Extreme heat increasing in the Midwest United States

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Extreme heat is the biggest weather-related killer in the United States, and dangerously hot weather is already occurring more frequently in the Midwest than it did 60 years ago, according to a new report by the Union of Concerned Scientists.

Heat in the Heartland: 60 Years of Warming in the Midwest, presents an original analysis of weather data for five major urban areas—Chicago, Cincinnati, Detroit, Minneapolis and St. Louis—and five smaller nearby cities.

High temperatures not only can lead to dehydration, heat exhaustion and deadly heatstroke, but can can also aggravate existing medical conditions, such as diabetes, respiratory disease, kidney disease and heart disease. Heat claims, on average, more lives each year than floods, lightning, tornadoes and hurricanes combined. From 1999-2003, exposure to excessive heat killed an estimated 3,442 U.S. residents.

The report examines how the average daytime temperatures, humidity levels and nighttime temperatures within different types of weather systems have changed over time. Key findings include:

  • Heat waves lasting three days or more have become more common over the last six decades. St. Louis has approximately four more three-day heat waves each year than it did in the 1940s.
  • On average, hot humid days have increased more rapidly in frequency, while hot dry days have increased in temperature more rapidly across the Midwest since the 1940s and 1950s.
  • In general, hot air masses have become hotter and more humid during nighttime hours.
  • In some cities, average nighttime temperatures within some air mass types have increased as much as 4-5 degrees Fahrenheit (˚F) over the six decades.
  • Relief from heat is harder to find—all of the cities studied now have fewer cool, dry days in the summer.
  • The results are not due solely to an urban heat island effect on major cities. Less urban neighboring locations showed similar increases in hot summer air masses.

The report sheds light on the importance of city-level efforts to minimize the health risks of future climate change. The findings suggest several consequences for public health, as well as implications for local preparedness and efforts to reduce the effects of a changing climate.

“We need strategies to both build climate-resilient communities and reduce the global warming emissions that are driving climate change,” the study concludes.

It is the third report in a series on Climate Change and Your Health.

1. Perera EM, Sanford T, White-Newsome JL, et al. Heat in the Heartland: 60 Years of Warming in the Midwest. Cambridge, Mass.: Union of Concerned Scientists, 2012.

Using HIV programs to support NCD services

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Although HIV and non-communicable diseases (NCDs) are traditionally thought of as two very different health challenges, some of the systems, tools and approaches developed for HIV programs could be used for NCDs as well, according to an article published in the Journal of Acquired Immune Deficiency Syndromes.

The availability of treatment has transformed HIV into a chronic condition, and local HIV program in low- and middle-income countries have the capability to support continuity care. For example, the appointment books, defaulter tracking, patient counseling, medical records, standardized treatment protocols, referral networks, and linkages to laboratory and pharmacy services available through HIV clinics—and all critical for continuity care—could be used for diabetes and hypertension services.

“Strengthening health systems to deliver continuity care is likely to enhance the performance of both HIV and NCD programs and is a shared priority,” the article concludes.

1. Rabkin M, Nishtar S. Scaling up chronic care systems: Leveraging HIV programs to support noncommunicable disease services. Journal of Acquired Immune Deficiency Syndromes 2011; 57: s87-s90. (open access)

Management of diabetes and associated cardiovascular risk factors in seven countries

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A substantial proportion of individuals with diabetes remain undiagnosed and untreated, both in developed and developing countries, according to a multi-country study using nationally representative health examination surveys from Colombia, England, Iran, Mexico, Scotland, Thailand and the United States.

The figures range from 24 percent of women in Scotland and the United States to 62 percent of men in Thailand. The proportion of individuals with diabetes reaching treatment targets for blood glucose, arterial blood pressure, and serum cholesterol was very low, ranging from one percent of male patients in Mexico to about 12 percent in the United States. Income and education were not found to be significantly related to the rates of diagnosis and treatment anywhere except in Thailand, but in the three countries with available data insurance status was a strong predictor of diagnosis and effective management, especially in the United States.

Based on this comparison of how well these seven countries are performing in terms of population-level management of diabetes, hypertension and high cholesterol, the study researchers make the following recommendations:

  1. It is critical to track diabetes care at the population level and to focus on actual outcomes, rather than on the process of care. It is also critical to study other countries with larger numbers of individuals with diabetes, such as China and India, for which nationally representative studies are not readily available.
  2. It is important to prioritize the development and implementation of national guidelines and the use of new incentive programs for the management of hypertension and high cholesterol among individuals with diabetes in developing countries. The study findings suggest that such progress may be more feasible and more likely to have a larger population health impact than blood glucose control.
  3. There are opportunities for innovation in providing incentives, in the technology of diabetes management and in improving financial access to care.

Real progress at the population level in the management of diabetes will likely require all three: monitoring performance in meeting treatment targets, expanding management of hypertension and high cholesterol in individuals with diabetes, and innovations in the delivery of and access to care.

The estimated global prevalence of diabetes is around 6.4 percent and more than 280 million people in the world have diabetes—the majority live in the developing world. Projections indicate that diabetes accounted for almost four million deaths worldwide in 2010. The burden of diabetes will only continue to grow, since the number of adults with diabetes in developing countries is projected to rise by more than two-thirds between 2010 and 2030.

1. Gakidou E, Mallinger L, Abbott-Klafter J, et al. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys. Bulletin of the World Health Organization 2011; 89: 172-183. (open access)

Walking may help ward off diabetes

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Walking will lower your risk of diabetes

Taking more steps every day will not only ward off obesity but will also reduce the risk of diabetes, finds a study published on bmj.com. While several studies have shown that physical activity reduces body mass index and insulin resistance—an early stage in the development of diabetes—this is the first study to estimate the effects of long-term changes in daily step count on insulin sensitivity.
A popular guideline is to do 10,000 steps every day, though a more recent recommendation is 3,000 steps, five days a week.

The study researchers estimate that, in their setting, a sedentary person who takes a very low number of daily steps but who was able to change behavior over five years to meet the popular 10,000 daily step guideline would have a threefold improvement in insulin sensitivity compared with a similar person who increased his or her steps to meet the more recent recommendation of 3,000 steps for five days a week.

“These findings, confirming an independent beneficial role of higher daily step count on body mass index, waist to hip ratio, and insulin sensitivity, provide further support to promote higher physical activity levels among middle aged adults,” the study concluded.

1. Dwyer T, Ponsonby A-L, Ukoumunne OC, et al. Association of change in daily step count over five years with insulin sensitivity and adiposity: population based cohort study. BMJ 2011; 342: c7249. (open access)

Heart disease risk exacerbated by diabetes in Iran

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Adults in Iran with diabetes, especially men, have a risk of coronary heart disease similar to non-diabetics with a history of heart disease, new research indicates.

Women with diabetes and who had previous coronary heart disease had the worst prognosis, with eight times greater risk of having a coronary event. Men with diabetes and previous coronary heart disease were at four times greater risk.

The findings reinforce the urgent need for intensive care and prophylactic treatment for cardiovascular diseases, the study concluded.

1. Hadaegh F, Fahimfar N, Khalili D, et al. New and known type 2 diabetes as coronary heart disease equivalent: results from 7.6 year follow up in a middle east population. Cardiovascular Diabetology 2010; 9: 84. (open access)

More than half of all 7 million diabetic adults in Mexico will be dead by 2026

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Diabetes is the principal cause of death in Mexico. More than seven million Mexican adults have type 2 diabetes: nearly 14 percent of all adults in 2006, up from 6.7 percent in 1993. A new study suggests that the impact of diabetes on the Mexican health system will be significantly greater in the next two decades.

The study estimates that 53.9 percent of adults currently with diabetes will be dead by the year 2026. Their life expectancy will be reduced to an average of 10.9 years. The predicted 20 year-incidence of the principal cardiovascular complications per 1000 diabetic individuals are: ischemic heart disease 112, heart attack 260, heart failure 113, stroke 101 and amputation 62.

“These predictions must urge the Mexican health system to establish effective treatment programs and improve diabetes care,” according to the study. “In the absence of such measures, the resources required to manage future diabetes related complications will surpass the capability of the Mexican health system.”

1. Reynoso-Noverón N, Mehta R, Almeda-Valdes P, et al. Estimated incidence of cardiovascular complications related to type 2 diabetes in Mexico using the UKPDS outcome model and a population-based survey. Cardiovascular Diabetology 2011; 10: 1. (open access)

Obesity and metabolic syndrome among Chinese children

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More than 11% of children are overweight in Guanzhou, China

China has experienced an increase in the prevalence of childhood overweight and obesity over the last decades. The overall prevalence of overweight and obesity among children in China were approximately five percent and two percent, respectively, in the 1980s. In 2002, 155 million children worldwide were overweight or obese, of which 12 million lived in China.

A new study conducted among school children (age 7-14 years) in Guanzhou City found that more than 11 percent were overweight and seven percent were obese. The prevalence of metabolic syndrome among the children was 6.6 percent overall, 33.1 percent in obese, 20.5 percent in overweight and 2.3 percent in normal weight children. Metabolic syndrome refers to a clustering of specific cardiovascular disease risk factors, such as insulin resistance, abdominal obesity, impaired glucose, elevated blood pressure, elevated triglycerides and reduced high-density lipoprotein (HDL) cholesterol.

“To address the problem of increasing prevalence of obesity and potentially deadly consequences of metabolic syndrome in Chinese children, more research will be needed focusing on the reasons for the increase of overweight/obesity in children and interventions so as to reduce the epidemics of overweight/obesity and metabolic syndrome in the population,” the study concluded.

1. Liu WJ, Lin R, Liu AL, et al. Prevalence and association between obesity and metabolic syndrome among Chinese elementary school children: a school-based survey. BMC Public Health 2010; 10: 780. (open access)

High levels of B vitamins linked to diabetes and obesity

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Long-term exposure to high levels of B vitamins (niacin, thiamin, riboflavin) may be involved in the increased prevalence of obesity and type 2 diabetes in the United States in the past 50 years, a new study suggests.

The findings, together with the evidence that niacin may induce glucose intolerance, insulin resistance and liver injury, imply the possibility that, among the fortified B-vitamins, excess niacin consumption may play a major role in the development of obesity and 2 diabetes.

Since the high level consumption of niacin in the US is mainly due to the implementation of mandatory grain fortification, therefore, it may be of significance to carefully evaluate the long-term safety of food fortification, the study concludes.

1. Zhou S-S, Li D, Zhou Y-M, et al. B-vitamin consumption and the prevalence of diabetes and obesity among the US adults: population based ecological study. BMC Public Health 2010; 10: 746. (open access)

Improving diabetes and hypertension guidelines in Barbados

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A study has shown numerous deficiencies in the quality of hypertension and diabetes primary care in Barbados, despite distribution of regional guidelines.

Current hypertension and diabetes guidelines were considered by some primary health care providers to be outdated, unavailable, difficult to remember and lacking in advice to tackle barriers. Practitioners thought that guidelines should be circulated widely, promoted with repeated educational sessions and kept short. Patient-oriented versions of the guidelines were welcomed.

Patient factors causing barriers to ideal outcome included denial and fear of stigma; financial resources to access an appropriate diet, exercise and monitoring equipment; confusion over medication regimens, not valuing free medication, belief in alternative medicines and being unable to change habits.

System barriers included lack of access to blood investigations, clinic equipment and medication; lack of human resources in polyclinics; and an uncoordinated team approach.

Patients faced cultural barriers with regards to meals, exercise, appropriate body size, footwear, medication taking and taking responsibility for one’s health; and difficulty getting time off work to attend a clinic.

Suggestions for how the health care system could help providers improve the health of those with diabetes and hypertension included educating both the public and persons with the condition, screening programs, providing free home monitors and adequate staffing.

Suggestions for how the wider society could help providers improve the health of those with diabetes and hypertension involved educational outreach to promote family support in managing the condition (cooking, encouraging exercise, giving insulin); a greater role for volunteer groups and retired persons in providing education, support, exercise groups and screening programs; starting associations for hypertension, hyperlipidemia and diabetes; the provision by the government of sidewalks and bicycle lanes for safe exercise; healthy food choices at schools and work places; a tax on unhealthy fast food and an attempt to bring down the cost of healthy food by the government; a requirement that fast food outlets provide healthy alternatives; labeling of all food to include fat, salt and calorie content; encouraging a kitchen garden program; time off by employers to attend appointments; and prominent persons with the disease should speak out to reduce stigma, and give hope that a good life can be had while living with chronic disease.

1. Adams OP, Carter AO. Diabetes and hypertension guidelines and the primary health care practitioner in Barbados: knowledge, attitudes, practices and barriers-a focus group study. BMC Family Practice 2010; 11: 96. (open access)

Famine linked to non-communicable diseases in Nigeria

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Fetal and infant undernutrition is associated with significantly increased risk of hypertension, overweight and impaired glucose tolerance or diabetes among Nigerians who were born during the famine that afflicted the Biafra region of Nigeria during its civil war (1967-1970). Of the one to three million Igbo people that are estimated to have lost their lives during the Nigerian Civil War, only about 10 percent died of military violence. The majority succumbed to starvation.

 Prevention of undernutrition during pregnancy and in infancy should therefore be given high priority in health, education and economic agendas.

1. Hult M, Tornhammar P, Ueda P, et al. Hypertension, diabetes and overweight: looming legacies of the Biafran Famine. PLoS ONE 2010; 5(10): e13582. (open access)

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