Egg Harvesting For Stem Cell Research

Women’s health and human rights advocates worldwide are increasingly concerned that overzealous pursuit of new scientific discoveries may once again be threatening women’s health. This time, young women are being asked to donate or sell their ova, not only for use in fertility clinics, but increasingly for non-clinical use in experimental cloning research.

Diane Beeson and Abby Lippman, based at California State University and McGill University, Montreal respectively, report on medical risks and ethical problems associated with collection of human oocytes (eggs) during IVF practice from donors who give them to other women who desperately want a child. Doubts are emerging about donating oocytes in this manner, even when recipients use them to establish a pregnancy. Their article Egg harvesting for stem cell research: medical risks and ethical problems is published in the journal Reproductive BioMedicine Online [www.rbmonline/Article/2503 - e-pub ahead of print 14 August 2006].

Widely practised in IVF, but not yet proven to be fully safe, various hormones are given to donors to stimulate several eggs to develop. Using ultrasound, ripe oocytes are then aspirated from within their follicles. The oocytes are often donated free, although the HFEA has given permission for donors to receive some compensation via discounts for their own IVF treatment. In one case reported, the donor oocytes were needed for stem cell research, which makes ethicists even more furious about ‘selling’ human oocytes.

It is hard to separate ethically this decision from giving direct payments to donors, or from fertilizing the eggs and then giving them away for research. In all these examples, many donors might have suffered from mild symptoms of ovarian hyperstimulation, among other disorders, without their knowledge.

Recent research has stressed the risks of using hormonal stimulants to induce follicle growth and ovulation in women. Surprisingly, Beeson and Lippman claim that pharmaceutical companies have not been compelled to submit their information on the risks of such forms of ovulation induction to the US Food and Drug Administration. Claims are made of 25 deaths among donors, although this requires verification. Claims that cancers may be induced in some patients have been questioned or denied, although an increase arose in another study on >3500 women donors, and critics stress that many of these studies had short-term follow-ups in only a few women. These patients were among the first to attempt IVF, and their risks of tumours are now emerging and will be analysed in the near future.

IVF children have not yet displayed such anomalies, though significant abnormalities are reported in offspring of mice following similar treatments. These investigating authors nevertheless cited earlier reports on anomalies, including cancers, in offspring of women receiving exogenous hormones, perhaps due to the release of steroids. In view of all these known and unknown risks to women donors, these authors refer to organizations established to protect women undergoing IVF and other ovarian treatments. It is one thing, however, to raise a fuss about uncertain risks but quite another to gain hard data from the complex reports emerging in the world of assisted human conception.

About the REPRODUCTIVE HEALTHCARE LTD.

Reproductive BioMedicine Online is an international peer-reviewed journal of biomedical and clinical research on human reproduction and the embryo. Chief Editor of RBMOnline is Professor Robert Edwards. With rapid responsible publishing on web and in print (monthly), it is aimed at researchers, clinicians, practitioners and patients. Accepted papers are published in full online within 2-4 weeks of acceptance. Abstracted and indexed on MEDLINE, EMBASE and Chemical Abstracts; visit www.rbmonline to see the latest publications. Published by Reproductive Healthcare Ltd., Duck End Farm, Dry Drayton, Cambridge CB3 8DB, UK. Tel. +44 1954 781812, Fax. +44 1954 781816. For further information, please contact enquiriesrbmonline.

REPRODUCTIVE HEALTHCARE LTD.
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Dry Drayton

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Sleep Centre At Papworth Hospital Seeking Participants For Ethically Approved Sleep Study, England

Do you have insomnia? The Sleep Centre at Papworth Hospital, a recognised leading sleep research centre, is running an ethically approved sleep study.

– Do you have difficulty sleeping for more than 6.5 hours a night?
– Do you wake-up several times a night?
– Are you aged 18-65?
– Would you like to take part in a clinical study?

For more details and an informal discussion call 01480 364168.
You will be compensated for your time and travel.
All our studies are approved by an independent research ethics committee.

Papworth Hospital NHS Foundation Trust
papworthhospital.nhs

Detaining Patients Is Justified To Contain Deadly TB Strain In South Africa Say Experts

A team of medical ethics and public health experts say tough isolation measures, involuntary if need be, are justified to contain a deadly, contagious, drug-resistant strain of TB in South Africa and to prevent “a potentially explosive international health crisis.”

In a policy paper in the international health journal PLoS Medicine, Dr Jerome Singh of the Centre for the AIDS Programme of Research in Durban, South Africa (who is also an Adjunct Professor at the Joint Centre for Bioethics, University of Toronto) and colleagues say that “the forced isolation and confinement of extensively drug resistant tuberculosis (XDR-TB) and multiple drug resistant tuberculosis (MDR-TB) infected individuals may be a proportionate response in defined situations given the extreme risk posed.”

On September 01, 2006, the World Health Organisation announced that a deadly new strain of XDR-TB had been detected in Tugela Ferry, a rural town in the South African province of KwaZulu-Natal, the epicentre of South Africa’s HIV/AIDS epidemic. Of the 544 patients studied in the area in 2005, 221 had MDR-TB (Mycobacterium tuberculosis resistant to at least rifampicin and isoniazid). Of these 221 cases, 53 were identified as XDR-TB (i.e. MDR-TB plus resistance to at least three of the six classes of second line drug treatments). Of the 53, 44 were tested for HIV and all were HIV infected.

This strain of XDR-TB in Kwazulu-Natal proved to be particularly deadly: 52 of the 53 patients died (within a median of 16 days of the initial collection of sputum for diagnostic purposes).

But the authors say that there have been a number of obstacles in the way of dealing effectively with the crisis. “The South African government’s initial lethargic reaction to the crisis,” they say, “and uncertainty amongst South African health professionals concerning the ethical, social and human rights implications of effectively tackling this outbreak highlights the need to address these issues as a matter of urgency lest doubt and inaction spawns a full-blown XDR-TB epidemic in South Africa and beyond.”

###

Citation: Singh JA, Upshur R, Padayatchi N (2007) XDR-TB in South Africa: No time for denial or complacency. PLoS Med 4(1): e50.

PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT

CONTACT:

Terry Collins
Toronto, Canada

PLEASE MENTION THE OPEN-ACCESS JOURNAL PLoS MEDICINE (plosmedicine/) AS THE SOURCE FOR THESE ARTICLES AND PROVIDE A LINK TO THE FREELY-AVAILABLE TEXT. THANK YOU.

All works published in PLoS Medicine are open access. Everything is immediately available without cost to anyone, anywhere–to read, download, redistribute, include in databases, and otherwise use–subject only to the condition that the original authorship is properly attributed. Copyright is retained by the authors. The Public Library of Science uses the Creative Commons Attribution License.

Contact: Andrew Hyde

Public Library of Science

Comparative Analysis Of Surgical Margins Between Radical Retropubic Prostatectomy And RALP

UroToday – The purpose of this article was to compare surgical margin status between Radical Retropubic Prostatectomy [RRP] and Robotic Assisted Laparoscopic Prostatectomy [RALP] as performed by a single urologist. This topic has been addressed in multiple articles with comparable positive margin status between the two techniques. 1, 2

What we felt was missing from previous published material was the exclusion of results from the learning curve or initial cases. This is important for urologists considering transferring from open to robotic surgery. There is substantial fear that the initial patients subjected to robotic surgery will be “experimented on” or “sacrificed”. Does an experienced urologist with ample success at RRP have to compromise his patient’s results in order to proceed forward with a new technology?

We retrospectively compared our last 50 of 1200 similarly matched RRP patients to our first 50 RALP patients, essentially comparing our best RRP (end of series) to our worst RALP (beginning of series). None of our initial robotic cases were omitted. To further ensure that we had similar cohorts we also matched the two groups according to pre-operative CAPRA scores.

The RALP group had fewer overall positive margins than the RRP group (22% vs. 36%, p=0.007) despite having fewer low risk patients and a higher proportion of patients with Gleason 7 disease.

The primary limitation of this study was related to its retrospective design and small patient population. We recognize that other peri-operative outcome measures are important (estimated blood loss, hospital stay, complications, short term functional outcomes, etc.) and are currently evaluating our existing data.

In addition we realize that our positive margin rate in the RRP group was high compared to most published series, but it does fall within our average range of previously examined data for our open cases.

We have demonstrated that a statistically significant lower positive margin rate can be achieved in RALP patients even during the learning curve.

References:

1. Smith JA, Chan RC, Chang SS, et al. A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. J Urol. 2007;178:2385-2390.
2. Laurila TAJ, Huang H, Jarrard DF. Robotic assisted laparoscopic and radical retropubic prostatectomy generates similar positive margin rates in low and intermediate risk patients. Urol Oncol. 2008 July 18. [Epub ahead of print]

Michael A. White, Alexander P DeHaan, D. Dawon Stephens, Thomas K. Maatman, and Thomas J. Maatman as part of Beyond the Abstract on UroToday

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.

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Copyright © 2009 – UroToday

UIC Named NIH Islet Cell Resource Center

The University of Illinois at Chicago has been named a National Institutes of Health Islet Cell Resource Center and awarded a three-year $3.25 million grant.

One of seven federally funded centers in the United States, UIC will provide researchers across the country with human pancreatic islet cells for transplantation into diabetic patients and provide cells for basic science research.

“We will also conduct research and develop ways to improve cell isolation techniques, cellular viability and functioning, and shipping procedures for islet cells,” said JosГ© Oberholzer, principal investigator and director of cell and pancreas transplantation at UIC.

Working in collaboration with other islet resource centers, UIC will test and implement standardized methods for assessing islets to determine what factors may predict a successful islet transplant.

Insulin-producing islet cells from cadaveric donor pancreases are isolated and processed in a state-of-the-art, FDA-approved laboratory at the medical center.

The laboratory has provided islet cells for successful transplantation in patients at the medical center and has also shipped islets to institutions in the United States and Europe.

Islet cell transplantation allows patients with type-1 diabetes to achieve insulin independence, glucose control and freedom from hypoglycemic attacks, according to Oberholzer. Transplantation offers the most promise for achieving a functional cure for diabetes, but it also has limitations.

One shortcoming is the lack of organ donors. There are only 6,000 donor pancreases each year in the United States and each organ can only produce enough islets to help, at most, one diabetic.

Transplant recipients must also take drugs to suppress their immune system in order to avoid rejection of the islets.

“There are 20.8 million diabetic patients in the United States,” said Oberholzer, “and most of them could benefit from an islet transplant if an unlimited source of cells was available and if the cells could be protected from rejection by a better means than the current immunosuppression.”

Oberholzer and a team of international researchers have formed the Chicago Project, a collaboration of top scientists who are committed to helping diabetics worldwide by developing a cell-based cure for diabetes in the next five years. The Chicago Project aims to develop an unlimited supply of islet cells from donor pancreases and find a way to encapsulate the cells to prevent rejection.

“Becoming an NIH-funded Islet Resource Center will enhance our efforts to find a functional, or cell-based, cure for diabetes,” said Oberholzer. “Clinicans and researchers at other centers will also benefit by having high-quality islets procured, processed and distributed by a core facility with the highest standards.”

Part of UIC’s grant will fund scientific research at Northwestern University to improve the technology for evaluating the quality of islets.

###

UIC ranks among the nation’s top 50 universities in federal research funding and is Chicago’s largest university with 25,000 students, 12,000 faculty and staff, 15 colleges and the state’s major public medical center. A hallmark of the campus is the Great Cities Commitment, through which UIC faculty, students and staff engage with community, corporate, foundation and government partners in hundreds of programs to improve the quality of life in metropolitan areas around the world.

For more information about UIC, visit uic.edu/

Contact: Sherri McGinnis Gonzalez

University of Illinois at Chicago

Study Adds To Links Between Sleep Loss And Diabetes

Short or poor quality sleep is associated with reduced control of blood-sugar levels in African Americans with diabetes, report researchers from the University of Chicago in the Sept. 18, 2006, issue of the Archives of Internal Medicine.

The finding suggests that one inexpensive way to improve the health of patients with type 2 diabetes might be to improve the duration and quality of their sleep.

“Sleep is modifiable,” said Kristen Knutson, research associate (assistant professor) in the department of health studies at the University of Chicago and first author of the paper. “We’ve known for some time that skimping on sleep can impair glucose tolerance even for healthy people. Now we have evidence connecting chronic partial sleep deprivation and reduced blood-sugar control in patients with diabetes.”

“Although we can’t be certain whether sleep loss makes diabetes worse or the diabetes interferes with sleep, it only makes sense for everyone, but especially patients with diabetes, to give themselves the opportunity to get enough sleep,” Knutson said.

The study focused on 161 African-American patients being treated at the University of Chicago Hospitals for type 2 diabetes. The researchers asked participants how much sleep they thought they needed at night and how much sleep they managed to get on weeknights and weekends. They also assessed the quality of their sleep using a standard 19-item questionnaire, the Pittsburgh Sleep Quality Index (PSQI).

To assess blood sugar control they measured glycosylated hemoglobin, a standard tool for management of patients with diabetes. Glycosylated hemoglobin, or HbA1c, reflects the average blood glucose level over the previous three months. A normal HbA1c result is between four and six percent. Higher levels represent poor glucose control. Patients with diabetes are considered to be under good control if they can keep their levels below seven percent.

The researchers found that, on average, the 161 diabetes patients got very little sleep and had poor glucose control. Mean sleep duration was six hours a night. Only six percent reported getting eight hours of sleep on weeknights and only 22 percent reported getting at least seven hours. Seventy-one percent had poor sleep quality. The median HbA1c score was 8.3 percent.

Many patients with diabetes have painful complications that can interfere with sleep. Even after the researchers excluded 39 patients who reported such pain, however, two out of three of the remaining 122 patients reported poor quality sleep. The average HbA1c among those patients was almost as high: 8.2 percent.

Insufficient or poor quality sleep was closely associated with higher HbA1c results. For patients with no complications of their diabetes, a three-hour “perceived sleep debt”-the difference between how much sleep they felt they needed and how much they think they got-was associated with a 1.1 percentage-point increase in HbA1c levels, for example from 7.5 percent up to 8.6 percent.

For patients with at least one complication of diabetes-such as nerve pain, kidney damage or coronary artery disease-decreased sleep quality appeared to be more important. An increase of five points (out of 21) on the PSQI was associated with a 1.9 percentage-point increase in HbA1c, for example from 8.7 percent up to 10.6 percent.

“The magnitude of these effects,” the authors note, “is comparable to those of widely used oral antidiabetic agents.”

A long series of laboratory and epidemiologic studies has suggested that cutting back on sleep has a harmful effect on glucose control, insulin secretion and metabolism in ways that might increase diabetes risk, said Eve Van Cauter, professor of medicine at the University of Chicago and senior author of the study. The current study asks the question: is glucose control in subjects who already have diabetes adversely affected by too little sleep or poor sleep?

“Our findings suggest, at least in this study population, that short or poor sleep is associated with decreased blood-sugar control in patients who already have diabetes,” she said. “The growing tendency to burn the candle at both ends may be a significant contributor to the current epidemic of diabetes. One way to slow down this epidemic may be to avoid building a chronic sleep debt.”

The MacArthur Foundation, the American Diabetes Association and the National Institutes of Health funded this study. Additional authors are Armand Ryden, of the University of Chicago, and Bryce Mander, now at Northwestern University.

University of Chicago Hospitals

MC 6063, 5841 S. Maryland Ave
Chicago, IL 60637
United States

uchospitals.edu/

Anatomic Excision Of Anterior Prostatic Fat At Radical Prostatectomy: Implications For Pathologic Upstaging

UroToday- In the journal Urology, Dr. Finley and associates of Dr. Thomas Ahlering at U.C. Irvine report that the anterior prostatic fat (APF) may harbor lymph nodes draining the prostate and thus are important in prostate cancer (CaP) staging.

Between 2006 and 2007, 204 patients undergoing robotic-assisted laparoscopic radical prostatectomy by 2 surgeons had the APF removed, and the technique of the dissection reviewed on video. A total of 30 of these 204 men had lymph nodes found in the APF (14.7%). The number of lymph nodes ranged from 1-3 with an average of 1.4. The average lymph node size was 6 to 7mm. Four of the 204 men were found to have metastatic CaP in the lymph nodes of the APF. Three of these 4 men had Gleason score of 7 or greater. All of these 4 men had CaP in the anterior prostate and 3 of them had a focally positive surgical margin. In 2 of the 4 patients, metastatic CaP was identified in the posteriorly located periprostatic lymph nodes. The only variable that separated the men with APF lymph nodes from those without was a greater body mass index (29kg/m2 vs. 26.7729kg/m2).

The video analysis demonstrated that the fat overlying the anterior prostate extends back to the bladder neck and lateral to the obturator lymph node chain. The implication is that for a few patients undergoing radical prostatectomy, CaP in the anterior prostate combined with a greater body mass index puts the patients at risk for metastasis to the APF lymph nodes.

Finley DS, Deane L, Rodriguez E, Vallone J, Deshmukh S, Skarecky D, Carpenter P, Narula N, Ornstein DK, Ahlering’ TE

Urology. 70(5): 1000-1003, November 2007
doi:10.1016/j.urology.2007.09.028

Reported by UroToday Contributing Editor Christopher P. Evans, M.D

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:
www.urotoday

—————————-
Copyright © 2007 – UroToday
Reproduced for blog with permission of UroToday.
—————————-

Patency Of The “Third Inguinal Ring” In Children With Unilateral Cryptorchidism: Fact Or Fiction?

UroToday – A study by Dr. L.H. Braga, et al. evaluated the so-called “third inguinal ring” which is the entrance to the scrotum. It was thought to be an important finding and etiologic factor for undescended testes. Historical reports showed that it might be a true anatomic entity associated with undescended testes. The group assessed the patency of this “third inguinal ring” as an expected testicular path of decent into the scrotum with unilateral cryptorchidism.

Two-hundred consecutive children who underwent unilateral orchiopexy were prospectively evaluated at the time of surgery to determine the anatomical patency of the “third inguinal ring”. They were also evaluated for its association in relation to the patient’s age at surgery, the affected side, the position of the testis, epididymal anomalies and the patent processus vaginalis. The group found that the mean age at surgery was 5.2 years. The “third inguinal ring” was closed in 118 boys and open in 82 of them. The closed “third inguinal ring” was found more frequently in patients with an intraabdominal testis. There were no statistical significant factors observed between patency of the “third inguinal ring” and other factors that were evaluated.

The group concluded that the “third inguinal ring” may represent the passage point of the testis into the scrotum which really did not seem patent in over 60% of the patients with unilateral cryptorchidism. They felt that this anatomic finding is not an important factor in the pathogenesis of cryptorchidism.

Braga LH, Lorenzo AJ, Pippi Salle JL, Miranda ME, Tatsuo ES, Lanna JC.
Eur J Pediatr Surg. 2008 Aug;18(4):237-40
10.1055/s-2008-1038672

UroToday Medical Editor Pasquale Casale, MD

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.

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Copyright © 2008 – UroToday

Big Increase In Quitters Following Introduction Of Smokefree England

Statistics show unprecedented demand for Stop Smoking Services

Around 165,000 smokers quit between April and September 2007 – an
increase of 28 per cent compared to the same period the previous
year, according to new statistics out yesterday.

The statistics, recorded by the NHS Stop Smoking Service, are the
first to show the impact of the Smokefree legislation which came into
force on 1 July 2007. They record the number of smokers who had
successfully quit at the four-week follow up interview.

Additional figures show that the new Department of Health ‘Getting
Off Cigarettes’ campaign, launched on 26 Dec 2007, has also resulted
in a large increase in calls to the Stop Smoking Hotline.

Between the launch and the 13th January:

– almost 73,000 smokers had visited the campaign website;

– around 9,000 smokers had called the NHS Smoking Helpline for more
information;

– just under 13,000 people had requested for an information pack via
text message or interactive TV.; and

– more than 25,000 smokers had been sent the free ‘Get Support’ DVD,
giving more information about the NHS support available.

Public Health Minister Dawn Primarolo said:

“It’s great news that so many smokers have been able to quit,
preventing serious health problems and complications. It’s not easy
to overcome a nicotine addiction so it’s clear that the NHS Stop
Smoking Service is providing a vital service. And these figures are
confirmation that the ВЈ56 million we invested into the service last
year was money well spent.

“This follows the news last week that a smaller proportion of adults
now smoke – 22 per cent down from 24 per cent. We are well on track
to meet our target to reduce the proportion of smokers in England to
21 per cent by 2010″.

The ‘Getting Off Cigarettes’ campaign was designed to promote the
wide range of support available to those who want to quit. These
statistics follow a number of measures taken by the Government to
reduce smoking.

In 2007, the age of sale of tobacco was increased from 16 to 18 years
and hard hitting picture warnings will appear on all tobacco products
produced for the UK market from 1 October 2008.

Later this year, the Department of Health will consult on the next
steps in tobacco control and the further regulation of tobacco
products, including around the display of tobacco at the point of
sale, access to tobacco from vending machines and packaging.

Notes

1. The statistics are official statistics and are published by the
Information Centre on behalf of the Department of Health.

2. The current NHS campaign promotes the range of free support
available to give quitters the best chance of success. The ‘Getting
Off Cigarettes’ adverts, which will run for a total of three months,
feature a cityscape dotted with giant cigarettes to bring to life the
challenge of quitting smoking and remind smokers that many others are
going through similar experiences. Different rescue operations
arrive on the scene to help smokers to ‘get off’ the cigarettes,
illustrating the range of free stop smoking support provided by the
NHS.

3. To access NHS Stop Smoking Services call the the NHS Smoking
Helpline – 0800 169 0 169 for details of the free NHS support
available to boost your chances. Alternatively, you can order a free
DVD from 0800 917 6699 to find out about the full range of NHS
support available to help you quit.

4. 164,711 successful 4 week quits were generated by the NHS Stop
Smoking Services between April and September 2007.

5. The statistics, recorded by the NHS Stop Smoking Service, record
the number of stop smoking treatment episodes that resulted in
smokers being successfully quit at the four-week follow up interview.

Department of Health

Climate Change Will Affect Public Health: A Call To Action

Extreme heat events (EHE), or heat waves, are the most prominent cause of weather-related human mortality in the United States, responsible for more deaths annually than hurricanes, lightning, tornadoes, floods and earthquakes combined. These events, and other climate-related changes in the worldwide environment that directly affect public health, are examined in the November issue of the American Journal of Preventive Medicine. This special issue provides a crucial state-of-the art overview of many of the issues at the intersection of climate change and health.

Guest Editors – Howard Frumkin, MD, DrPH, and Jeremy J. Hess, MD, MPH, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta; and Anthony J. McMichael, PhD, National Centre for Epidemiology and Population Health, Australian National University, Canberra – and their colleagues issue a call to action. Dr. Frumkin observes that “a decade ago there was active debate about whether climate change was real, and whether human contributions have played a major causal role in the recently observed global warming. That debate is largely over, although the inherent complexities of climate system science and various uncertainties over details remain. A corollary question – whether climate change would have implications for public health – also has been settled. The answer is yes. A range of possible effects has been identified, some now fairly well understood and others yet unclear. …Public health and preventive medicine, as applied disciplines, share a common mission: to prevent illness, injury and premature mortality, and to promote health and well-being. This mission therefore carries a mandate to address climate change. Fortunately, the basic concepts and tools of public health and preventive medicine provide a sound basis for addressing climate change…Climate change, an environmental health hazard of unprecedented scale and complexity, necessitates health professionals developing new ways of thinking, communicating, and acting. With regard to thinking, it requires addressing a far longer time frame than has been customary in health planning and it needs a systems approach that extends well beyond the current boundaries of the health sciences and the formal health sector. Communicating about the risks posed by climate change requires messages that motivate constructive engagement and support wise policy choices, rather than engendering indifference, fear, or despair. Actions that address climate change should offer a range of health, environmental, economic and social benefits. The questions at present, then, are not so much whether or why, but what and how? What do we do to prevent injury, illness and suffering related to climate change, and how do we do it most effectively?”

This issue of the American Journal of Preventive Medicine offers a range of articles by a group of experts who helps answer these questions. Meanwhile, there also remains for health researchers the extremely important task of assisting society in understanding the current and future risks to health, as part of the information base for policy decisions about the mitigation of climate change itself.

Beginning with an overview, Frumkin and McMichael emphasize the broad challenges climate change poses to our customary ways of thinking, communicating, and acting to protect health. Four commentaries address specific concerns to preventive medicine: research (Andy Haines); local public health (Mayor Michael Bloomberg and Rohit Aggarwala); world health protection (Maria Neira); and medical education and training (Robert Lawrence and Peter Saundry).

Irrespective of the extent to which human activity accounts for climate change, the next five papers present evidence of health impacts of climate change, including the direct effects of heat (George Luber and Michael McGeehin); vectorborne diseases (Kenneth Gage and colleagues); waterborne diseases (Jon Patz and colleagues); and air quality (Pat Kinney). The authors of the final paper in this section (Jeremy Hess and colleagues) describe the way these and other health effects vary by location, emphasizing the importance of geographic thinking in health.

Discussions of climate change involve scientific complexity, considerable uncertainty, ample misinformation and many vested interests with the resulting potential to frighten, confuse and/or alienate people. Health communication has therefore emerged as a key discipline in preventive medicine. The papers by Jan Semenza et al. and Ed Maibach et al. provide both empirical data and theoretical background on climate change communication, grounded in the insights of health communication.

Much public health activity will have to focus on adaptation – reducing harm from the effects of climate change. Key principles of adaptation are discussed by Kristie Ebi and Jan Semenza, and lessons learned from public health disaster preparedness are described by Mark Keim. Margalit Younger et al. expand on the ways in which policies and actions can both address climate change and yield additional health, environmental, and other benefits. Finally, Michael St. Louis and Jeremy Hess expand the discussion to global health, an appropriate focus since some of the most pressing challenges to health are expected to occur in the world’s poorest nations.

###

The articles appear in the November 2008 issue of the American Journal of Preventive Medicine, Volume 35/Issue 5, published by Elsevier. In recognition of the importance of this topic, award-winning health reporter Kenny Goldberg (with the National Public Radio station KPBS, 89.5 FM in San Diego) has interviewed five of the contributing authors. These interviews are available as freely downloadable podcasts at: ajpm-online/content/podcast. To access the full text of the associated articles visit ajpm-online/content/advance.

PODCASTS

Howard Frumkin, CDC – framing the set of issues
Climate Change and Public Health: Thinking, Communicating, Acting

Rohit T. Aggarwala, Director, Long-Term Planning and Sustainability, City of New York – exemplifying the translation of public health principles into policy
Think Locally, Act Globally: How Curbing Global Warming Emissions Can Improve Public Health

Michael McGeehin, CDC – focusing on the impact of heat waves
Climate Change and Extreme Heat Events

Edward W. Maibach, Center for Climate Change Communication, George Mason University – examining the potential of communication and marketing interventions
Communication and Marketing as Climate Change Intervention Assets: A Public Health Perspective

Kristie L Ebi, ESS LLC – synthesizing key principles and applying to all areas of climate change
Community-Based Adaptation to the Health Impacts of Climate Change

Climate Change and the Health of the Public
Special Issue of the American Journal of Preventive Medicine
Volume 35/Issue 5 (November 2008)

Guest Editors

Howard Frumkin
National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, CDC, Atlanta, Georgia

Anthony J. McMichael
National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia

Jeremy J. Hess
National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, CDC, Atlanta, Georgia

TABLE OF CONTENTS

Introduction and Overview

Introduction and Acknowledgments
Climate Change and the Health of the Public
Howard Frumkin, Anthony J McMichael, and Jeremy J. Hess

Climate Change and Public Health: Thinking, Communicating, Acting
Howard Frumkin, Anthony J. McMichael

Commentary

Climate Change and Health: Strengthening the Evidence Base for Policy
Andrew Haines

Think Locally, Act Globally: How Curbing Global Warming Emissions Can Improve Local Public Health
Michael R. Bloomberg, Rohit T. Aggarwala

2008: A Breakthrough Year for Health Protection from Climate Change?
Maria Neira, Roberto Bertollini, Diarmid Campbell-Lendrum, David L Heymann

Climate Change, Health Sciences, and Education
Robert S. Lawrence and Peter D. Saundry

The Health Impacts of Climate Change

Climate Change and Extreme Heat Events
George Luber and Michael McGeehin

Climate and Vectorborne Diseases
Kenneth L. Gage, Thomas R. Burkot, Rebecca J. Eisen, Edward B. Hayes

Climate Change and Waterborne Disease Risk in the Great Lakes Region of the U.S.
Jonathan A. Patz, Stephen J. Vavrus, Christopher K. Uejio, Sandra L. McLellan

Climate Change, Air Quality, and Human Health
Patrick L. Kinney

Climate Change: The Importance of Place
Jeremy J. Hess, Josephine N. Malilay, Alan J. Parkinson

Behavioral and Public Communication Issues

Public Perception of Climate Change: Voluntary Mitigation and Barriers to Behavior Change
Jan C. Semenza, David E. Hall, Daniel J. Wilson, Brian D. Bontempo, David J. Sailor, Linda A. George

Communication and Marketing as Climate Change Intervention Assets: A Public Health Perspective
Edward W. Maibach, Connie Roser-Renouf, Anthony Leiserowitz

Adaptation and Solutions

Community-Based Adaptation to the Health Impacts of Climate Change
Kristie L. Ebi, Jan C. Semenza

Building Human Resilience: the Role of Public Health Preparedness and Response as an Adaptation to Climate Change
Mark E. Keim

The Built Environment, Climate Change, and Health: Opportunities for Co-Benefits
Margalit Younger, Heather R. Morrow-Almeida, Stephen M. Vindigni, Andrew L. Dannenberg

Global Health
Climate Change: Impacts on and Implications for Global Health
Michael E. St. Louis, Jeremy J. Hess

Source: AJPM Editorial Office

Elsevier Health Sciences