EBM and Clinical Support Librarians@UCHC

A blog for medical students, faculty and librarians about their use of evidence based medicine, clinical literature, Web 2.0, sources and search strategies

Tag Archives: Public Health

Teaching & Learning in Medicine, Research Methodology, Biostatistics: Show Me the Evidence (Part 4): Causality, Airplanes and GIDEON

As accident re-enactments go, this one is pretty Riveting

Links courtesy of NJ.com and Exosphere3D – All rights reserved – Copyright 2011


The focus and calm of U.S. Airways Captain Chesley Sullenberger can be appreciated by listening to the audio portion of this re-enactment, as he made critical analyses – over a period of only a few minutes – on how (and where) to land a disabled aircraft sinking earthward over a densely populated area. His decisions saved 100% of the lives on board that day.

Hang out with a bunch of epidemiologists long enough and eventually the conversation while turn to Causality. They will tell you that there are some big differences in semantics between linking causation, etiology and “proof” that X exposure caused Z disease or health condition. When I looked up the terms “causation” and “causality” (on Google) there were major sidetracks, such as WBA (Why-Because-Analysis) as in, Why did the airplane crash? Why did the reactor experience a meltdown?

Why? From the viewpoint of a physician, an engineer or an epidemiologist… because of X-Y-Z.  

X-Y-Z could be bird strikes, human error, engine failure, weather conditions, crazed people bearing guns, lack of fuel or a thousand other accidents waiting to happen. Often the causes can be identified. Sometimes one can only attribute unanticipated events to gauzy, fuzzy concepts such as “it was a one in a million chance” or “this was God’s will”,  “causes unknown” or just plain Karma. The harder (non-fuzzy) data can be applied towards improvements in systems design, development of new vaccines, engineering safety… all targeted towards avoidance of future accidents (or disease outbreaks).


Epidemiologists save lives.  Sometimes this association accumulates slowly… as in proving associations between Exposure X and development of Disease Y decades later.  In other cases, evidence mounts up as an emergency, such as the identification of a novel virus identified as SARS in 2002.  But linking health effects of exposures over a human life-span is so much more elusive than showing evidence that birds got sucked into a jet engine at 2,500 feet (as above).

Turning to the PubMed database, a screenshot below from Medical Subject Headings List (MeSH) reveals how the term “causation” is mapped in the online thesaurus of medical indexing terms:

Image Source: NLM (http://www.ncbi.nlm.nih.gov/mesh) – All rights reserved – copyright 2011

One way to search a large database such as PubMed is to simply type in some words – for an example, Liver Cancer AND Epidemiology.  This pulls up over 18,000 retrievals…  too many (!), but by then selecting and applying standard Limit Fields such as Language, Journal Subset, Age Group, Gender and others, the retrievals can be filtered down to a more-manageable number.

A more precise way to search a large database like PubMed is to use the Medical Subject Headings list. In the example below, the term Liver Cancer was typed into the MeSH search page, which maps automatically to the preferred MeSH term — Liver Neoplasms. While this search still retrieves thousands of citation, they can be limited by selecting and applying any MeSH Subheading (or clinical qualifiers) that are appropriate to the search. These subheadings include clinical concepts such as Virology, Immunology, Genetics, Epidemiology, Transmission and 80 others.  Following is a screenshot of that type of search:

Image Source: NLM (http://www.ncbi.nlm.nih.gov/mesh) – All rights reserved – copyright 2011

Remember that a librarian’s idea of “causality” could be defined, in part, by the number or types of clinical subqualifiers selected (immunology, virology, epidemiology and those types of “background” concepts) to be combined with the formal MeSH term.

There are many ways to search. It helps a novice medical searcher sometimes to tell them just that: There is no one right way to search. Sounds enigmatic and it is.

Here is an example which I found recently in the medical literature, a 2010 article which discusses application of Bradford Hill criteria (listed here):

  • strength of association
  • consistency
  • specificity
  • temporality
  • biological gradient (dose-response)
  • biological plausibility
  • biological coherence
  • experimental evidence and
  • analogy

 Image: http://www.ncbi.nlm.nih.gov/pubmed/20644061 – All rights reserved – Copyright 2011


Those searching for practical answers about causality, transmissible agents, disease etiology, global prevalence or current treatments might want to search GIDEON (Global Infectious Disease Epidemiology Online Network), an interesting “niche” information source targeting the research requirements of epidemiologists, clinical & translational researchers, MPH students, toxicologists or anyone interested in tracking or diagnosing infectious diseases on a country- or world-wide scale (subscription required). Updated weekly, the database is produced by Gideon Informatics and hosted on the EBSCO platform.

A search for causality or epidemiology done in the resources indexed by GIDEON is quite unlike a search done in PubMed about the etiology of Liver Cancer. The producers collect, review and index factual data collected from around the globe; their data encompasses a wide and diverse group of human cultures, agricultural, societal, economic or environmental practices.

Below is a screenshot of one example of the type of data that can be searched on GIDEON: bacterium (causative agent), typhoid (identifiable infectious agent) and United States (location, recorded incidence over time):

.Finally, a screenshot of What’s New at GIDEON (May 11 2011):

Image Source: GIDEON – All rights reserved – copyright 2011

Oncology, Statistics, Summary Reports: Treating Cancer, Living with Cancer

Ask almost anyone you know about cancer, and they will have stories to relate about parents or family, close friends or co-workers (or themselves) who have received a diagnosis of cancer, or are going through treatments, or who have been declared cancer-free.  Living as a cancer survivor has become more common, thankfully, than in previous decades, and represents one of the health success stories of our era.

This post presents a short, eclectic sample of recent cancer-related news, statistics, research or summary reports.  The final portion of the post links to video presentations given by two UCHC research faculty as they discuss clinical and translational cancer research (filmed in November 2009).


First: The National Conference of State Legislatures (NCSL) website provides an assortment of statistics or background pieces on state-based social or economic indicators, health initiatives, legislation or other current issues.  This site is a valuable resource for reference librarians, epidemiologists, policy-makers or anyone seeking current statistics about state-sponsored programs.

NCSL provides a collection of documents about Cancer Data, Trends and Policy 2009 reports, free and open to anyone to access (although registration is required to view some of the tables).  That page is where the table describing U.S. Cancer Incidence, 2009 shown below. According to statistics from the American Cancer Association, lung, prostate or breast cancers represent the most common diagnoses in the United States in 2009:

Image Source: http://www.ncsl.org/Portals/1/Documents/magazine/articles/2009/SL0110_Statestats.pdf – All rights reserved – Copyright 2009


Next:  Several paragraphs from a December 2009 article written by Harmon J. Eyre, formerly chief medical officer of the American Cancer Society, entitled “Winning the Cancer Fight: Looking at the Future“:

” The medical management of cancer for the past 100 years has grouped cancers by the organ in which they originate and used standard interventions such as surgery, radiation, and chemotherapy.  With the development of the cancer genome anatomy of various cancer sites, individualized cancer therapy will quickly follow.

Specific genetic profiles are being introduced to project the risk of breast cancer recurrence and to shape the choice of treatment agents. We have decades of data on outcomes using estrogen receptor, progesterone receptor, and human growth factor receptor 2 testing which dictates treatment in breast cancer. Tests such as these are needed for lung, colon, prostate, lymphoma, leukemia, and other cancers. They are beginning to be developed and disseminated, with encouraging early results.

Despite keeping records in cancer registries for many decades, widespread evaluation of the level of quality care in cancer is lacking. We know that large variations in the delivery of care occur by hospital, city, state, and region. There are a number of groups working to develop indicators of quality cancer care, but there is a lack of agreement on these indicators and they are not being widely collected. For optimal outcomes, quality care has to be delivered nationwide to all cancer patients. ”

Text Source: Page 863 – Primary Care, Vol. 36:859-865 (December 2009) – All rights reserved – Copyright 2010


An 18-page annual report from American Society of Clinical Oncology entitled “Clinical Cancer Advances 2009: Major Research Advances in Cancer Treatment, Prevention, and Screening—A Report
From the American Society of Clinical Oncology
” was published in December, 2009.  Following is an excerpt from this report:

This report [from ASCO] now it its fifth year, was developed under the guidance of a 18-person editorial board made up of leading oncologists and other cancer specialists… The editors reviewed research published in peer-reviewed scientific journals and the results of research presented at major scientific meetings over a 1-year period (October 2008 to September 2009).

Only studies that significantly altered the way a cancer is understood or had an important impact on patient care were included. Research in each section is divided into “major advances” and “notable advances,” depending on the impact of the advance on patient care and survival. “

Excerpt from ” Clinical Cancer Advances 2009: Major Research Advances in Cancer Treatment, Prevention, and Screening—A Report“, published Dec 10 2009 in Journal of Clinical Oncology – Vol. 27, No. 35:6052-606

ASCO provides links to reference information about current cancer treatments for physicians or other clinical staff, called Cancer Portal, which can be accessed at this link.

The society also provides free cancer information targeted for people living with cancer on their website, Cancer.net.


Next: Two segments from a lecture series given in 2009 by UCHC faculty.  Oncologist Susan Tannenbaum is Medical Director of the Clinical & Translational ResearchProgram at UCHC, is shown in a 54-minute presentation on trends and improvements in the treatment of metastatic breast cancer.

The second video is a presentation on translational research given by Kevin P. Claffey, PhD, who is co-director of the UConn Health Center Breast Cancer Translational Research Group and an associate professor in Cell Biology, Center for Vascular Biology.



Video Credits: http://mediasite.uchc.edu/Mediasite41/Viewer/?peid=22f078e3c075411380af60acdab8da83 – All rights reserved – Copyright UCHC 2010


Next: Regarding a May 6 2010 New York Times editorial written by Nicholas D. Kristof:

In “New Alarm Bells About Chemicals and Cancer” (column, May 5 2010) writer Nicholas D. Kristof drew attention to a document being released by the President’s Cancer Panel that warns that – in Mr. Kristof’s words – “our lackadaisical approach to regulation may have far-reaching consequences for our health. ”

Text Source: The New York Times – All rights reserved – Copyright 2010


I found readers’ comments as (or more) interesting to read as the original editorial.  There are 200+  comments which can be read at this link:  http://www.nytimes.com/2010/05/08/opinion/l08kristof.html

Public Health, Health Infrastructure, Humanitarian Aid: Health Crisis in Haiti

The recent major earthquake in the capital city of Port-au-Prince, Haiti on Jan 12 2010 has been a catastrophic and life-altering event for those living there.  The death toll climbed this week to an estimated 200,000 people.  For world leaders (and regular citizens), viewing the news reporting and photos from afar, the downtown area resembles a post-nuclear landscape.  Thankfully, many millions of people worldwide have donated monies toward the relief effort currently gearing up for their aid.

Watching the grim news from this poor Caribbean country unfold,  it seems unfortunately predictable as a sober demonstration of what happens when a government does (next to) nothing for a few days after a major catastrophe.  “No one” was in charge of managing the after-effects of this disaster.  Bodies piled up in the streets, people trapped under rubble – and whom might have lived had they been pulled away from the buildings which collapsed around them – were not rescued, roads are not cleared, the government was not visible. The infrastructure failed.

Injured people waited in pain and fear for help which only began to arrive on Friday, Jan 15th.   Those folks lucky enough to walk out of fallen buildings with non life-threatening injuries – an estimated 1.1 million people survived the Jan 12th quake in Port-Au-Prince – are now homeless.  Growing civil unrest is gaining hold.

This is the second wave of their public health emergency.

The public health infrastructure in Haiti was thin to begin with, but now with the city’s port severely damaged, roads blocked by fallen debris, scant fuel supplies, no functional communication networks and a lack of coordination among international aid agencies, newly-arrived emergency health personnel* and security forces ready to distribute aid are hard-pressed to get it quickly to those most in need.

An NPR reporter on the ground on Sunday Jan 17 was quoted as saying: “Money means little here right now.  People are dying from exposure, lack of drinking water and from injuries which are now infected… the stench of death and raw sewage is everywhere“.  Age-old scourges – communicable diseases (measles, meningitis, tetanus or malaria),  secondary infections (such as gangrene) from untreated traumatic injuries, dehydration, psychological shock, lack of food or medicine and rising criminal activities by a few – will be working against those survivors who have been literally camped out, sleeping on the ground for six nights. Click here to read an article dated Jan 17 2010 about a field hospital in Port-au-Prince, where Sanjay Gupta, physician and medical correspondent for CNN, stayed to treat patients after Belgian health personnel left due to security threats.

In most places, the infrastructure works (until it does not). So much about public health is essential yet unglamorous, addressing basic human needs: adequate and safe food, clean water, shelter from the elements, a means of earning a living, sewage and waste management, knowledge of basic healthcare practices, and the means to implement them, a chance for an education, safety from danger or interpersonal violence, peace of mind if possible.

There will be little of that (peace of mind, that is) on the island of Haiti in the near-term, but as one of of the many Haitian politicians interviewed on a news programs stated last week: “Maybe now we can rebuild a new Haiti”.

That would be a great public health opportunity for the citizens of this devastated country.


* One charitable international volunteer agency, Medicins sans Frontiere, filed this report on Jan 19 2010 regarding the work of their medical staff(s) in Port-au-Prince.

** Link here to an assortment of non-profit international agencies coordinating aid to the population in Haiti, collected by Google.


Addendum #1: On the morning of Jan 20 2010, a second earthquake of 6.1 magnitude struck near Port-au-Prince.  Read a brief report about this new quake from the U.S. Geological Survey.

Addendum #2: On Thurs Jan 21, this entry was added:  Dr. Robert Fuller, director of Emergency Medicine at UCHC, is currently in Haiti as a volunteer physician for International Medical Corps. Dr. Fuller spoke with with CNN reporter Wolf Blitzen on Jan 19 2010 about the medical rescue efforts in Port au Prince (link here for video).

News, Public Health, Public Service: H1N1 Fact Page from Ebsco

This year, Ebsco Publishing has created an evidence-based medicine source for current factual diagnostic or treatment information for H1N1 influenza virus, written for clinicians, nurses and the general public.

This site is open to anyone in the world to access, at no cost.  Following is a brief description found on the front page of Ebsco Publishing Influenza Evidence-Based Information Portal:

Due to Pandemic H1N1 Influenza (formerly known as Swine Flu) and concerns about the 2009/2010 flu season, the EBSCO Publishing Medical and Nursing editors of DynaMed, Nursing Reference Center™ (NRC) and Patient Education Reference Center™ (PERC) have made key influenza information from these resources freely available to health care providers worldwide. The information is designed to inform patients and their families, and provide information to clinicians to help them with H1N1 diagnosis and H1N1 treatment by making up-to-date diagnosis and treatment information availableThis site includes more than 50 evidence-based topics including patient education information in 17 languages.”

Source/ text credit: http://www.ebscohost.com/flu/ – All rights reserved – Copyright 2009

As shown in this screenshot below, there are sections written for clinicians, nurses and patients.

Photo credit: http://www.ebscohost.com/flu/ – All rights reserved – Copyright 2009

If you treat patients who speak Arabic, French, German, Hindi, Chinese (traditional or simplified), Japanese, Italian, Korean, Portuguese, Russian, Spanish, Farsi, Polish, Tagalog, Vietnamese (or English), this is an excellent free resource – bookmark it!

Thanks to Ebsco for producing this EBM influenza page.

Public Health, News, Epidemiology: H1N1 News and a Feed from CDC

H1N1virusImage – H1N1 Influenza Virus

Photo/Image Credit: Courtesy of http://www.microbiologystudents.com/gallery_image.php?image_id=4


Last week, in anticipation of the beginning of ‘regular’ flu season in the Northern hemisphere and the public health concerns over the pandemic spread of H1N1 influenza worldwide, it seemed logical to add a news-feed to the EBM and Clinical Support Librarians@UCHC blog from the Centers for Disease Control & Prevention for current news, advisories and practical information about Pandemic Flu (H1N1).

Flu.gov is open and available for anyone in the world to access at no cost, in English or Spanish language versions.  The focus of the CDC website is on incidence of influenza among Americans, but there are also links to current information about H1N1 posted by the World Health Organization (WHO) and other sources.

A section of Flu.gov is dedicated to the information needs of clinical care providers (or medical students), and is titled “For Professionals“.  Below is a screenshot of that page:



Image/Photo Credit: http://pandemicflu.gov/index.html – All rights reserved – Copyright 2009


Here are several links which might be of particular interest for professional (and amateur) epidemiologists.  First: an excerpt of text found on the FluView page:  ” Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView.

Next: true news junkies will appreciate the many updates found on the CDC H1N1: What’s New? page.

Third: Disease transmission through public or private school populations is of special concern worldwide.  Dated Aug 25 2009, here is a link to an online document summarizing Vaccines Advisory for Specific Population Groups (i.e., infants, children enrolled in schools K-12, college-age students, etc.).   Another recent advisory of interest to administrators of institutions of higher education (abbreviated IHE), such as the “CDC Guidance for Responses to Influenza for Institutions of Higher Education during the 2009-2010 Academic Year“.

CDC Podcasts are available on many different topics; here’s a link to one written specifically for children entitled “All You Have to Do is Wash Your Hands“.


Lastly, here are some links to other sources for information on the 2009 H1N1 pandemic (in no particular order):

  • Eurosurveillance is “an open-access peer-reviewed journal about infectious diseases surveillance prevention and control in Europe. Over 14,000 readers around the world subscribe to our weekly online edition, which is published every Thursday…. “.
  • The goal of HealthMap is to ” bring together disparate data sources to achieve a unified and comprehensive view of the current global state of infectious diseases and their effect on human and animal health. This freely available Web site integrates outbreak data of varying reliability, ranging from news sources (such as Google News) to curated personal accounts (such as ProMED) to validated official alerts (such as World Health Organization)
  • An entry from Wikipedia – “2009 Flu Pandemic by Country” – features many maps for reported incidences shown both by country and continent (but note: their data lags behind that reported by other international public health sites).
  • Public Health Agency of Canada provides current links to the spread of the disease throughout the country;  their FluWatch interactive maps are useful (screenshot shown below):


Image credit: Public Health Agency of Canada – All rights reserved – Copyright 2009


Finally, UCHC library users can search GIDEON, a subscription database (note: Proxy access required from off-campus). Why is GIDEON a unique resource for epidemiologists, researchers, students and public health administrators?  Here is an excerpt from their “About” page:

GIDEON is made up of four modules: Diagnosis, Epidemiology, Therapy and Microbiology. The database includes 337 diseases, 224 countries, 1,147 microbial taxa and 306 antibacterial (-fungal, -parasitic, -viral) agents and vaccinesData sources include the entire world’s literature and adhere to the standards of Evidence Based Medicine… There are  20,000 images, graphs, interactive maps and reference updates “.

Source:  http://www.gideononline.com/product.htm



An earlier post about H1N1 on this blog (May 7 2009) can be read here.


Note: Here is a link to a free 4-page H1N1 patient-education pamphlet from BMJ Clinical Evidence.

News, Public Health, Disease Prevention: Saturday, June 27 is National HIV Testing Day

Saturday, June 27 2009 is National HIV Testing Day


Photo credit: http://www.hivtest.org – All rights reserved – Copyright 2009

An annual event co-sponsored by the National Association of People With AIDS (NAPWA) and Centers for Disease Control & Prevention (CDC), this public health promotional effort encourages sexually-active Americans to be tested each year for infection with the HIV virus or other sexually transmitted diseases.

A separate CDC website at HIVTest.org allows a person to type in their individual zip-code or city/state location which will then bring up a directory of local sites where testing services will be available on Saturday.

Another means of finding local test site information is to call this toll-free phone number:   1-800-CDC-INFO (or 1-800-232-4636).


A recently published report in MMWRVol. 58 (24);661-665 (June 26 2009) recaps the ill-effects of “Late HIV Testing in 34 States, 1996-2005”.

Here is an excerpt from that report – and one which represents a very sobering statistic for any epidemiologist: Current estimates suggest that 21% of HIV infections in the United States are undiagnosed.”


CDC sponsors a related consumer-health information source page called “Nine and A Half Minutes” (for the estimated frequency of new STD infections among Americans).  Here is a screenshot of that site:

HIVfactsPhoto credit: http://www.hivtest.org – All rights reserved – Copyright 2009


A 14-page HIV Testing Fact Sheet (in English or Spanish language) is available from CDC at this link.

Finally, below is a short list of other statistical or factual sites for current sexual health information:


Public Health, Epidemiology, Medical History: Swine Flu? Over-Hype for Some, A Dress Rehearsal for Others

The alarm around this particular strain [A-H1N1] has a couple of roots. First is, it’s new… it’s novel. And new is always cause for some amount of concern. Second, it does appear to have just recently jumped from one species, pigs, to another, humans. And very commonly, in the whole world of viruses – not just influenzas – when they first make the jump from one species to another is when they’re really hot viruses, dangerous viruses. That certainly was the case with SARS, which had just made the jump from bats to civets, civets to humans.  So we always worry when we see a recent jump. ”

A quote from Laurie Garrett, during an interview with the Online News Hour (transcript link here) on May 1 2009.


Ms. Garrett, author of The Coming Plague: Newly Emerging Diseases in a World Out of Balance (1994), and The Betrayal of Trust: The Collapse of Global Public Health (2000), is currently a senior fellow for global health at the Council on Foreign Relations.

How A/H1N1 influenza – identified in Mexico in March 2009 – continues to develop in human populations is still uncertain, as the virus spreads to every continent.  The good news is that clinicians seem to think it is not as virulent as first feared; the bad news is that over time, the possibility still exists that we are witnessing a phenomena that every epidemiologist dreads in his or her lifetime: the emergence of an uncontainable virus in a human population who have little or no immunity against it.

While many people thought the media hype over this emerging virus was of hysterical proportions, and discounted the severity of the strain, a different way to view these events is as a sort of dress rehearsal which demonstrated that world-wide networks of disease surveillance, data-collection and cooperative intelligence sharing are functioning reasonably well.  (But I’m not a virologist so maybe I know no more than the next guy on the street.)

If nothing else, it shows that swarm-intelligence and citizen-journalism is alive and well!


You could say that some of my reactions to public health crises have been shaped in part by having lived in city of San Francisco in the early 1980’s, when a different public health crisis unfolded with the identification of a novel viral infection which came to be known as human immunodeficiency virus.  If you haven’t already read And The Band Played On by Randy Shilts, who was a reporter at the time for the San Francisco Chronicle, it is truly worth the time. *

Let’s hear it for more dress rehearsals, and fewer real-life epidemics.


Following are a few books or online resources for background information on epidemiological investigations, medical detective work and emerging infectious diseases, for your consideration:

  • The Threat of Pandemic Influenza: Are We Ready?” A Workshop Summary, 2005 (free online full-text from National Academies Press site – link to PDF here).
  • Book: The Great Influenza: The Epic Story of the Deadliest Plague in History by John Barry (Viking, 2004).
  • Book: When Germs Travel: Six major epidemics that have invaded America since 1900 and the fears they have unleashed by Howard Markel (Pantheon Books, 2004).
  • Book: Microbial Threats to Health: Emergence, Detection and Response by Mark Smolinski, Margaret Hamburg, Joshua Lederberg (National Academies Press, 2003).
  • Book: The Molecular Epidemiology of Human Viruses, by Thomas Leitner (Kluwer, 2002).
  • Book: The Invisible Enemy: A Nature History of Viruses, by Dorothy Crawford (Oxford University Press, 2000).
  • Online Book: Bird Flu: A Virus of Our Own Hatching by Dr. Michael Greger (Human Society Press, 2006).  Free fulltext book at this link.
  • Book:  Man and Microbes: Diseases & Plagues in History and Modern Times, by Arlo  Karlen (Putnam Books, 1994).
  • Robert Preston is the author of two popular works, The Demon in the Freezer: A True Story (Random House, 2o02) and The Hot Zone: A terrifying true story (Random House, 1995).
  • Book:  Emerging Viruses in Human Populations by Edward Tabor (Volume 17 of Perspectives in Medical Virology, Elsevier, 2007).
  • Book: Seasonal Patterns of Stress, Immune Function, and Disease by Randy Nelson (Cambridge University Press, 2002).
  • Book:  Human Virology: A Text for Students of Medicine, Dentistry and Microbiology by Leslie Collier (Oxford University Press, 2006).
  • A professor of virology from Columbia University blogs at the Virology Blog.


* Randy Shilts, who was a great journalist and a brave activist for gay rights, died of AIDS in 1994 at age 42.

News, Public Health, Emerging Technologies: Delivering the News… Online We Are

It’s been a big news week.  Global health developments have occurred with such rapidity that reporting the news of this week  gives additional meaning to the use of the term “viral” as in… tracking the global spread of a novel virus:  A/H1N1 – swine influenza.

After writing this post, I then noticed that only one of items on the list below refers to materials which are in print (that of the journal Public Health Reports).  It is online that we are.

  • DynaMed, an evidence based medicine resource which UCHC Library subscribes to, announced this week that an online section for current clinical information on Swine Influenza A/H1N1 will be available to anyone in the world at no cost – at this link.  The database, produced by Ebsco, is updated daily.
  • Finally, the cartoonist-blogger XKCD drew a great comic this week, arguing against getting one’s news of the day from Twitter and re-tweets.  Many other bloggers worldwide have featured this cartoon this week, but in case you missed it…
xkcdtwitterfluPhoto/Source credit:http://xkcd.com/574/


IMHO: The option of becoming a vegetarian is growing more and more attractive.

News, Public Health, Global Health: A Potential Pandemic of Influenza

Public health concerns dominate the news headlines this week, as evidence continues to unfold of a global outbreak of a novel strain of swine influenza A/H1N1.

Thanks to an active international group of Medical Bloggers and Librarians connected through social networking sites such as FriendFeed or Twitter, as I arrive at work on Monday morning, this connectedness becomes a great advantage for those of us in the United States, as our European colleagues have already scanned and posted many news or website links on items of vital concern, as emerging news continues to pour in from many places around the world.

Following are a brief set of links to global health information, disease-tracking and interactive-maps for the spread of Swine Influenza A/H1N1 (reported as of Monday, Apr 27 2009):



Image credit:  http://www.tweetdeck.com – All rights reserved – Copyright 2009


  • The International Society for Infectious Diseases (ISID) produces ProMed-Mail, described as the global electronic reporting system for outbreaks of  emerging infectious diseases & toxins, open to all sources“. Subscription to ProMed-Mail is available to anyone, free of charge; updates can be set up for daily or weekly email alerts.
  • UCHC Library subscribes to GIDEON (Global Infectious Diseases and Epidemiology Online Network), which is a specialized database for epidemiologists used for “… diagnosis and reference in the fields of tropical and infectious diseases, epidemiology, microbiology and antimicrobial chemotherapy.  GIDEON currently tracks 337 diseases, 224 countries, 1,147 microbial taxa and 306 antibacterial (-fungal, -parasitic, -viral) agents and vaccines, including over 10,000 notes outlining the status of specific infections within each country and over 20,000 images, graphs, interactive maps and references“.  GIDEON is updated daily.

United States

Tracking the Outbreaks

  • Google provides a free service called News Alert, which you can create yourself using any key-words to search on.


I’d like to acknowledge the cooperative work of many European scientists and medical librarians – and in particular, bloggers Laikas, Berci and DigiCMB – who are always 6-8 hours ahead of me, both literally speaking in the real world and in many Web 2.0 innovations, who have posted scientific links and news about swine flu and steered  me to several links for this post today.   Thank you to these talented, and generous, colleagues.

News, Healthcare Administration: An AHA report

Many [U.S.] hospitals find it significantly more difficult or even impossible to access tax-exempt bonds or other sources of capital.

Excerpt from “The Capital Crisis: Impact on Hospitals” – Courtesy of the American Hospital Association – All rights reserved – Copyright 2009

Founded in 1898, the American Hospital Association (AHA) is a not-for-profit voluntary association of 5,000 member hospitals or health systems and 38,000 individuals that are committed to the improvement of health in their communities.  AHA provides education for health care leaders and is a source of information on health care issues and trends.

AHA publishes a free information service called Trendwatch, which reports annually on U.S. health care economics, management, trends or market developments and governmental or regulatory influences.

A recently released report, entitled “The Capital Crisis: Impact on Hospitals” provides data from 639 U.S. hospitals, collected by AHA from late December 2008 through January 6, 2009.

Click here to read this free 14-page report (opens in PDF format).