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Mr Epidemiology

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science outreach

Which diseases do we get to “fight”?

About two weeks ago, the Hospital for Sick Children, also known as SickKids, launched their new ad campaign. For those who aren’t from Canada, SickKids is based in Toronto, Ontario, is the second largest children’s hospital in the world, and does some truly amazing and inspiring work. I highly recommend watching the ad, as the messaging and production quality is absolutely amazing. The imagery and symbolism is strong, and shows these children as fighters who will vanquish their foes. It shares more in common in terms of tone and imagery with NBA and NFL commercials than typical hospital advertisements.

I have mixed feelings on this ad campaign. On the one hand, it is meant to provide a strong, motivational message to children undergoing treatment, and to help raise funds for the SickKids Foundation. In this, it is wildly successful, with an ad that has been viewed almost half a million times (as of this writing), and one that has sparked lots of discussion. However, while the ad is motivational and empowering, it is not without fault.

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How can one person completely change the results of a survey?

In public health, we rely heavily on samples, as measuring everyone you are interested is often impractical. However, this requires a lot of thought and development in order to avoid unintentionally biasing your sample, as was the case for the USC Dornslife/LA Times Daybreak poll.

Last week, a story came out about how one 19-year old black man in Illinois was single-handedly changing the standings of the US Presidential election. This was based on the results from the USC Dornsife/Los Angeles Times Daybreak, a survey of voter attitudes on “a wide range of political, policy, social and cultural issues.” In this survey, Donald Trump has generally held the lead, until last week, when Hillary Clinton came out in front. Interestingly, this is markedly different than most other national polls, that have shown Clinton is generally ahead, or a much closer contest than that poll would have you believe. So what happened?

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Going to #CPHA2014

Toronto_at_Dusk_-a
The 2014 CPHA conference will be held in Toronto, ON | Picture courtesy Wikimedia
Commons

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).

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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.

Background:
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.

Objectives:
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.

Methods:
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.

Results:
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.

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

Implications:
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

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 NovaScotia.com
The Joggins Fossil Cliffs UNESCO World Heritage Site | Photo via NovaScotia.com

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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Battlestar Pedagogica: Using Science Fiction to teach Science!

Science fiction is educational - SO SAY WE ALL! Picture courtesy BattlestarWiki
Science fiction is educational – SO SAY WE ALL! | Picture courtesy Battlestar Galactica Wiki

I’m a huge fan of science fiction and fantasy. There are few feelings quite as impressive as when an author crafts a world that draws you in (See: Arrakis, Middle Earth, Westeros, LV-246, Hogwarts etc). Perhaps what I find most fascinating though, is how quickly science fiction can turn into real life. For example, the tricorder from Star Trek was a fictional device that could scan different aspects of the environment depending on the requirement, ranging from geological, such as mineral content of rocks, to metereological, such as air pressure and temperature, to biological, such as heart rate and blood pressure. While this sounded like a great dream in the 1960s (when The Original Series aired), we’re now, within a single generation (pun *totally* intended), able to turn this into reality. The new Samsung Galaxy S4, for example, is slated to be released with a suite of health apps (dubbed S Health), including apps to measure heart rate, blood pressure as well as track caloric expenditure. Even things as simple as being able to communicate without needing a bulky cellphone have now become a reality.

As teachers and educators, we suffer from a very real limitation when it comes to teaching. Either due to time, lack of equipment or other constraints we cannot teach some issues the way we would like. But even in the most well-equipped lab, sometimes we can’t teach a concept because the technology doesn’t exist. In those situations, we can use outlandish examples to discuss a concept, and then work backwards from there to discuss the limitations we currently face, a concept called a Thought Experiment. By imagining a scenario, we can push the boundaries of our understanding, discussing the issue from a “what about if X happened,” or “Would Y still occur if A and B happened.” There are many types of thought experiments, and it means different things to different disciplines. I’m going to be using it to refer the use of a metaphor to explain a concept, which corresponds to the “prefactual” type of thought experiment, ie. what outcome would we expect if we had conditions A, B and C.

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