Ruminating Out Loud

ABC news is reporting that people are being advised “Don’t shake hands, don’t kiss on the cheeks, don’t go to the movies — best of all, just stay at home” in Mexico, where this deadly outbreak has already sickened more than 1,000 people and killed as many as 68. Various new cases are now being reported here in the U.S.

Courtesy of CDC, below are facts about Swine Flu you should be aware of. Please make sure you understand the risks of dissemination and seek for medical help if and when you start seeing the symptoms. Thanks.

[Update] Public health emergency has been declared as the 20th case has been confirmed in the U.S. “warning Americans to prepare for widespread outbreaks now or in the future, yet urging them not to panic.” The government is moving aggressively to prevent any potential major outbreak: “U.S. Homeland Security Secretary Janet Napolitano said the government would release a quarter of its 50-million-unit strategic reserve of antiviral medications, which combat the disease in infected patients, to states where outbreaks have occurred. Besser said the CDC has begun laying the groundwork to manufacture a swine flu vaccine if one becomes necessary.”

[Update II] Governments around the world are racing to ready themselves to prevent a potential spread of the Swine Flu.

[Update III] CDC has just released an updated Q&A on Swine Flu. Please check it out for more information on this issue.

[Update IV] President Barack Obama has no flu symptoms after Mexico visit. This is great news given the state of affairs Mexico is in.

Swine Flu in Humans

What is Swine Influenza?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.

Can humans catch swine flu?
Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.

How common is swine flu infection in humans?
In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza have been reported.

What are the symptoms of swine flu in humans?
The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.

Can people catch swine flu from eating pork?
No. Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.

How does swine flu spread?
Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.

What do we know about human-to-human spread of swine flu?
In September 1988, a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later. A swine H1N1 flu virus was detected. Four days before getting sick, the patient visited a county fair swine exhibition where there was widespread influenza-like illness among the swine.

In follow-up studies, 76% of swine exhibitors tested had antibody evidence of swine flu infection but no serious illnesses were detected among this group. Additional studies suggest that one to three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection.

How can human infections with swine influenza be diagnosed?
To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to CDC for laboratory testing.

What medications are available to treat swine flu infections in humans?
There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs, the most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.

What other examples of swine flu outbreaks are there?
Probably the most well known is an outbreak of swine flu among soldiers in Fort Dix, New Jersey in 1976. The virus caused disease with x-ray evidence of pneumonia in at least 4 soldiers and 1 death; all of these patients had previously been healthy. The virus was transmitted to close contacts in a basic training environment, with limited transmission outside the basic training group. The virus is thought to have circulated for a month and disappeared. The source of the virus, the exact time of its introduction into Fort Dix, and factors limiting its spread and duration are unknown. The Fort Dix outbreak may have been caused by introduction of an animal virus into a stressed human population in close contact in crowded facilities during the winter. The swine influenza A virus collected from a Fort Dix soldier was named A/New Jersey/76 (Hsw1N1).

Is the H1N1 swine flu virus the same as human H1N1 viruses?
No. The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses.

I love graphs and pictures. They tell a story better than any other medium of communication. That is why I include them in these pages from time to time to anchor our thoughts on the human experience by hard-to-face facts and realities. The graphs included here were obtained from the UC Atlas of Global Inequality, which is also the source of the graph in a previous post. They show the life expectancy at birth in countries around the world for the years of 1962 and 2004. While significant progress has been successively made in all continents and countries, the sub-Saharan Africa remains to be one place where multitudes of people are being left behind; left to die at less than half the lifetime of those living in most other parts of the world. It is simultaneously amazing and depressing that almost no change has been made with regard to life expectancy at birth in this forgotten corner of the world for almost half a century! Sadly, given the existing structural disadvantages of the people living in this part of the world, it difficult to see a way forward in overcoming this stagnation of life in the near future. Lawlessness and cruelty, disease and despair, and poverty of leadership are raping the continent. A call for drastic intervention is in order to liberate the millions of people out of misery and humiliation.

Comparison in life expectancy between 1962 and 2004.

First there was smoking. We learned that it is disastrous for the smoker’s health. One in five deaths and millions of illnesses every year in the US is caused by smoking. Millions more die and suffer from diseases and cancers caused by it. Then, we learned that, in fact, those around smokers are not safe either. This phenomenon, called second-hand smoking, has also been found to cause various heart and respiratory diseases as well us lung cancer.

A new study has come out indicating that third-hand smoke, yes there is such a thing!, is not safe either. It is consists of the transfer of toxins from surfaces which had been exposed to smoke. Here is an excerpt of the reporting via Science Daily:

In the January issue of Pediatrics, researchers at MassGeneral Hospital for Children (MGHfC) and colleagues across the country describe how tobacco smoke contamination lingers even after a cigarette is extinguished – a phenomenon they define as “third-hand” smoke…

“When you smoke – anyplace – toxic particulate matter from tobacco smoke gets into your hair and clothing,” says lead study author, Jonathan Winickoff, MD, MPH, assistant director of the MGHfC Center for Child and Adolescent Health Policy. “When you come into contact with your baby, even if you’re not smoking at the time, she comes in contact with those toxins. And if you breastfeed, the toxins will transfer to your baby in your breastmilk.” Winickoff notes that nursing a baby if you’re a smoker is still preferable to bottle-feeding, however.

Particulate matter from tobacco smoke has been proven toxic. According to the National Toxicology Program, these 250 poisonous gases, chemicals, and metals include hydrogen cyanide, carbon monoxide, butane, ammonia, toluene (found in paint thinners), arsenic, lead, chromium (used to make steel), cadmium (used to make batteries), and polonium-210 (highly radioactive carcinogen). Eleven of the compounds are classified as Group 1 carcinogens, the most dangerous.

Small children are especially susceptible to third-hand smoke exposure because they can inhale near, crawl and play on, or touch and mouth contaminated surfaces. Third-hand smoke can remain indoors even long after the smoking has stopped. Similar to low-level lead exposure, low levels of tobacco particulates have been associated with cognitive deficits among children, and the higher the exposure level, the lower the reading score. These findings underscore the possibility that even extremely low levels of these compounds may be neurotoxic and, according to the researchers, justify restricting all smoking in indoor areas inhabited by children…

Winickoff’s study shows that increasing awareness of how third-hand smoke harms the health of children may encourage home smoking bans. It also will be important to incorporate knowledge about third-hand smoke contamination into current tobacco control campaigns, programs, and routine clinical practice.”

There has recently been a tremendous amount of buzz spreading all over the internet around the shirtless pictures of President-elect Barack Obama. O!, gushed The Huffington Post.

O!

Thinking about this incident, I could not help but be impressed by the subtle, but symbolic, example it sets for the nation. Every bit of news coverage of  his daily work activities during the transition process has been making note of the fact that he incessantly goes to a gym without fail. He is probably one of the busiest persons on the planet and yet makes time to exercise on a daily basis. Needless to say, the fruits of such habits clearly manifest themselves in his good physical health and shape the images that surfaced project.

This is to be contrasted with the obesity epidemic that is affecting the nation. Below are graphs from CDC that show the percent of U.S. adults that are obese:

Percent of Obese (BMI > 30) in U.S. Adults (2007)

It is incredible to note that almost all the states have > 20% of their population as obese. Now, let us look at the same type of map from years past:

1986

1995

2001

The pace at which the numbers have been increasing is cause for alarm and is crying out for a major intervention and an act of strong leadership. What are the consequences of obesity? The answer to this question can be found from Weight-control Information Network, at National Institute of Health:

Obesity is more than a cosmetic problem. Many serious medical conditions have been linked to obesity, including type 2 diabetes, heart disease, high blood pressure, and stroke. Obesity is also linked to higher rates of certain types of cancer. Men who are obese are more likely than nonobese men to develop cancer of the colon, rectum, or prostate. Women who are obese are more likely than nonobese women to develop cancer of the gallbladder, uterus, cervix, or ovaries. Esophageal cancer has also been associated with obesity.

Other diseases and health problems linked to obesity include:

• Gallbladder disease and gallstones.
• Fatty liver disease (also called nonalcoholic steatohepatitis or NASH).
• Gastroesophageal reflux, or what is sometimes called GERD. This problem occurs when the lower esophageal sphincter does not close properly and stomach contents leak back—or reflux—into the esophagus.
• Osteoarthritis, a disease in which the joints deteriorate. This is possibly the result of excess weight on the joints.
• Gout, another disease affecting the joints.
• Pulmonary (breathing) problems, including sleep apnea, which causes a person to stop breathing for a short time during sleep.
• Reproductive problems in women, including menstrual irregularities and infertility.

Health care providers generally agree that the more obese a person is, the more likely he or she is to develop health problems.

Emotional suffering may be one of the most painful parts of obesity. American society emphasizes physical appearance and often equates attractiveness with slimness, especially for women. Such messages make overweight people feel unattractive.

Many people think that individuals with obesity are gluttonous, lazy, or both. This is not true. As a result, people who are obese often face prejudice or discrimination in the job market, at school, and in social situations. Feelings of rejection, shame, or depression may occur.”

That is where I see Obama leading by example. Without saying a word, the good physical shape he is in communicates the result of sustaining an active lifestyle. The discipline with which he goes about attending to his daily workouts communicates the type of committement it requires to stay healthy and, for that matter, overcome obesity. He is indeed a leader unlike any other.

Happiness is the fruit of satisfaction, the result of a fulfillment of want/need and the attainment of meaning to life. There apparently are ways, supported by scientific research, to actively ensure that one is happy.  Recent studies are finding out “how things like money, attitude, culture, memory, health, altruism, and our day-to-day habits affect our well-being.” The ten things that researches in positive psychology have shown to make people feel good are:

1. Savor Everyday Moments

Pause now and then to smell a rose or watch children at play. Study participants who took time to “savor” ordinary events that they normally hurried through, or to think back on pleasant moments from their day, “showed significant increases in happiness and reductions in depression,” says psychologist Sonja Lyubomirsky.

2. Avoid Comparisons

While keeping up with the Joneses is part of American culture, comparing ourselves with others can be damaging to happiness and self-esteem. Instead of comparing ourselves to others, focusing on our own personal achievement leads to greater satisfaction, according to Lyubomirsky.

3. Put Money Low on the List

People who put money high on their priority list are more at risk for depression, anxiety, and low self-esteem, according to researchers Tim Kasser and Richard Ryan. Their findings hold true across nations and cultures. “The more we seek satisfactions in material goods, the less we find them there,” Ryan says. “The satisfaction has a short half-life — it’s very fleeting.” Money-seekers also score lower on tests of vitality and self-actualization.

4. Have Meaningful Goals

“People who strive for something significant, whether it’s learning a new craft or raising moral children, are far happier than those who don’t have strong dreams or aspirations,” say Ed Diener and Robert Biswas-Diener. “As humans, we actually require a sense of meaning to thrive.” Harvard’s resident happiness professor, Tal Ben-Shahar, agrees, “Happiness lies at the intersection between pleasure and meaning. Whether at work or at home, the goal is to engage in activities that are both personally significant and enjoyable.”

5. Take Initiative at Work

How happy you are at work depends in part on how much initiative you take. Researcher Amy Wrzesniewski says that when we express creativity, help others, suggest improvements, or do additional tasks on the job, we make our work more rewarding and feel more in control.

6. Make Friends, Treasure Family

Happier people tend to have good families, friends, and supportive relationships, say Diener and Biswas-Diener. But it’s not enough to be the life of the party if you’re surrounded by shallow acquaintances. “We don’t just need relationships, we need close ones” that involve understanding and caring.

7. Smile Even When You Don’t Feel Like It

It sounds simple, but it works. “Happy people…see possibilities, opportunities, and success. When they think of the future, they are optimistic, and when they review the past, they tend to savor the high points,” say Diener and Biswas-Diener. Even if you weren’t born looking at the glass as half-full, with practice, a positive outlook can become a habit.

8. Say Thank You Like You Mean It

People who keep gratitude journals on a weekly basis are healthier, more optimistic, and more likely to make progress toward achieving personal goals, according to author Robert Emmons. Research by Martin Seligman, founder of positive psychology, revealed that people who write “gratitude letters” to someone who made a difference in their lives score higher on happiness, and lower on depression — and the effect lasts for weeks.

9. Get Out and Exercise

A Duke University study shows that exercise may be just as effective as drugs in treating depression, without all the side effects and expense. Other research shows that in addition to health benefits, regular exercise offers a sense of accomplishment and opportunity for social interaction, releases feel-good endorphins, and boosts self-esteem.

10. Give It Away, Give It Away Now!

Make altruism and giving part of your life, and be purposeful about it. Researcher Stephen Post says helping a neighbor, volunteering, or donating goods and services results in a “helper’s high,” and you get more health benefits than you would from exercise or quitting smoking. Listening to a friend, passing on your skills, celebrating others’ successes, and forgiveness also contribute to happiness, he says. Researcher Elizabeth Dunn found that those who spend money on others reported much greater happiness than those who spend it on themselves.