Important Findings on West Nile Virus, Lead Poisoning, Ecstasy Use, and Doctors??? Performance in Latest Journal of Urban Health

NEW YORK CITY, Jan. 17 - Research examining an array of urban health topics can be found in the current issue of the Journal of Urban Health, published by The New York Academy of Medicine. Studies investigate compelling issues including: the health risks of ???ecstasy,??? failures in media coverage of West Nile virus; lead poisoning risks posed by home repairs; and, shortcomings in monitoring the quality of care provided by doctors and hospitals.

Media failures in West Nile virus coverage: The print media has done a generally poor job comparing the risk of cont racting West Nile virus with the risk of being harmed by mosquito-controlling pesticides, according to a study led by Boston College biologist John P. Roche. The media roundly failed to provide statistical information on the potential health risks of the pesticides used, leaving citizens ???in the dark??? over whether to support pesticide spraying programs as a method of controlling the mosquito-borne virus, Roche said. The research team (which was not advocating a position for or against pesticide use) analyzed 359 newspaper articles published in 2000. Less than 3 percent of the articles surveyed gave numerical information about the risks of pesticide spraying. None of the articles provided numerical comparisons between the health risks of pesticide spraying and those of West Nile encephalitis, which is caused by the virus.

Roche emphasized that while journalists disseminate a wealth of valuable information, they often fall short in providing information about statistical risk. ???This lack of precise risk information makes it harder for citizens to place risks in perspective,??? he said. But reporters are not solely to blame. ???Scientists and public health experts can help by getting the word out to journalists,??? Roche said. So what are the health risks of pesticides, compared to those of West Nile? ???That is obviously a key question,??? Roche said. That information was not compiled for this study. Last year, 3,873 U.S. residents were diagnosed with West Nile encephalitis and 246 died.

Lead poisoning and home renovation: New York City children living in pre-1950 homes are more likely to have elevated blood lead levels if the homes were recently renovated or repaired and the work included dry-sanding of painted surfaces. Elevated blood lead levels were also more likely when dust was from the work was not contained, according to a study co-authored by Academy epidemiologist Thomas Matte. In this study, such activities had occurred in the homes of approximately 10 percent of the affected children. The results highlight the importance of city laws designed to minimize the exposure risk, the authors said. Since November 1999, the city has prohibited the use of dry-scraping or dry-sanding of lead-based paint, or of paint with an unknown lead content, in any dwelling unit. The regulations also mandate safe work practices, including appropriate cleanup methods, when doing repairs in pre-1960 multiple-dwellings where children younger than age 6 reside. Exposure to house dust contaminated with lead from deteriorating paint is considered the most important exposure pathway for U.S. children. Approximately 900,000 U.S. children are estimated to have blood lead levels high enough to adversely affect cognitive performance and behavior. Leaded house paint was banned in 1978, but paint in pre-1950 homes contained up to 50 percent lead by weight.

Ecstasy hangover: Those who take the recreational drug known as ecstasy are at risk for an ???ecstasy hangover??? that causes altered mental status, according to a case study of a 19-year-old female, reported by doctors at the New York City Poison Control Center. The ???hangover??? is actually hyponatremia, a condition in which abnormally low concentrations of sodium ions are present in the circulating blood. The condition may be related to ecstasy-users??? tendency to drink large quantities of water, which can actually depress sodium levels in the blood. Ecstasy users tend to guzzle water either because they are dancing frenetically (common for users of this drug) or because they believe it will prevent high fever, a known side effect of the drug. Hyponatremia may also occur because ecstasy causes the body to release ???anti-diuretic hormone,??? which also depresses sodium levels. After treatment with fluid restriction, the doctors said, the patient???s mental status and sodium level returned to normal.

Performance monitoring of doctors, hospitals falls short: Managed care insurers are having little success generating quality improvements among the doctors and hospitals in their plans. That???s because physician groups participate in many managed care plans, so the efforts of any given plan have limited effect. Doctors and hospitals also view insurers??? system of collecting performance data as too burdensome and disjointed, and feel it is sorely in need of an overhaul, according to a study led by Gerry Fairbrother, Ph.D., a Senior Scientist in the Academy???s Division of Health and Science Policy. Researchers examined the current systems for collecting, reporting and using quality performance data, studying New York City???s Montefiore Medical Center and three managed care insurance plans. They focused on breast cancer screening data.

The current performance-monitoring system has two inherent problems, researchers found. First, insured patients are spread out among many different providers, so information about their care is stored in a variety of unconnected locations. Second, each of those providers contracts with many different health plans, making it difficult for any one insurer to get a thorough portrait of a provider???s performance. Doctors and hospital administrators in the study complained that multiple insurers request the same data at different times, forcing caregivers??? staff to constantly pull charts and respond to queries in a manner that is duplicative and time-consuming. ???Both health care providers and the managed care plans expressed willingness to improve this performance monitoring through collaboration,??? Fairbrother said. If managed care insurers were to collaborate when requesting data from a given hospital or doctor, researchers said, that would ease the administrative burden and produce a clearer record of the provider???s overall performance, rather than chronicling performance within a single insurance plan.

Posted on January 17, 2003

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