Take a deep breath and Read This One!...

Dr. Uzoma Nwosu is a graduate of University of Nigeria Medical School and worked for several years in Clinical Medicine. He also worked in research positions in Abbott Laboratories, Pharmacia, Pfizer , and NYU. His book ‘The Chiology way to happiness’ is about the Chi. The Chi was described by Mbonu Ojike and Chinua Achebe as the ‘personal god’ of an individual. According to Ojike, “a man’s Chi is equal to that man..”. Dr. Nwosu describes the Chi as the summary of an individual. The content of the Chi of an individual determines their destiny or outcomes. For example, if the Chi contains negative emotions such as fear, anger, frustration, depression, jealousy, anxiety, etc, they may experience a misfortune. An Individual, who has ‘hypertension’ in their Chi, may have a stroke. Ordinarily, an individual would endeavor to be as healthy as possible. Mental health is as important as physical health.
One of the ways to relax the mind is through the breath known as ‘ume’. Oxygen obtained from the breath, is converted into energy in the cell mitochondria. Energy is also known as ‘ume’. When we slow our breaths down to about 5 breaths per minute, we begin to relax after about 10 minutes. This new relaxed state can be described as ‘umeana’. A person with umeana is widely known to be strong, productive, diligent, respectful, and well-behaved.
The Chiology way to happiness contains a description of the Chi and how an understanding of the Chi could be used in the pursuit of success and happiness. This book allows you to assess how knowledgeable the ancient Igbo people were in the understanding of the workings of life.
It’s a book that would relax you and help you enter into the realm of happiness.

More at www.chiology.org

How fruit juice went from health food to junk food

This week, it looked as if fruit juice might finally lose its claim to healthiness and be put into the same category as fizzy drinks. It emerged that a headteacher, Elizabeth Chaplin, who runs Valence primary school in Dagenham, wrote to parents about a new rule to confiscate juice cartons from children's lunch boxes. Instead, pupils would only be allowed to drink water.

Days earlier, Susan Jebb, a government advisor and head of the diet and obesity research group at the Medical Research Council's Human Nutrition Research unit at Cambridge University, told the Sunday Times that the government's official advice that a glass counts towards your recommended minimum five-a-day servings of fruit and vegetables should be changed.

"Fruit juice isn't the same as intact fruit and it has as much sugar as many classical sugar drinks," said Jebb, who has stopped drinking juice. "It is also absorbed very fast, so by the time it gets to your stomach your body doesn't know whether it's Coca-Cola or orange juice, frankly. I have to say it is a relatively easy thing to give up. Swap it and have a piece of real fruit. If you are going to drink it, you should dilute it."

This comes on top of a year or so of stories about the high sugar content of fruit juice. The same US scientists who warned about the use of high-fructose corn syrup in fizzy drinks have now turned their attention to juice. "Fruit juice and smoothies are the new danger," Barry Popkin, professor of nutrition at the University of North Carolina, told the Guardian in September. Work by Dr Robert Lustig – whose book Fat Chance: the Bitter Truth about Sugar received much attention last year – and studies such as one published in the British Medical Journal in the summer, which found fruit juice is associated with an increased risk of type 2 diabetes, are starting to make people realise that fruit juice may not be as wholesome as they once believed.

So why is fruit juice still being pushed as a healthy option? "You can't trust government health advice," says Joanna Blythman, author of What to Eat. "They have the same advice that they've been recycling for 50 years and rarely change it. It's embarrassing to admit they've made a mistake."

Does she drink juice? "I don't, really – not in any great quantity," she says. At one point, she says, in the late 1980s and early 90s, she was "a very enthusiastic orange juicer. I remember coming back from the States, where everyone juices like mad, and I got a juicer. Then over the last couple of years there has been more and more evidence that sweet juices are basically just fructose, and have a similar effect on the body to fizzy and soft drinks in terms of sugar."

The juice industry has long enjoyed a healthy image. Anything to do with fruit, says Blythman, "has always been used to put a halo of health around dubious products that don't merit it. That's business as usual for the food industry."

For all their reliance on phrases such as "100% pure" and "pure squeezed", many of the big commercial orange juice manufacturers make a processed product, as detailed by Alissa Hamilton in her 2009 bookSqueezed: What You Don't Know about Orange Juice.

In the early 20th century, juice was mainly sold in cans. During the second world war, the US government commissioned scientists to develop a product that would supply vitamin C to soldiers overseas. "That's when research into developing a frozen concentrate that people would actually like started," says Hamilton. Until then, it had been fairly tasteless – the concentrating process removed the water, but also the natural chemicals that gave orange juice its taste. "They started adding fresh juice to the concentrate and that made it taste good. The discovery was too late for the war, but after the war that's when orange juice started to become really popular."

One primary school in Dagenham is to start confiscating fruit juices from children's lunch boxes. Photograph: Kidstock/Getty Images/Blend Images

However, as the market grew, it was becoming too expensive to use fresh juice to add flavour back to concentrate. "They developed the technology around the 1960s to capture and break down the essences and oils that were lost when the juice was concentrated, and came up with these things called flavour packs."

Producers of pasteurised orange juice began storing their juice in vast tanks. In order to keep it "fresh", the product had to be stripped of oxygen. Once this had been done, the juice could be stored for up to a year. The only problem was that this process also removed much of the taste. "You need flavour packs to make it taste like anything we know as orange juice," says Hamilton.

So, does she still drink juice? "I actually never did," she says. "I try to eat the whole thing. If I have an orange, I don't even stop at the fruit – I eat the pith, the peel. Juicing anything would not be my choice."

For most of us it is, though, and it is not obvious that any of the sugar scare stories are affecting the fruit juice market yet. In its latest report, the research company Mintel found that 83% of people drink fruit juice, a juice drink or smoothie at least once a week. It also estimates that the market will grow by 13% by 2018. It found 34% of consumers were concerned about the amount of sugar, but "a striking 76%" believed juice and smoothies to be healthy.

As part of its end-of-year "top products" survey, the retail trade journal the Grocer found a mixed picture for juice brands. The leading brand, Tropicana, experienced a downturn in sales of 5.4% throughout 2013, though sales of Innocent smoothies, owned by Coca-Cola, were up more than 7%. However, Innocent was one of the brands highlighted last yearas containing high levels of sugar: a 250ml serving of its pomegranate, blueberry and acai smoothie contains 34g of sugar, around the same as a 330ml can of Coke.

"I think the current coverage about fruit juice and sugar will have an influence on consumers," says Heidi Lanschützer, food and drink research analyst at Mintel. "The question is whether it's a short- or long-term impact." She says this will depend on how ongoing the coverage is, and whether more schools ban juice, though the biggest impact will be if the government takes Susan Jebb's advice and removes it from the five-a-day list. This, she says,"is one of the market's biggest selling points – if the market is not allowed to use that any more, that will definitely have an impact."

Not everybody is racing to demonise juice just yet. "It's about portion size. 150ml of fruit juice is perfectly acceptable as one of your five-a-day," says Azmina Govindji, dietitian and spokesperson for the British Dietetic Association. "But we would suggest you have it with a meal so it doesn't make your blood sugar go up too quickly. I think the difficulty comes when people think of fruit juice as being a really healthy drink and having half a pint, or having it throughout the day, or where children are being brought up on large amounts.

"The key message is that small amounts – a 150ml glass is quite small – as part of a healthy varied diet is fine. You get fluid and vitamin C but you need to be aware that it does contain sugar. If you can, always choose fresh fruit and veg [over juice]. You're going to get fibre, more nutrients and you're likely to have fewer calories."

Does she think the advice on juice being part of the five-a-day will change? "I think what needs to change is advice on portion size."

Blythman, meanwhile, understands that the mixed messages about juice are perplexing for consumers. "People are thoroughly confused," she says. "But I think [growing awareness of sugar levels] will have an effect. The simplest way to put it is: eat whole fruit, don't drink juice."

The rise and fall of our favourite foods – what's in:

Halloumi: Britons have become the biggest European consumers of the rubbery, squeaky white cheese outside of Cyprus. Tesco's halloumi sales rose by 35% during 2011 and 2012, while Waitrose reported a 104% increase. "I don't think it was one event that explains halloumi's popularity," says Louis Constantinou, director of the Cypressa food company, founded by his uncles in the 1960s, which now supplies halloumi to supermarkets. "It got exposure by celebrity chefs. It's a versatile product in the sense you can do lots with it – grill it, eat it as it is."

Hummus: Waitrose claims to be the first supermarket to have stocked hummus, around 20 years ago. Now, says Jonathan Moore, the supermarket's executive chef, they have around 19 varieties. "It has become a staple – people are using it on bread instead of butter." One recent survey found 41% of Britons had a pot of hummus in their fridge, and the British taste for the chickpea paste, which originates in the Middle East, is worth around £60m a year.

Sweeter apples: Theresa Huxley, apple technologist for Sainsbury's, says consumers are looking for sweeter apples. The supermarket is stocking a record 57 varieties of apple, including more British varieties than before. "Royal Gala remains our most popular variety, and that's a very sweet one, but there are lots of new varieties that are becoming more and more popular: Jazz, which has a peardroppy flavour, and Rubens which has tones of melon, and Zari, which is a sweet, juicy apple."

Bottled water: Environmentalists have long tried to wean us off our attachment to bottles of water, and for a while it looked like it might work – in 2009 sales fell by 9%. However, as a report for the Grocer put it last month, "all is forgotten". Last year we drank 8.7% more bottled water than in 2012.

Ceviche: The decreasing cost of international travel and the ability of a growing number of people to experience other cultures and cuisines, says Moore, have had a huge influence on our national palate. Middle Eastern influence has been strong, thanks to chefs such as Yotam Ottolenghi, but Moore is also looking at food inspired by South America, especiallyceviche – raw fish cured with citrus juices. "Ceviche is, for me, the sushi of 20 years ago. Twenty years ago, would anyone have said sushi was going to be this big in the UK?"

And what's out:

Meat: According to one survey published in November, a quarter of Britons are eating less meat, with a further 34% saying they would consider eating less. Just 2% reported eating more than they had previously. The survey was conducted for Eating Better, an alliance of groups including Friends of the Earth, launched in summer 2013 to encourage people to eat less meat. It attributed the results to the fallout from the horsemeat scandal, and growing awareness of the environmental impact of rearing animals for meat. Others blamed falling sales on rising costs – according to the Financial Times last month[http://www.ft.com/cms/s/0/b41bd746-61a3-11e3-916e-00144feabdc0.html#axzz2nnzEoiNl], British beef prices are at record highs, and sales of the most expensive cuts, such as roasting joints, are down by a quarter on the previous year.

Builders' tea: "The mainstream tea category has lost its sparkle," Neil Manders, Twinings' commercial director, told the Grocer recently. In September, the trade journal published a report on the hot drinks market. It found that people are moving away from traditional tea and – if they are not drinking coffee instead – towards fruit and herbal varieties, and green tea (sales are up 15% and 19% respectively). In a more recent report, the Grocer found volume sales of tea were down 6.1% in 2013, a bigger decline on the previous year.

Whole lettuces: The 1980s were the glory years for the iceberg lettuce, but over the last few years sales of whole lettuces have been falling[http://www.telegraph.co.uk/finance/personalfinance/8347648/Era-of-iceberg-lettuce-is-over.html] as consumers developed a taste for more unusual leaves and the popularity of ready-washed bagged salads took off. In a final indignity, last year the Office for National Statistics removed the round lettuce from its "typical" shopping basket to illustrate retail prices, though the iceberg lettuce remains. For now.

4th Ebola Patient to be cured....Round of applause for Emory!

Accompanied by beaming family members and amidst hugs and applause from the health care workers who treated her, nurse Amber Vinson departed a press conference at Emory University Hospital on Tuesday as the fourth patient successfully treated for Ebola virus infection here.

"As a nurse, and now as someone who has experienced what it's like to be cared for through a life-threatening illness, I am so appreciative and grateful for your exceptional skill, warmth and care," Vinson told the more than two dozen Emory University Hospital employees gathered behind her on the stage during the press conference.

Prior to Vinson's remarks, Dr. Bruce Ribner, medical director for Emory University Hospital's Serious Communicable Disease Unit, discussed her discharge, Emory's commitment to caring for such patients, and how the hospital seeks to share its knowledge to help others battling Ebola virus disease around the world.

"After a rigorous course of treatment and thorough testing, we have determined that Ms. Vinson has recovered from her infection with Ebola virus, and that she can return to her family, to the community and to her life, without any concerns about transmitting this virus to any other individuals," Riber said.

Vinson was the second of two health care workers infected while caring for a patient with Ebola virus disease at Texas Health Presbyterian Hospital in Dallas. She was transferred to Emory University Hospital via air ambulance on Oct. 15 by request of the Centers for Disease Control and Prevention and Texas Health Resources.

"As fellow members of the health care community, we deeply admire Ms. Vinson's courage and dedication in caring for patients with serious communicable diseases," Ribner said. "Nurses are on the front lines 24 hours a day in treating our patients, and it is their skill, their knowledge, and their passion for healing that makes one of the critical differences in caring for our patients."

The patient Vinson cared for became infected with Ebola in Liberia, then traveled to Dallas where he became ill, was diagnosed and treated at Texas Health Presbyterian Hospital, and died Oct. 8.

Vinson and another nurse who cared for the patient in Dallas, Nina Pham, were the first people to become infected with the Ebola virus in the United States. Pham was transferred to the National Institutes of Health in Bethesda, Maryland, the day after Vinson's transfer to Emory; she was discharged from NIH, free of the virus, Oct. 24.

"Now that Ebola virus transmission has occurred in the United States, we all recognize that there is a lot of anxiety in the community, and that is understandable. But the American health care system has been able to successfully treat patients with Ebola virus disease. We have the resources, we have the expertise and we have the knowledge," Ribner said.

"We must not let fear get in the way of our primary mission, which is caring for patients with serious diseases such as Ebola virus infection."

Sharing what Emory has learned

Vinson is the fourth patient to be successfully treated at Emory University Hospital for Ebola virus infection.

Dr. Kent Brantly and Nancy Writebol, the first Ebola patients to be treated in the United States, arrived at Emory University Hospital in early August after becoming infected with the Ebola virus while providing humanitarian aid in Liberia. Writebol was discharged Aug. 19; Brantly left the hospital Aug. 21. A third patient, who did not want to be identified publicly, was transported to Emory on Sept. 9 and was discharged Oct. 19.

All of the patients were treated in Emory University Hospital's Serious Communicable Disease Unit, which was set up 12 years ago in collaboration with the CDC to care for CDC scientists and others who have traveled abroad and become exposed to infectious diseases.

On Oct. 20, Emory Healthcare launched an external website to serve as a resource for health care organizations regarding best practices for safe and effective screening, diagnosis and treatment for patients with Ebola virus disease.

"As grateful as we are for Ms. Vinson's recovery, we do recognize that our role as the American health care system, and our nation's role, is far from over," Ribner noted. "Emory has taken a lead in posting our protocols online as well as participating in webinars, answering myriads of phone calls and emails, and trying to spread knowledge of the management of this disease around the world."

Vinson: "I am so grateful to be well"

As Amber Vinson departed Tuesday's press conference, she hugged each of the health care workers involved in her treatment. Photo by Jack Kearse.

During the Oct. 28 press conference, Vinson was joined on the stage by the Emory University Hospital employees who helped care for her, as well as her grandparents, aunt and uncle.

"I am so grateful to be well, and — first and foremost — I want to thank God. I sincerely believe that with God all things are possible," Vinson said. "While the skill and dedication of the doctors, nurses and others who have taken care of me have obviously led to my recovery, it has been God's love that has truly carried my family and me through this difficult time, and has played such an important role in giving me hope and the strength to fight."

Vinson thanked her family and all of those who contributed to her care at Emory Healthcare and at Texas Health Presbyterian Hospital. She also thanked Brantly and Writebol "for your donations of plasma for me and other patients, and thank you for your leadership in helping to educate the public about this difficult but treatable disease."

Vinson offered a plea for continued attention to the plight of Ebola victims around the world.

"While this is a day for celebration and gratitude, I ask that we not lose focus on the thousands of families who continue to labor under the burden of this disease in West Africa," she said.

Changing the algorithm for Ebola care

Vinson did not take questions after giving her statement, but remained on the stage with her family while Ribner answered questions from the media.

Several questions centered on what Emory has learned from successfully treating four patients with varying severities of illness from Ebola virus infection.

Since beginning caring for Ebola patients in August, Emory physicians have confirmed that they can be tremendously helped by the kind of aggressive supportive care available at Emory and other hospitals in developed countries, Ribner said.

"The other thing that we have really changed the mindset on is how aggressive we can be with Ebola virus disease," he said, noting that previously, the prevailing medical mindset was if Ebola patients were ill enough to need dialysis or ventilators,  "there was no purpose in doing those interventions because they would invariably die."

"I think we have shown, with our colleagues in the U.S. and elsewhere, that that is certainly not the case, and therefore I think we have changed the algorithm for how aggressive we are going to be willing to be in caring for our patients with Ebola virus disease," he said.

Doctors don't know definitively why Vinson and Pham recovered more quickly than some other patients with Ebola, Ribner said. One theory is that the two nurses are among the youngest patients treated for Ebola infection in developed countries, and evidence from Africa suggests younger people are more likely to recover. Ribner also noted that Vinson was wearing personal protective equipment when she cared for the Dallas patient "and therefore the amount of virus that she was exposed to was substantially less than what we see in patients who get infected in less developed countries."

In response to a question about quarantine, Ribner noted the need to reassure the American public and advocated for a global perspective.

"I think the thing we really have to keep in mind is that the only way that we are truly going to be able to make our citizens safe is if we control the outbreak in West Africa, which is having a devastating impact on those countries. And so as we put in place various measures to try and protect citizens of this country, we have to be very mindful of any unintended consequences which may make it more difficult to manage patients in the African continent," he said, while noting that Emory is represented on an Ebola task force created by Georgia Gov. Nathan Deal to offer guidance on such issues here.

Asked what overall message he would give to help quell public fear over Ebola, Ribner offered a reminder that the Ebola virus is spread through blood and other bodily fluids, not through the air or casual contact.

"Again, as we look at measures in the United States to potentially control additional exposures that might occur, we need to keep the science in mind," he said.

http://www.cdc.gov/cdctv/Babybook/

http://www.cdc.gov/cdctv/Babybook/

Study shows global need to produce more fruits and vegetables...

The global supply of fruits and vegetables falls short of the needs of the population, according to a study by researchers at Emory's Rollins School of Public Health.
Low fruit and vegetable intake is a leading risk factor for death and disability globally and is attributed to approximately 1.7 million annual deaths worldwide. With current global dietary guidelines recommending a daily fruit and vegetable consumption of at least five servings, researchers analyzed whether the supply of fruits and vegetables is sufficient to meet current and growing population needs.
"There is a strong relationship between higher fruit and vegetable consumption and lower mortality," says Karen Siegel, MPH, in the Hubert Department of Global Health at Rollins School of Public Health. "This relationship extends to major chronic diseases such as cardiovascular disease, diabetes and certain cancers. Although much of the world's population does not consume the recommended servings, if health professionals are to encourage these recommendations, we must also consider the shortage of supply."
Using global population and agriculture databases, the team compared the global supply of fruits and vegetables  (supply)  with the recommended dietary intake (demand) for the year 2012. They also projected the supply and demand for 2025 and 2050. 
Findings suggest that the global supply of fruits and vegetables falls 22 percent short of  the global population's needs and approximately 95 percent short in lower income countries. An estimated fruit and vegetable supply gap of 34 percent and 43 percent was projected for years 2025 and 2050 respectively, if current production levels remain constant.
"Our research is significant because it shows that these gaps may only worsen with time, particularly for low-income countries," K.M. Venkat Narayan, MD, Ruth and O.C. Hubert Chair of Global Health at Rollins School of Public Health and study co-author. "This information sets the stage for further analyses and a deeper look into policy levels for increasing production and supply. Change is possible

Contact

Melva Robertson 
404-727-5692
melva.robertson@emory.edu

I'm a Failure (And That's OK)

This post by Greg Hodgin on LinkedIn,  i find very informative and inspiring. Please read it.

This is my first post on LinkedIn, so please: be brutal and merciless in your comments. First, thanks for even opening this. I am going to assume this is being read by maybe 5 people, so thanks, 5 people reading! This wasn’t written by anyone else; this is me typing at my computer at 12 on a Wednesday. A little about myself: I’m finishing up a Ph.D. in Political Science and I started a non-profit, Peacebuilding Solutions, in 2008. That’s not why I’m writing though. I’m writing because I’m a failure. Many times over. And I want to tell you why that’s all right, and why failure isn’t as bad as people think it is.

This is my third career. That’s right, third. I’m 36 now, and my first two careers went down in flames, I must admit. First it was medical school. I got my degree in Chemistry from a decent school, and I thought my future was set. 8 hours doing a rotation at the university hospital taught me otherwise: I must have lost 3 pounds throwing up. I had a pathological fear of blood and fluids so medical school definitely wasn’t for me. I tried to do industrial chemistry but that was just too boring for me. I ended up drifting from low paying job to low paying job, alcohol numbing the pain for a bit as I realized that my dream wasn’t going to happen. I’d never be a medical doctor. I’d never save lives, and there was nothing I could do about it.

That was career one. Mercifully, it was short. And it was the first big failure of my life. I took it very hard as you can easily see. But I did learn one thing: medicine wasn’t for me, and I was kidding myself if I thought otherwise. So. Back to the drawing board.

I started teaching high school. Career two. I lasted three years. The students loved me; I still have students from that part of my life telling me that they actually enjoyed chemistry when I taught it. Who knew that someone would actually enjoy chemistry? But teaching wasn’t for me either. By the third year, I was completely burnt out and it showed: sloppy lesson plans, lack of energy… lack of passion. It wasn’t for me. Even my students told me my heart wasn’t in it anymore. So I asked the principal to move me to another subject, possibly history as I always had a social studies interest. I was told there were no jobs there, so I quit. I went to grad school (which sad to say I’m still in but the end is in sight, I am happy to report).

That was career two, and it was a failure too. I only lasted three years and I was terrible at it. By this point I was in my late 20s and had two failed careers behind me. 0 for 2. As any sports fan will tell you, those aren’t the best numbers.

So grad school it was. At first I wanted to just get a master’s in education; maybe make some more money at the career I wasn’t good at. I lasted a semester. I wasn’t cut out for that, either.

Massive failure number three. Second one in a year. It was looking grim. I started taking classes in the political science department at Georgia State University as they had graciously allowed me to transfer over.

Then, I fell in love. I soaked up this discipline with gusto and fervor. And I was good at it. I knocked out the Master’s program and stuck around for the Ph.D. While in school, I founded Peacebuilding Solutions. You’re welcome to look it up if you’d like; I won’t bore you with the details here but suffice it to say I found something that when I wake up in the morning and I look in the mirror I get to think:

My job is great. I’m helping people by letting them help themselves.

I went to Haiti earlier this year to finish up some field work and I talked with the community we’re going to help. When I told them what we were going to do with them, they started clapping.

Money can’t buy that.

Am I a failure? Yes. Absolutely. Many times over. Will I fail again? Oh God yes. More times than I can imagine. But failure is one of life’s great lessons. Unfortunately, a lot of people don’t want to learn.

I hope I fail again. Many times. Failing my first 30 years of life gave me more lessons than any book or any school ever could. And I am grateful I had the opportunity to fail so often.

Just remember: failure is a crucible that forges us. You’re welcome to stay the lump of iron you are, or you can use it to forge yourself (with some good carbon, of course) into a strong steel plowshare or sword (feel free to choose the metaphor that fits you best).

Thanks for reading. Feel free to contact me.

I’m going to go fail again. I invite you to do the same.

Happy Day of the Girl Child!

Also praying for the return of the Chibok girls.

The Medicalization of Human Conditions and Health Care: A Public Health Perspective By Daryl A. Mangosing

"Public Health" focuses on the upstream causes of poor health, particularly those related to social and environmental factors that impact health status. However, biomedical advances in the last century have shifted the public's health to another aspect of care: individual causes and manifestations of illness and disease. This transition has led to what we call medicalization or “the process by which previously nonmedical problems become defined and treated as medical problems.” The medicalization of human conditions releases a ripple of effects, one being whether a consumer of health care recognizes a health problem that needs to be medically addressed. These problems are generally the result of failures in biology, hygiene, and behaviors, and they are resolved through biomedical treatments delivered by providers.

If such is the case, two significant questions surrounding health care arise: what is the relationship between medicalization and health care spending and health policy, and is the medicalization of human conditions generally justified at the public health level? The answers to these questions, as we shall see, warrant implicative actions that shift the direction of public health interventions to a more social, community-based effort in attacking the heart of poor health. Put simply, we have to translate the knowledge gained and lessons learned from medicalization of human conditions into preventive measures that go beyond what we may think is beneficial for health not just at the individual-level but ultimately at the population-level.

Individual problems of ill health have attracted the attention of money and manpower, lending to increasing concerns of medicalization driving up health care costs in the U.S. It is essential then that we take a further look into these estimations. For example, a study that estimated medical spending in the U.S. of identified medicalized conditions generated the following sum: $77.1 billion or 3.9% of total domestic expenditures on health care costs. Although it is a relatively minor portion of national health care expenditures, such an amount implies a substantial cost to private and public sectors as well as consumers. Whether this spending is inappropriate depends on the economic, social, and political dimensions of health care. Conversely, one can look to managed care, a major type of health insurance, as another major driver of U.S. health care. Conditions that are covered by health insurance fuel medicalization whereas the lack of coverage may slow it down; for example, Medicare and other medical insurance plans decided to consider obesity a reimbursable illness while some insurance plans do not cover certain conditions such as infertility. Furthermore, the only way to get human services paid for/reimbursed is to define a condition as a medical problem, thereby creating an incentive to medicalize more problems. The medicalization of human conditions therefore influences health care spending indefinitely, with increasing costs yielding unknown results. 

Policymakers have focused on increasing financial and geographic access to personal health services because of the assumption that health status problems are fixed by medical care. As the health problems of vulnerable populations became more medicalized, public policy started expanding access to individualized medical care. This approach may broadly help to achieve some public health goals, but key social and economic causes of health vulnerability and disparities lose attention. For instance, Medicaid provides a funding umbrella through which states finance expanded services and social supports that extend beyond medical treatment but services only become available or accessible after an individual is diagnosed with the health problem. On top of health care spending, the political drivers behind it have relied on medicalization to address health vulnerabilities by increasing access, but again, policy may lose sight of the root of the problem.   

When looking at patterns of health, patient/doctor ratios, the availability of tools for the job, and numbers of hospital beds may bear little relation to improvements in public health, and even disease and disability continues to directly result from medical intervention. Medicalization can also negatively affect how populations manage health problems in the following ways: the creation of ill-informed demand, enforcement of the belief that one has to spend more on medical services to secure a healthier population, and dependence on a system for medical help from womb to grave. Disease prevention then looks like a reliance on authoritative systems that give insufficient consideration for empowering people themselves to take responsibility for their health, giving people no choice but to support the system.  

The medicalization of human conditions have spurred the “individualization of social problems,” making social or environmental interventions either ignored or secondary and reinforces technical fixes for complex problems. One complex problem in which medicalization may be at odds with public health is alcoholism: is it truly a disease or is it just deviant social behavior? Not a single cause of alcoholism has been established or likely will be as patterns of alcohol abuse vary individually and are influenced by social structure and external events. Another surprising proposition is that prevention itself has become a key driver of over-medicalization. Certain diseases and conditions have a long lead-time, leading people to opt for treatment that possibly lengthens their “disease survival” without lengthening their lifespan. If screening was not enough to halt disease progression, physicians may intervene earlier or screen for “pre-disease” (e.g. pre-hypertension) that may or may not pay dividends in the end. In all truthfulness nonetheless, the medicalization of certain conditions and behaviors may surely benefit certain individuals more so than others. These others then unfortunately miss the intended benefits.

In summary, several conclusions can be inferred from what we know regarding medicalization and its effect on health care: medicalization influences health care spending indefinitely, policy has focused on increasing health access, prevention may have promoted reliance on authoritative systems, and medicalization may benefit some more than others. What remains common among these assumptions is the neutral yield of both benefits and losses, thereby calling for further research and analysis of such data. However, the implication raised here is to return to the public health view of upstream causes of health. This means policy action in income security, education, housing, nutrition/food security, and the environment to improve health among all populations, especially among socially disadvantaged groups. Accompanying this step is the transition from medicalization to “healthization” – lifestyle and behavioral causes and interventions – turning health into the moral rather than the moral into health. Doing so creates efficacious communities and stronger families, which serve as mediating institutions that can screen out the individual and social effects of disease. Put simply, the key could be a form of strong community self-help. The medicalization of human conditions is not an inherently negative asset of health care, but rather, it is a way for us improve our understanding of disease processes so that we may delve into deeper solutions that attack the root of the problem. In this case, the starting point is the holistic, societal unit of the individual: the community. References

Bastian, H. (2014). The disease prevention illusion: A tragedy in five parts. Scientific American Global RSS. Retrieved from http://blogs.scientificamerican.com/absolutely-maybe/2014/03/23/the-disease-prevention-illusion-a-tragedy-in-five-parts/

Conrad, P. (2013). Medicalization: Changing contours, characteristics, and contexts. In W.C. Cockerham (Ed.), Medical sociology on the move (pp. 195-214). Dordrecht, Netherlands: Springer.

Conrad, P., Mackie, T., & Mehrotra, A. (2010). Estimating the costs of medicalization. Social Science and Medicine, 70(12), 1943-7. doi:10.1016/j.socscimed.2010.02.019

Lantz, P.M., Lichtenstein, R.L., & Pollack, H.A. (2007). Health policy approaches to population health: The limits of medicalization. Health Affairs, 26(5), 1253-1257. doi:10.1377/hlthaff.26.5.1253

Paton, A. (1974). Medical Nemesis – three views. “Medicalization” of health. British Medical Journal, 4, 573-577. doi:10.1136/bmj.4.5944.573

Walsh, D.C. (1991). Medicalization run amok? Health Affairs, 10(1), 205-207. doi:10.1377/hlthaff.10.1.205

New HIV Prevention Guidelines

I came across this article in the Rollins school of Public Health site of Emory University and i thought we all need it.

 An innovative approach to HIV prevention, an interdisciplinary group of experts has come together for the first time to lay out a framework of best practices to optimize the role of the clinician in achieving an AIDS-free generation.

Published online in the Journal of the American Medical Association (JAMA), the recommendations integrate both cutting-edge biomedical advances and evidence-based behavioral interventions for the care of people living with HIV or at high risk for HIV infection.

The recommendations, developed by an expert volunteer panel assembled by the International Antiviral (formerly AIDS) Society–USA (IAS-USA), are intended as guidelines for clinicians to implement a combined biomedical-behavioral approach to HIV care and prevention. They are based on a comprehensive review of data that was either published or presented at scientific conferences over the past 17 years.

Among the new recommendations is a call for the use of antiretroviral therapy (ART), which suppresses HIV replication and virtually eliminates the risk of transmitting the virus, for all HIV-infected individuals and as pre-exposure prophylaxis (PrEP) for HIV-uninfected individuals at high risk of infection. The guidelines emphasize the integration of behavioral and social interventions—such as psychosocial counseling or treatment for drug dependence—in health care systems to help individuals living with HIV or at high risk for infection to access and remain in high quality HIV care.

"The tools to prevent HIV infection and disease progression are better than ever, but providers need encouragement and support to integrate best practices in communication and counseling with the biomedical measures that can render patients less- and ideally non-infectious," says Jeanne M. Marrazzo, MD, MPH, professor of medicine at the University of Washington; medical director of the Seattle STD/HIV Prevention Training Center; a co-chair of the IAS-USA panel; and corresponding author of the paper.

According to the recommendations, the availability of combination antiretroviral therapy (ART) has changed the lives of millions of individuals living with HIV, transforming HIV from a fatal infection to a manageable chronic disease. But while the incidence of new HIV-1 infections worldwide has decreased by an estimated 33 percent since 2001, it still remains high—approximately 2.3 million new infections occurred in 2012. In the United States alone, approximately 50,000 new infections occur each year—a number that has remained largely unchanged since the 1990s.

Carlos del Rio | See Expert Bio

"We are at a time where scientific advances in HIV allow us to effectively implement interventions that could stop HIV transmission," says Carlos del Rio, MD, chair of the Department of Global Health at the Rollins School of Public Health at Emory University, professor of medicine at Emory University School of Medicine, co-director of the Emory Center for AIDS Research, co-chair of the IAS-USA Panel, and a member of the IAS-USA volunteer board of directors. "But the success of both biomedical and behavioral HIV prevention measures depends on clinicians’ ability and willingness to implement them."

"These guidelines provide a practical, science-based approach that any clinician can implement," says David Holtgrave, PhD, chair of the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and a co-chair of the IAS-USA Panel. "They are designed to promote the integration of the best available services—both behavioral and biomedical—and to create a clear pathway to access these services and realize their full benefit."

The panel’s recommendations include the following:

All adults and adolescents should be tested at least once for HIV, with repeated testing for those at increased risk of acquiring HIV.

Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if infection is suspected.

Individuals diagnosed with HIV should be linked to care for timely initiation of antiretroviral therapy (ART).

Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) should be included in the care of HIV-infected individuals.

Uninfected persons at high risk of HIV infection should be prioritized for interventions such as pre-exposure prophylaxis (PrEP) and individualized counseling on risk reduction.

Daily emtricitabine/tenofovir disoproxil fumarate is recommended as PrEP for persons at high risk for HIV based on recent diagnosis of STIs, use of injection drugs or shared needles, or recent use of post-exposure prophylaxis; ongoing use of PrEP should be guided by regular risk assessment.

For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically-assisted therapies, including opioid agonists and antagonists). Low-threshold detoxification and drug cessation programs should be made available.

Post-exposure prophylaxis (PrEP) is recommended and should be initiated as soon as possible for all persons exposed to HIV from a known infected source.

The recommendations note that while implementing them may present structural, economic, or political challenges, the benefits should be substantial in preventing disease progression, promoting the gain of healthy life years and preventing new HIV infections.

In addition to Marrazzo, del Rio and Holtgrave, panel members included  Myron S. Cohen, MD, University of North Carolina at Chapel Hill; Seth C. Kalichman, PhD, University of Connecticut; Kenneth H. Mayer, MD, Harvard Medical School; Julio S. G. Montaner, MD, University of British Columbia; Darrell P. Wheeler, PhD, MPH; Loyola University Chicago; Robert M. Grant, MD, MPH, University of California San Francisco; Beatriz Grinsztejn, MD, PhD, Evandro Chagas Clinical Research Institute (IPEC)–FIOCRUZ; N. Kumarasamy, MD, YR Gaitonde Centre for AIDS Research and Education; Steven Shoptaw, PhD, University of California Los Angeles; Rochelle P. Walensky, MD, MPH, Massachusetts General Hospital; Francois Dabis, MD, PhD; Université de Bordeaux; Jeremy Sugarman, MD, MPH, The Johns Hopkins University; and Constance A. Benson, MD, University of California San Diego.

IAS-USA is a 501(c)(3) not-for-profit organization that sponsors continuing medical education for physicians and medical practitioners involved in the care of people with HIV, HCV, or other viral infections. IAS-USA, located in San Francisco, sponsored and funded the guidelines entirely. In this same issue of JAMA another expert volunteer panel brought together by the IAS-USA is publishing updated recommendations for the use of antiretrovirals for the treatment of HIV-1 infected adults.  The IAS-USA treatment guidelines are widely used by clinicians since they were first published in 1996.  

Less Salt!

I love this campaign...and have always encouraged people to imbibe.

Less Salt in your diets: It only takes two weeks to adjust your taste buds...Give it a go and cut salt from your diet!

Less Salt guys!

Busy Busy Busy!

Hello Public Health Lovers:

I have been holed up in a couple of courses i am taking online that i haven't had time to blog.

I will be back on as soon as i get a little chance.

Take care and stay healthy!

Gastroenteritis: All You Need to Know & The Precautions to take.

Gastroenteritis or infectious diarrhea is a medical condition from inflammation of the gastrointestinal tract that involves both the stomach and the small intestine. It causes some combination of diarrhea, vomiting, and abdominal pain and cramping.^[1]Dehydration may occur as a result. Gastroenteritis has been referred to as gastro, stomach bug, and stomach virus. Although unrelated toinfluenza, it has also been called stomach flu and gastric flu.

Globally, most cases in children are caused by rotavirus. In adults,norovirus and Campylobacter are more common. Less common causes include other bacteria (or their toxins) and parasites. Transmission may occur due to consumption of improperly prepared foods or contaminated water or via close contact with individuals who are infectious. Prevention includes the use of fresh water, regular hand washing, and breast feeding especially in areas where sanitation is less good. The rotavirus vaccine is recommended for all children.

The key treatment is enough fluids. For mild or moderate cases, this can typically be achieved via oral rehydration solution (a combination of water, salts, and sugar). In those who are breast fed, continued breast feeding is recommended. For more severe cases, intravenous fluids from a healthcare centre may be needed. Antibiotics are generally not recommended. Gastroenteritis primarily affects children and those in the developing world. It results in about three to five billion cases and causes 1.4 million deaths a year.

Signs & Symptoms : Gastroenteritis typically involves both diarrhea and vomiting,or less commonly, presents with only one or the other.Abdominal cramping may also be present. Signs and symptoms usually begin 12–72 hours after contracting the infectious agent.If due to a viral agent, the condition usually resolves within one week. Some viral causes may also be associated with fever, fatigue, headache, and muscle pain. If the stool is bloody, the cause is less likely to be viral and more likely to be bacterial. Some bacterial infections may be associated with severe abdominal pain and may persist for several weeks.

Children infected with rotavirus usually make a full recovery within three to eight days. However, in poor countries treatment for severe infections is often out of reach and persistent diarrhea is common. Dehydration is a common complication of diarrhea, and a child with a significant degree of dehydration may have a prolonged capillary refill, poor skin turgor, and abnormal breathing. Repeat infections are typically seen in areas with poor sanitation, and malnutrition, stunted growth, and long-term cognitive delays can result. 

Reactive arthritis occurs in 1% of people following infections with Campylobacter species, and Guillain-Barre syndrome occurs in 0.1%.Hemolytic uremic syndrome (HUS) may occur due to infection with Shiga toxin-producing Escherichia coli or Shigella species, causing low platelet counts, poor kidney function, and low red blood cell count (due to their breakdown).Children are more predisposed to getting HUS than adults.^[12] Some viral infections may produce benign infantile seizures.

Cause: Viruses (particularly rota virus) and the bacteria Escherichia coli and Campylobacter species are the primary causes of gastroenteritis.There are, however, many other infectious agents that can cause this syndrome.Non-infectious causes are seen on occasion, but they are less likely than a viral or bacterial cause.Risk of infection is higher in children due to their lack of immunity and relatively poor hygiene.

Viral: Rotavirus, norovirus, adenovirus, and astrovirus are known to cause viral gastroenteritis. Rotavirus is the most common cause of gastroenteritis in children,and produces similar rates in both the developed and developing world.Viruses cause about 70% of episodes of infectious diarrhea in the pediatric age group. Rotavirus is a less common cause in adults due to acquired immunity.Norovirus is the cause in about 18% of all cases.

Norovirus is the leading cause of gastroenteritis among adults in America, causing greater than 90% of outbreaks.These localized epidemics typically occur when groups of people spend time in close physical proximity to each other, such as on cruise ships, in hospitals, or in restaurants.^[1] People may remain infectious even after their diarrhea has ended. Norovirus is the cause of about 10% of cases in children.^[1]

Bacterial: In the developed world Campylobacter jejuni is the primary cause of bacterial gastroenteritis, with half of these cases associated with exposure to poultry.In children, bacteria are the cause in about 15% of cases, with the most common types being Escherichia coli, Salmonella, Shigella, andCampylobacter species. If food becomes contaminated with bacteria and remains at room temperature for a period of several hours, the bacteria multiply and increase the risk of infection in those who consume the food. Some foods commonly associated with illness include raw or undercooked meat,poultry, seafood, and eggs; raw sprouts; unpasteurized milk and soft cheeses; and fruit and vegetable juices.In the developing world, especially sub-Saharan Africa and Asia, cholera is a common cause of gastroenteritis. This infection is usually transmitted by contaminated water or food.^[20]

Toxigenic Clostridium difficile is an important cause of diarrhea that occurs more often in the elderly.^[12] Infants can carry these bacteria without developing symptoms. It is a common cause of diarrhea in those who are hospitalized and is frequently associated with antibiotic use.Staphylococcus aureus infectious diarrhea may also occur in those who have used antibiotics. "Traveler's diarrhea" is usually a type of bacterial gastroenteritis. Acid-suppressing medication appears to increase the risk of significant infection after exposure to a number of organisms, including Clostridium difficile, Salmonella, and Campylobacter species.The risk is greater in those taking proton pump inhibitors than with H2 antagonists.

Parasitic:A number of protozoans can cause gastroenteritis – most commonly Giardia lamblia – but Entamoeba histolytica andCryptosporidium species have also been implicated. As a group, these agents comprise about 10% of cases in children. Giardia occurs more commonly in the developing world, but this etiologic agent causes this type of illness to some degree nearly everywhere.It occurs more commonly in persons who have traveled to areas with high prevalence, children who attend day care, men who have sex with men, and following disasters.

Transmission: Transmission may occur via consumption of contaminated water, or when people share personal objects. In places with wet and dry seasons, water quality typically worsens during the wet season, and this correlates with the time of outbreaks. In areas of the world with four seasons, infections are more common in the winter. Bottle-feeding of babies with improperly sanitized bottles is a significant cause on a global scale. Transmission rates are also related to poor hygiene, especially among children, in crowded households, and in those with pre-existing poor nutritional status. After developing tolerance, adults may carry certain organisms without exhibiting signs or symptoms, and thus act as natural reservoirs of contagion. While some agents (such as Shigella) only occur in primates, others may occur in a wide variety of animals (such as Giardia).

Non-Infectious: There are a number of non-infectious causes of inflammation of the gastrointestinal tract. Some of the more common include medications (like NSAIDs), certain foods such as lactose (in those who are intolerant), and gluten (in those withceliac disease). Crohn's disease is also a non-infection source of (often severe) gastroenteritis.Disease secondary totoxins may also occur. Some food related conditions associated with nausea, vomiting, and diarrhea include: ciguatera poisoning due to consumption of contaminated predatory fish, scombroid associated with the consumption of certain types of spoiled fish, tetrodotoxin poisoning from the consumption of puffer fish among others, and botulism typically due to improperly preserved food.

Pathophysiology: Gastroenteritis is defined as vomiting or diarrhea due to infection of the small or large bowel.The changes in the small bowel are typically noninflammatory, while the ones in the large bowel are inflammatory.The number of pathogens required to cause an infection varies from as few as one (for Cryptosporidium) to as many as 10⁸ (for Vibrio cholerae).

Diagnosis: Gastroenteritis is typically diagnosed clinically, based on a person's signs and symptoms.Determining the exact cause is usually not needed as it does not alter management of the condition. However, stool cultures should be performed in those with blood in the stool, those who might have been exposed to food poisoning, and those who have recently traveled to the developing world.Diagnostic testing may also be done for surveillance. As hypoglycemia occurs in approximately 10% of infants and young children, measuring serum glucose in this population is recommended. Electrolytes and kidney function should also be checked when there is a concern about severe dehydration.

Dehydration: A determination of whether or not the person has dehydration is an important part of the assessment, with dehydration typically divided into mild (3–5%), moderate (6–9%), and severe (≥10%) cases.In children, the most accurate signs of moderate or severe dehydration are a prolonged capillary refill, poor skin turgor, and abnormal breathing. Other useful findings (when used in combination) include sunken eyes, decreased activity, a lack of tears, and a dry mouth.A normal urinary output and oral fluid intake is reassuring.Laboratory testing is of little clinical benefit in determining the degree of dehydration.

Differential Diagnosis: Other potential causes of signs and symptoms that mimic those seen in gastroenteritis that need to be ruled out includeappendicitis, volvulus, inflammatory bowel disease, urinary tract infections, and diabetes mellitus.Pancreatic insufficiency, short bowel syndrome, Whipple's disease, coeliac disease, and laxative abuse should also be considered. The differential diagnosis can be complicated somewhat if the person exhibits only vomiting or diarrhea (rather than both).

Appendicitis may present with vomiting, abdominal pain, and a small amount of diarrhea in up to 33% of cases. This is in contrast to the large amount of diarrhea that is typical of gastroenteritis. Infections of the lungs or urinary tract in children may also cause vomiting or diarrhea. Classical diabetic ketoacidosis (DKA) presents with abdominal pain, nausea, and vomiting, but without diarrhea.One study found that 17% of children with DKA were initially diagnosed as having gastroenteritis.

Prevention

Lifestyle: A supply of easily accessible uncontaminated water and good sanitation practices are important for reducing rates of infection and clinically significant gastroenteritis.Personal measures (such as hand washing) have been found to decrease incidence and prevalence rates of gastroenteritis in both the developing and developed world by as much as 30%.Alcohol-based gels may also be effective. Breastfeeding is important, especially in places with poor hygiene, as is improvement of hygiene generally.Breast milk reduces both the frequency of infections and their duration.Avoiding contaminated food or drink should also be effective.

Vaccination: Due to both its effectiveness and safety, in 2009 the World Health Organization recommended that the rotavirus vaccinebe offered to all children globally.Two commercial rotavirus vaccines exist and several more are in development.In Africa and Asia these vaccines reduced severe disease among infants and countries that have put in place national immunization programs have seen a decline in the rates and severity of disease.This vaccine may also prevent illness in non-vaccinated children by reducing the number of circulating infections.Since 2000, the implementation of a rotavirus vaccination program in the United States has substantially decreased the number of cases of diarrhea by as much as 80 percent.The first dose of vaccine should be given to infants between 6 and 15 weeks of age.The oral cholera vaccine has been found to be 50–60% effective over 2 years.

Management: Gastroenteritis is usually an acute and self-limiting disease that does not require medication. The preferred treatment in those with mild to moderate dehydration is oral rehydration therapy (ORT). Metoclopramide and/or ondansetron, however, may be helpful in some children, and butylscopolamine is useful in treating abdominal pain.

Rehydration: The primary treatment of gastroenteritis in both children and adults is rehydration. This is preferably achieved by oral rehydration therapy, although intravenous delivery may be required if there is a decreased level of consciousness or if dehydration is severe.Oral replacement therapy products made with complex carbohydrates (i.e. those made from wheat or rice) may be superior to those based on simple sugars.Drinks especially high in simple sugars, such as soft drinks and fruit juices, are not recommended in children under 5 years of age as they may increase diarrhea.Plain water may be used if more specific and effective ORT preparations are unavailable or are not palatable.Anasogastric tube can be used in young children to administer fluids if warranted.

Dietary: It is recommended that breast-fed infants continue to be nursed in the usual fashion, and that formula-fed infants continue their formula immediately after rehydration with ORT. Lactose-free or lactose-reduced formulas usually are not necessary.Children should continue their usual diet during episodes of diarrhea with the exception that foods high in simple sugars should be avoided.The BRAT diet (bananas, rice, applesauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding.Some probiotics have been shown to be beneficial in reducing both the duration of illness and the frequency of stools. They may also be useful in preventing and treating antibiotic associated diarrhea.Fermented milk products (such as yogurt) are similarly beneficial. Zinc supplementation appears to be effective in both treating and preventing diarrhea among children in the developing world.

Antiemetic medications may be helpful for treating vomiting in children. Ondansetron has some utility, with a single dose being associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting.Metoclopramide might also be helpful.However, the use of ondansetron might possibly be linked to an increased rate of return to hospital in children.The intravenous preparation of ondansetron may be given orally if clinical judgment warrants.Dimenhydrinate, while reducing vomiting, does not appear to have a significant clinical benefit.

Antibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are particularly severe or if a susceptible bacterial cause is isolated or suspected. If antibiotics are to be employed, amacrolide (such as azithromycin) is preferred over a fluoroquinolone due to higher rates of resistance to the latter.Pseudomembranous colitis, usually caused by antibiotic use, is managed by discontinuing the causative agent and treating it with either metronidazole or vancomycin. Bacteria and protozoans that are amenable to treatment includeShigella Salmonella typhi, and Giardia species. In those with Giardia species or Entamoeba histolytica,tinidazole treatment is recommended and superior to metronidazole.The World Health Organization (WHO) recommends the use of antibiotics in young children who have both bloody diarrhea and fever.   

Antimotility medication has a theoretical risk of causing complications, and although clinical experience has shown this to be unlikely,these drugs are discouraged in people with bloody diarrhea or diarrhea that is complicated by fever.Loperamide, an opioid analogue, is commonly used for the symptomatic treatment of diarrhea.Loperamide is not recommended in children, however, as it may cross the immature blood–brain barrier and cause toxicity. Bismuth subsalicylate, an insoluble complex of trivalent bismuth and salicylate, can be used in mild to moderate cases, butsalicylate toxicity is theoretically possible.

Epidemiology

Disability-adjusted life year for diarrhea per 100,000 inhabitants in 2004.

no data   ≤less 500   500–1000   1000–1500   1500–2000   2000–2500   2500–3000

3000–3500   3500–4000   4000–4500   4500–5000   5000–6000   ≥6000

It is estimated that three to five billion cases of gastroenteritis resulting in 1.4 million deaths occur globally on an annual basis,with children and those in the developing world being primarily affected.As of 2011, in those less than five, there were about 1.7 billion cases resulting in 0.7 million deaths,with most of these occurring in the world's poorest nations. More than 450,000 of these fatalities are due to rotavirus in children under 5 years of age.Cholera causes about three to five million cases of disease and kills approximately 100,000 people yearly.In the developing world children less than two years of age frequently get six or more infections a year that result in clinically significant gastroenteritis. It is less common in adults, partly due to the development of acquired immunity.

In 1980, gastroenteritis from all causes caused 4.6 million deaths in children, with the majority occurring in the developing world. Death rates were reduced significantly (to approximately 1.5 million deaths annually) by the year 2000, largely due to the introduction and widespread use of oral rehydration therapy.In the US, infections causing gastroenteritis are the second most common infection (after the common cold), and they result in between 200 and 375 million cases of acute diarrhea and approximately ten thousand deaths annually,with 150 to 300 of these deaths in children less than five years of age. 

The first usage of "gastroenteritis" was in 1825.Before this time it was more specifically known as typhoid fever or "cholera morbus", among others, or less specifically as "griping of the guts", "surfeit", "flux", "colic", "bowel complaint", or any one of a number of other archaic names for acute diarrhea.

Gastroenteritis is associated with many colloquial names, including "Montezuma's revenge", "Delhi belly", "la turista", and "back door sprint", among others.It has played a role in many military campaigns and is believed to be the origin of the term "no guts no glory".

Gastroenteritis is the main reason for 3.7 million visits to physicians a year in the United States^[1] and 3 million visits in France. In the United States gastroenteritis as a whole is believed to result in costs of 23 billion USD per year with that due to rotavirus alone resulting in estimated costs of 1 billion USD a year.

There are a number of vaccines against gastroenteritis in development. For example, vaccines against Shigella and enterotoxigenic Escherichia coli (ETEC), two of the leading bacterial causes of gastroenteritis worldwide.

Many of the same agents cause gastroenteritis in cats and dogs as in humans. The most common organisms areCampylobacter, Clostridium difficile, Clostridium perfringens, and Salmonella.A large number of toxic plants may also cause symptoms.

Some agents are more specific to a certain species. Transmissible gastroenteritis coronavirus (TGEV) occurs in pigs resulting in vomiting, diarrhea, and dehydration.It is believed to be introduced to pigs by wild birds and there is no specific treatment available.It is not transmissible to humans.