Mr Epidemiology

No, I'm not a skin doctor


public health

“Oh no! What happened?” “W220.2XD: Walked into lamppost, subsequent encounter.”

Last week, I ran across this very entertaining piece over in Healthcare Dive about the new ICD-10 codes. The International Classification of Diseases (ICD) is an incredibly useful tool in public health that basically can reduce an injury to a series of numbers. As you can imagine, this is very powerful when it comes to determining if something is on the rise. Researchers can easily count the number of times something occurs, and if it’s up from previous years, there might be something there.

Part of the beauty of the ICD-10 codes is how specific they are. The previous system, ICD-9 (creative, I know) wasn’t nearly as specific as they only had 13,000 codes compared to the 68,000 in ICD10. With the advent of ICD-10, The Powers That Be have gone into painstaking detail breaking down injuries, diseases and other maladies into incredible precise codes that can be used by researchers and public health professionals.

Today, we’re going to go through my favourite ones.

Do you know what code it is if you get hit by a Macaw? Because one exists. | Photo via National Geographic
Do you know what code it is if you get hit by a Macaw? Because one exists. | Photo via National Geographic

W55.89XA: Other contact with other mammals
There are many codes for contact with mammals. Raccoons, cows, pigs and cats are all represented. However, the mighty seal is not covered, which made Buster Bluth very sad. He would have suffered from W55.89XA.


W61.12XA: Struck by macaw, initial encounter. ​

Look like our patient
*puts on sunglasses*
Is a little Macaw-struck

(The other option here was for an AC/DC reference…)

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Bullet Points: This article has no waiting period

In December of 2012, I was asked my thoughts on the Sandy Hook shooting on Twitter, and if I was going to write about it through a public health lens. I said no – I didn’t want to weigh in so soon, and I didn’t really know where to start. Sandy Hook capped off a year where 130,437 people were shot by firearms. Of these, 31,672 people died, with almost 60% listed as suicides. Since that exchange, there have been several more mass shootings (defined as 4 or more fatalities in one instance – not including the shooter), and I kept surfing the internet to explore the arguments on both sides of the gun control debate. As pointed out by Kathleen Bachynski over on The 2×2 Project’s series on gun violence, aptly titled “Fully Loaded“, if “measles or mumps killed 31,672 people a year, we would undoubtedly consider the situation to be a public health emergency.”

The Smith & Wesson Model 29 became a classic after the Dirty Harry movies starring Clint Eastwood were released

The issue is, I’m not inherently against owning firearms. Sure, I don’t understand it, and it makes little to no sense to me how owning a gun makes you feel safer given how every other country in the Western world doesn’t and they seem to be getting along just fine, but that’s not the point. Many gun owners own firearms for self-defence, but use them mainly for fun and recreation – shooting targets and hunting are two of the major uses. More importantly though, Americans don’t want to give up their firearms, and that attitude isn’t going away any time soon: Anyone who thinks advocating for a universal ban on firearms in the US is wasting their time.

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Going to #CPHA2014

The 2014 CPHA conference will be held in Toronto, ON | Picture courtesy Wikimedia

Next week, I (Atif) will be heading to the Canadian Public Health Association Conference, where I’ll be presenting at two different points.

I’ll be chairing a session titled “Youth Injury Prevention in Canada – Where should we direct our intervention resources.” It promises to be an interesting presentation, where we’ll be discussing injury in Canada, and where to start tackling the problem of injury. This session is scheduled for Wednesday, May 28th from 1:30pm – 3:00pm.

Injury represents one of the most important negative health outcomes experienced by young people in Canada today. Injuries inflict a large burden on children and adolescents and their
families and communities. Injury events are costly in so many ways, whether measured in premature mortality, or the pain, disability, lost productivity and emotional consequence of non-fatal events.

This panel will be made up of child injury researchers and advocates who will make their case for different forms of injury prevention intervention. At the end of this panel, delegates will: understand more about the burden of youth injury in Canada; be aware of at least four different avenues for injury prevention intervention (primordial intervention, context-level interventions, safe sport and peer-influence interventions); have identified the rationale, strengths and limitations of each intervention approach; and have learned more about ways to undertake and gain support for youth injury prevention (from the CPHA conference program).

Click to go to the conference website

My second presentation is one of the studies from my PhD, titled “The influence of location of birth and ethnicity on BMI among Canadian youth.” This is a study that’s in press (woo!), and represents my own research focus. This one will be in the Kenora Room, on Thursday May 29th 2014, from 11:00am to 12:30pm.

Body mass indices (BMI) of youth change when they immigrate to a new country. This occurs by the adoption of new behaviors and skills, a process called acculturation.

We investigated whether differences existed in BMI by location of birth (Canadian vs foreign born) across 7 ethnic groups, both individually and together. We also examined whether time since immigration and health behaviors explained any observed BMI differences.

Data sources were the Canadian Health Behaviour in School-Aged Children Study and the Canada Census of Population. Participants were youth in grades 6-10 (weighted n = 19,272). Sociodemographic characteristics, height, weight, and health behaviors were assessed by questionnaire. WHO growth references were used to determine BMI percentiles.

Foreign-born youth had lower BMI than peers born in Canada, a relationship that did not decrease with increased time since immigration. Similarly, East and South East Asian youth had lower BMI than Canadian host culture peers. Finally, Arab/West Asian and East Indian/South Asian youth born abroad had lower BMI than peers of the same ethnicity born in Canada. These differences remained after controlling for eating and physical activity behaviors.

Location of birth and ethnicity were associated with BMI among Canadian youth both independently and together.

Our findings stress the importance of considering both ethnicity and location of birth when designing and implementing interventions. While currently either one or the other is addressed, our study shows there is heterogeneity in BMI by specific ethnic groups depending on whether they were born in Canada or not.

As always I’ll be trying to livetweet the conference. I’ll be using the #CPHA2014 hashtag, so feel free to follow along online! As always, there are a wide range of presentations and workshops, so I’m excited to attend.

If you’re attending the conference, leave a comment with details of your own presentation so that other readers can attend your talks. And if you see me at the conference, be sure to say hi!

This was posted simultaneously on my blog PLOS Blogs Public Health Perspectives

Thinspo, eating disorders and the seedy underbelly of The Internet

Trigger warning: I’m going to avoid triggering language as much as possible, but I will be discussing eating disorders and body image in this post.


We’ve all seen those photos. The inspirational quote, set to a background of a sunset, or a “One More Rep” picture with airbrushed model standing there, glistening ever so slightly while doing squats/deadlifts that is supposed to give us the motivation to push through. If we do that one extra rep, or run that one extra mile, maybe we too can look like that person. We all have that model in us, we just need to push through the pain to get there. However, what happens when this mentality goes too far?

The internet, like all tools, can be used for good and for evil, especially when it comes to exercise. Perhaps the biggest strength is the ability to get really good information from people you otherwise wouldn’t. Eric Cressey, Kelly Starrett and others give you access to information and videos based on sound science. They can push you to be stronger, workout smarter, and live the healthiest life you can. And sometimes, you can use those pictures of people being physically active as inspiration, a trend the kids these days call “fitspo,” a portmanteau for fit-inspiration. This can motivate you and gives you a goal to strive towards. Indeed, it’s a trope that has been used in movies ad nauseum. Who can forget the montage in Rocky IV where Rocky keeps looking at the picture of Ivan Drago in the mirror through his montage, eventually crumpling it in a most dramatic fashion (with heavy metal guitars playing in the background). The two ads featured here use the same idea to try and capitalize on this sense of greatness that we all hope is within all of us. However, like all behaviours, this is a balancing act, and can have devastating consequences.

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Childhood obesity drops 40% in the last decade. Or not really, but who’s checking?

“A lie that is half-truth is the darkest of all lies.”
― Alfred Tennyson

Last week, a study published in the Journal of the American Medical Association looked at the prevalence of childhood obesity over the last 10 years. The study, performed by Cynthia Ogden and colleagues at the CDC, aimed to describe the prevalence of obesity in the US and look at changes between 2003 and 2012. The study itself had several interesting findings, not least among them that the prevalence of obesity seems to have stabilized in many segments of the US population. However, they made one observation that caught the media’s attention:

“There was a significant decrease in obesity among 2- to 5-year-old children (from 13.9% to 8.4%; P = .03)”

This is where things get interesting, as the focus was not on the 5.5 percentage points difference. Instead of reporting the absolute difference, i.e. how much something changed, news outlets focused on the relative difference, i.e. how much they changed compared to each other. In that case, it would be (5.5/13.9 =) 40%. Which is much more impressive than the 5.5% change reported in the study. So you can guess what the headlines loudly proclaimed.

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Where I politely explain to a politician that they’re wrong

Last week, I was forwarded an opinion piece written by the Honorable Leo Glavine for the King’s County News. Now, if there’s one thing that I hate, it’s when people who are in positions of power, wealth and/or privilege tell “the others” how to live their lives – whether that be “work harder,” or “be healthier,” with absolutely no idea or acknowledgement about their own privilege.

In short, the road to health that many prescribe to the unhealthy is a two step model:

1) Be healthy
2) Don’t be not healthy

Which is why, when I read pieces that blame the poor or unhealthy for their situation, it makes me very angry. And you wouldn’t like me when I’m angry.

The Joggins Fossil Cliffs UNESCO World Heritage Site | Photo via
The Joggins Fossil Cliffs UNESCO World Heritage Site | Photo via

But lets get back to Mr Glavine’s commentary. In case you didn’t know, Mr Glavine is the Minister of Health and Wellness for the Province of Nova Scotia, and has been in politics since 2003. Prior to that, he was a school teacher. By all metrics, he’s very popular in his riding – winning the last election with a whopping 74% of the votes.

Mr Glavine starts off his piece rather innocuously, stating that the objectives of government are to represent the people, to provide services, and to take care of their health. We’re in agreement there. He also points out that they have to do more with less funding, and that will require creative and innovative thinking to continue to provide services for the populace. So far, we’re on the same page, and I don’t envy how difficult it is to balance all those demands.

And then things take a wild left turn.

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Physicality in Sports: How can you cheer when people are getting seriously injured?

As I write this post, I’m sitting here watching the 49ers take on the Seahawks. It’s been a great game so far, although the sheer number of injuries have been terrifying, culminating in an absolutely horrific injury to 49ers linebacker NaVorro Bowman where his leg bent in ways it shouldn’t under any circumstances.


Like a lot of people, I like sports. In fact, I was one of the 56 million people who tuned into that NFC Championship game mentioned above – more than the entire population of Spain, and the total population of California and Florida together. Getting together with friends, watching football, hockey, UFC, or any other sport is one of my favourite passtimes. The drama that comes along with professional sports in the form of redemption stories, a veteran’s final chance at a title, and the bad blood associated with historic rivalries all lead to a great afternoon/evening/day. In addition, there’s the sheer skill and athletic ability of the competitors and watching years of practice and training pay off. Along with this comes one of the most exciting things for any spectator, especially those who like football or hockey, to witness.

The Bone Crushing Hit.

You know what this is. A player gets the puck/ball and runs towards the goal/endzone, and a defensive player absolutely destroys them. You’re sitting at home, miles away, and you cringe with the sheer impact. It makes every highlight reel, and transcends sports, appearing on highlights reels for the NHL and the NFL. Sometimes this is illegal but more often than not, it’s perfectly legal, and considered “part of the game.” This is where I have trouble.

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The Biggest Public Health Stories of 2013

2013 was a big year for public health. We were thrust to the forefront again with disease outbreaks, and have had to deal with increased skepticism of the nature of what we do from the public. Meanwhile, within the establishment, rifts have been growing between groups, as different professional organizations vie for power and control. Here are my top five public health stories for 2013, presented in no particular order, but I’d love to hear yours in the comments.

1. Polio in Syria
Polio is a crippling disease that has been covered on the blog before. It’s been almost completely eradicated, but is still endemic to certain parts of the word. However, following civil unrest in Syria, polio has started to spread again and has, to date, crippled 17 children. Before the March 2011 uprising, vaccination rates were estimated to be above 90%. However, since then, estimates for vaccination rates hover around 68% – enough to prevent the benefits of herd immunity from kicking in. In order to increase immunization rates, the UN is trying to mobilize a vaccine drive. However, due to political and safety concerns, they are having a hard time ensuring that all children are vaccinated. To quote NPR:

Polio does not stop at borders or military checkpoints. Without a comprehensive response to stop the virus, aid workers fear that the outbreak could become a public health catastrophe.

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On Men’s Health and Moustaches

Movember is one of, if not the biggest, charity aimed at raising awareness about men’s health (Click image for more)

In Canada, the top three causes of death for men are cancer (31.1%), heart disease (21.6%) and unintentional injuries (5.0%). The top two are the same for women, although with slightly different percentages: cancer and heart disease account for 28.5% and 19.7% of all deaths among women, with stroke (7.0%) coming in third. In the US, men die at an overall rate 1.4-times higher than women, of heart disease 1.6-times more, and are twice as likely to die from an unintentional injury.

In fact, women outlive men by 4.5 years on average worldwide – 66.5 years vs 71.0 years. This difference increase to 7 years in the developed world. Not only are men more likely to die from the causes above, men are also more likely to commit suicide than women. This gender difference increased following the recession. A time trend analysis from the UK found that approximately 850 more men, and 155 more women committed suicide than would have been expected based on historical trends following the 2008 economic downturn, with the highest increases in those regions that were most affected by rising unemployment.

But what leads to these outcomes? Given we live in a world where people can get help when they need it, why should men be dying at a rate that is that much higher than women for (almost) the same diseases? And why are they dying younger than women?

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Book Review: Deadly Outbreaks: How Medical Detectives Save Lives Threatened by Killer Pandemics, Exotic Viruses, and Drug-Resistant Parasites

Deadly Outbreaks: How Medical Detectives Save Lives Threatened by Killer Pandemics, Exotic Viruses, and Drug-Resistant Parasites | Click image to go to CSTE website

Anyone who follows my writing knows that I’m a big proponent of using stories to talk about science. We’ve discussed how you can use science fiction teach science, zombies to talk about disease outbreaks, and my TEDx talk discussed using principles of storytelling in how we discuss science. So when I was asked to review (see disclaimer below) Dr Alexandra Levitt’s new book “Deadly Outbreaks: How Medical Detectives Save Lives Threatened by Killer Pandemics, Exotic Viruses and Drug-Resistant Parasites,” I jumped on the opportunity.

The CDC has a program known as the Epidemiologic Intelligence Services, where individuals trained in fields such as epidemiology, medicine, statistics and veterinary sciences come together to identify causes of diseases. For an overview of the EIS, check out this review of “Inside the Outbreaks” by Travis Saunders over at Obesity Panacea. The EIS was set up Alexander Langmuir, who has been profiled on the blog, and their work has been instrumental in learning about, and thus containing, disease outbreaks all over the world. Dr Levitt is well positioned to speak on these issues, having worked at the CDC since 1995, although it should be noted that this was written in her free time, not as part of her position at the CDC.

To continue reading, click here!

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