Change of the society seems necessary 

Cardiovascular diseases (CVD) result from a negative interaction between genes, lifestyle and environment. To prevent CVD, it is necessary to influence the natural history of the disease development in an individual. While we cannot change our genes, we can do a lot to our lifestyles and environments. It is generally agreed that individuals alone should not be blamed for chronic diseases such as CVD, but that society also has its role and responsibilities. Governments, in cooperation with their stakeholders (e.g., industry, nongovernmental organizations, and health professionals), play a central role in creating an environment that empowers and encourages individuals, families, and communities to make positive, life-enhancing behaviour changes in terms of diet and patterns of physical activity. In addition to direct health policy and services, the responsibility of governments includes sectors that have a pivotal influence on health, such as agriculture, education, and transportation. Social determinants of health are also mediated by fiscal policy and employment opportunities. Consequently, it is imperative that the executive of the government, especially the head of the government, and the finance minister be involved in discussions that traditionally have been limited to matters of microeconomic reform inside the health portfolio. Commerce, industry, and labour traditionally have not been invited to the discussion, but should also be involved. 

The WHO states that civil society and nongovernmental organizations can help to ensure that consumers ask governments to provide support for healthy lifestyles and ask the food industry to provide healthy products. Civil society is the key platform for mobilizing and actualizing associative behaviours designed to promote awareness, education, and advocacy for health. They advocate for representatives of business and commerce becoming involved in defining the problem, proposing solutions, and implementing those solutions, because a healthy workforce and market are central to these representatives’ core business. Recently, it has also been noted that the power of the Internet in promoting what may be called the “globalization of associative behaviour” is important. 

“Parents Jury” is a case in point. It is an Internet-based initiative that offers parents information and a say in matters that affect their children’s physical activity and nutrition (e.g., advertising of junk food during prime time television hours). “GLOBALink”, another Web site, passes on lessons from one generation of tobacco control advocates to the next, and “Patient View”, a group that monitors and analyzes developments in health, communicates its findings with health and social campaigners via its electronic publication, HSCNews. The “People’s Health Movement” is another “free association” that is working to influence social policy. Guided by a vision of “a world in which people’s voices guide the decisions that shape our lives, The Peoples’ Health movement leads the production of “Global Health Watch”, the first alternative health report. This alternative report, which was started on the basis that civil society needs to produce its own global health report unfettered by political restrictions, challenges the relevance of the WHO World Health Reports. 

Although there is a need to invest in building the evidence base around the role of policy, and, in particular, finding the appropriate tools for evaluating a policy’s impact, there is clearly a convergence of opinion that it is time to enact policies aimed at creating healthier social and physical environments. This opinion is accompanied by an emerging trend to return to not only the concept but the reality of community: where we live and the types of societies we want. Governments have the classic tools of legislation, regulation, and taxation at their disposal to enact social policies that can serve to turn the tide of CVD, diabetes, obesity, and other chronic conditions. Thanks to the growing and increasingly concerted voices of lobby groups, governments are beginning to take this role more seriously. 

The major modifiable risk factors for CVD, smoking, high serum cholesterol, high blood pressure, physical inactivity, obesity and diabetes have shown non-uniform trends; some risk factors have diminished, some increased. Many of those changes are related to changes in society and environment. Smoking is an excellent example, and the food industry and catering has also significantly contributed to the dramatic decrease in CVD mortality in the middle-aged populations in most developed countries. For instance, in Finland CVD mortality has fallen over 70% during the past 40 years in middle-aged men. The epidemiological analysis of the data unequivocally shows that this has mainly happened thanks to improvements in smoking habits, serum cholesterol and blood pressure. These improvements have taken place across the entire population, not only in high risk individuals cared by health sector. Thus, there is no doubt that societal changes have been primarily behind the prevention of premature CVD in this country and many other countries as well. It is important that health sector together with other policies will have a common goal: getting healthier choices in lifestyles and environments easier to adopt and maintain. Increased investments in these areas will bring both health and financial gains in the longer term. 

Reference: European Society of Cardiology, Professor Jaakko Tuomilehto, Can we change society? Barcelona, Spain, 31 August, 2009

Only a few studies have investigated non-malignant respiratory effects of glass microfibers and these have provided inconsistent results. Our objective was to assess the effects of exposure to glass microfibers on respiratory and skin symptoms, asthma and lung function.  

A cross-sectional study of 102 workers from a microfiber factory (response rate 100%) and 76 office workers (73%) from four factories in Thailand was conducted. They answered a questionnaire on respiratory health, occupational exposures, and lifestyle factors, and performed spirometry. Measurements of respirable dust were available from 2004 and 2005.  

Workers exposed to glass microfibers experienced increased risk of cough (adjusted OR 2.04), wheezing (adjOR 2.20), breathlessness (adjOR 4.46), nasal (adjOR 2.13) and skin symptoms (adjOR 3.89) and ever asthma (adjOR 3.51), the risks of breathlessness (95%CI 1.68-11.86) and skin symptoms (1.70-8.90) remaining statistically significant after adjustment for confounders. There was an exposure-response relation between the risk of breathlessness and skin symptoms and increasing level of microfiber exposure. Workers exposed to sensitizing chemicals, including phenol-formaldehyde resin, experienced increased risk of cough (3.43, 1.20-9.87) and nasal symptoms (3.07, 1.05-9.00).  

This study provides evidence that exposure to glass microfibers increases the risk of respiratory and skin symptoms, and has an exposure-response relation with breathlessness and skin symptoms. Exposure to sensitizing chemicals increased the risk of cough and nasal symptoms. The results suggest that occupational exposure to glass microfibers is related to non-malignant adverse health effects, and that implementing exposure control measures in these industries could protect the health of employees 

Literature:  Sripaiboonkij P, Sripaiboonkij N, Phanprasit W, Jaakkola MS, Respiratory and skin health among glass microfiber production workers: a cross-sectional study,Environ Health. 2009 Aug 18;8(1):36.  

Fulltext: Respiratory and skin health among glass microfiber production workers: a cross-sectional study 

The aim of the following study was to investigate the effective Chinese medicine treatment of chronic fatigue syndrome (CFS).  

Seventy-five CFS patients meeting the inclusive criteria were enrolled from March 2007 to April 2008 and randomized into two groups.  

The 40 patients in the treated group were orally treated with Lixu Jieyu Recipe (LJR, consisted of milkvetch root 30 g, kudzuvine root 30 g, asiabell root 15 g, red sage root 10 g, aizoon stonecrop 15 g, epimeddium herb 10 g, curcuma root 10 g, and grassleaved sweetflag rhizome 10 g, made into 200 mL of decoction), for 100 mL twice a day. The 35 patients in the control group were treated with vitamin B tablets (10 mg twice a day), adenosine triphsphate (ATP, 20 mg, thrice a day) and Oryzanol tablets (20 mg thrice a day).  

The laboratory indicators including serum immunoglobulins (IgG, IgA, IgM, IgE), blood immune cells, as T-cells (Th and Ts), B-cells, natural killer cells, as well as CD4/CD8 ratio were measured before and after 3-month treatment.  

After treatment the difference in scores of fatigue symptoms between the two groups was significant (P < 0.01), the scores of various SCL-90 factors and the total score significantly reduced in the treated group after treatment (P < 0.01). Levels of the immunoglobulins measured before treatment were in an equilibrium state, they all were unchanged after treatment in both groups (P > 0.05), and showed no significant difference between groups either before or after treatment. As for the immune cells, significant increase of the lowered Th, Ts cells, and decrease of CD4/CD8 ratio were found in both groups after treatment (P < 0.05), but the improvement was more significant in the treated group, so the difference between groups in these indices after treatment also showed statistical significance (P < 0.05). LJR shows superiority in treating CFS. 

Reference:   Zhang ZX, Wu LL, Chen M., Zhongguo Zhong Xi Yi Jie He Za Zhi., Effect of lixu jieyu recipe in treating 75 patients with chronic fatigue syndrome, Shanghai University of Traditional Chinese Medicine, 2009 Jun;29(6):501-5.

This is one of series of review articles on formaldehyde and formaldehyde-releasers (others: formaldehyde in cosmetics, in clothes and in metalworking fluids and miscellaneous).  

Thirty-five chemicals were identified as being formaldehyde-releasers. Although a further seven are listed in the literature as formaldehyde-releasers, data are inadequate to consider them as such beyond doubt. Several (nomenclature) mistakes and outdated information are discussed.  

Formaldehyde and formaldehyde allergy are reviewed: applications, exposure scenarios, legislation, patch testing problems, frequency of sensitization, relevance of positive patch test reactions, clinical pattern of allergic contact dermatitis from formaldehyde, prognosis, threshold for elicitation of allergic contact dermatitis, analytical tests to determine formaldehyde in products and frequency of exposure to formaldehyde and releasers. The frequency of contact allergy to formaldehyde is consistently higher in the USA (8-9%) than in Europe (2-3%).  

Patch testing with formaldehyde is problematic; the currently used 1% solution may result in both false-positive and false-negative (up to 40%) reactions. Determining the relevance of patch test reactions is often challenging.  

What concentration of formaldehyde is safe for sensitive patients remains unknown. Levels of 200-300 p.p.m. free formaldehyde in cosmetic products have been shown to induce dermatitis from short-term use on normal skin. 

Reference:   de Groot AC, Flyvholm MA, Lensen G, Menné T, Coenraads PJ., Formaldehyde-releasers: relationship to formaldehyde contact allergy. Contact allergy to formaldehyde and inventory of formaldehyde-releasers, Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, Contact Dermatitis. 2009 Aug;61(2):63-85. 

By 2015 2M will die each year from tobacco-induced cancers

The Tobacco Atlas, Third Edition, published by the American Cancer Society and World Lung Foundation, estimates that tobacco use kills some six million people each year- more than a third of whom will die from cancer- and drains US$500 billion annually from global economies. Unveiled at the LIVESTRONG Global Cancer Summit, the Atlas graphically displays how tobacco is devastating both global health and economies, especially in middle- and low-resource countries, and tracks progress and outcomes in tobacco control. 

The Most Preventable Cause of Cancer

According to The Tobacco Atlas, 2.1 million cancer deaths per year will be attributable to tobacco by 2015. By 2030, 83% of these deaths will occur in low and middle-income countries. Unique among cancer-causing agents, the danger of tobacco is completely preventable through proven public policies. Major measures include tobacco taxes, advertising bans, smokefree public places, and effective health warnings on packages. These cost-effective policies are among those included in the Framework Convention on Tobacco Control (FCTC), a global treaty endorsed by more than 160 countries, and recommended by the World Health Organization MPOWER policy package. 

A $500 Billion Hole in Global Economy

The global economy lost a staggering US$500 billion due to tobacco use. These economic costs come as a result of lost productivity, misused resources, missed opportunities for taxation, and premature death. 

• Because 25 percent of smokers die and many more become ill during their most productive years, income loss devastates families and communities.
• Cigarettes are the world’s most widely smuggled legal consumer product. In 2006, about 600 billion smuggled cigarettes made it to the market, representing an enormous missed tax opportunity for governments, as well as a missed opportunity to prevent many people from starting to smoke and encourage others to quit.
• Tobacco replaces potential food production on almost 4 million hectares of the world’s agricultural land, equal to all of the world’s orange groves or banana plantations.
• In developing countries, smokers spend disproportionate sums of money relative to their incomes that could otherwise be spent on food, healthcare, and other necessities.  

Burden Shift to the World’s Poorest Countries

• The Tobacco Atlas crystallizes an undeniable trend: the tobacco industry has shifted its marketing and sales efforts to countries that have less effective public health policies and fewer tobacco control resources in place:
•  In 2010, 72 percent of those who die from tobacco related illnesses will be in low- and middle-income countries.
• Since 1960 global tobacco production has increased three-fold in low- and middle-resource countries while halving in high-resource countries.  
• In Bangladesh alone, if the average household bought food with the money normally spent on tobacco, more than 10 million people would no longer suffer from malnutrition and 350 children under age five could be saved each day.

Quotes from Leadership

“The Tobacco Atlas is crucial to helping advocates in every nation get the knowledge they need to combat the most preventable global health epidemic,” said John R. Seffrin, Ph.D. chief executive officer, American Cancer Society. “It is especially appropriate to present the Atlas here in Ireland, where so much progress has already been made against the scourge of tobacco. By utilizing this information to develop public health strategies to reduce tobacco use and help people stay well, we will save millions of lives.”

“The Tobacco Atlas presents compelling evidence that the health burden is shifting from richer countries to their lower-resource counterparts,” said Peter Baldini, chief executive officer, World Lung Foundation.” This evidence clearly articulates the breathtaking scope and dimensions of the problem. It calls out to be used actively in strengthening the case for policy change.”

“I’m not telling people how to live their lives,” said Lance Armstrong, “but I am certainly trying to educate them on healthy lifestyles and preventing this train wreck that potentially awaits them.” 

Reference:  American Cancer Society, 2009 edition of the Tobacco Atlas catalogues catastrophic toll of tobacco worldwide, 25-Aug-2009