Biomonitoring: is body burden relevant to public health?

Biomonitoring is the study of the presence and concentration of chemicals in humans usually by the measurement of blood, urine or breath (exhaled air). Properly conducted, these data provide a picture of the amount of a chemical or agent actually absorbed into the body for a specific period of time. This review provides a history of biomonitoring, as well as the limitations and potential benefits of these studies. Examples of the proper and possibly improper use of biomonitoring and the impact made on our society are provided. Reasons for having comprehensive national biomonitoring programs are summarized, along with the societal benefits and risks. A brief discussion of the history of the NHANES program and select results from the 2005 Report are presented. By 2010, it has been predicted that the Centers for Disease Control (CDC) will be monitoring nearly 1000 chemicals in persons from all regions of the nation. The measurement of chemicals and biomarkers has revolutionized the field of exposure assessment. Overall, we recommend an approach of careful interpretation, understanding that the data obtained are useful for establishing baseline information about exposure, rather than equating detection with risk. We present suggestions for contextualizing biomonitoring results in order to provide the public with the tools to distinguish genuine health risks from trivial ones.     

Acinetobacter baumannii: a universal threat to public health?

Acinetobacter spp. are non-fermentative, strictly aerobic, Gram-negative microorganisms with a confusing taxonomic history. The Acinetobacter baumannii-Acinetobacter calcoaceticus complex is the species most commonly isolated from clinical specimens. It is ubiquitous in nature and has been found as part of the normal skin, throat and rectal flora as well as in food and body lice. It colonises patients in Intensive Care Units and contaminates inanimate hospital surfaces and devices as well as wounds, including war injuries. Although a frequent coloniser, Acinetobacter can be the cause of severe and sometimes lethal infections, mostly of nosocomial origin, predominantly ventilator-associated pneumonia. Bacteraemic infections are rare but may evolve to septic shock. Acinetobacter also emerges as a cause of nosocomial outbreaks and is characterised by increasing antimicrobial multiresistance. Antibiotic use, especially carbapenems and third-generation cephalosporins, is recognised as the most important risk factor for multiresistance. Described resistance mechanisms include hydrolysis by beta-lactamases, alterations in outer membrane proteins and penicillin-binding proteins, and increased activity of efflux pumps. Today, Acinetobacter resistant to carbapenems, aminoglycosides and fluoroquinolones presents a challenge to the clinician. However, sulbactam, tigecycline and colistin represent the current therapeutic approaches, which are associated with satisfactory efficacy.     

Does alcohol advertising have an impact on the public health?

This presentation draws on recent New Zealand and international research to examine a number of questions about the possible public health impact of policy which allows alcohol to be advertised on the broadcast media. The relevant public health questions include: the contribution of alcohol advertising to aggregate levels of consumption and alcohol-related problems; the impact on the drinking and attitudes of the heaviest drinking sector, young males, who tend to be a primary target for the advertising; the impact on those already experiencing problems associated with their drinking and wanting to abstain or cut down; the impact on the young as they move towards becoming drinkers; the impact on the likely efficacy of educational campaigns about drinking; and the impact on the social climate surrounding alcohol and in turn on the support for effective public policies to reduce alcohol-related harm. Research in this area has increased in both conceptual and methodological sophistication in the past decade and studies using a number of complementary methods are available to assist our understanding of the likely impact of broadcast alcohol advertising. Evidence that advertising is likely to contribute to higher levels of drinking and related problems has strengthened over the past decade, suggesting that public health interests should be considered as one of the relevant voices in the ongoing policy debate around alcohol advertising.     

Does the health status of intimate partner violence victims warrant pharmacies as portals for public health promotion?

ObjectivesTo explore whether the health status of intimate partner violence (IPV) victims warrants pharmacies to be portals for public health promotion. Specific objectives included (1) identifying prevalence of IPV including domestic violence (DV) and sexual assault (SA) in a community sample, (2) describing characteristics and correlates of DV/SA between participants who reported and did not report DV/SA, and (3) exploring whether DV/SA status is related to mental health medication use.DesignCross sectional.SettingUpstate New York during 2006.ParticipantsEnglish- and Spanish-speaking respondents younger than 65 years of age answering four questions to assess DV/SA.InterventionSecondary analysis of a countywide random telephone survey, the 2006 Monroe County Adult Health Survey, which collects prevalence data on health behaviors and health status indicators.Main outcome measureTo determine whether those reporting DV/SA are at increased odds for mental health medication use, controlling for other sociodemographic- and health-related variables.ResultsThe survey response rate was 30.3%, with 1,881 respondents meeting inclusion criteria. Those reporting DV/SA were almost twice as likely to use mental health medications. However, when controlling for other variables, only poor mental and physical health were significant in increasing the odds of mental health medication use.ConclusionThe analyses reported here suggest that DV/SA victims in a community sample use mental health medications. When controlling for other variables, survey respondents reported worse physical and mental health. If pharmacies are suitable portals for DV/SA outreach, curricula would need to provide the knowledge and skills needed to take an active role in this public health promotion.     

Should ethanol be scheduled as a drug of high risk to public health?

Six criteria described in the New Zealand Misuse of Drugs Act and used by the Expert Advisory Committee on Drugs (EACD) for determining the risk of a drug to public health were examined in relation to ethanol, using gamma-hydroxybutyric acid (GHB) as a comparator drug. GHB is an ideal candidate for use as a comparator because it is a sedative substance very similar to ethanol and has been previously investigated by the EACD using these six criteria. GHB was subsequently classified as a Class B1 drug under the Misuse of Drugs Act, that is, as a prohibited drug of high risk to public health. The dangerousness level of ethanol was found to be at least similar to that of GHB in this analysis. This highlights a major discrepancy in public policy.     

What's in a cost? Comparing economic and public health measures of alcohol's social costs

Studies based on a cost of illness method frequently assert large social costs from a variety of risky activities, the harms from which most typically fall upon the risk-taker himself. Many of these costs are inadmissible in a standard economic framework; consequently, figures derived by the cost of illness method are not comparable with other economic notions of cost and are of very limited policy use.     

On the frontline against COVID-19: Community pharmacists’ contribution during a public health crisis

The global spread of COVID-19 is placing unprecedented demands on healthcare services. In this time of crisis, innovative and adaptive methods of practising will be required across all health professions. In order to maximise the use of current available resources, it is vital that existing services are comprehensively reviewed and full use is made of any unrealised potential among healthcare providers. Community pharmacy is one of a number of health professions that has a key role to play in responding to the current pandemic. As the scope of community pharmacy practice varies considerably across countries, it is important to examine ways in which the profession can assist with the public health response to COVID-19 and maintaining the continuity of healthcare services. This article seeks to highlight roles and activities that community pharmacists can undertake to help in relieving pressure on other areas of the health service, such as general practice. This information could help to inform future decisions about the restructuring of existing health services by governments, public health bodies and policy makers in response to public health crises such as COVID-19.     

Cocaine and crack use and dependence in Europe – experts view on an increasing public health problem

Background: The spread of cocaine and crack use in Europe poses a challenge to the European health-care systems. The assessment of the extent of the problem as well as the support needs of the users require involving all relevant parties in research and future planning.

Method: Within the framework of a European multi-center and multi-modal research project, experts of nine European cities were interviewed according to a standardised structural interview protocol.

Results: Cocaine use is considered to be on the increase in Europe. The prevalence rates vary substantially between countries and the problem emerges in different target groups in distinct patterns of use. Although cocaine and crack specific risks can be diagnosed, health risks follow basically the general risks of illicit drug use. Proposals for future planning include the broadening of the existing services and the implementation of evidence-based approaches to the problem.

Conclusion: In dealing with the cocaine problem in Europe, a comprehensive public health approach is appropriate. An overall strategy should include preventive, harm reductive as well as rehabilitative measures. Consequently, cross-national guidelines should be established and their implementation as well as evaluation should be monitored.     

Does pharmacogenomics provide an ethical challenge to the utilisation of cost-effectiveness analysis by public health systems?

Pharmacogenomics promotes an understanding of the genetic basis for differences in efficacy or toxicity of drugs in different individuals. Implementation of the outcomes of pharmacogenomic research into clinical practice presents a number of difficulties for healthcare. This paper aims to highlight one of the unique ethical challenges which pharmacogenomics presents for the utilisation of cost-effectiveness analysis by public health systems. This paper contends that pharmacogenomics provides a challenge to fundamental principles which underlie most systems for deciding which drugs should be publicly subsidised. Pharmacogenomics brings into focus the conflict between equality and utility in the context of using cost-effectiveness analysis to aid distribution of a limited national drug budget.     

Presenting features of meningococcal disease, public health messages and media publicity: are they consistent?

AIMS: To investigate whether the presenting features of meningococcal disease as promoted in public health awareness material and in the print media accurately reflect the clinical features in patients admitted to Auckland hospitals with meningococcal disease January 1998 to June 1999. METHODS: Hospital record, public health message and newspaper article review, with analysis by presenting feature, age group and disease complex. RESULTS: The most common presenting features were fever (95%), rash (65%), vomiting and nausea (64%), lethargy (62%), headache (44%), refusing food and drink (35%), irritability (33%), muscle ache and joint pains (27%) and stiff neck (26%). Public health messages gave appropriate emphasis to the key features, whereas newspaper articles under-emphasised these. The term 'meningitis' was used more frequently in newspapers (65%) than in public health messages (30%), despite meningitis alone presenting less frequently (38% of cases) than meningococcal septicaemia, and having a less serious prognosis. CONCLUSIONS: Presenting features currently noted in the Ministry of Health's health education resource material are appropriate. Public health specialists dealing with the media should ensure that appropriate messages are incorporated into media reports. A greater use of the term 'meningococcal disease' by both public health agencies and media would convey to the public the message that this disease has a spectrum of presenting features, with those of septicaemia more common, but also indicating an even greater need for urgency of action than with 'classical' meningitic features.