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Time for Schools to Act: Sleeping and Adolescents

This is a follow up to my two columns in CommonHealth offering a brief list of resources related to sleep and adolescents. A subject that has not been addressed by the school systems in Greater Boston.  The evidence on the case of sleeping is overwhelming but few schools are responding accordingly. The article by the New York Times is a good tool for parents to bring the attention of superintendents and principals. Time for a change.

New York TimesThe sputtering, nearly 20-year movement to start high schools later has recently gained momentum in communities like this one, as hundreds of schools in dozens of districts across the country have bowed to the accumulating research on the adolescent body clock.

Research Evidence Selected Resources

Great suggestion by one of my twitter friends on sleep and adolescents in GoPubMed

Filed under: Emergency, Media, Policy, psychology trauma, public health, Research

Pacientes, Web 2.0 y los Nuevos Modelos de Financiacion: Que Necesitan y que buscan los pacientes en las redes sociales?


Filed under: eHealth, global health, public health

Family Systems and Health and The Walking Gallery Photo by Regina Holliday

Filed under: eHealth, public health

How should we define health? A MUST READ BMJ Article

The current WHO definition of health, formulated in 1948, describes health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”  At that time this formulation was groundbreaking because of its breadth and ambition. It overcame the negative definition of health as absence of disease and included the physical, mental, and social domains. Although the definition has been criticised over the past 60 years, it has never been adapted. Criticism is now intensifying, and as populations age and the pattern of illnesses changes the definition may even be counterproductive. The paper summarises the limitations of the WHO definition and describes the proposals for making it more useful that were developed at a conference of international health experts held in the Netherlands. Full article

Filed under: eHealth, Emergency, global health, obesity, Policy, public health, Research, Urgent

eHealth Research Evidence in 2011

eHealth Research Evidence (PubMed database) in 2011

by @bacigalupe

Selected References

Link to full references. Kudos to Open Source!! Still too many references are not available to everyone.

If you have a link to those unavailable here or you are the author, please share a link in the comments area)

Filed under: eHealth, global health, Media, public health, Research

BMA warns against letting patients have access to their electronic records (BMJ) by e-Patient Dave

BMA warns against letting patients have access to their electronic records (BMJ)

According to the British Medical Journal, the British Medical Association (BMA) has taken a big, paternalistic step backward regarding patient participation. Or perhaps it’s a step in the right direction, formalizing their position as embracing 20th century thought: they warn that it’s not wise to let patients see their records, doctors will be deluged with emails, etc.

The concerns are familiar but archaic. Kaiser has ten years of experience showing that email reduces the total number of patient touches, and besides, patients love being able to read and write 24/7; etc. Our co-founder Dr. Danny Sands said, “How can patients participate if they can’t see the same information?” And how are they supposed to participate in shared decision making?

It’s not sufficient to say “The doctor will tell the patient whatever they need to know.” The record shows that time-pressured physicians commonly do not. And as we’ve said many times, whose data is it, anyway? Whose health is it?

You’re welcome to comment on the BMJ site. Anyone can submit a “rapid response” comment at this link. The online extract is here.

Note: the BMA was responding to an initiative described in the National Health Service’s white paper Equity and Excellence: Liberating the NHS(PDF, 339k), which we wrote about in November.

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Filed under: eHealth, Policy, public health

Undocumented Immigrants Excluded from Health Care Reform

Letter from Richard David:

Dear Friends –

Of all the dissapointments of this year’s health reform legislation, maybe the most politically destructive was the intentional exclusion of undocumented immigrants. They can’t even BUY health insurance in the exchanges! This concession to xenophobia is dangerous. Nationalist sentiment and attacks on minoroties in a time of economic crisis and ever expanding wars is not just another political trend. It is a particularly ugly and dangerous direction for American politics.

Michael Lyon, from California, drafted a late-breaker resolution to oppose the exclusion of immigrants from health reform. It is pasted in below. Please support this effort to put APHA on record on this issue.

Building multi-racial support for Latinos and other immigrants is urgently needed. If you want to help build support for this policy statement, please get in touch now or in Denver and we will coordinate our efforts. We need to have copies circulated in every business meeting and scientific session. People should stand up and speak out on this issue in every possible forum.


Opposing the Exclusion of Undocumented Immigrants from Health Care Reform

The American Public Health Association,

Noting that the Obama Health Plan, The Patient Protection and Affordable Care Act (PPACA), not only leaves at least 23 million uninsured[i], but it explicitly excludes ALL undocumented immigrants,[ii] and,

Noting that the PPACA even forbids undocumented immigrants from using their own money to buy health insurance at discounted prices through the exchanges,[iii] and,

Noting that, as a group, undocumented immigrants have arguably the greatest need of having healthcare expanded to them because:

FIRST: Undocumented immigrants are twice as likely to be uninsured as documented immigrants,[iv] and,

SECOND: Undocumented immigrants are excluded from Medicaid and SCHIP[v] by federal law, and,

THIRD: Undocumented immigrants’ future access to healthcare will be more challenging because  (1) increasing raids[vi] and deportations[vii], and the Secure Communities Initiative[viii] make undocumented immigrants fearful of being visible, (2) State and County budget cuts are eliminating health services for  undocumented immigrants[ix], (3) Anti-immigrant groups are pressing jurisdictions to withdraw health services from undocumented immigrants[x], and (4) Legislators are even at the point of considering withdrawing citizenship from US born children of undocumented immigrants, contravening a 150-year old constitutional right,[xi] and,

FOURTH:  Many of the factors contributing to poor health indicators for immigrants in general are worse for undocumented immigrants, such as immigrants’ fears of presenting to health institutions, immigrants’ increasing unemployment rates and the higher cost of buying individual insurance, and health institutions’ fear of losing funding for treating immigrants.   Even among the insured, immigrants’ and their children’s access to ambulatory and emergency care is worse than that of citizens,[xii] and,

Noting that measures taken to deny healthcare to undocumented immigrants result in citizens losing healthcare also, as exemplified by the 2004 cancellation of Colorado’s Presumptive (Medicaid) Eligibility program, which had allowed pregnant women to receive prenatal care while their Medicaid applications were processed. The entire program was eliminated because about half of the women were later found to be ineligible by immigration status. Citizen and immigrant women alike were put at risk, as well as their unborn children.[xiii]

And finally, noting that  APHA has taken a clear positions against withholding medical care from undocumented immigrants in its resolution 2001-23, which “Urges the President and the Congress to oppose denial of eligibility for programs providing nutritional, prenatal, public health, medical care, and behavioral health benefits and services to any person residing in the United States on the basis of her or his immigration status”, [xiv] its resolution 9501, which “Opposes any mandates and initiatives that would limit access to public health interventions and health services for undocumented and documented immigrants and their children.”[xv] and its resolution LB04-07, which “Deplores and warns against measures curtailing, eliminating, or disrupting health care to undocumented immigrants.”[xvi]

Therefore, the American Public Health Association

Directs its Executive Leadership to communicate to the President, Congress, and media APHA’s opposition to the exclusion of healthcare for undocumented immigrants from Health Reform legislation, and

Directs its Executive Leadership to communicate to the President, Congress, and media APHA’s support of health reform that provides equal, comprehensive, affordable, accessible healthcare for everyone, regardless of status of health, employment, income, or legalization,  that is, Single-Payer Healthcare, and

Directs its Executive Leadership to communicate to the President, Congress, and media APHA’s demand that community health centers receiving $11 billion of dollars of federal aid over the next five years through the PPACA[xvii] give undocumented immigrants comprehensive health care, and

Encourages its members and Affiliates to attend future events on immigration reform (public rallies, demonstrations, press conferences and the like) with the demand of comprehensive, affordable, accessible medical care for all immigrants, regardless of legalization status.

[v] Kaiser Commission on Medicaid and the Uninsured, “Summary: Five Basic Facts on Immigrants and Their Health Care,”, March, 2008, (Accessed Oct 3, 2010).


[xi] Newsweek Magazine, “The Next Front on Immigration,”, August 1, 2010, (Accessed Oct. 3, 2010),

Politico, “John McCain backs citizenship hearings,”, August 4, 2010, (Accessed Oct. 3, 2010).


[xiii] Wall Street Journal, “Prenatal Care Is Latest State Cut In Services for Illegal Immigrants,”, October 18, 2004, (Accessed Oct. 3, 2010).

[xiv] APHA Policy Statement 2001-23: “Protection of the Health of Resident Immigrants in the United States,”, October 24, 2001, (Accessed Oct. 3, 2010).

[xv] APHA Policy Statement 9501: “Opposition To Anti-Immigrant Statutes,”, (Accessed Oct. 3, 2010).


[xvi] APHA Policy Statement LB04-07 “Responding to Threats to Health Care for Immigrants,” November 9, 2004



Filed under: global health, immigrants, Media, Policy, public health, Urgent

1st International Health & Medicine Photography Contest

Revista MEDUSS lanza el 1er Concurso Internacional de Fotografía en Salud

Retratar los diversos aspectos de la salud es el objetivo del concurso de fotografía que organiza la revista MEDUSS perteneciente a la Escuela de Medicina de la Universidad San Sebastián sede Puerto Montt y que convocará a fotógrafos e interesados en esta materia, tanto de Chile como del extranjero.

Argentina, México, España, Colombia, Venezuela y Perú, serán los países que junto a Chile podrán participar del 1° Concurso Internacional de Fotografía en Salud y que tendrán la oportunidad de retratar aspectos y tendencias del área de la salud que sean característicos de sus respectivas culturas de origen.

En el concurso pueden participar estudiantes universitarios y profesionales de cualquier área, los que podrán enviar sus trabajos a cuatro categorías distintas: “Relación profesional-paciente”, “Instrumental médico-quirúrgico, “Vida de un paciente” y “Medicina para el alma”.

El jurado conformado por Adolfo Ugarte, Vicerrector de Comunicaciones de la Universidad San Sebastián; Rubén Gennero, MBA MPH Imperial Collage of London UK y Editor de; Boris Groisman, Médico Genetista, Director de y Jefe de Residentes de Genética Clínica del Centro Nacional de Genética Médica en Buenos Aires, Argentina; Michel Baró y Juan Ignacio Vargas, Médicos Internistas y académicos de la USS; Mario Mendoza, Fotógrafo profesional; y Cristián Duarte, Reportero Gráfico del diario el Llanquihue; serán los encargados de determinar las mejores imágenes del concurso.

Los ganadores podrán acceder a importantes premios como cámaras fotográficas y discos duros entre otros estímulos.

Los interesados deben bajar las bases y enviar sus trabajos hasta el 25 de Octubre mediante la página web de la revista:

Filed under: eHealth, global health, Media, public health

Ambiguous Loss and the Chilean Mineworkers: A Systemic Tragedy

Ambiguous Loss and the Chilean Mineworkers: A Systemic Tragedy

by Gonzalo Bacigalupe, EdD, MPH, Ikerbasque Research Professor, University of Deusto, Bilbao, Spain

For more than two weeks, 33 miners have been buried alive in the North of Chile.

The tragedy occurs at a mine that very recently has had other accidents and where the rescue operations have been frustrated by lack of accurate information about the mine and a general disregard for basic safety norms. Mine accidents happen but in this case the lack of real care for the lives of the mineworkers seems to be the real cause of the tragedy.

These two weeks have been full of political posturing on the part of the government mostly as well as the former governing coalition. Everyone is ready to blame the other although we silently know that this is the responsibility of business greed and government corruption that includes the whole governing spectrum. Chilean copper, gold, and other fine minerals extraction is the core of the country’s economy. In the case of medium and small mines, the overseeing of safety regulations is grounds for corruption and shortcuts, not so dissimilar from the causes of mines accidents or the BP spill in the Gulf of Mexico.

In Chile, inaccurate assessments of the situation have been packed with allusions to religion (God is mention by the President every day) and a general pretense of caring for the miners’ families has permeated the media. Tragedy sells. The fact is we know little about the people underground.  Psychologists called to the grounds provided misleading, inaccurate, and vague information about what should be expected and how families could be supported. A disaster of this nature should have been addressed with clear protocols in which the government, civil society and non-governmental organizations know exactly how to act in the aftermaths.

From a psychological and relational perspective, the tragedy contains all the ingredients of what has been coined as “ambiguous loss.” Ambiguous loss differs from ordinary loss in that there is no verification of death or no certainty that the person will come back or return to the way they used to be (Boss, 1999).  In Chile, with an unresolved past of disappeared citizens, the ability to resolve ambiguous loss is severely handicapped. Chile, as a society, is still unprepared to deal with the psychological and social sequelae of people suffering ambiguous loss. The anxiety, the loss of meaning, the ambivalence, and the hopelessness that this sort of catastrophe generates continues to paralyze the political establishment via blame games. Civil society and the media end acting in stereotypical and unhelpful ways to deal with ambiguous loss. Reparatory work is unseen in those circumstances. The tragedy of the mineworkers is also about trying to forget our past, to believe that simplistic solutions provide closure, and to think that one side is the one to blame for it all. It is irresponsible for political leaders and the media to continue playing the same game over and over again. We know how to address a loss of this magnitude; what we need now is the political leadership to implement those actions appropriately.

Filed under: Disaster, Emergency, global health, psychology trauma, public health, trauma, Urgent, , ,

Salud: Nuevos impuestos para una nueva epidemia by Gonzalo Bacigalupe

Salud: Nuevos impuestos para una nueva epidemia [Health: New Taxes for a New Epidemic] Revista Que Pasa April 30, 2010 by Gonzalo Bacigalupe

¿Impuestos a la comida chatarra en Chile? Estoy de acuerdo. Pese a que es sabrosa y barata, le cuesta caro al país. La obesidad es su resultado más visible.

Los males de la comida chatarra: provoca desnutrición y genera una adicción invisible.

La obesidad en Chile afecta a cerca de cuatro millones de personas y causa enfermedades crónicas letales, como la hipertensión vascular, diabetes y varias formas de cáncer. Como consecuencia, el aumento en las expectativas de vida corre el peligro de revertirse debido a un estilo de vida que se apoya en la comida chatarra, una de las causas principales de esta epidemia.

¿Por qué la comida chatarra es nuestra enemiga si tantos la consideran sabrosa y barata? Los alimentos nos debieran nutrir, pero la comida chatarra provoca desnutrición debido a sus ingredientes de baja calidad y no provoca saciedad, generando una adicción invisible. El precio es bajo para el consumidor, pero tiene un alto costo para Chile debido a la mayor demanda por salud, el ausentismo laboral y las deficiencias en el aprendizaje escolar debido a enfermedades físicas y sicológicas causadas por la obesidad.

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Filed under: eHealth, global health, obesity, Policy, public health

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