An Ounce of Prevention...

A Publication of the
Program on Prevention
In Education & Practice

March 2000 - Volume 1, Number 3

Happy Spring!

Great news from the Program on Prevention-
We will be changing our office location the beginning of April and will be located on the third floor of Wing D, next to the Department of Social Medicine. Our offices will be located in the 387 suite at the end of that hallway. Our phone, fax, and CB numbers will remain the same.
As most of you know, our current location is completely surrounded by dump trucks, bulldozers, cement trucks and lots of dirt. We are anxiously awaiting our move to a cleaner and safer environment.

We look forward to you visiting us in our new office space.

Risky Business

During the Prevention portion of the Special Topics Days, The Program on Prevention gave first-year medical students an introduction to the concept of risk in health and health care. We first asked students the following questions.
See how you do on this risky quiz!

1. Which lifetime risk is higher:
Your risk of being killed by lightning
Your risk of being killed in an airplane crash
Your risk of being killed in a car crash

2. Each year there are about 175,000 new cases of breast cancer diagnosed in America. What fraction of those proves fatal?
One-quarter
One-third
Two-thirds

3. What is the biggest risk for kids in a bathtub?
Electrocution
Drowning
Scalding

4. You know that the average household is full of "accidents" waiting to happen, but what part of the house is the most risky?
Bathroom
Stairs
Kitchen

5. Which is more likely:
You'll have a serious mental disorder in your lifetime
You'll start a diet sometime this year

6. Which is higher - the chances that:
You'll die because a plane fell on you
You'll be given a new identity under the US Witness Security Program

We then discussed measuring risk status (using "risk factors"), the difference between scientific risk and risk perceptions, and different ways to communicate risk information to patients. We plan to develop these concepts more fully with the students as they go through medical school.

And now for the answers:

1. car crash- lifetime risk
2. one-quarter
3. scalding
4. stairs
5. mental disorder
6. US Witness Security Program

Newsworthy Notes

Prevention News Around Campus...

Ferrell Lectureship- Suzanne Fletcher, MD
Mark Your Calendars...

The Preventive Medicine Residency Program announces the 4th John Atkinson Ferrell Lectureship on May 17, 2000 at 5 pm. This year’s recipient of the Ferrell Prize for Outstanding Contributions to Preventive Medicine and Public Health is Suzanne Fletcher, MD, MSc of Harvard University, and a former faculty member at UNC. Dr. Fletcher will speak on "Breast Cancer Screening: Lessons for Prevention".

John Atkinson Ferrell, MD, a native son of North Carolina, had a distinguished career in public health prior to his death in 1965. A trust from his estate was made available to the UNC School of Medicine to enhance preventive medicine education at the University. The Preventive Medicine Residency Program established an endowed prize and lectureship in Preventive Medicine at UNC, to be awarded annually to a physician with ties to the University or the state who has had a distinguished career in preventive medicine and public health. Former recipients of the Prize are Robert Lawrence, MD, Ronald Levine, MD, MPH, and Edward Wagner, MD, MPH.

In addition to the lecture by Dr. Fletcher on May 17, six preventive medicine residents will give presentations of their research and several UNC faculty members will present their work done in conjunction with the US Preventive Services Task Force. More details will follow in the May newsletter.

Around the Country...

We Are Healthier Than Our Parents

A recent report, an extension of the Framingham Study, provides important new information about changes in disability over the past 20 to 30 years.

Many people know about the original Framingham Study. Started in 1948 to determine the causes for the new epidemic of heart disease, the study followed about 5200 residents of Framingham, MA, for over 20 years. Each study participant was examined every two years, including blood tests, electrocardiograms, and a history and physical examination.

In the 1970's, the study was expanded to include the offspring of the original study participants. These participants were also examined every two years for a number of years, using many of the same tests that had been used for their parents.

A recent report in the American Journal of Public Health compares measures of physical function in the original cohort (in 1977) with the same measures in their children (in 1994) at the same age (55-70 years). While 52% of men in the original cohort had limitation in at least one function, 36% of their male offspring had a similar limitation. Women showed a similar difference: 72% of the original cohort had at least one limitation compared with 54% of their female offspring at the same age. A number of other measures gave similar results.

Compared to their parents, a smaller percentage of the offspring had such chronic illnesses as cardiovascular disease, hypertension and arthritis. The decrease in functional limitations, however, was present both for those with a chronic illness and for those without. One chronic illness, diabetes, did increase in the offspring cohort compared with their parents.

This is one of the most dramatic illustrations of the improving health of Americans. Not only are we living longer, but we are also less disabled than our parents. Prevention has played an important role in this trend toward improved health.

PREVENTION WORKS!

Allaire SH, LaValley MP, Evans SR, O'Connor CT, Kelly-Hayes M, Meenan RF, Levy D and Felson DT. Evidence for decline in disability and improved health among persons aged 55 to 70 years: The Framingham Heart Study. American Journal of Public Health. 1999;89(11):1678-1683.

Around the World...

Childhood Immunization Schedule -2000 Update

Each year the CDC's Advisory Committee on Immunization Practices reviews the Recommended Childhood Immunization Schedule making changes necessary to ensure the health of children. Several changes have been implemented on the 2000 schedule. They include:

Rotovirus vaccine removal due to evidence of a strong association between the vaccine and intussesception among infants 1-2 weeks following vaccination.
An all-inactivated poliovirus vaccine (IPV) schedule for polio vaccination to eliminate the risk for vaccine-associated paralytic poliomyelitis.
Exclusive use of acellular pertussis vaccines.
Hepatitis A vaccine added for children living in states and communities with consistently elevated rates of hepatitis A. The inclusion on the schedule should alert providers to find out the hepatitis A recommendations for their communities.

MMWR. Recommended Childhood Immunization Schedule - United States, 2000. Jan. 21, 2000;49(2):35-47.

Around the World Wide Web...

People have more access to health care information than ever before. Not only do they hear about health news in the media but more and more individuals are looking to the WWW for information. There is a whirlwind of information out there but directing your patients to credible and reliable information is the key. The Web can be a valuable resource for educational material for patients and providers alike if it is used wisely.

One excellent site for patients who are planning overseas travel is the CDC's travel website. It contains information about recent outbreaks, vaccine recommendations for specific locations, special needs for children or individuals with chronic conditions, and food and water risks in various areas. Must-have information for anyone who wants to have an enjoyable and safe trip! http://www.cdc.gov/travel/

The Immunization Action Coalition produces a website that is completely dedicated to education about immunization/vaccination. This site features printable material in many languages, including Spanish, for children and adults and is appropriate for patient, community or provider education. The site is updated frequently and also has a weekly
e-newsletter. http://www.immunize.org

Developed by the Harvard Center for Cancer Prevention, YourCancerRisk is a personalized tool that estimates your risk of cancer and provides tips for prevention. This website is designed for individuals (40 and over) who would like to determine their risk for breast, colon, lung or prostate cancer. It gives a thorough description of the type of cancer, describes what risk and risk factors are and what a screening test is designed to do. As an individual answers a series of health-related questions, it tallys the person's risk for getting the cancer. Patients will find this site very user friendly and appropriately targeted to their level of understanding. http://www.yourcancerrisk.harvard.edu/index.htm

Look for our next edition of "An Ounce of Prevention" in May, 2000.
If you have comments or questions about this newsletter or its contents, please e-mail alward@med.unc.edu.

Program Co-Directors: Russ Harris, MD, MPH and Linda Kinsinger, MD, MPH
Education Coordinator & Editor: Amy L. Ward

Go to the Program on Prevention Homepage