 2016. 8.        Escobar E. Zika e microcefalia : O mistériode Sergipe – resolvido. Estadão.http://ciencia.estadao.com.br/blogs/herton-escobar/zika-e-microcefalia-o-misterio-de-sergipe-resolvido/.Published 2016. Accessed April 3, 2016. 9.        Butler D. Zika and birth defects: what weknow and what we don’t. Nature. 2016:1-7. doi:10.1038/nature.2016.19596. 10.      World Health Organization. Microcephaly. Mediacentre, fact sheet.http://www.who.int/mediacentre/factsheets/microcephaly/en/. Published March 2,2016. 11.      Calvet1 G, Aguiarv RS, Melo AS, et al.Detection and sequecing of Zika virus from amniotic fluid of fetuses withmicrocephaly in Brazil: a case study. Lancet Infect Dis.2016;3099(16):In press. doi:10.1017/CBO9781107415324.004. 12.      Fountora R. Zika atinge placenta emqualquer fase da gestação. Agência fiocruz de notícias.https://agencia.fiocruz.br/zika-atinge-placenta-em-qualquer-fase-da-gestacao.Published March 14, 2016. 13.      Garcez PP, Loiola EC, Costa RM da, et al.Zika virus impairs growth in human neurospheres and brain organoids. PeerJPrepr. 2016:1-21. Créditos da música: Adam Selzer, Charmed Life.

Guest: Alan Peaceman, MD Host: Lisa Mazzullo, MD Cesarean section on maternal request is becoming a more common discussion in doctors offices around the country. Since the late 90’s, cesarean section rates continue to rise with overall estimates of 29% noted in 2004. The ethics of patient autonomy war with medical concerns about potentially unnecessary surgery. The challenges posed by elective cesarean section are discussed with Dr. Alan Peaceman, professor of ob/gyn at Northwestern University Feinberg School of Medicine and chief of the division of MFM. Neonatal and maternal safety, long term sequelae of vaginal birth and NIH recommendations on how to deal with this potentially emotional issue are thoroughly discussed. Reference Articles 1. Declercq, E, PhD, et al. Factors associated with the rise in Primary Cesarean Births in the US in 2002, Am J Public Health, 2006; 96(5): 867-872 2. National Institute of Health- Cesarean Childbirth. UDHHS- 2006, , 1982-2067 3. Greene, M. et al. Vaginal Delivery after Cesarean section – is the risk acceptable? N Engl J Med 2001, 345:55-56 4. Andrist, Linda, PhD, RNC. NPWH 2006- Cesarean Section on Maternal Request_ the debate.

Guest: Alan Peaceman, MD Host: Lisa Mazzullo, MD Cesarean section on maternal request is becoming a more common discussion in doctors offices around the country. Since the late 90’s, cesarean section rates continue to rise with overall estimates of 29% noted in 2004. The ethics of patient autonomy war with medical concerns about potentially unnecessary surgery. The challenges posed by elective cesarean section are discussed with Dr. Alan Peaceman, professor of ob/gyn at Northwestern University Feinberg School of Medicine and chief of the division of MFM. Neonatal and maternal safety, long term sequelae of vaginal birth and NIH recommendations on how to deal with this potentially emotional issue are thoroughly discussed. Reference Articles 1. Declercq, E, PhD, et al. Factors associated with the rise in Primary Cesarean Births in the US in 2002, Am J Public Health, 2006; 96(5): 867-872 2. National Institute of Health- Cesarean Childbirth. UDHHS- 2006, , 1982-2067 3. Greene, M. et al. Vaginal Delivery after Cesarean section – is the risk acceptable? N Engl J Med 2001, 345:55-56 4. Andrist, Linda, PhD, RNC. NPWH 2006- Cesarean Section on Maternal Request_ the debate.