RxPG News : USA

Measles, Mumps make a comeback in US

Sat, 26 Jan 2013 14:38:03 PST

( from http://www.rxpgnews.com ) Washington, Jan 26 - Childhood diseases, like measles, that were said to be eliminated in the US a decade ago are slowly making a comeback, in part due to an increasing number of Americans choosing not to get vaccinated, officials with the Centers for Disease Control and Prevention - told RIA Novosti.

I think one of the biggest misconceptions is that these diseases aren't a problem anymore, said Gregory Wallace, a medical epidemiologist with the CDC.

People have associated vaccines with health risks and studies have not shown that to be the case, Wallace said.

In 2000, the CDC announced measles had been eliminated in the US. But in 2011, 220 Americans contracted the disease, the most cases the government health agency had seen in 15 years, officials said.

It's one of the most contagious vaccine-preventable diseases, Wallace told RIA Novosti.

Approximately two-thirds of the 220 Americans who caught measles in 2011 fell ill because they had not received the measles vaccination and had contracted the disease during international travel or after coming into contact with someone who had been traveling, particularly in Western Europe, Wallace said. The remaining cases of infections were foreigners visiting the US.

In some cases measles can result in a serious lung infection, such as pneumonia. And while severe cases are rare, measles can cause swelling of the brain and even death particularly in infants and in people who have weakened immune systems including the elderly and those with HIV or types of cancer.

Mumps has also seen a resurgence in the US, though the circumstances surrounding the spike differ from measles, CDC officials said.

The vaccine advocacy for mumps isn't quite as good as measles, Wallace said. In certain settings if mumps gets a foothold in a community it can sometimes overwhelm the vaccine.

And because the virus has mutated in recent years, the standard vaccine has become less effective, CDC officials said.

--IANS/RIA Novosti

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India adds spice to US life, keeps it healthy

Fri, 11 Jan 2013 11:52:04 PST

( from http://www.rxpgnews.com ) India is the second largest drug exporter and the seventh largest food exporter to the US with nearly one quarter of the spices, oils and food colourings used in America coming from India.

As such, the Food and Drug Administration - works hard to make sure that these India-produced foods and drugs are safe, effective and of good quality, the US watchdog agency said in a consumer update.

With offices in New Delhi and Mumbai staffed by technical experts and experienced investigators in food and medical products, FDA maintains close contact with the Indian government, industries, trade associations, and scientific and academic communities.

Consequently, Indian officials are better informed about FDA's import requirements and the agency is able to share best practices involving the production of FDA-regulated products, it said.

Such contacts have been especially helpful when unexpected issues arise.

We know who the decision makers are and who to contact to mobilise a response when problems arise that could affect people at home, Bruce Ross, FDA's country director in India based in New Delhi, was quoted as saying.

Ross describes FDA's India office as a portal through which safety information on food and drugs flows back and forth among FDA, the Indian government and industry.

Either we provide answers to their questions or we link them to the right people who can, he said.

FDA's India office also shares information gleaned from facility inspections with Indian officials so they can take action to improve product safety and quality.

FDA responds to requests from the Indian government to train representatives from industry, agriculture and commerce in agricultural and manufacturing standards and practices used in the US.

It's a very pro-active way for us to ensure products imported to the states are safe and meet our standards for quality, Ross explained.

For example, FDA-working with India's drug regulators-engaged in training that focused on good clinical practices.

This training facilitated and supported the development of an Indian-specific programme for the inspection and monitoring of clinical research sites, FDA said.

Fitness club memberships help insurance plans to enrol healthier patients

Thu, 12 Jan 2012 02:15:42 PST

( from http://www.rxpgnews.com ) Because healthy enrollees cost them less, Medicare Advantage plans would profit from selecting seniors based on their health, but Medicare strictly forbids practices such as denying coverage based on existing conditions. Another way to build a more profitable membership is to design insurance benefits that attract the healthiest patients. In a study published in the Jan. 12, 2012, edition of the New England Journal of Medicine, Brown University researchers report that plans have managed to do just that by offering fitness club memberships as a covered benefit.

"Offering a fitness membership does not mean that you are denying people coverage, but you are changing your benefits to appeal selectively to people who are healthy," said co-author Amal Trivedi, a Brown public health professor and a physician at the Providence VA Medical Center. "Policymakers intended for Medicare Advantage plans to compete on the basis of improving quality and reducing costs, rather than on their ability to attract healthier patients. What we found in the study is that offering coverage for fitness membership is a very effective strategy to attract a much healthier population."

That conclusion comes from Trivedi's and lead author Alicia Cooper's rigorous statistical comparisons among thousands of patients in 22 Medicare Advantage plans — 11 "case" plans that added fitness club memberships in 2004 or 2005 and 11 similar "control" plans that didn't. They looked at when each plan member enrolled, when plans started offering the benefit, and what each plan member said about his or her health in the Medicare Health Outcomes Survey from 2006 to 2008.

One analysis compared the self-reported health of seniors who enrolled in case plans before the fitness club benefit was offered to the health of those who enrolled after the benefit was offered. While 29.1 percent of the seniors who enrolled before the benefit was available described themselves to be in excellent or very good health, 35.1 percent of the seniors who enrolled after it became available reported that level of health. In the before group, 56.1 percent reported some limitation to their physical activity but only 45.7 percent in the after group did. Also, a third of the before group reported difficulty walking compared to just a quarter in the after group.

Once the Medicare Advantage plans started covering health club memberships, they enrolled healthier enrollees with fewer physical limitations. In the control plans, which did not offer the benefit, self-reported health levels over the same timeframe changed only slightly. In comparison to the control plans, eight of the 11 case plans (the ones that added fitness club coverage) enrolled seniors with better overall health, 10 of the 11 case plans enrolled seniors with fewer restrictions in physical activity, and nine of the 11 case plans enrolled seniors that had less difficulty walking.

An increasing practice

Trivedi and Cooper studied the benefit structures of 101 Medicare Advantage health plans between 2002 and 2008 to select plans for comparison. What they found is a rapid growth in the number of plans offering fitness club memberships, from 14 in 2002 to 58 in 2008.

"This trend suggests that offering fitness memberships may be an attractive business strategy for Medicare plans," Trivedi said.

Trivedi acknowledged that if every plan offered the fitness benefits, it would no longer be an effective way of selecting for the healthiest members. However, given the continued incentive to enroll more profitable enrollees, he said, insurers may employ other related tactics to cherry-pick desirable enrollees.

"In general, policymakers have regulated the Medicare Advantage insurance market to prevent the ability of private plans to select the healthiest enrollees," Trivedi said. "If Medicare plans do engage in favorable selection, then unhealthy enrollees can be concentrated in a small number of plans or in the traditional Medicare program, driving up the costs for those enrollees and the tax-payers that fund the Medicare program."

White children far more likely to receive CT scans than Hispanic, African-American children

Mon, 17 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) White children are far more likely to receive cranial computed tomography (CT) scans in an emergency department following minor head trauma than are African-American or Hispanic children, a study by researchers at UC Davis has found.

The study findings do not indicate that CT scans are underused in treating African-American and Hispanic children, the researchers said. Rather, they suggest that white children may receive too many CT scans -- and for that reason may be exposed to unnecessary radiation.

The study results were presented today at the American College of Emergency Physicians (ACEP) Scientific Assembly by JoAnne E. Natale, associate professor of pediatric critical care medicine at the UC Davis School of Medicine and the study's lead author.

The higher rates of cranial CT scan use in children at low risk for clinically significant brain injury may represent overuse in white children, leading to increased radiation exposure and health-care costs, Natale said.

Cranial computed tomography imaging commonly is used to determine the severity of injury in children and adults in emergency departments. Cranial CT scans use X-rays to image the cranium, brain, eye sockets and sinuses.

However, in children with mild head trauma, earlier studies have found that fewer than 10 percent of CT scans identify a traumatic brain injury. CT scans use a significant amount of radiation and thus increase the risk of potential subsequent malignancies.

For the current study, researchers examined data from children whose race and/or ethnicity was Hispanic, non-Hispanic African American, or non-Hispanic white. Although all of the children had minor head trauma, some could be categorized as being at greater risk of a clinically significant injury in which a CT scan may be indicated.

Natale, who also is the medical director of the UC Davis Children's Hospital Pediatric Intensive Care Unit, said that the study utilized data compiled for a seminal 2009 study by UC Davis authors, which found that CT scans are not necessary for children at very low risk of clinically significant traumatic brain injury.

The 2009 study was lead by Nathan Kuppermann, co-author of the current study and chair of the UC Davis Department of Emergency Medicine. That study enrolled more than 40,000 children nationwide with minor head trauma who presented at 25 U.S. emergency departments, under the auspices of the Pediatric Emergency Care Applied Research Network (PECARN) between 2004 and 2006.

The current study found that a child's race and/or ethnicity did not influence the likelihood of receiving a CT scan among children with minor head trauma at the greatest risk of having a clinically important brain injury. However, among lower-risk children, non-Hispanic white children were more likely to receive a CT scan than were non-Hispanic African-American children and children of Hispanic descent.

In addition to the increased risks posed by radiation exposure, overuse of CT scans in non-Hispanic white children also has impacts on overall health-care costs, Natale said. She said that the overuse of CT scans is part of a well-documented pattern of providing more care than is necessary to individuals of certain racial and/or ethnic groups, which in turn places additional burdens on health-care costs.

Clearly, further studies should focus on explaining racial differences in the use of emergent neuroimaging, Natale said. Our study highlights the importance of strong, evidence-based guidelines to ensure equal and optimal care for all children.

Daunting barriers found in accessing psychiatric care

Thu, 21 Jul 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A new study by Harvard Medical School researchers published today in the Annals of Emergency Medicine finds that access to outpatient psychiatric care in the greater Boston area is severely limited, even for people with reputedly excellent private health insurance. Given that the federal health law is modelled after the Massachusetts health reform, the findings have national implications, the researchers say.

Study personnel posed as patients insured by Blue Cross Blue Shield of Massachusetts PPO, the largest insurer in Massachusetts. They called every Blue Cross-contracted mental health facility within a 10-mile radius of down town Boston, stating they had been evaluated in an emergency department for depression and discharged with instructions to obtain a psychiatric appointment within two weeks – i.e. they signalled they needed urgent care.

Only 8 of the 64 facilities (12.5 percent) listed by Blue Cross as preferred providers offered appointments; only 4 (6.2 percent) offered an appointment within two weeks. These findings indicate that even patients with top-drawer private insurance face grave difficulties in securing mental health services in the Boston area.

According to the study, 23 percent of phone calls seeking appointments were never returned, even after a second attempt. Another common reason appointments were unavailable was that 23 percent of psychiatric providers required that the patient already be enrolled with a primary care doctor affiliated with their psychiatric facility.

"People with mental health problems often can't advocate for themselves – especially in a crisis," said lead author Dr. J. Wesley Boyd, an attending psychiatrist at the Harvard-affiliated Cambridge Health Alliance. "Health insurers know this and yet, thanks to their restrictive provider networks and their low reimbursement rates for psychiatric services, they've created a situation where a patient with a potentially life-threatening disorder, such as the severe depression portrayed in our callers' scenario, is essentially abandoned at a time of great need."

"Despite having private coverage, our simulated patient faced daunting barriers when trying to access psychiatric care," Boyd continued. "How likely is it that a real patient in the grip of severe depression would persevere through so many unsuccessful attempts?"

Senior author Dr. Rachel Nardin, chief of neurology at Cambridge Health Alliance, said: "The incentives of the current health insurance system are aligned against patients with mental illness. Insurers try to protect their bottom line by reimbursing poorly for psychiatric services and by constraining their in-network provider lists, both of which limit patients' options so severely as to make services essentially unavailable."

"Lack of adequate access to mental health care strains our entire health care system," said Nardin. "Emergency departments are overwhelmed with boarding psychiatric patients for whom no other resources exist."

"A good first step would be for insurance companies to immediately provide improved reimbursements for psychiatric care," Nardin said. "A more fundamental solution, however, would be to remove private insurers from the picture altogether and to establish a single-payer national health insurance program – a program that would cover mental health services as part of its comprehensive benefits package."

Obama names Indian American health researcher White House Fellow

Fri, 26 Jun 2009 09:24:38 PST

( from http://www.rxpgnews.com ) Washington, June 26 - President Barack Obama has appointed Anish Mahajan, an Indian-American internist and health services researcher, as one of the 15 persons to serve as White House Fellows this year.

The 2009-2010 class of White House Fellows represents a diverse cross-section of professions including medicine, business, media, education, non-profit and state government, as well as two branches of the US military, the White House announced Thursday.

'We are thrilled that these exceptional men and women will be joining us here in Washington for the next year,' said First Lady Michelle Obama.

Mahajan, 34, a Robert Wood Johnson Clinical Scholar and a Master of Science in Health Services from the University of California, Los Angeles, 'is committed to the ideal that health policy formulation should be informed by scientific evidence and stakeholder engagement,' the White House said.

'He has led innovative research collaborations between academic, government, and relevant stakeholder organizations on an array of domestic and international health policy issues.'

Mahajan has given presentations and published numerous peer-reviewed articles on topics including HIV/AIDS prevention and treatment, the private sector response to the South African AIDS epidemic, high-deductible health plans, and adherence to medications for chronic illnesses.

His work has addressed health care challenges in the US, India, and South Africa and he has previously served as a consultant to The Ford Foundation and RAND Corporation.

Dedicated to public service, he is currently serving a 2-year term as a publicly elected council member on a City of Los Angeles neighbourhood council. He is Vice-Chair on the council's Public Policy Committee.

Mahajan has received a B.A. in Public Policy and M.D. from Brown University. He also earned a M.P.H. in International Health from Harvard School of Public Health.

CNN Chief Medical Correspondent, Dr. Sanjay Gupta, has also served as a White House Fellow under a programme created in 1964 by President Lyndon B. Johnson to give promising American leaders 'first hand, high-level experience with the workings of the Federal government, and to increase their sense of participation in national affairs.'

Indian American helps design vaginal ring to prevent HIV transmission

Thu, 18 Jun 2009 12:27:59 PST

( from http://www.rxpgnews.com ) An Indian American endocrinologist has helped develop a vaginal ring that would prevent conception and transmission of HIV infection, by releasing multiple types of non-hormonal agents and microbicides.

Worldwide, there are about five million new infections and three million deaths every year caused by HIV/AIDS alone.

If proven successful in future clinical trials, the vaginal ring could empower women to protect themselves from unintended pregnancy and sexually transmitted diseases.

The ring may also someday represent a novel method to prevent STDs for those with aversion to currently available methods, with hormonally derived active agents, or with allergies to latex condoms.

'This device is a new approach to birth control, because it avoids the long-term use of hormonal methods that have been associated with increased risk of certain cancers,' said Brij Saxena, study co-author and professor of reproductive biology and endocrinology at Weill Cornell Medical College -.

'At the same time, this is the first device to simultaneously offer the possibility to prevent unintended pregnancy and HIV transmission,' said Saxena, who did his B.Sc, M.Sc and Ph.D from Lucknow University - in 1949, 1951 and 1954, respectively.

'No one has ever conquered a viral epidemic with treatment, so prevention is the most effective option. Ideally, an HIV vaccine is the most desirable method, but that is not foreseeable in the near future,' explained Jeffrey Laurence, study co-author and physician at New York-Presbyterian Hospital/WCMC.

'The next best thing would be something that would prevent infection and put the power in the susceptible female partner's control. That's the potential a device such as this can offer.'

The vaginally inserted ring is incorporated with multiple antiviral drugs that prevent HIV infection and are time-released over a period up to 28 days, said a WCMC release.

'The compounds in the device are natural materials that are already approved by the US Food and Drug Administration for use in humans,' explained Saxena.

The results were published recently in AIDS.

US Senate approves sweeping tobacco legislation

Fri, 12 Jun 2009 03:29:04 PST

( from http://www.rxpgnews.com ) The US Senate Thursday approved sweeping new controls on tobacco products, including a ban on the labelling of 'light' cigarettes and increasing the size of health warning labels.

The bill for the first time gives a federal regulator, the US Food and Drug Administration -, broad authority over tobacco companies. It was welcomed by health advocates and even some major tobacco companies.

The legislation, passed 79-17 by the Senate, would bar companies from labelling cigarettes as 'light' or 'ultra-light', though it does not specify how they should be labelled instead. Anti-smoking advocates argue cigarettes with less tar are no less harmful to one's health.

Fruit or sweet-flavoured cigarettes - often criticized for targeting children - will also be banned, while new warning labels on cigarette packets will take up about half of the space.

'This legislation represents the strongest action Congress has ever taken to reduce tobacco use,' said Matthew Myers, president of the Campaign for Tobacco-Free Kids, a Washington-based lobby group.

'The time finally has come to end the special protection the tobacco industry has enjoyed for too long and at such great cost to the nation's health,' he said.

The US House of Representatives approved a similar bill in April, but the House must hold one more vote on the Senate's version before it can reach President Barack Obama's desk for signature.

Obama said the bill 'will make history by giving the scientists and medical experts at the FDA the power to take sensible steps that will reduce tobacco's harmful effects and prevent tobacco companies from marketing their products to children'.

Altria Group, the parent company of cigarette producers Philip Morris, also welcomed the bill's passage.

'The legislation is an important step forward to achieve the goal we share with others to provide federal regulation of tobacco products,' Altria said in a statement.

Hacker demands $10 mn ransom for stolen medical records

Fri, 08 May 2009 11:37:39 PST

( from http://www.rxpgnews.com ) Washington, May 8 - A cyber hacker who claimed to have stolen the medical records of more than 8.3 million residents of the state of Virginia is demanding $10 million for their return, the Washington Post reported.

The FBI and state officials have confirmed that they are investigating the incident.

The report Thursday came a week after someone managed to take over a Virginia Department of Health website that monitors prescriptions to track the sales of controlled substances. The hacker shut down the site and posted a ransom note online, claiming to have stolen and encrypted the data and threatening to sell the data to the highest bidder if authorities did not pay him by Thursday.

'Attention Virgina,' the demand read, 'In my possession right now are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too.'

The incident comes at a time of heightened concerns about the privacy and security of medical data as US President Barack Obama is attempting to introduce a new national health records system.

Sandra Whitley Ryals, director of Virginia's Department of Health Professions, declined to comment on the details of the case. But she confirmed that the entire system has been shut down since Thursday to protect the security of the programme data.

'We are satisfied that all data was properly backed up and that these backup files have been secured,' she said.

Nearly Half of Primary Care Doctors in US Would Like to Quit

Thu, 20 Nov 2008 00:18:26 PST

( from http://www.rxpgnews.com ) A survey released today by The Physicians’ Foundation depicts widespread frustration and concern among primary care physicians nationwide, which could lead to a dramatic decrease in practising doctors in the near future. The survey examined the causes behind the doctors’ dissatisfaction, the state of their practices and the future of care. The resulting findings show the possibility of significantly decreased access for Americans in the years ahead, as many doctors are forced to reduce the number of patients they see or quit the practice of medicine outright.

An overwhelming majority – 78 percent – of physicians believe that there is an existing shortage of primary care doctors in the United States today. Additionally, nearly half of them – 49 percent, or more than 150,000 practicing doctors– say that over the next three years they plan to reduce the number of patients they see or stop practising entirely.

“Going into this project we generally knew about the shortage of physicians; what we didn’t know is how much worse it could get over the next few years,” said Lou Goodman, PhD, President, The Physicians’ Foundation. “The bottom line is that the person you’ve known as your family doctor could be getting ready to disappear – and there might not be a replacement.”

The Physicians’ Foundation believes the future of primary care could have a significant impact on the American healthcare debate.

“At a time when the new Administration and new Congress are talking about ways to expand access to healthcare, the harsh reality is that there might not be enough doctors to handle the increased number of people who might want to see them if they get health insurance,” said Walker Ray, MD, Vice President, The Physicians’ Foundation. “It’s as if we’re talking about expanding access to higher education without having enough professors to handle the influx of students. It’s basic supply and demand.” The loss of primary care doctors creates a demand and leaves open opportunity at institutions such as UCLA health.

The reported reasons for the widespread frustration among physicians include increased time dealing with non-clinical paperwork, difficulty receiving reimbursement and burdensome government regulations. Physicians say these issues keep them from the most satisfying aspect of their job: patient relationships.

“Tens of thousands of primary care doctors face the same problems as millions of ordinary citizens: frustrations in dealing with HMOs and government red tape,” said Sandra Johnson, Board Member, The Physicians’ Foundation. “The thing we heard over and over again from the physicians was that they’re unhappy they can’t spend more time with their patients, which is why they went into primary care in the first place.”

Stem cell research to get a boost under Obama

Wed, 12 Nov 2008 16:23:48 PST

( from http://www.rxpgnews.com ) Washington, Nov 11 - The new US administration under Barack Obama will take a more pro-active view on the issue of stem cell research than his predecessor George W. Bush, his aides have said.

John Podesta, an aide in Obama's transition team, told The New York Times that Obama would give the green signal to stem cell research without waiting for a decision of the Congress as soon as he takes over Jan 20, 2009 from outgoing President Bush.

In 2007, President Bush vetoed the legislation to finance the research with public funds, for the second time in his presidential mandate, despite the fact that Congress supported a less restrictive resolution on the subject.

The Bush administration argued that the projected legislation put scientific investigation and ethical principles in conflict and violate moral principles.

US scientific community has overwhelmingly supported stem cell research as the harbinger of a new age of medical science.

Stem cells have the remarkable potential to develop into many different cell types in the body.

Serving as a sort of repair system for the body, they can theoretically divide without limit to replenish other cells as long as the person or animal is alive. Stem cell research is said to have heralded new promises in the treatment of a wide variety of diseases that still baffle medical science.

US requires 40,000 more health IT professionals

Fri, 18 Apr 2008 15:24:21 PST

( from http://www.rxpgnews.com ) Washington, April 18 - United States alone requires an additional 40,000 IT professionals to move its healthcare toward a paperless system that cuts costs and medical errors.

That is the finding of an analytical report presented here on Friday at the meeting of Steering Committee on Tele-health and Healthcare Informatics, by William Hersh of Oregon Health and Science University .

The report was based on an analysis of the HIMSS Analytics database, the largest and most comprehensive source of its kind, with information from 5,000 US hospitals.

'The need for IT professionals in health information technology settings is large and will increase as more advanced systems are implemented,' Hersh and co-author Adam Wright concluded in their report.

'If our data represent a correct sampling of the entire US, then the current IT staff workforce is about 108,390 full-time equivalents -. However, if HIT agenda is fulfilled and hospitals move to higher levels of adoption, an additional 40,784 FTEs will be required,' Hersh said.

That represents an increase of 37.6 percent over the current FTE total. This level of staffing, the authors said, would bring US hospitals up to the advanced level of HIT adoption that has been shown to be associated with quality improvements and cost savings.

The meeting was moderated by US Representative David Wu. 'A workforce trained in healthcare IT is essential to bringing greater quality and efficiency to the healthcare industry,' he said.

'These findings also demonstrate the need to better understand and develop education and training for health IT professionals,' said Hersh, who directs OHSU's educational programmes in biomedical informatics.

Indian American doctor under scanner for malpractices

Sat, 08 Mar 2008 20:37:48 PST

( from http://www.rxpgnews.com ) New York, March 8 - A prominent Indian American doctor in Las Vegas is being investigated for medical malpractices, which have led to a huge health scare in the community.

Health authorities have shut down Dipak Desai's Endoscopy Centre of Southern Nevada and affiliated clinics after reuse of syringes and vials of anaesthesia there was believed to have put some 40,000 residents at risk of contracting hepatitis C.

Nevada newspapers have been pursuing the matter for quite some time and it has now blown up into a big scandal.

The city of Las Vegas shut down Desai's clinic and suspended its licence indefinitely Feb 29 after state health officials determined that six patients had contracted hepatitis C after taking medical procedures at the clinic.

The officials are also trying to inform the 40,000 people treated at the centre between March 2004 and Jan 11 this year that they should take tests for hepatitis, strands B and C, and for HIV.

Hepatitis C is a blood-borne infectious disease that can cause liver inflammation and lead to other complications.

Clinic staff told authorities that the practice of reusing some medical materials was ordered by the management. Five nurses associated with the clinic have surrendered their licences, according to local papers.

The FBI and Internal Revenue Service - too have launched Medicare fraud investigations into the clinic.

Desai, originally from Gujarat, is a gastroenterologist who has been practising medicine in Nevada for 28 years. He has grown wealthy enough to have made contributions to poll campaigns of several politicians in both parties.

TV crews had a field day focussing on his luxurious home said to be worth $3.4 million.

Desai has refused to speak to the media. Instead, he chose to release a full-page ad Sunday in a local paper maintaining that 'evidence does not support that syringes or needles were ever re-used from patient to patient at the centre'.

While expressing his 'deepest sympathy to all our patients and their families for the fear and uncertainty that naturally arises from this situation', he claimed that in cooperation with the health agencies and officials he has reviewed the clinics' procedures and implemented the recommended changes.

The Las Vegas Review Journal reported Friday that the Medicare fraud investigations focus on allegations that Desai's centre billed Medicare for visits of more than 30 minutes when doctors spent less than half that amount of time with a patient.

The paper also quoted a former doctor at Desai's clinic saying that he and other physicians at the centre were ordered to perform unnecessary biopsies to run up patient charges and to bill for up to 40-minute 'patient consults' while spending about five minutes with each patient.

Bloggers are now asking why Desai should not pick up the tab for tests that people have to take because of his wrongdoing.

Further, in a country known to go for litigation in such matters, a class action suit against Desai's clinic is bound to come up. His share in the medical facility is 65 percent. Lawyers in fact already think they are on to a big kill. Websites have cropped up trying to contact the 40,000 exposed.

Las Vegas Sun has criticised the Nevada health agency responsible for inspecting medical facilities for not conducting a single full inspection of Desai's centre since 2001 till the recent hepatitis C outbreak was traced to his clinic.

The hepatitis C outbreak at Desai's clinic may be the tip of an iceberg of safety problems at clinics around the country, the head of the Centres for Disease Control and Prevention, Julie Gerberding, has been quoted as saying.

4.5 percent of US prisoners report sexual abuse

Mon, 17 Dec 2007 09:50:30 PST

( from http://www.rxpgnews.com ) Washington, Dec 17 - Nearly one in 20 inmates of US prisons reported being sexually victimized in the previous 12 months, according to a report.

The report from the Bureau of Justice Statistics, released by the government Sunday, said 4.5 percent of state and federal prisoners surveyed reported being raped or sexually abused in jail, with 2.1 percent of inmates reporting sexual abuse involving another inmate and 2.9 percent reporting misconduct involving prison staff.

More than 23,000 prisoners at 146 prisons were surveyed to comply with a law that aims to prevent prison rape. Inmates at only six prisons reported no incidents, and 10 facilities had more than 9.3 percent of prisoners report sexual abuse against them.

The bureau said the confidential survey was based only on prisoner allegations and noted about a quarter of allegations made to prison authorities in 2006 were 'unfounded'.

The 1.6 million prisoners in US federal and state jails represent one of the highest per capita prison populations in the world.

New York-based Human Rights Watch said the report made 'clear that prison authorities are not doing enough to prevent these serious crimes'.

'Prison rape is not inevitable, but it is all to predictable when prison authorities fail to enforce a zero-tolerance policy on sexual abuse,' said Jamie Fellner, a senior official at the rights organization.

Five of the ten jails with the highest reported rates of inmate-on-inmate victimization are in Texas, and the rights group called on authorities there to do more to stop sexual abuse in those facilities.

Osteoporosis drug approved to cut breast cancer risk

Sat, 15 Sep 2007 13:39:48 PST

( from http://www.rxpgnews.com ) In 1997, FDA approved Evista, which is manufactured by Eli Lilly and Company, for the prevention of osteoporosis in postmenopausal women and in 1999, for the treatment of osteoporosis in postmenopausal women.

Evista Friday became the second drug approved to reduce the risk of breast cancer. Evista is commonly referred to as a selective oestrogen receptor modulator -. In reducing the risk of invasive breast cancer, SERMs may act by blocking oestrogen receptors in the breast.

'Today's action provides an important new option for women at heightened risk of breast cancer,' Steven Galson, director of FDA's Centre for Drug Evaluation and Research, said Friday.

'Because Evista can cause serious side effects, the benefits and risks of taking Evista should be carefully evaluated for each individual woman,' he said.

The serious side effects include blood clots in the legs and lungs, and death due to stroke. Women with current or prior blood clots in the legs, lungs, or eyes should not take Evista. Other potential side effects include hot flashes, leg cramps, swelling of the legs and feet, flu-like symptoms, joint pain, and sweating.

Evista should not be taken by pre-menopausal women and women who are or may become pregnant because it may cause harm to the unborn baby, FDA warned in its statement.

In addition, Evista should not be taken with cholestyramine - or estrogens.

Evista does not completely prevent breast cancer. Breast examinations and mammograms should be done before starting Evista and regularly thereafter, said FDA.

Doctor shortage looms in Massachusetts, USA

Sat, 28 Jul 2007 04:26:24 PST

( from http://www.rxpgnews.com ) The Massachusetts health reform plan is in full swing, but so is an acute doctor shortage that may curtail the state's goal of providing care to hundreds of thousands of new patients who will want it, according to a new study.

Today, new patients wait an average of 52 days to see an internist or family doctor for a routine visit, according to the physician workforce study by the Massachusetts Medical Society.

And about half of all internists have stopped accepting new patients.

``We are down by hundreds, if not thousands of primary care physicians,''

B. Dale Magee, president of the Massachusetts Medical Society told United Press International.

Add to this the 500,000 new patients expected to enroll in the state's new health plan this year and Massachusetts may have a crisis of healthcare access on its hands, Magee said.

``This is particularly important because of health reform. We expect demand to increase, as individuals come on board,'' Magee said.

The primary care shortage has been ongoing for a number of years, but is worse today. An overall shortage exists throughout much of the United States, he said.

The backbone of Massachusetts' plan, considered by some a model for the nation, is a mandate that almost every uninsured person must obtain health insurance or be penalized. Massachusetts has the most expensive healthcare and health insurance in the United States.

Insurers have created new insurance plans in order to extend coverage to many of those currently without it.

The new insurance plans are considered lower cost, with monthly premiums of about $250 for a healthy 37-year-old, with a deductible of $2,000 per year, plus co-pays for doctor visits of $25 to $50 and additional co-pays for prescription drugs. People up to 300 percent of poverty are eligible for subsidized insurance.

Many people will have insurance and access to basic health care for the first time in their lives. Some will bring with them problems that have never been treated, and will require extra attention from their physicians, Magee said.

``It is reasonable to expect that many people who haven't had insurance for many years may require greater intensity of care. For example, they may not know they have diabetes or high blood pressure and those conditions will need to be stabilized,'' Magee said.

Other doctors are in short supply in Massachusetts, too, the study found, including those in anesthesiology, cardiology, gastroenterology, neurosurgery, psychiatry, urology and vascular surgery, according to the study.

Magee believes the state jumped ahead with health reform without a plan to also increase the number of doctors because finally all the players in Massachusetts were finally on board to do something about the uninsured.

``Everyone involved felt we were at a moment in time when everyone was willing to collaborate and was ready to move forward. This may stress the system but in the end everyone will be better off,'' he said.

The main reason for the nearly national primary care shortage is the lower pay of family physicians, who come out of medical school with a massive debt.

``Many if not most studs go in with the ideal and intention of going into primary care. But by the end of medical school, most have been attracted by another specialty. This is understandable because they emerge with $150,000 debt,'' Magee said.

Years ago, more students focused on primary care, Magee said. Part of the reason is that more scholarships and low-cost loans were available then to medical students, compared to today.

What's needed is for a federal and state loan forgiveness program, he said.

And overall medical school enrollment hasn't kept up with the demand for health care. The U.S. population has grown, but also we have an aging population, which requires more care and more obesity in young people, and they need more care, too, Magee said.

``What's happened is part of the gap is being filled by foreign medical school graduates,'' Magee said.

One way to increase the number of primary care providers is to create new health care models built around nurse practitioners and physician assistants, who can provide primary care in a doctor-supervised setting.

The fact that oncologists are paid three times as much as primary care doctors is a policy decision, set by Medicare and insurance companies, said Steffie Woolhandler, co-founder of Physicians for a National Health Program, which advocates one, national health care system.

``Policymakers made this decision,'' and could easily have provided different incentives to promote primary care, she said.

While Woolhandler believes the primary care shortage should be addressed, she is not convinced that the new Massachusetts plan will cause a run on health care.

``People above 300 percent of poverty have huge deductibles. Even though they will have insurance it's not clear to me that their access will improve,'' she said.

``What we need is a plan that gives people real access,'' she said.

Stephen Schoenbaum, executive vice president at The Commonwealth Fund, which studies health plans, believes that market forces will take care of the primary care physician shortage.

``It was very perceptive of Massachusetts to enact its health reform and if now it is discovering that there's a shortage of primary care physicians that will be the next problem that will be addressed,'' he said.

``No one is going to put the supply there until there is a demand for it,'' he said.

In terms of the difference in salaries between primary care doctors and specialists, ``there is no logical reason why it can't be addressed,''
he said.

``You may get concerned that this will make health care more expensive, but in fact we know that in parts of the U.S. where there is a larger supply of primary care physicians compared to specialty physicians, that there tend to be lower costs and better outcomes,'' he said.

--
Copyright 2007 by United Press International.
All rights reserved.

California Health Insurance Coverage Is Becoming Less Affordable

Sat, 16 Jun 2007 15:21:20 PST

( from http://www.rxpgnews.com ) For many Californians in the individual and small-group markets, sky-rocketing healthcare costs mean benefit drop-offs or spiking premiums, a new study says.

Some healthcare reform advocates -- including President Bush -- have suggested moving all Americans out of employer-based health insurance and into plans purchased on the individual market, arguing that more choices for consumers will lead to lower premiums.

In California, individual insurance premiums do seem to be increasing at a slower rate than small-group market premiums, according to the study appearing Thursday on the Web site of the journal Health Affairs.

But the trade-off for lower premiums is steep reductions in benefits, the study found.

Between 2003 and 2006, premiums for employees of small businesses rose 53 percent from $250 to $382, while premiums in the individual market increased only 23 percent to $259.

However, individual-market policies paid 75 percent of medical costs on average in 2003 but only 55 percent in 2006. In contrast, small-group policies retained their actuarial value, paying for roughly 83 percent of medical expenses across the period.

What's more, individual-market enrollees faced much higher cost-sharing in 2006 than their small-group-market counterparts. The average deductible in the individual market was $2,136, more than six times the size of the average small-group-market deductible of $348.

"If you look only at premiums, individual coverage in California looks like a good deal, while small-group coverage looks increasingly expensive" said study author Jon Gabel, a senior fellow at NORC in Washington. "However, if you consider all out-of-pocket expenses facing policyholders, individual coverage in California is growing more unaffordable as fast as, and in fact even faster than, small-group coverage."

One possible explanation for the difference, the authors said, is the different way that consumers shop for individual and small-group health insurance. Individual purchasers, they found, care much more about price -- even if it means sacrificing benefits.

On the other hand, bare-bones products with lower premiums but skimpier coverage and high out-of-pocket costs have not sold well in the small-group market.

Advocates of employer- and government-based universal healthcare coverage say such premium increases and steep benefit cuts illustrate why relying on individual and small-group insurance to cover the uninsured is a bad idea.

"The individual and small-group markets are the most troublesome from the perspective of consumers," said Ron Pollack, executive director of Families USA, a healthcare consumer advocacy group. "Costs are considerably higher and they are most vulnerable to changes."

If everyone is moved into the individual market "the situation will go from bad to worse," Pollack told United Press International. "We should be promoting coverage where groups are large and risks can be spread out."

But supporters of the individual insurance market say the study results are a sign they are working.

"This is how it's supposed to work," Michael Cannon, director of health policy studies at the Cato Institute, told UPI.

"If the cost of healthcare goes up, the cost of insurance goes up," Cannon said. "That makes consumers pare back their coverage which encourages them to keep healthcare costs down."

In the small-group market, where employers and not consumers choose what level of coverage to buy, premiums must increase to compensate, even if employees would rather pay less for less comprehensive insurance.

A better idea would be to pay employees the cost of health insurance in salary and let them decide how much coverage is best for them, he said.

"This study argues for letting workers in the small-group market control their healthcare dollars."

New Warnings About Suicidal Thinking and Antidepressants

Thu, 03 May 2007 03:59:59 PST

( from http://www.rxpgnews.com ) The FDA proposed that makers of all antidepressant medications update the existing black box warning on their products' labeling to include warnings about increased risks of suicidal thinking and behavior, known as suicidality, in young adults ages 18 to 24 during initial treatment which is generally the first one to two months.

The proposed labeling changes also include language stating that scientific data did not show this increased risk in adults older than 24, and that adults ages 65 and older taking antidepressants have a decreased risk of suicidality. The proposed warning statements emphasize that depression and certain other serious psychiatric disorders are themselves the most important causes of suicide.

"These actions represent FDA's commitment to a high level of post-marketing evaluation of drug products," said Steven Galson, M.D., MPH, director of FDA's Center for Drug Evaluation and Research. "Depression and other psychiatric disorders can have significant consequences if not appropriately treated. Antidepressant medications benefit many patients, but it is important that doctors and patients are aware of the risks."

The proposed labeling changes apply to the entire category of antidepressants. Results of individual placebo-controlled scientific studies are reasonably consistent in showing a slight increase in suicidality for patients taking antidepressants in early treatment for most of the medications. Available data are not sufficient to exclude any single medication from the increased risk of suicidality.

At that time, FDA asked manufacturers to add a black box warning to the labeling of all antidepressants to describe this risk and to emphasize the need for appropriate monitoring and close observation, particularly for younger patients taking these medications. In addition, FDA directed manufacturers to develop Medication Guides, FDA-approved user-friendly information for patients, families and caregivers, that could help improve monitoring. Medication Guides are intended to be distributed at the pharmacy with each prescription or refill of a medication.

Also in 2005, FDA began a comprehensive review of 295 individual antidepressant trials that included over 77,000 adult patients with major depressive disorder (MDD) and other psychiatric disorders, to examine the risk of suicidality in adults who are prescribed antidepressants.

In December 2006, FDA's Psychopharmacologic Drugs Advisory Committee agreed that labeling changes were needed to inform health care professionals about the increased risk of suicidality in younger adults using antidepressants. Additionally, the committee noted product labeling needed to reflect the apparent beneficial effect of antidepressants in older adults and to remind health care professionals that the disorders themselves are the most important cause of suicidality.

Foodborne illnesses on rise in United States

Fri, 13 Apr 2007 02:52:09 PST

( from http://www.rxpgnews.com ) A report released Thursday by the Centers for Disease Control and Prevention (CDC) shows a leveling of cases for some foodborne infections after a period of decline. For others, incidences of infection which had declined appear to be returning to earlier levels.

The findings are from 2006 data reported to the CDC as part of the agencyâs Foodborne Diseases Active Surveillance Network (also known as FoodNet). FoodNet monitors foodborne disease and related epidemiologic studies to help health officials better understand the epidemiology of foodborne diseases in the United States.

Camplylobacter, Listeria, Shigella and Yersinia show a sustained decline in incidence compared to baseline data from 1996-1998, but most of the decrease occurred between 1999 and 2002.

The FoodNet data showed there continues to be little change in the incidence of Salmonella cases, and progress made in 2003 and 2004 in reducing the number of cases of with E. coli O157 infections has been lost. Vibrio infections, which are often related to the consumption of raw shellfish like oysters, have increased to the highest level since FoodNet began conducting surveillance.

"As recent outbreaks have shown, too many people in the United States are getting sick each year from foodborne illnesses," said Dr. Julie Gerberding, CDC director. "For instance, the outbreaks involving tomatoes, lettuce and spinach underscore the need to more effectively prevent contamination of produce. We're also working to strengthen our ability to quickly detect and identify foodborne illnesses. We know the faster we can detect an outbreak, the faster we can take actions that will help protect people."

The 2006 FoodNet data indicated that the incidence of infections caused by E. coli O157 and Salmonella was similar to 1996-1998 baseline years. The reasons for the lack of decrease in the incidence of infections caused by E. coli O157 and Salmonella are not fully understood. One possible explanation is the development of cases of disease in foods that previously were not associated with these diseases, such as spinach and peanut butter. Previous efforts to decrease the incidence of E. coli O157 in ground beef and Salmonella in eggs have been successful, but contamination of other foods may be the problem now, according to Dr. Robert Tauxe, deputy director of CDCâs Division of Foodborne, Bacterial and Mycotic Diseases.

âFoodNet is an important part of our food safety efforts,â said Tauxe. âWeâre constantly working to improve our ability to quickly detect foodborne illness outbreaks and determine the cause. With additional resources, particularly at the state and local levels, we can investigate and prevent foodborne illness in a timelier manner.â

Consumers can reduce their risk for foodborne illness by following safe food-handling recommendations and by avoiding the consumption of unpasteurized milk, raw or undercooked oysters, raw or undercooked eggs, raw or undercooked ground beef, and undercooked poultry. The risk for foodborne illness can also be decreased by choosing in-shell pasteurized eggs, irradiated ground meat, and high pressure-treated oysters.

FDA Warns Five Firms To Stop Compounding Topical Anesthetic Creams

Tue, 05 Dec 2006 14:59:38 PST

( from http://www.rxpgnews.com ) The Food and Drug Administration (FDA) is warning five firms, Triangle Compounding Pharmacy, University Pharmacy, Custom Scripts Pharmacy, Hal’s Compounding Pharmacy, and New England Compounding Center, to stop compounding and distributing standardized versions of topical anesthetic creams, which are marketed for general distribution rather than responding to the unique medical needs of individual patients. Firms that do not resolve violations in FDA warning letters risk enforcement such as injunctions against continuing violations and seizure of illegal products.

FDA is concerned about the serious public health risks related to compounded topical anesthetic creams. Exposure to high concentrations of local anesthetics, like those in compounded topical anesthetic creams, can cause grave reactions including seizures and irregular heartbeats. Two deaths have been connected to compounded topical anesthetic creams made by Triangle Compounding Pharmacy and University Pharmacy, two of the five pharmacies receiving warning letters. Similar topical anesthetic creams are compounded by the other firms, and today’s action serves as a general warning to firms that produce standardized versions of these creams.

"Compounded topical anesthetic creams, like all compounded drugs, are not reviewed by FDA for safety and effectiveness, and are not FDA-approved. These high‑potency drugs may expose patients to unnecessary risk, especially when they are used without proper medical supervision,” said Dr. Steven Galson, Director of FDA's Center for Drug Evaluation and Research. FDA is advising consumers who have questions or concerns about compounded topical anesthetic creams to contact their health care providers.

Compounded topical anesthetic creams are often used to lessen pain in procedures such as laser hair removal, tattoos, and skin treatments. They may be dispensed by clinics and spas that provide these procedures, or by pharmacies and doctors’ offices.

These creams contain high doses of local anesthetics including lidocaine, tetracaine, benzocaine, and prilocaine. When different anesthetics are combined into one product, each anesthetic’s potential for harm is increased. This potential harm may also increase if the product is left on the body for long periods of time or applied to broad areas of the body, particularly if an area is then covered by a bandage, plastic, or other dressing.

The risk of harm is even greater in small children, patients with pre-existing heart disease, and patients with severe liver disease.

FDA-approved topical anesthetic products are commercially available and properly labeled, and are regularly used in health-care settings. However, some pharmacies create their own standardized versions of these products, often including combinations of ingredients and ingredients at higher strengths than found in FDA-approved products, and often lacking appropriate warnings or directions for use.

The five firms warned by FDA have stated that they produce their topical anesthetic creams as part of the practice of pharmacy compounding. Traditional pharmacy compounding typically involves pharmacies preparing drugs that are not commercially available, such as a unique medicine for a patient who is allergic to an ingredient in a FDA‑approved drug. This kind of compounding follows a physician’s decision that his or her patient has a special medical need that cannot be met by FDA‑approved drugs.

FDA normally permits such traditional pharmacy compounding and the agency’s action is not targeting this practice. By contrast, FDA is concerned that the five firms receiving warning letters are behaving like drug manufacturers, not traditional compounding pharmacies, because they produce standardized versions of topical anesthetic creams for general distribution.

Susan C. Winckler Appointed as Acting FDA Chief of Staff

Tue, 05 Dec 2006 10:15:31 PST

( from http://www.rxpgnews.com ) Dr. Andrew von Eschenbach, Acting Commissioner of Food and Drugs (FDA), today announced the appointment of Susan C. Winckler, RPh, Esq., as the agency’s Acting Chief of Staff. Ms. Winckler is replacing Patrick Ronan who announced his resignation last week after several years of service at the FDA.

In this role, Susan will coordinate staff activities in the Office of the Commissioner and serve as the principal liaison to Department of Health and Human Services.

"Susan has taken a leadership role on important policy initiatives, such as the implementation of improvements to our Advisory Committee process," said Dr. von Eschenbach. "She has a distinguished record of public health leadership and will bring her perspective as healthcare provider to the management challenges of this important post."

Susan joined FDA in September 2006 as the Director, Policy Communications, in the Office of Policy and Planning within the Office of the Commissioner. In this capacity she has been a point person for constituent communications and policy development on key issues, including updating policies and operations related to the management and operation of FDA advisory committees.

Prior to joining the agency, Susan most recently served as the Vice President for Policy and Communications and Staff Counsel for the American Pharmacists Association, the national professional society of pharmacists. In that capacity, she was responsible for coordinating the Association's legislative, regulatory and private sector advocacy agenda and public relations programs. Ms.Winckler served as a frequent spokesperson for the Association for media interviews, on Capitol Hill, and with external organizations.

Susan is a graduate of the University of Iowa College of Pharmacy and the Georgetown University Law Center, magna cum laude. Winckler is a licensed pharmacist in Iowa and is admitted to the bar in the Commonwealth of Virginia.

Susan will begin her new role in early January 2007.

Profiles of serial killers have limitations

Sun, 29 Oct 2006 21:28:00 PST

( from http://www.rxpgnews.com ) Dennis Rader, the notorious BTK murderer who eluded capture for more than 30 years until his arrest in 2005, did not fit precisely into the FBI's method for profiling serial killers on the basis of crime scenes.

And Aileen Wuornos, the Florida prostitute executed in 2002 for slaying seven men over a two-year period in the early 1990s, didn't fit at all because the database of convicted serial killers used by the FBI in developing their profiling method did not include women.

The cases of Rader and Wuornos are among the topics to be explored during a panel discussion led by Dr. Charles L. Scott, a forensic psychiatrist at UC Davis Health System, at the annual meeting of the American Academy of Psychiatry and the Law Friday at the Marriott Hotel in downtown Chicago. Scott will examine the way the bureau develops the personality profiles used by investigators in serial murder cases. He also will look at alternative profiling methods, such as one developed by a crime writer that uses motive to sketch a female offender's likely character traits.

"The FBI profiling method has many positive attributes. But it also has some inherent limitations," Scott said. Scott, associate professor of clinical psychiatry with the Department of Psychiatry and Behavioral Science, will be one of four panelists in the talk, dubbed "Serial Killers: From Cradle to Grave." It is one of many events slated at the meeting, which began Thursday and runs through Sunday. The annual conference seeks to cover the major issues facing forensic psychiatrists.

Scott has extensive experience in legal psychiatric issues. He directs the psychiatry department's forensic case seminar, which trains psychiatrists in criminal and civil psychiatric evaluations, including assessments on insanity, competency to stand trial, personal injury evaluations, medical malpractice and danger assessments. He also serves as psychiatric consultant to the Sacramento County Jail and directs his department's forensic psychiatry residency program, overseeing training and education in landmark mental health law cases.

The purpose of Friday's panel discussion is not to critique the FBI, Scott said. Instead, it is to acquaint forensic psychiatrists with how the bureau profiles serial killers, defined as someone who has killed at least three times.

"Often, forensic psychiatrists are not trained in how the FBI does its analysis," Scott said.

Such training is important, Scott said, because forensic psychiatrists can play "an important collaborative role" with law enforcement when it comes to profiling. To support his view, Scott will cite a study that found psychiatrists were more accurate than police in profiling murder suspects. To an FBI agent, the crime scene is the key.

"The FBI would say the crime scene is like a fingerprint," Scott said. Interpreted properly, "it is likely to identify the kind of offender who would do this."

According to Scott, the bureau categorizes murder crime scenes as either organized or disorganized. An organized crime scene is one in which the killer exerted careful control of the environment and left little evidence behind. This suggests a well-educated and socially competent suspect. In a disorganized crime scene, things are left in disarray and evidence is plentiful. This suggests a murderer with a low level of education and social competence who may habitually use alcohol or drugs.

The problem with that approach, Scott said, is that crime scenes often have both organized and disorganized components. Take Rader's first crime scene, when he killed Joseph and Julie Otero and their two children on Jan. 15, 1974. There was clear evidence of advance planning and the murderer's domination of the environment Rader both strangled and suffocated his victims, forcing them to pass out and then allowing them to revive somewhat "as a way to extend their death," Scott said.

But, Scott said, there were disorganized elements as well. Rader -- or BTK for Bind, Torture, and Kill -- left behind the Venetian blind cords he used as a strangling device. He also did not get rid of the bodies. While Scott stated that he has not seen any FBI profile of the BTK killer, who was sentenced to 10 consecutive life sentences last summer, Scott said that "Rader had many of the characteristics of an organized killer." For example, Rader, a resident of a Wichita, Kan., suburb, was employed and lived near his crime scenes. As a result, Scott said the signs of disorganization that were present in his first crime scene and in subsequent ones were potential red herrings, at least in terms of developing a profile. Rader was not, for example, under the influence of alcohol during his killings, nor did he frequently travel and change jobs -- traits of an organized killer under the FBI scheme.

When the FBI develops profiles of serial killers, Scott said the bureau is relying on interviews its investigators have conducted with 36 convicted sexual or serial murderers. Scott said a shortcoming with the database is that it does not include a single female serial killer. Consequently, its applicability to someone like Wuornos, portrayed in the 2003 movie "Monster" by Charlize Theron, "just isn't there," Scott said.

The database's relevance to non-Caucasian serial killers is also lacking, Scott said, as 90 percent of the men interviewed were white. It also doesn't explain a "very rare subset -- children who serially kill," Scott said. Probably the most well-known in this category, Scott said, is Jesse Pomeroy, a Massachusetts boy who, in the 1870s, brutalized other boys when he was only 12 and who killed a 10-year-old girl when he was 14.

Concerns over abortion law in the US state of South Dakota

Sun, 29 Oct 2006 21:26:00 PST

( from http://www.rxpgnews.com ) In this weeks BMJ, a senior doctor raises serious concerns over abortion law in the US state of South Dakota.

Earlier this year, South Dakota passed a bill which bans virtually all abortions in the state except for circumstances in which the procedure is necessary to prevent the death of the mother. Under this new legislation, doctors face prosecution for the termination of any pregnancy in which maternal death is not clearly averted by its performance.

This law does great harm to women with complicated pregnancies and must be opposed, argues, Dr Marvin Buehner, an obstetrician and gynaecologist who has practiced in South Dakota since 1993.

Even then elective abortions were performed only in a single clinic in this state, which was picketed for years, giving rise to the notion that providing abortion services would be professional suicide for any private practitioner, he writes.

The environment of intimidation here is still so pervasive that neither I, nor my colleagues, nor our state medical association spoke in objection when the legislature proposed a sweeping abortion ban, vetoed in 2004, or when it was reintroduced this year.

But despite the difficulties, he is determined to continue to provide termination options for women with serious medical complications.

He has publicly testified that the law does great harm to women with complicated pregnancies and has worked with the South Dakota State Medical Association and the American College of Obstetricians and Gynaecologists to oppose the law for its horrific medical consequences.

As a result, he faces a daily parade of protesters outside his office, even though neither he nor any of his partners perform abortions at their clinic.

Polling data show that 70% of physicians in the state oppose the law, and that the public is poised to reverse this draconian bill in a November referendum, primarily because there are no exceptions for victims of rape or incest, he says.

If the law is overturned, the battle over abortion will continue to rage on in the United States. But perhaps the defeat will allow more reasonable voices to be heard over the harsh rhetoric of extremists, he concludes.

Lawrence Berkeley National Laboratory Opens the National Center for X-ray Tomography (NCXT)

Fri, 13 Oct 2006 22:54:00 PST

( from http://www.rxpgnews.com ) The National Center for X-ray Tomography (NCXT) has officially been dedicated at the U.S. Department of Energys Lawrence Berkeley National Laboratory (Berkeley Lab). Located at Berkeley Labs Advanced Light Source (ALS), this new center features a first-of-its-kind x-ray microscope that will enable scientists to perform CAT scans on biological cells, just one of many unprecedented capabilities for cell and molecular biology studies.

X-ray microscopy is an emerging new technology that expands the imaging toolbox for cell and molecular biologists, and we are going to make this technology available to the greater biological community, said cell biologist and microscopy expert Carolyn Larabell, who is the principal investigator for the new center. Larabell, holds a joint appointment with Berkeley Labs Physical Biosciences Division and the Anatomy Department of UC San Francisco. Her co-principal investigator at the center is
Berkeley Lab physicist Mark Le Gros.

The new soft x-ray microscope at the National Center for X-ray Tomography captured its first x-rays on August 23, 2006

The NCXT is being funded with grants from the U.S. Department of Energy (DOE) and from the National Institutes of Health (NIH). For construction and five years of operation, the Biological and Environmental Research (BER) program in DOEs Office of Science has provided about $7 million. NIH has provided about $5 million through its National Center for Research Resources program, which establishes biomedical technology resource centers, such as the NCXT, to provide scientists and clinical researchers with the environments and tools they need to understand, detect, treat, and prevent a wide range of diseases.

As an NIH technology resource center, the NCXT will be available to qualified biomedical researchers throughout the nation.

Said Larabell, Although there are currently many powerful techniques for imaging biological cells, each with its own unique strengths and limitations, there remains a gap between the information that can be obtained with light microscopy and electron microscopy. X-ray microscopy can bridge this gap by combining some of the best features associated with light and electron microscopy, plus bringing in some entirely new capabilities.

The centerpiece of the NCXT is the first soft x-ray transmission microscope to be designed specifically for biological and biomedical applications. It is capable of imaging whole, hydrated cells at resolutions of about 35 nanometers, and specific structural elements within the cell at a resolution of at least 25 nanometers. Future improvements could put the resolution of this microscope as fine as 10 nanometers. This superior resolution is made possible by a combination of the high brightness of x-ray light produced off an ALS bend magnet beamline and nanofabricated zone plate optics produced by Berkeley Labs Center for X-ray Optics.

Berkeley Labs ALS is an electron-based synchrotron/storage ring capable of generating x-ray beams that are one hundred million times brighter than those from the best x-ray tubes. The intensity of the beamline will make it possible for users of the NXCT to collect a complete data set for an x-ray tomography image in a matter of minutes, compared to the days and even weeks required for electron microscopy.

With the NCXT microscope, we can examine whole cells, identify subcellular components and locate macromolecules inside cells at substantially better resolutions than light microscopy and without the elaborate specimen preparations needed for electron microscopy, said Larabell.

Microscopy using photons that fall within the visible light region of the electromagnetic spectrum remains the workhorse of biology because it enables scientists to examine living cells in their natural state. Resolution, however, is typically no better than 200 nanometers, and that is only when the light is focused on a single spot.

Microscopy techniques based on the use of electrons can provide images at a resolution of five nanometers or better. However, samples must be sliced thin and put through an elaborate chemical preparation and stained in order for the electrons to penetrate and yield high-res images.

With transmission x-ray microscopy, samples are rapidly frozen and need no further chemical alteration or staining to be imaged. Because of the quick turnaround time between sample preparation and data collection, scientists using the NCXT will be able to accumulate a statistically significant volume of data within a relatively short time.

With transmission x-ray microscopy, samples are rapidly frozen and need no further chemical alteration or staining to be imaged. Furthermore, with the use of metal tags,
the position of molecules can be determined. Because of the quick turnaround time between sample preparation and data collection, scientists using the NCXT will be able to accumulate a statistically significant volume of data within a relatively short time.

Special features of the NCXT microscope include improved zone plates, the optic devices composed of nanometer-scale concentric metal rings that are used to focus x-rays for imaging purposes, and greater energy tunability, which means it can be used to obtain images of thicker samples as well as high-res images of thinner samples just by spinning to a different zone plate. Through multiple labeling of proteins, the NCXT microscope can also be used to study protein complexes as well as individual proteins.

In many instances the role played by a protein is determined by its cellular location, said Larabell. Soft x-ray tomography is an excellent method for obtaining information on the spatial location and distribution of individual proteins in the cell.

States That Easily Grant Immunization Exemptions Have Higher Incidence Of Whooping Cough

Wed, 11 Oct 2006 05:14:00 PST

( from http://www.rxpgnews.com ) States that have personal belief exemptions for school immunization requirements, and exemptions that are easily obtained, have higher rates of new cases of pertussis (whooping cough) than states in which obtaining immunization exemptions is more difficult, according to a study in the October 11 issue of JAMA.

State-mandated school immunization requirements have played a major role in achieving and maintaining low rates of vaccine-preventable diseases in the United States. All states and the District of Columbia require children entering school to provide documentation that they have met the state vaccine requirements, according to background information in the article. As of March 2006, all states permitted medical exemptions to school and daycare immunization requirements; 48 states allowed religious exemptions; and 19 states had a provision for personal belief exemptions, such as religious, philosophical, and any other unspecified nonmedical exemption.

States that make exemptions widely available to parents, either by offering a personal belief exemption or making the exemption option easy to obtain, may have higher rates of exemptions or may experience substantial increases in exemption rates. Increasing exemption rates can increase individual and community risk to vaccine-preventable diseases, the authors write. The role of exemption policies may be especially important for pertussis, which remains present in certain areas of the United States and has been increasing in incidence during the past decade.

Saad B. Omer, M.B.B.S., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues conducted a study to determine if the rates of nonmedical exemptions differ and have been increasing in states that offer only religious vs. personal belief exemptions, and if the incidence of pertussis is associated with policies of granting personal belief exemptions and ease of obtaining exemptions. The researchers analyzed state-level rates of nonmedical exemptions at school entry from 1991 through 2004 and data for incidence of pertussis from 1986 through 2004 for individuals age 18 years or younger.

From 2001 through 2004, states that permitted personal belief exemptions had higher nonmedical exemption rates than states that offered only religious exemptions, and states that easily granted exemptions had higher nonmedical exemption rates in 2002 through 2003 compared with states with medium and difficult exemption processes. The average exemption rate increased an average of 6 percent per year from 1991 to 2004 among states that offered personal belief exemptions. In states that easily granted exemptions, the rate increased 5 percent per year from 1991 to 2004. No statistically significant change was seen in states that offered only religious exemptions or that had medium and difficult exemption processes. However, the researchers also found that easier granting of exemptions was associated with a 53 percent increased incidence of pertussis, and the availability of personal belief exemptions was associated with a 48 percent increased incidence.

States must balance parental autonomy with the tremendous public health benefit of vaccines when considering the types of exemptions allowed and how policies are implemented. An approach similar to the model applied to conscientious objectors to [military] conscription, which focuses on the sincerity of the applicants beliefs and includes administrative controls, may provide a reasonable middle ground. Our findings support the need for effective administrative controls over granting nonmedical exemptions. Moreover, state-level policies on nonmedical exemptions and documentation of immunization status should be viewed as part of the efforts to control or eliminate vaccine-preventable diseases, the authors conclude.

Study calls for 39 percent more family physicians in USA

Sun, 01 Oct 2006 23:04:00 PST

( from http://www.rxpgnews.com ) With an aging population and an increasing prevalence of chronic disease, now more than ever the United States is in dire need of family physicians. A study released this week on the U.S. physician workforce calls for a significant increase in the number of family physicians to meet the escalating health care needs of the American people. The study was conducted by consultants from the University of Utah School of Medicine and the Utah Medical Education Council.

The report, titled "Family Physician Workforce Reform: Recommendations of the American Academy of Family Physicians" has been approved by the American Academy of Family Physicians' (AAFP) Congress of Delegates, the organization's governing body, as the AAFP's official workforce policy.

The new AAFP policy confirms data showing the United States does not have an adequate number of primary care physicians to care for all Americans. However, the study goes further to claim the nation is experiencing a dire shortage of family physicians specifically. The report asserts that unless the U.S. health care system changes soon, the shortage will become even more severe within the next 10 years as the American population continues to age and the need for health care increases.

"We've known for a long time the nation needs more primary care physicians," said Rick Kellerman, M.D., president of the AAFP. "And our new workforce policy makes the case that family physicians are the specialists that can close the current gaps in our country's health care system."

The report explains that to meet the nation's anticipated need for primary care in the year 2020, the United States must have at least 139,531 family physicians, or a ratio of 41.6 family physicians per 100,000 people. (In 2004, there were 31.2 family physicians per 100,000 people.) To achieve that target, 3,725 family physicians will need to be produced annually by Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residencies, and 714 annually by American Osteopathic Association (AOA)-accredited family medicine residencies. The typical ACGME-accredited family medicine residency will need to expand from an average of 21 residents to 24 residents. Overall, the new AAFP workforce policy calls for an approximate 39 percent increase in the number of family physicians to meet the health care needs of the American people.

The new study, unlike previous physician workforce studies, takes into account socioeconomic factors such as population growth, increased use of health information technology and increasing health risk factors of the country's aging population. The "Family Physician Workforce Reform" study is congruent with the recent American Association of Medical Colleges (AAMC) report, which calls for a 30 percent increase in the production of U.S. physicians. However, the AAFP's new policy specifically indicates what type of physicians the nation needs now and will need in the future.

The study also considered modern trends that significantly affect the number of physicians available to care for patients, including the fact that the number of internal medicine physicians practicing as generalists is decreasing. There also is a trend toward an increasing proportion of non-physician providers, such as physician's assistants and nurse practitioners limiting their practice to subspecialty areas.

"We know that a health care system based on primary care leads to better overall quality of care for patients, as well as more affordable health care services," said Perry Pugno, M.D., M.P.H., C.P.E., director of the AAFP's medical education division. "Because family physicians are trained to care for patients of all ages and conditions and in all environments, they are best equipped to meet the wide-range of health care needs in our country. Until the health care system places a greater value on family medicine and other primary care specialties, millions of Americans will struggle to obtain high-quality, affordable care."

In response to the study's findings, the AAFP has identified a number of goals it plans to pursue to help reform the family physician workforce, including:

* Encourage its 94,000 members to implement the TransforMED Model of Care, which includes the use of electronic health records, redesigned office space, open-access scheduling and overall care that centers on the patient;
* Support efforts to ensure health care access for all Americans;
* Actively lobby and advocate for increased payments to family physicians, which will attract medical students to the specialty and retain current family physicians;
* Work with health insurance companies, as well as with the government, to encourage them to contribute to the costs of medical education;
* Work with medical schools to attract the students who are most likely to select career paths and practice locations that will improve the current maldistribution of physicians;
* Work with residency programs to better prepare family physicians to care for the evolving U.S. patient population greater training on care of older adults, health disparities and the management of complex patients with chronic illnesses;
* Help establish a public-private entity to allocate funding for graduate medical education; and
* Advocate for preferential funding to residency programs that support diversity and produce those physicians most likely to practice in underserved communities in rural or inner-city areas.

The American Academy of Family Physicians last approved a workforce policy in September 1998. The 1998 policy offered recommendations based on a scenario of 50 percent family physicians among all physician generalists. That study concluded that accredited U.S. residency programs needed to produce 3,682 to 4,082 family physicians annually.

FDA safety alerts for automated external defibrillators occur frequently

Wed, 09 Aug 2006 17:34:00 PST

( from http://www.rxpgnews.com ) The FDA frequently issues safety advisories for automated external defibrillators (portable electronic device used to restore regular heart beat in patients with cardiac arrest) and accessories, although the number of actual device malfunctions appears to be relatively small, according to a study in the August 9 issue of JAMA.

Sudden cardiac death is a leading cause of death in the United States, accounting for nearly 330,000 deaths annually. Successful resuscitation of persons with cardiac arrest depends on prompt emergency care, with early defibrillation a key component to improved survival. The use of automated external defibrillators (AEDs) and their increasingly widespread distribution in public places, including many airports, sports arenas, and shopping centers, has resulted in the saving of innumerable lives, according to background information in the article. AEDs are easy to use, but are technically complex devices that occasionally malfunction. The U.S. Food and Drug Administration (FDA) is responsible for the safety and oversight of medical devices in the United States, and occasionally issues recalls and safety alerts (collectively referred to as "advisories"), a number of which have involved AEDs. Little is known about the reliability of AEDs.

Jignesh S. Shah, M.D., and William H. Maisel, M.D., M.P.H., of Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, analyzed weekly FDA Enforcement Reports between Jan. 1996 and Dec. 2005 to identify all recalls and safety alerts involving AEDs and AED accessories. Confirmed AED device malfunctions were identified by reviewing AED-related adverse events reported to the FDA.

There were 52 advisories (4.5 per year) during the study period, affecting 385,922 AEDs and AED accessories. Automated external defibrillators were recalled in 9 of the 10 study years, and AED accessories were recalled in 7 of the 10 years studied. No year was advisory free. Overall, 21.2 percent of AEDs were affected by advisories during the study period, most often due to electrical or software problems. Every major AED manufacturer recalled products during the study period. Recalls and safety alerts more often involved AEDs than AED accessories.

"This study reassuringly demonstrates that despite increasing AED complexity, the AED advisory rate did not significantly increase during the study period. However, AED and AED accessory advisories do occur frequently. The annual number of AED advisories and the annual number of AEDs affected by advisories increased, and numerous confirmed AED malfunctions occurred during the past decade. Still, the total number of device malfunctions is small compared with the number of lives saved. Indeed, hundreds of thousands of patients underwent attempted resuscitation of ventricular arrhythmias by an AED during the study period accounting for thousands of lives saved," the authors write.

"As the prevalence of AEDs continues to increase, the number of devices affected by advisories can also be expected to increase. Efforts should be directed at developing a reliable system to locate and repair potentially defective devices in a timely fashion."

In an accompanying editorial, N. A. Mark Estes III, M.D., of the New England Medical Center and Tufts University School of Medicine, Boston, comments on the findings of Drs. Shah and Maisel.

"While efforts to develop rigorous mechanisms to accurately monitor device performance will undoubtedly have costs, these efforts are essential to achieve the best possible clinical outcomes. Device manufacturers and the federal government should allocate the funds required to make this effort successful. Initial steps should be guided by knowledge that many advisory AEDs remain in service and have not been appropriately evaluated. Additional measures to accurately track those who purchase and use these devices are needed. Subsequent measures will require the best efforts of health care professionals, regulators, manufacturers, and the public working collaboratively to develop a transparent, rigorous, and systematic approach using the best practices of evidence-based medicine in postmarketing surveillance. From these efforts, guidelines for monitoring, communicating, and performance should be established. During cardiac arrest, when each minute really matters for survival, all stakeholders share the duty of ensuring the highest possible standards of AED reliability."

Hospital Performance Results Do Not Always Reflect Patient Outcomes

Wed, 05 Jul 2006 19:07:00 PST

( from http://www.rxpgnews.com ) Hospital quality measures do not fully account for the variation in hospital death rates for heart attack patients, according to a study in the July 5 issue of JAMA.

As part of the national effort to improve hospital quality, the Centers for Medicare & Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) monitor and publicly report hospital performance on acute myocardial infarction (AMI heart attack) core process measures approved by the Hospital Quality Alliance, according to background information in the article. Although the CMS/JCAHO process measures are considered indicators of quality of AMI care, little is known about how these measures track with each other. And the degree to which process measure performance conveys meaningful information about short-term death rates remains unclear.

Elizabeth H. Bradley, Ph.D., of the Yale University School of Medicine, New Haven, Conn., and colleagues used data from the National Registry of Myocardial Infarction (NRMI) and CMS to determine the correlations among AMI process measures and the association between hospital performance on process measures and hospital-specific, risk-standardized, 30-day death rates, derived from Medicare claims data. The researchers used 2002-2003 data from 962 hospitals participating in the NRMI and used information on AMI patients aged 66 years or older.

The researchers found moderately strong correlations between beta-blocker use at admission and discharge, aspirin use at admission and discharge, and angiotensin-converting enzyme (ACE) inhibitor use, and weaker, but statistically significant, correlations between these medication measures and smoking cessation counseling and time to reperfusion therapy measures. Some process measures were significantly correlated with risk-standardized, 30-day death rates but together explained only 6.0 percent of hospital-level variation in risk-standardized, 30-day death rates for patients with AMI.

This finding suggests that a hospitals short-term mortality rates after AMI cannot be reliably inferred from performance on the publicly reported process measures. Our results highlight that the current process measures provide information that is complementary to, but not redundant with, a measure of 30-day mortality, the authors write.

In conclusion, although the core measures are important in pursuing improved AMI outcomes, they capture in aggregate only a small proportion of the hospital-level variation in short-term 30-day mortality rates. Until additional process measures are developed that explain more of the variation, reporting not only the current core measures but also short-term risk-standardized mortality rates is a reasonable approach to characterize hospitals overall quality of care, the researchers write.

In an accompanying editorial, Ashish K. Jha, M.D., M.P.H., of the Harvard School of Public Health and Brigham and Womens Hospital, Boston, comments on the findings by Bradley et al.

Although the U.S. health care system is now committed to quality measurement and the public reporting of such data, debates will continue about what to measure, who collects the data, and what to report publicly. More information is needed on processes and outcomes across a large number of conditions for hospitals, physician practices, and other health care settings and practitioners. Much of these data are on their way, led by major payers such as Medicare and coalitions of employers who want greater accountability for the care they purchase and to stimulate improvements in quality of care. In the most expensive health care system in the world, patients and physicians should expect nothing less.

US suicide rate drops as antidepressant prescriptions rise

Wed, 14 Jun 2006 19:40:00 PST

( from http://www.rxpgnews.com ) A just published UCLA study suggests that the use of antidepressants to treat depression has saved thousands of lives, despite the concern about a possible link between suicide risk and the class of drugs called selective serotonin reuptake inhibitors (SSRI).

The lead author of the study is Dr. Julio Licinio, the new chairman of the Department of Psychiatry and Behavioral Sciences at the University of Miami Leonard M. Miller School of Medicine. Licinio conducted the study at UCLA while he was the director of the Center for Pharmacogenomics and Clinical Pharmacology at the Semel Institute for Neuroscience and Human Behavior.

Published in the June 2006 edition of the peer-reviewed journal PLoS Medicine, the study analyzes federal data on overall suicide rates since the early 1960s and sales of the SSRI fluoxetine, or Prozac, in the United States since the antidepressant's introduction in 1988 through 2002.

The data show the U.S. suicide rate held fairly steady for 15 years prior to the introduction of fluoxetine, then dropped steadily over 14 years as sales of the antidepressant rose. The research team found the strongest effect among women.

Mathematical modeling of probable suicide rates from 1988 to 2002, based on pre-1988 data, suggests a cumulative decrease in expected suicide mortality of 33,600 people since the introduction of the antidepressant.

"Our findings certainly suggest that the introduction of SSRIs has contributed to reduction of suicide rates in the United States," Licinio said. "However, the findings do not preclude the possibility of increased risk of suicide among small populations of individuals."

The Food and Drug Administration introduced "black box warnings" on the most popular SSRIs in 2004 amid rising concerns in the United States and United Kingdom concerning the relationship between suicide and antidepressant use in children and adults.

A key unanswered question involves whether antidepressants increase suicide over and above the underlying disorder, such as major depression.

"Much of the psychiatric community fears that the absence of treatment may prove more harmful to depressed individuals than the effects of the drugs themselves," Licinio said. "Most people who commit suicide suffer from untreated depression. Our goal is to explore a possible SSRI suicide link while ensuring that effective treatment and drug development for depression is not halted without cause."

The study examined age-adjusted suicide rate data from the Centers for Disease Control and the U.S. Census Bureau from the early 1960s until 2002. Data show suicide rates fluctuated between 12.2 and 13.7 per 100,000 people for the entire U.S. population until 1988. Since then, suicide rates have gradually declined, with the lowest rate at 10.4 per 100,000 in 2000. The decline is significantly associated with increased numbers of fluoxetine prescriptions dispensed, from 2.47 million in 1988 to 33.32 million in 2002.

Major depressive disorder affects approximately 10 percent of American men and 20 percent of women over their lifetimes. Because the prevalence is so high and treatment lasts several months or years, antidepressant medications are the most common form of treatment. Fluoxetine is the most widely prescribed antidepressant medication in the world and the only antidepressant that is FDA-approved for treatment of depression in children.

FDA Counterfeit Drug Task Force's recommendations adopted

Sat, 10 Jun 2006 21:06:00 PST

( from http://www.rxpgnews.com ) The U.S. Food and Drug Administration (FDA) announced new steps to strengthen existing protections against the growing problem of counterfeit drugs. The measures, which were recommended in a report released today by the agency's Counterfeit Drug Task Force, emphasize certain regulatory actions and the use of new technologies for safeguarding the integrity of the U.S. drug supply.

"The adoption of the FDA Counterfeit Drug Task Force's recommendations will further reduce the risk that counterfeit products will enter the U.S. drug distribution system and reach patients," said Dr. Andrew C. von Eschenbach, the FDA's Acting Commissioner. "We must remain vigilant in our efforts to ensure our nation's drug supply is protected against an increasingly sophisticated criminal element engaging in a dangerous type of commerce."

Among other new measures, FDA will fully implement regulations related to the Prescription Drug Marketing Act of 1987, which requires drug distributors to provide documentation of the chain of custody of drug products -- the so-called "pedigree" -- throughout the distribution system. FDA had placed on hold certain regulatory provisions because of concerns raised at the time about the impact on small wholesalers. Most recently, in early 2004, FDA delayed the effective date of certain regulatory provisions regarding pedigrees to allow the industry time to adopt electronic technology for tracking drugs through the supply chain. Based on information from drug supply stakeholders, the FDA had expected this technology to be in widespread use in the drug supply chain by 2007, but it now appears that these expectations will not be met. Further, FDA has not heard that the concerns raised in the past regarding the impact on small wholesalers remains, and in fact, FDA was encouraged by most drug stakeholders to allow the hold to expire. Doing so would also provide clarity in the drug supply chain regarding who is and is not required to pass a pedigree. Continuing the hold would perpetuate the current confusion and further allow opportunities for counterfeit and diversionary practices. FDA has, therefore, determined that it can no longer justify not implementing these regulations.

Accordingly, the hold, which will expire in December, will not be continued.

A potential new measure to safeguard the drug supply is the use of electronic track and trace technology, such as radio-frequency identification (RFID), which creates an electronic pedigree (e-pedigree) for tracking the movement of the drug through the supply chain. The FDA had expected this technology to be in widespread use in the drug supply chain by 2007. In early 2004 FDA delayed the effective date of the regulatory provisions regarding pedigrees to allow the industry time to adopt this technology. However, it now appears that FDA's expectations for adoption of the technology by 2007 will not be met. FDA therefore has determined it can no longer justify delaying implementation of the pedigree regulations.

Consistent with recommendations of the Task Force, FDA also announces that, during the next year, its enforcement of the pedigree regulations will focus on products most susceptible to counterfeiting and diversion. FDA intends to announce in the Federal Register the availability of a draft compliance policy guide for public comment describing this enforcement approach. By providing guidance on the types of drugs that are currently of greatest concern to FDA, the agency intends to give wholesale distributors a better idea on where and how to focus their initial energies to come into complete compliance with the regulations (21 CFR Part 203) for all the prescription drugs they distribute. The draft guidance clarifies how FDA intends to prioritize its pedigree-related enforcement resources in 2007. FDA may, under appropriate circumstances initiate regulatory action, including criminal prosecution, for pedigree violations that do not meet the factors listed in the guidance.

The Task Force report also underlines the agency's belief that widespread use of e-pedigrees using electronic track and trace technology, including RFID, would provide an electronic safety net for our nation's drug supply. The report therefore recommends that stakeholders continue to work expeditiously toward that goal, and that their implementation of RFID technology be used first on products most susceptible to counterfeiting and diversion.

Rapid Approval of Gardasil Marks Major Advancement in Public Health

Fri, 09 Jun 2006 02:00:00 PST

( from http://www.rxpgnews.com ) The Food and Drug Administration (FDA) today announced the approval of Gardasil, the first vaccine developed to prevent cervical cancer, precancerous genital lesions and genital warts due to human papillomavirus (HPV) types 6, 11, 16 and 18. The vaccine is approved for use in females 9-26 years of age. Gardasil was evaluated and approved in six months under FDA's priority review process--a process for products with potential to provide significant health benefits.

"Today is an important day for public health and for women's health, and for our continued fight against serious life-threatening diseases like cervical cancer," said Alex Azar, Deputy Secretary, U.S. Department of Health and Human Services (HHS). "HHS is committed to advancing critical health measures such as the development of new and promising vaccines to protect and advance the health of all Americans."

HPV is the most common sexually-transmitted infection in the United States. The Centers for Disease Control and Prevention estimates that about 6.2 million Americans become infected with genital HPV each year and that over half of all sexually active men and women become infected at some time in their lives. On average, there are 9,710 new cases of cervical cancer and 3,700 deaths attributed to it in the United States each year. Worldwide, cervical cancer is the second most common cancer in women; and is estimated to cause over 470,000 new cases and 233,000 deaths each year.

For most women, the body's own defense system will clear the virus and infected women do not develop related health problems. However, some HPV types can cause abnormal cells on the lining of the cervix that years later can turn into cancer. Other HPV types can cause genital warts. The vaccine is effective against HPV types 16 and 18, which cause approximately 70 percent of cervical cancers and against HPV types 6 and 11, which cause approximately 90 percent of genital warts.

"This vaccine is a significant advance in the protection of women's health in that it strikes at the infections that are the root cause of many cervical cancers," said Andrew C. von Eschenbach, MD, Acting Commissioner of Food and Drugs. "The development of this vaccine is a product of extraordinary work by scientists as well as by FDA's review teams to help facilitate the development of very novel vaccines to address unmet medical needs. This work has resulted in the approval of a number of new products recently, including Gardasil, which address significant public health needs."

Gardasil is a recombinant vaccine (contains no live virus) that is given as three injections over a six-month period. Immunization with Gardasil is expected to prevent most cases of cervical cancer due to HPV types included in the vaccine. However, females are not protected if they have been infected with that HPV type(s) prior to vaccination, indicating the importance of immunization before potential exposure to the virus. Also, Gardasil does not protect against less common HPV types not included in the vaccine, thus routine and regular pap screening remain critically important to detect precancerous changes in the cervix to allow treatment before cervical cancer develops.

"This is the first vaccine licensed specifically to prevent cervical cancer. Its rapid approval underscores FDA's commitment to help make safe and effective vaccines available as quickly as possible. Not only have vaccines dramatically reduced the toll of diseases in infants and children, like polio and measles, but they are playing an increasing role protecting and improving the lives of adolescents and adults," said Jesse Goodman, MD, MPH, Director of FDA's Center for Biologics Evaluation and Research.

Four studies, one in the United States and three multinational, were conducted in 21,000 women to show how well Gardasil worked in women between the ages of 16 and 26 by giving them either the vaccine or placebo. The results showed that in women who had not already been infected, Gardasil was nearly 100 percent effective in preventing precancerous cervical lesions, precancerous vaginal and vulvar lesions, and genital warts caused by infection with the HPV types against which the vaccine is directed. While the study period was not long enough for cervical cancer to develop, the prevention of these cervical precancerous lesions is believed highly likely to result in the prevention of those cancers.

The studies also evaluated whether the vaccine can protect women already infected with some HPV types included in the vaccine from developing diseases related to those viruses. The results show that the vaccine is only effective when given prior to infection.

Two studies were also performed to measure the immune response to the vaccine among younger females aged 9-15 years. Their immune response was as good as that found in 16-26 year olds, indicating that the vaccine should have similar effectiveness when used in the 9-15 year age group.

The safety of the vaccine was evaluated in approximately 11,000 individuals. Most adverse experiences in study participants who received Gardasil included mild or moderate local reactions, such as pain or tenderness at the site of injection.

Antiretroviral therapy saved three million life years

Sat, 03 Jun 2006 09:07:00 PST

( from http://www.rxpgnews.com ) On the 25th anniversary of the first reported cases of AIDS in the United States, a new article in The Journal of Infectious Diseases estimates that antiretroviral therapy has saved nearly three million years of life among people with HIV infection.

But there is still no cure. Antiretroviral therapy is the only way to extend patients' lives. Patients have the best chance of survival if they receive therapy before they develop symptoms. That makes early testing for HIV infection the key to saving lives.

"Yet one in four people living with HIV in the United States don't know they're infected. Even today, 25 years after the U.S. epidemic began, too many people aren't tested until they're already sick with AIDS," said Daniel R. Kuritzkes, MD, chair of the HIV Medicine Association.

People who test positive for HIV usually change their behavior to prevent spreading the virus. Low rates of testing are a factor in why the epidemic is still growing by an estimated 40,000 infections a year.

Part of the reason so few people are getting tested for HIV infection is because one has to ask to be tested. Furthermore, in order to be tested, the patient must receive lengthy counseling before and after the test that can take up to an hour.

"Almost no other disease requires that," added HIVMA Vice Chair Arlene Bardeguez, MD, MPH. "Imagine having to ask your doctor for a Pap smear, or to be screened for high blood pressure or diabetes, and then spending an hour on counseling. Those successful prevention efforts would reach a lot fewer patients than they do today."

The Centers for Disease Control and Prevention is developing guidelines that would make HIV testing a routine part of medical care. Patients in doctors' offices, hospitals, emergency rooms, and other medical settings would be informed that they will be tested for HIV unless they choose not to be. The sooner they become national policy, the better. Pregnant women are already being screened using this "opt-out" system, and it has reduced mother-to-child HIV transmission to near zero in this country.

However, once patients test positive, it is imperative that they be connected with care. HIV is striking most often among those who can least afford care. Implementing CDC's recommendations will identify substantial numbers of people who will need help from public programs.

All of these programs are already stretched thin. The Ryan White CARE Act is chronically under-funded and needs a major overhaul to put medical care first. Staff at Ryan White-funded institutions are already overworked and burning out. Several states have patients on waiting lists for medications or have other restrictions on care. Medicaid programs are cutting back. Medicare isn't faring much better.

Dr. Kuritzkes said, "A quarter century into the U.S. AIDS epidemic, the number of infections is still growing. We've saved three million years of life with antiretroviral therapy, and we can save many millions more--but we can't save lives until we know who needs treatment. Routine testing would identify many more people needing care. Once we have found them, the United States needs to make a commitment to provide lifesaving treatment so that no one is denied treatment simply because they can't afford it."

Dr. Bardeguez concludes, "In addition to helping those infected to live longer, we also need to help people to not get infected. Until we get effective vaccine or microbicide, we need to encourage disclosure of serostatus and decrease discrimination."

Society should support breastfeeding

Mon, 22 May 2006 03:16:00 PST

( from http://www.rxpgnews.com ) Although the act of breastfeeding is not "illegal," women in various parts of the U.S. can be arrested for "public indecency" when breastfeeding their baby in public. As of November 2005, 12 states and Washington, DC had not enacted at least some kind of law regarding breastfeeding.

The U.S. Healthy People 2010 target is to increase the proportion of mothers who choose to breastfeed their babies for at least six months to 50%; the World Health Organization recommends that babies be breastfed exclusively for the first six months. However, these goals may be difficult to meet since some mothers in the U.S. face challenges to breastfeeding. Many women view their return to work as a cause for ending their breastfeeding regime early. Even women who use a breast pump require 30 minutes of privacy each workday to expel breast milk. In the May issue of The Journal of Pediatrics, a commentary by Dr. Tonse Raju from the National Institutes of Health reflects on the continued barriers for breastfeeding mothers.

Most industrialized nations guarantee maternity leave for up to 16 weeks at 75-100% of pay. Norway exceeds that by providing up to 42 weeks of maternity leave with full pay or 52 weeks with 80% pay. The U.S., however, allows a woman 12 weeks of unpaid leave, without the risk of losing her job, during any 12-month period. Allowing new mothers more time off work may encourage the continuation of breastfeeding, potentially minimizing societal limitations. Although it might be difficult to enact a policy similar to that of Norway, the U.S. should consider what is needed to support women who choose to breastfeed.

Barriers to breastfeeding in the workplace include a perception of a disruption in job performance, lack of privacy for the mother, problems with insurance regulations, difficulty finding a daycare facility close to the mother's workplace, and the devaluation of the cumulative benefits from high rates of breastfeeding exceeding the potential inconvenience of accommodating breastfeeding in the workplace. It should be noted, however, that there are also potential benefits to employers, such as an increase in employee retention and a reduction in health insurance costs and absenteeism; this can contribute to a boost in both morale and productivity of all employees.

Dr. Raju reminds us that "Much can be achieved by educating employers and the public about the health and economic benefits from high rates of breastfeeding." Employers and mothers should discuss options that maintain an effective workplace environment while focusing on common sense, respect, flexibility, and accommodation for mothers' feeding choices. Dr. Raju believes that "our society ought to support breastfeeding as a natural, inherently humane, biological act, as basic and essential as breathing."

Impact of state CON programs on heart attack treatment

Wed, 10 May 2006 13:01:00 PST

( from http://www.rxpgnews.com ) People who have heart attacks are about 15 percent less likely to be treated with bypass surgery or angioplasty within the first few days of the incident in states with certificate of need (CON) regulatory programs. However, these patients are no more likely to experience adverse events, such as death, than patients who had heart attacks but were treated within the first days in states without CON.

CON programs involve state-enacted regulations that seek to limit unnecessary expansion of medical services. The study also showed that increased CON stringency is associated with lower use of the two procedures but without a negative impact on survival.

"The study implies that certificate of need programs, which require hospitals to obtain prior approval for establishing high-cost services, limit the growth of these services. In spite of limiting the diffusion of these services, CON regulations did not adversely affect patients," said Gary Rosenthal, M.D., the study's senior investigator and professor of internal medicine in the UI Roy J. and Lucille A. Caver College of Medicine. Rosenthal also is director of the Center for Research in the Implementation of Innovative Strategies in Practice at the VA Iowa City Health Care System.

The study involved a review of the administrative records of 1,139,792 Medicare beneficiaries age 68 and older who had heart attacks and had been admitted to 4,587 hospitals in the United States between 2000 and 2003.

Certificate of need became optional for states in the mid-1980s. During the study, 27 states, including the District of Columbia, had CON regulations for open-heart surgery.

The authors also rated the stringency of the state CON programs, based on the scope of services covered by the CON regulations and the review process hospitals experience when requesting authorization to establish a new program. Using this rating, three states had high CON stringency, eight states had moderate CON stringency and 16 states, including Iowa, had low CON stringency.

"The findings indicate that the more stringent the CON program, the lower the use of bypass surgery and angioplasty for these patients, yet death rates remained the same as in states with less stringent CON or states without CON," explained the study's lead author Ioana Popescu, M.D., a Quality Scholar with the VA Iowa City Health Care System and UI fellow in internal medicine.

Rosenthal and Popescu noted that there still is pressure on states to remove CON regulations because of claims that it limits free competition.

"A problem for policy makers is there haven't been enough studies on the impact of certificate of need programs on quality of care and how well patients do," Rosenthal said. "There may still be an important role for regulatory policy at the state level to ensure services are not unnecessarily duplicated and to control quality of care."

"States with CON regulations tend to have fewer hospitals performing high-tech procedures, thus consolidating the delivery of such services and creating higher volume programs. Hospitals that do more of a certain procedure to treat a certain diagnosis, will, on average, do better than hospitals that do fewer of the procedure," Popescu said.

Rosenthal said that maintaining higher volume per institution may be particularly important for bypass surgery, which is being used less frequently overall in the United States because more patients are being treated with angioplasty.

Indian American doctor pushes for healthcare reforms

Sun, 30 Apr 2006 23:00:00 PST

( from http://www.rxpgnews.com ) An Indian American physician, who is president-elect of the Chicago Medical Society, has said that doctors should take the lead and work with lawmakers in the US on healthcare reforms that should include a reduction in fines to be paid in cases of medical negligence.

Foremost on his agenda, he said, would be to mobilise physicians to work towards a better health system that would include reducing medical malpractice premiums that have to be paid by doctors in cases of negligence.

"Something must be done before physicians start leaving Illinois. For the specialties most affected - neurosurgery and obstetrics and gynaecology - the malpractice premiums have gone sky high," Swaminathan told IANS.

"Moreover, medicare reimbursements are a concern. So, as a physician, you are hit with a triple whammy - the overheads are going up, malpractice insurance is going up, while the reimbursements are going down," he said.

Swaminathan said physicians had been "left off the table" in the current struggle for healthcare reforms.

"The key to working towards healthcare reform is for physicians to work with the legislators. Today physicians (in the US) are isolated. There is a need for them to be politically involved and be better connected to legislators," he said.

"I think physicians have been left off the table (in the debate on healthcare reforms). But if we physicians don't look after the patients' interests, who will? It is we who have to shepherd the flock."

According to him, there was also the need for better patient safety and better interaction with consumer groups.

"We cannot push for medical reforms without working for better patient safety. And patient safety involves working to eliminate judgment errors and system errors. Then, doctors, private hospitals and consumer activists have to come together to present a persuasive argument for liability reform," he said.

"Physicians have not done an adequate job of building bridges with consumer groups. We need to do a better job of addressing the problems of the uninsured, and patients with pre-existing conditions. As a physician, I cannot refuse to take a patient just because he or she has had a history of diabetes and is, therefore, high risk."

Swaminathan has been a practising psychiatrist for three decades and said there had been a change in the attitude of Indians towards mental illness.

"When I was doing my residency in 1974, I would see one patient a year. Today I see over 50 annually. The perceptions have changed. Indians have begun to see mental illness as a bona fide physical illness."

Indian patients with mental illness were benefited because they had a very strong family network to fall back upon, Swaminathan said, adding that like other immigrants, Indians, too, were more comfortable seeing physicians of their own culture.

When he is not seeing patients or involved with healthcare issues, Swaminathan likes to take centrestage along with his musical group that performs Hindi pop songs.

Despite being a sought after singer at private events here, Swaminathan is modest about his talent. "My wife is a much better singer. I just accompany her on stage," he said.

Autism Costs $35 Billion Per Year to U.S.

Wed, 26 Apr 2006 18:26:00 PST

( from http://www.rxpgnews.com ) It can cost about $3.2 million to take care of an autistic person over his or her lifetime. Caring for all people with autism over their lifetimes costs an estimated $35 billion per year. Those figures are part of the findings in the first study to comprehensively survey and document the costs of autism to U.S. society. Michael Ganz, Assistant Professor of Society, Human Development, and Health at Harvard School of Public Health, authored the study, which appears in a chapter titled, The Costs of Autism, in the newly published book, Understanding Autism: From Basic Neuroscience to Treatment (CRC Press, 2006). Ganz hopes his research will help policymakers allocate scarce resources to its treatment and prevention as well as provide a useful reference for policymakers and advocates to help them more fully understand the financial impact of autism on U.S. society.

Ganzs analysis of the costs includes direct and indirect medical costs associated with the disorder. But he believes the $35 billion annual societal cost for caring for and treating people with autism likely underestimates the true costs because there are a number of other services that are used to support individuals with autism, such as alternative therapies and other family out-of-pocket expenses, that are difficult to measure. In addition, Ganz believes that the level of cost could be higher if there were more useful and widespread treatment options available. Given that the federal autism research budget has been historically less than $100 million per year and given that research budgets for other conditions with similar numbers of affected individuals are sometimes orders of magnitude higher, I hope that my research can help focus more attention on directing more resources toward finding prevention and treatment options for autism, Ganz said. (For comparison purposes, he notes estimated annual costs of other conditions, including Alzheimers disease ($91 billion); mental retardation ($51 billion); anxiety ($47 billion); and schizophrenia ($33 billion).)

Autism is a pervasive developmental disorder (PDD) that involves severe deficits in a persons ability to communicate and interact with others. Children with autism often have trouble using their imagination, have a limited range of interests, and may show repetitive patterns of behavior or body movements. The disorder is often associated with some degree of mental retardation. Autism is the most prevalent PDD and the most common of all serious childhood disorders. It affects an estimated 1.5 million Americans and is increasing at a rate of 10-17 percent each year. It is four times more common in boys than in girls. The exact cause of autism is not known and there is currently no cure for the disorder.

Ganz broke down the total costs of autism into two components: direct and indirect costs. Direct costs include direct medical costs, such as physician and outpatient services, prescription medication, and behavioral therapies (estimated to cost, on average, more than $29,000 per person per year) and direct non-medical costs, such as special education, camps, and child care (estimated to annually cost more than $38,000 for those with lower levels of disability and more than $43,000 for those with higher levels).

Indirect costs equal the value of lost productivity resulting from a person having autism, for example, the difference in potential income between someone with autism and someone without. It also captures the value of lost productivity for an autistic persons parents. Examples include loss of income due to reduced work hours or not working altogether. Ganz estimates that annual indirect costs for autistic individuals and their parents range from more than $39,000 to nearly $130,000.

Since people with autism receive services from a wide variety of sources, Ganz believes future research efforts should focus on identifying those sources and linking those costs to non-financial data about the burdens of autism. These complementary sources of data can provide a richer picture that will be useful to policymakers in the future to assist them in devoting resources to address the financial and non-financial effects of autism.

Mammography screenings for breast cancer show ethnic disparities

Tue, 18 Apr 2006 14:14:00 PST

( from http://www.rxpgnews.com ) Inadequate use of screening mammography may be an important reason that African-American women are more likely to be diagnosed with advanced stage breast cancer than members of other ethnic groups, according to a new study led by a University of California, San Francisco imaging specialist.

Results from the six-year study analyzing data from mammograms of 1 million women 40 years of age and over are reported in the April 18 issue of the Annals of Internal Medicine.

Through the 1990s, mortality rates from breast cancer in the United States decreased as the use of mammography increased. These decreases primarily benefited non-Hispanic white women, whereas the mortality rate for African-American women changed very little, according to the research team.

"We found significant differences in the patterns of mammography by race and ethnicity. All minority women were significantly more likely to be inadequately screened with mammography than white women," said Rebecca Smith-Bindman, MD, lead investigator and UCSF associate professor in the departments of radiology, epidemiology and biostatistics, and obstetrics, gynecology and reproductive sciences. "It was important to determine whether the use of mammography was the reason for the racial and ethnic differences in breast cancer. There has been an ongoing debate whether biology, or use of screening mammography, is primarily the cause for the racial and ethnic differences in outcomes."

The researchers linked data from mammography and tumor registries from facilities that form the Breast Cancer Surveillance Consortium funded by the National Cancer Institute. Surveys completed by patients at each mammography examination included questions on race, ethnicity, presence of breast symptoms and previous mammography use.

"We explored stage of disease at diagnosis, tumor characteristics and lymph node involvement among women of different races and ethnicities whose patterns of mammography use were similar," Smith-Bindman said.

The data showed that African-American women are more likely to have large, advanced-stage tumors at diagnosis of breast cancer than white women.

Researchers explored mammography use as a possible cause of the racial and ethnic differences in the rates of advanced cancer. They found that white women were more likely to be screened at an interval of one to two years. Compared with 72 percent of white women, only 63 to 68 percent of African-American, Hispanic, Asian and Native American women were frequently screened. African-American, Hispanic and Asian women were more likely to have never undergone screening; therefore they were more likely to have their first mammogram because of a physical examination finding or breast symptom.

For example, 18 percent of white women with breast cancer were inadequately screened with mammography prior to breast cancer, while 34 percent of African-American, 24 percent of Hispanic and 27 percent of Native American women were inadequately screened before their breast cancer diagnosis.

"Most of the differences in breast cancer characteristics at diagnosis were eliminated once we grouped women by their patterns of mammography use. Women who had undergone similar screening had similar types of tumors, irrespective of race and ethnicity. We can conclude that underuse of mammography may be an ongoing issue," said Smith-Bindman. "While Asian and Native American women had significantly lower rates of large, advanced stage tumors than white women, they also tended to underutilize mammography. Thus, these women could possibly reduce their burden of advance-stage disease even further if they increase their use of screening mammography."

Over the past two decades, health agencies on the federal and state level have made efforts to increase mammography use through outreach programs to underserved women. According to the study, some minority groups do not undergo regular screening and this is probably attributable to a combination of factors that may include financial barriers, difficulty in accessing facilities that perform mammography, and multiple personal and cultural reasons for choosing not to undergo screening.

"Additional work needs to be done to understand how to improve outreach and provide screening to these women," said Smith-Bindman. "It seems that many women do not undergo routine mammography. Increased use of mammography screening may enable discovery of tumors before they have progressed to an advanced stage and result in decreased mortality rates."

Congenital rubella syndrome nearly eradicated in the US

Mon, 10 Apr 2006 14:04:00 PST

( from http://www.rxpgnews.com ) Congenital rubella syndrome, a birth defect caused by the rubella virus (also known as German measles), has practically been eliminated in the U.S., according to a statement published in the April 2006 issue of Birth Defects Research Part A, the official journal of The Teratology Society.

Endorsed by the Teratology Society, the Organization of Teratology Information Specialists (OTIS), the Neurobehavioral Teratology Society, and the Behavioral Toxicology Society, the statement notes that rubella is no longer an endemic disease in this country and congenital rubella syndrome "is almost a thing of the past in the United States." Birth defects resulting from rubella may include blindness, deafness, and congenital heart disease. A rubella epidemic in the early 1960s caused more than 11,000 fetal deaths and 20,000 infants to be born with congenital rubella syndrome, but a more effective vaccine introduced in the 1970s has helped in eliminating transmission of rubella from expectant mothers to their unborn babies.

"Effectively, congenital rubella syndrome has been nearly eradicated from the United States," according to the statement. There were fewer than 10 cases or rubella reported in the U.S. last year and in the past 5 years there have only been 4 cases of congenital rubella syndrome reported, only one of which was in a child whose mother had been born in the U.S.

The remarkable success of the immunization program to eliminate rubella is due to joint efforts by the Centers for Disease Control and Prevention, various state and local health departments, the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, and the March of Dimes, according to the statement. Maintaining high rubella immunization rates is crucial to the continued success of these efforts. The statement concludes: "Effective strategies, such as continued universal childhood and adolescent immunization, must be secured to extend this success worldwide."

Indian American wants ayurveda practitioners in US licensed

Fri, 07 Apr 2006 13:52:00 PST

( from http://www.rxpgnews.com ) An Indian American practitioner of ayurveda wants those who practice this ancient Indian medical system to get licences in the US.

Lakshmi C. Mishra, director of the Ayurvedic Health Care Center in Rockville, Maryland, has proposed to Maryland's Board of Physicians to introduce an official licensing programme, according to the Indus Business Journal (IBJ).

The ayurveda system of medicine is based on the theory of balance between the body, the soul and the mind. Though it is believed that this system is as old as humanity, it was recorded down in texts between 4000 BC and 6000 BC.

Mishra wants Maryland to introduce a training system similar to the one that he had undergone in India.

He has proposed that the system should include four and a half years of education followed by a year of internship in a hospital. This is similar to the programme followed by the 200-odd ayurveda medical colleges in India.

"The home of ayurveda is India, and that's where it developed for the last thousands of years. So I'm taking that as the model," he told IBJ.

As of now, there is no law in the US which requires practitioners of ayurveda to have a licence.

Explaining that ayurvedic medicine considers the patient more important than the disease, he said that those who practice this system without proper training might end up making wrong diagnoses and prescribing wrong treatments, making the patient sicker and delaying correct treatment.

Mishra has also expressed concern over the prescription of ayurvedic drugs by people who are not formally trained. Ayurvedic drugs use animal, mineral and vegetable-based products.

Pointing out that a chiropractor in the US needs to have at least 3,000 hours of training before starting to practise and even a masseur needs 500 hours, he said there was no such law for ayurveda. The Indian programme includes 2,900 hours of education and 700 hours of lab work.

There are around 20-odd ayurveda training institutes in the US, most of which offer short-term courses.

Karen Wuff, a member of the Maryland Board of Physicians, was quoted in the report as saying that the board was aware of the issue of licensing ayurveda practitioners.

However, this was a new area and legislation could take years.

Mishra is planning to contact the Department of Health and Mental Hygiene in Maryland and the Maryland Insurance Administration over this issue. The American Association of Physicians of Indian Origin (AAPI) is backing him.

Donning uniform was my best move: US Army nursing chief

Mon, 03 Apr 2006 07:09:00 PST

( from http://www.rxpgnews.com ) Gale Pollock was so impressed by the way the military treated her elder brother after he was wounded in Vietnam that she decided to become a nurse. Thirty years down the line, she's a major general and heads the US Army Nurse Corps.

"I decided to join the army when I was a teenager. I had a big brother who was injured in Vietnam and the army medical department took very good care of him. So I decided I was going to be a nurse so I could help someone else's big brother," said Pollock.

"It's been wonderful. I really think choosing to join the army was the best decision of my life," Pollock told IANS on the sidelines of the just-concluded 16th Asia-Pacific Military Medicine Conference here.

"They have provided me wonderful opportunities - my education, opportunities to serve around the world," added the Honolulu-based Pollock who is one of the 14 star-ranked officers in the 490,000-strong US Army.

One of the proudest days of her life undoubtedly was July 26, 2004 when she jumped two ranks from colonel to major general in a single day as a result of a 2003 US law requiring that a two-star officer head the Army Nurse Corps.

Pollock was selected for the Walter Reed Army Institute of Nursing (WRAIN) scholarship programme and received a bachelor's of science in nursing from the University of Maryland, and a direct commission in the Army Nurse Corps in 1976.

She has attended the US Army Nurse Anesthesia Programme and is a Certified Registered Nurse Anaesthetist (CRNA), and a Fellow of the American College of Healthcare Executives (FACHE).

She received her master's in Business Administration from Boston University, a masters in Healthcare Administration from Baylor University and a master's in National Security and Strategy from the National Defence University.

"I keep busy. I love what I do. I love taking care of the service members and their families. And then, there's the opportunity to work with people who are very committed to helping people," Pollock maintained.

"We medical people enter healthcare because we care about other people - to join in an environment like this with people from other countries with the same values: we want to care for people, we want people to be well, we want people to get along. It's wonderful to be in this environment," she said.

It's this very philosophy that Pollock brought to the military medicine conference, which is held in a different Asia-Pacific country every year and co-hosted by the Honolulu-based US Pacific Command.

"It is very important for all the countries in the Asia-Pacific region to understand one and another better, to begin to work together better because it is such a large geographic region and it is home to the majority of natural disasters," she explained.

"It made sense that the US play the guiding hand, to lead people into working together better," Pollock said, adding: "So, over the years, we have looked at the medical issues that are important to those regions."

Much of the work has been on dengue fever, anti-malarial treatments, HIV/AIDS.

"As we learnt how to work better, the countries (of the region) felt they needed more support than they could provide, they would know where to look to."

This became apparent in the wake of the Dec 26, 2004 tsunami that claimed nearly 230,000 lives.

"We certainly found that to be true after the tsunami when the entire region came together to try and support the different countries. Because of the relationships we had, governments were able to say what exactly they wanted," Pollock pointed out.

"Now, over time, some of the people have come multiple times to the conferences. So they know each other well. It is really renewing and strengthening friendships when we get together," she maintained.

Media campaigns encourage parents to talk about sex

Thu, 23 Mar 2006 17:28:00 PST

( from http://www.rxpgnews.com ) Media campaigns are an effective tool in encouraging parents to talk with their children about sex, said US scientists.

Researchers in North Carolina studied the impact of a nine-month public awareness campaign on billboards, radio and television in their state with the slogan "Talk to your kids about sex. Everyone else is."

Results of a telephone survey of over 1,000 parents showed that the message had influenced them to talk to their children about sexual issues, the team at Brenner Children's Hospital and Wake Forest University School of Medicine in North Carolina, wrote in the March issue of the Journal of Adolescent Health.

"Parents are often concerned about the way schools teach sex education and the messages their children are exposed to on television and the internet," lead researcher Robert Durant said.

"But when parents convey their own values, attitudes and beliefs about sexual activity, birth control and pregnancy to their children it has a positive effect on their children's behaviour," he added.

North Carolina ranks ninth in the US for rates of teenage pregnancies, with 95 in every 1,000 teenage girls between 15 and 19 giving birth in 2000.

South Dakota passes law banning abortions

Wed, 08 Mar 2006 04:55:00 PST

( from http://www.rxpgnews.com ) In the biggest challenge in years to US women's right to abortion, the governor of South Dakota has signed a law banning most abortions that seems certain to inflame national debate on the highly charged issue.

The law was essentially designed to challenge a 1973 US Supreme Court decision, known as Roe vs. Wade, that made it legal for women across the nation to have an abortion.

Governor Mike Rounds, a member of President George W. Bush's Republican Party, acknowledged as much in his remarks on signing the legislation.

"Because this new law is a direct challenge to the Roe versus Wade interpretation of the Constitution, I expect this law will be taken to court and prevented from going into effect this July," he said.

Rounds said it would likely take years for the law to end up in the supreme court, but that the court would have an "opportunity to reconsider an earlier opinion".

The challenge to the 1973 decision came only weeks after the second of Bush's Supreme Court picks was sworn into office. New Chief Justice John Roberts and Associate Justice Samuel Alito are believed to be conservatives, and abortion opponents hope they could cast the decisive votes in overturning Roe vs. Wade.

The South Dakota law outlaws most abortions in the state, except if the mother's life is at risk. Doctors performing an abortion in other circumstances could risk a prison term of five years.

Nancy Keenan, head of the US abortion rights group NARAL Pro- Choice America, has called the measure "dangerous and unconstitutional".

The South Dakota law is seen as the most serious attempt to challenge Roe vs. Wade since a 1989 Supreme Court ruling upholding the right to an abortion.

Immigrants to US change diet

Sun, 12 Feb 2006 18:13:00 PST

( from http://www.rxpgnews.com ) Coming to the land of milk and honey can be hazardous to new immigrants' diet and health.

So says Ilana Redstone Akresh, a visiting professor of sociology at the University of Illinois at Urbana-Champaign and the author of a new analysis of dietary assimilation and immigrant health. In her study, Akresh considered the changes in immigrants' diets after coming to the United States and the subsequent relationship between those changes and Body Mass Index (BMI) and health status.

She found that 39 percent of her sample of 6,637 adults reported at least one significant change in their diet. The most commonly reported dietary changes were an increased consumption of junk food and meat, according to her findings in the not-yet published study.

More than 10 percent of the sample reported eating more junk food in the United States, while more than 8 percent said they ate more meat in America than they ate in their home countries. Nearly 15 percent reported eating fewer vegetables, fruit, fish or rice and beans. As a consequence of their acquired tastes, many new immigrants are not only bulking up, but also becoming less healthy, Akresh said.

Dietary change as an area of assimilation had not been studied, but Akresh believes that "in perhaps no realm more so than what one eats is assimilation more visible, tangible and directly experienced."

The changes that immigrants make may have short- and long-term health consequences, the professor said. "Understanding these changes and examining their determinants is an important precursor to a fuller understanding of immigrant health."

In her research, Akresh focuses on several aspects of immigrant acculturation and assimilation to the United States, giving a portrait of immigrant behaviors.

A second new study that will be published later this year explores the occupational mobility among legal immigrants to the United States. A third focuses on immigrant intentions and mobility.

For the latter two analyses, Akresh used data from the New Immigrant Survey Pilot study, which followed immigrants who received their green cards in 1996 for one year. The RAND Corp. conducted the pilot study. For her examination of dietary change, Akresh used the full New Immigrant Survey, conducted by the National Opinion Research Center at the University of Chicago. The first cohort of the survey was interviewed in 2003. Other findings from her dietary analysis:

* Consuming more junk food is associated with acculturation. Those immigrants who reported consuming more junk food in the United States also have more experience in the country, a higher likelihood of having a spouse from the United States, and a lower likelihood of having a spouse from the same country. They are also more likely to speak English as one of multiple languages at home, to speak English exclusively at work and with friends, and to have a significantly higher average BMI than those who do not.

* Immigrants who eat more meat in the United States have been here longer, have more children and live in younger households. They also have fewer years of education, a lower proportion of them are able to speak English well and they have lower rates of English language use with friends and at work than those who do not consume more meat. Individuals reporting increased meat consumption also have higher household incomes and higher average BMI.

"This pattern depicts immigrants who are perhaps less integrated, yet are doing well enough financially to afford meat. They may not have the nutrition information necessary to accurately assess the value of increased meat consumption or they may choose to ignore this information," Akresh wrote.

* Those who are married are more likely to maintain a diet similar to that which they had prior to immigration, while having a spouse born in the United States is associated with a greater change in diet.

* The fewer changes the immigrant incorporates into his diet, the lower his BMI.

The findings have policy implications, "particularly related to informing immigrants about the pros and cons of selecting the items in the grocery store that they might not be familiar with," Akresh said.

"Nutrition education targeting immigrants may decrease this trend and increase the proportion of this population that chooses the trajectory of dietary change associated with a positive health outcome. Using the New Immigrant Survey to identify immigrants' eating patterns by region of origin and to identify the prevalence of these behavioral changes will increase our understanding of what many may consider a negative outcome of the assimilation process."

In a second analysis, to be published later this year in International Migration Review, Akresh focused on occupational mobility, comparing immigrants' occupation in the United States with that of their last job abroad.

In that study she found that 50 percent of the immigrants experienced "occupational downgrading."

Among the highest skilled immigrants from Latin America and the Caribbean, more than three-fourths end up in lower-skilled jobs than what they had abroad.

"Human capital acquired in Latin America and the Caribbean is valued less than that from Europe, Australia and Canada in the U.S. labor market," she said, "while immigrants with some U.S. education can increase the returns to that acquired previously abroad."

In a third study, co-written with Princeton University sociologist Douglas S. Massey, to be published in Social Science Quarterly in December, the authors looked at immigrants' intentions and mobility in a global economy, connecting immigrants' objective circumstances to satisfaction with life in the United States, intentions with regard to naturalization and settlement, and "concrete behaviors" such as sending money back home and leaving the country.

They found that those people expressing a high degree of U.S. satisfaction are significantly more likely to intend to naturalize and also are more likely to want to stay in the United States forever.

However, those with high earnings and U.S. property are less likely to plan on naturalizing; those with high levels of education are least likely to be satisfied with the United States.

"The picture that emerges from this analysis is of a fluid and dynamic global market for human capital in which the bearers of skills, education and abilities seek to maximize earnings in the short term while retaining little commitment to any particular society or national labor market over the longer term," Akresh said.

Court upholds $79.5 mn ruling against tobacco giant

Fri, 03 Feb 2006 15:38:00 PST

( from http://www.rxpgnews.com ) The Oregon Supreme Court Thursday upheld a $79.5-million punitive damages award given to the family of a smoker who died of cancer.

The court said that the award against tobacco giant Philip Morris was not excessive given the "extreme and outrageous circumstances" which saw the company continue to aggressively market cigarettes despite clear evidence of the cancer-causing properties.

The ruling upheld a 1999 award by a county court jury to the family of Jesse D. Williams, a janitor who died in 1997 of lung cancer at the age of 67. The lawsuit, known as the Williams-Branch case, was brought on behalf of Williams' family.

The county court jury awarded $821,000 dollars in compensatory or actual damages, which were reduced under state law to $521,000. The trial court reduced the punitive damages award to $32 million, but in a June 2002 ruling the Oregon Court of Appeals reinstated the original $79.5 million punitive damage award.

Altria Group Inc., the parent company of Philip Morris, said in a news release Thursday the award, which is 152 times the compensatory judgment, is grossly excessive and bears no reasonable relation to the compensatory judgment in violation of the US Supreme Court's decision in State Farm v. Campbell. In that 2003 decision, the US Supreme Court imposed limitations on the imposition of punitive damages and stated that, in cases involving substantial actual or compensatory damages, punitive damages generally should not exceed the amount of compensatory damages.

Later in 2003, the US Supreme Court granted review of the case, directed the Oregon Court of Appeals to vacate its June 2002 opinion and ordered reconsideration of the case in view of State Farm. However, the Oregon Court of Appeals, and now the state's Supreme Court, rejected the US Supreme Court's holdings regarding punitive damages.

"Because this decision violates the rules set forth in State Farm, Philip Morris USA will once again seek review of this case by the US Supreme Court," William S. Ohlemeyer, Philip Morris USA vice president and associate general counsel, said in the release.

Mass behavioral health plan is cost effective - study

Tue, 31 Jan 2006 19:20:00 PST

( from http://www.rxpgnews.com ) A study released by the Mental Health and Substance Abuse Corporations of Massachusetts, Inc. (MHSACM), a statewide organization representing over 100 community-based mental health and substance abuse service providers, found that the MassHealth behavioral health carve-out provides efficient and effective mental health and substance abuse services and is of good taxpayer value to the Commonwealth.

The Romney Administration is currently considering dismantling the program.

"The behavioral health carve-out has encouraged cost-effective and innovative ways of delivering care," said Elizabeth Funk, President and CEO of MHSACM. "At the same time, it has been able to achieve a balance between saving the state money and providing adequate access for consumers."

In 1992, Massachusetts became the first state to implement a statewide, managed care "carve-out" of Medicaid-funded mental health and substance abuse services. The measure was designed to save the state money while maintaining behavioral health care access and quality. The carve-out program has been extensively studied, but until recently comparative data on the managed care organizations have not been available. This report compares the Primary Care Clinician Plan carve-out organization and MassHealth-contracted managed care organizations along access, quality, and cost measures.

"On first blush, it appeared that the MassHealth behavioral health carve-out to the Massachusetts Behavioral Health Partnership costs substantially more than the same services provided by MassHealth managed care organizations," stated Donald Shepard, the author of the study and a professor at the Schneider Institute for Health Policy at Brandeis University's Heller School. "However, the analysis in this report found that after correcting for the differences in the types of populations served, the cost per person was identical. It also found that the MBHP carve-out had better access to mental health and substance abuse services and thus seemed to be providing the Commonwealth and MassHealth members good value and should not be disbanded."

Second-hand tobacco smoke is toxic - California

Fri, 27 Jan 2006 19:38:00 PST

( from http://www.rxpgnews.com ) California has classified second-hand tobacco smoke as a toxic air pollutant, becoming the first US state to make such a declaration.

California, which pioneered smoking bans in the workplace and later in restaurants and bars, Thursday put drifting smoke in the same category as diesel exhaust and said it could lead to tougher regulation, reported the online edition of BBC News.

The decision to make such a declaration came after many scientific studies had linked passive smoking to a range of cancers and respiratory diseases, according to California Air Resources Board.

A study report released last September found a sharply increased risk of breast cancer in young women exposed to tobacco smoke. It also linked second-hand smoke to premature births, asthma and numerous health problems in children.

The study found that about 16 percent of all Californians smoked, but that 56 percent of adults and 64 percent of adolescents were exposed to second-hand smoke.

According to WHO, smoking is a greater cause of death and disability than any single disease considered responsible for approximately five million deaths worldwide every year.

It is believed there are 1.1 billion smokers in the world - 800 million of them in developing countries.

Trauma-Center Care Lowers Risk of Death

Thu, 26 Jan 2006 16:45:00 PST

( from http://www.rxpgnews.com ) Care at a trauma center lowers by 25 percent the risk of death for injured patients compared to treatment received at non-trauma centers, according to the results of a nationwide study conducted by researchers at the Johns Hopkins Bloomberg School of Public Health and the University of Washington School of Medicine. A National Evaluation of the Effect of Trauma Center Care on Mortality, to be published in the January 26, 2006, edition of the New England Journal of Medicine, is among the first studies to provide strong evidence of the effectiveness of specialized trauma-care facilities.

Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. Now we have conclusive data to show that trauma care is effective, said the studys lead author, Ellen J. MacKenzie, PhD, professor and chair of the Department of Health Policy and Management at the Bloomberg School of Public Health. The findings of this study argue strongly for continued efforts at regionalizing trauma care at the state and local levels to assure that patients who suffer serious injuries get to a trauma center where they are afforded the best possible care.

The National Study on the Costs and Outcomes of Trauma analyzed the outcomes of 5,190 adult trauma patients who received treatment at 18 level 1 trauma centers (the highest level of care) and 51 non-trauma centers. The researchers also analyzed the characteristics of each hospital, such as the number of patients treated and types of specialty services available.

After adjusting for factors such as severity of injury, patient age and pre-existing medical conditions, the researchers found a 25 percent overall decrease in the risk of death following care in a trauma center compared to receiving care at a non-trauma center. The adjusted in-hospital death rate was 7.6 percent for patients treated at trauma centers compared to 9.5 percent for patients treated at non-trauma facilities. The mortality rate one year following the injury was 10.4 percent for patients at trauma centers compared to 13.8 percent for patients at non-trauma centers.

The researchers noted that the effect of treatment at trauma centers was less significant among older patients with underlying health problems.

This study provides convincing evidence that care at a level 1 trauma center saves lives, said Gregory Jurkovich, MD, a University of Washington professor of surgery and a co-author of the study. Our next step is to see if level 1 trauma center care also improves the quality of life of trauma survivors. Well examine the differences in functional outcome and cost of care between level 1 trauma centers and non-trauma centers.

Caring for the acutely injured is a major public health issue and involves bystanders and community members, health care professionals and health care systems. This research provides state and community leaders with crucial information, so that they can make sound decisions regarding their trauma systems and the care that people receive after they are injured. It is one way that the Centers for Disease Control and Prevention contributes to reducing premature death and disability through research and partnerships, said Richard C. Hunt, MD, director of the CDCs Injury Centers Division of Injury Response.

New Prescription Drug Information Format to Improve Patient Safety

Fri, 20 Jan 2006 15:10:00 PST

( from http://www.rxpgnews.com ) The U.S. Food and Drug Administration (FDA) unveiled a major revision to the format of prescription drug information, commonly called the package insert, to give healthcare professionals clear and concise prescribing information. In an effort to manage the risks of medication use and reduce medical errors, the newly designed package insert will provide the most up-to-date information in an easy-to-read format that draws physician and patient attention to the most important pieces of drug information before a product is prescribed. The new format will also make prescription information more accessible for use with electronic prescribing tools and other electronic information resources.

"Providing healthcare professionals and patients with clear and concise information about prescriptions will help ensure safe and optimal use of drugs, which translates into better health outcomes for patients and more efficient delivery of healthcare," said HHS Secretary Mike Leavitt. Research shows that prioritizing the warning information has a greater impact on reducing such events. Therefore, the new prescription label format provides the most important information about a prescription product in a format that is better understood, more easily accessible and more memorable for physicians. By making these changes, FDA is seeking to reduce the complexity of information on prescription drug labels, making them more useful for physicians and their patients.

"Americans are overwhelmed with the complexity of health information. This problem is compounded by prescription medication information that reads more like legal disclaimers than useful or actionable health information."

Revised for the first time in more than 25 years, the new format requires that the prescription information for new and recently approved products meet specific graphical requirements and includes the reorganization of critical information so physicians can find the information they need quickly. * A new section called Highlights to provide immediate access to the most important prescribing information about benefits and risks.
* A Table of Contents for easy reference to detailed safety and efficacy information.
* A toll-free number and Internet reporting information for suspected adverse events to encourage more widespread reporting of suspected side effects.

"The new label design makes it easier for doctors to get access to important information about drug safety and benefits, and this in turn will help them have more meaningful discussions with their patients," said Andrew von Eschenbach, M.D., FDA Acting Commissioner of Food and Drugs. Designed to help healthcare professionals find the information they need quickly, Highlights will typically be half a page in length and will provide a concise summary of information about specific areas including: Boxed Warning, Indications and Usage, and Dosage and Administration; and will refer the healthcare professional to the appropriate section of the Full Prescribing Information. Over the past ten years, the prescribing information for newly approved products has become increasingly more complex, and specific information is often difficult to locate. Physicians will now be able to find critical information more quickly, through a new Table of Contents that refers readers to detailed information located in the label. The Full Prescribing Information is reorganized to give greater prominence to the most important and most commonly referenced information. The addition of a new Patient Counseling Information section places greater emphasis on the importance of communication between professionals and patients. If FDA has approved patient information for a prescription drug, it will be printed at the end of the label immediately following the Patient Counseling Information section or will accompany the label so it can be easily shared.

"In the last month, we have announced important steps toward creating an electronic environment for drug safety and effectiveness information that can provide patients and healthcare professionals with critical information at the point of care," said von Eschenbach. "This revised prescription information format, in combination with new requirements for electronic labels announced earlier this month and requirements for barcodes on drugs will dramatically improve the way healthcare professionals and consumers obtain information about prescription drugs."

The new prescription information format will be integrated into FDA's other e-Health initiatives and standards-setting efforts through a variety of ongoing initiatives at the agency. As prescription information is updated in this new format it will be used to provide medication information for DailyMed -- a new interagency online health information clearinghouse that will provide the most up-to-date medication information free to consumers, healthcare professionals and healthcare information providers. The DailyMed is now making up-to-date information about FDA-regulated products widely available on the Internet free of charge. This information can be accessed through the National Library of Medicine at http://dailymed.nlm.nih.gov. In the future, this new information will also be provided through a website called facts@fda, a comprehensive Internet resource designed to give one-stop access for information about all FDA-regulated products.

In December 2000, before issuing the proposed rule the agency evaluated extensive information it received on the usefulness of the present prescription drug labeling for healthcare professionals to determine how content and format could be improved. The agency used feedback from focus groups, national physician surveys, a public meeting and written comments to design the new prescription information format. FDA determined the most common practices for using prescription drug labeling, as well as information considered to be most important, and then developed the new format based on this information. The new drug labeling requirements will be phased in gradually and initially will apply to newly and recently approved prescription drugs and drugs that receive approval for new uses. All drugs approved within the past five years are included, and they will gradually be converted to the new prescribing information format.

Slow Progress in Improving In-patient Safety Systems

Wed, 14 Dec 2005 16:59:00 PST

( from http://www.rxpgnews.com ) While there has been some improvement in patient safety systems at hospitals, progress has been slow and the current systems are not close to meeting certain recommendations, according to a study in the December 14 issue of JAMA.

The 1998 Institute of Medicine (IOM) National Roundtable on Health Care Quality and subsequent reports ushered in a period of extensive research about the quality of the U.S. health care system, according to background information in the article. The IOM report, To Err Is Human, provided in-depth analyses of a wide range of patient safety problems and underscored the need for improvement. Subsequently, the IOM has called for "fundamental change to close the quality gap and save lives," and proposed a national initiative to "provide a strategic direction for redesigning the health care system of the 21st century." These documents indicate that successful implementation of change in the nation's overall health care system requires change in specific patient safety systems at the hospital level.

Daniel R. Longo, Obl.S.B., Sc.D., and colleagues from the University of Missouri-Columbia, conducted a study to assess the status of patient safety systems and examine changes from 2002 to 2004. The study included a survey of all acute care hospitals in Missouri and Utah at 2 points in time, in 2002 and 2004, using a 91-item comprehensive questionnaire (n = 126 for survey 1 and n = 128 for survey 2). The researchers analyzed the responses of the 107 hospitals that responded to both surveys to assess the changes over time.

Seven variables were constructed to represent the most important patient safety constructs studied: computerized physician order entry systems, computerized test results, and assessments of adverse events; specific patient safety policies; use of data in patient safety programs; drug storage, administration, and safety procedures; manner of handling adverse event/error reporting; prevention policies; and root cause analysis. For each hospital, the 7 variables were summed to give an overall measure of the patient safety status of the hospital.

The researchers found that development and implementation of patient safety systems is at best modest. "Self-reported regression in patient safety systems was also found. While 74 percent of hospitals reported full implementation of a written patient safety plan, nearly 9 percent reported no plan. The area of surgery appears to have the greatest level of patient safety systems. Other areas, such as medications, with a long history of efforts in patient safety and error prevention, showed improvements, but the percentage of hospitals with various safety systems was already high at baseline for many systems. Some findings are surprising, given the overall trends; for example, while a substantial percentage of hospitals have medication safety systems, only 34.1 percent reported full implementation at survey 2 of computerized physician order entry systems for medications, despite the growth of computer technology in general and in hospital billing systems in particular."

"Response from within the health care system clearly has been slow. In part, this is because of the complexities involved in implementing systems and changing cultures; however, complexity can also be an excuse," the authors write.

"Based on our findings, we recommend that individual hospitals, including their boards of directors, medical staffs, administration, and staff, review the list of patient safety systems our expert focus groups identified as needed in all hospitals. They can conduct their own survey of where they stand with regard to development and implementation of each of these and report where they stand to the community. While the list may seem long, it is very manageable when viewed by individual hospital departments to which given system characteristics apply. We concur with the larger recommendations of others that nationally there must be a far more aggressive agenda," the researchers write.

In an accompanying editorial, Stephen G. Pauker, M.D., Ellen M. Zane, B.A., M.A., and Deeb N. Salem, M.D., of the Tufts-New England Medical Center, Boston, comment on the study by Longo et al.

"To produce sustained change, it is essential to understand root causes of current problems, establish policies to induce and maintain change, create measurements at all levels that shape safer behaviors, and properly measure progress toward the goal of having a safer health care system. Longo et al provide data about the introduction of safety systems, but better measurement systems and better data are also needed about the incidence of adverse events."

"Rewarding safety will surely help. Some clinicians might consider being paid to perform as being unprofessional, but few could object to creating a safer and higher-quality health care system. Rather than labeling such initiatives as pay-for-performance programs, it may be preferable to think of them as paying for quality and paying for safety. The time has come to take bold action and to embrace change, but first it is time to understand the constraints to accomplishing that change," they write.

US data on influenza death may be more PR than science

Mon, 12 Dec 2005 16:03:00 PST

( from http://www.rxpgnews.com ) US data on influenza death may be more PR than science, argues a Harvard University graduate student in this weeks BMJ.

The Centers for Disease Control and Prevention (CDC) acknowledges a difference between flu death and flu-associated death yet uses the terms interchangeably, writes Peter Doshi. Statistical incompatibilities also exist between official estimates and national vital statistics data.

For example, CDC states that the historic 1968-9 Hong Kong flu pandemic killed 34,000 Americans. At the same time, CDC claims 36,000 Americans annually die from flu. What is going on, asks Doshi?

The CDC uses indirect modelling methods to estimate the number of deaths associated with influenza. Thus the much publicised figure of 36,000 is not an estimate of yearly flu deaths, as widely reported in both the lay and scientific press, but an estimate - generated by a model - of flu-associated death, he says.

Compounding these problems is a marketing of fear - a CDC communications strategy in which medical experts predict dire outcomes during flu seasons, he adds.

If passed, the Flu Protection Act of 2005 will revamp US flu vaccine policy. The legislation will require CDC to pay makers for vaccines unsold through routine market mechanisms. The bill will also require CDC to conduct a public awareness campaign emphasising the safety and benefit of recommended vaccines for the public good.

Yet Doshi believes that this bill obscures the fact that CDC is already working in manufacturers interest by conducting campaigns to increase flu vaccination.

If flu is in fact not a major cause of death, this public relations approach is surely exaggerated, he says. Moreover, by arbitrarily linking flu with pneumonia, current data are statistically biased. Until corrected and until unbiased statistics are developed, the chances for sound discussion and public health policy are limited, he concludes.

HIV Hospital Admissions Fell by More Than Half

Fri, 02 Dec 2005 20:09:00 PST

( from http://www.rxpgnews.com ) The number of hospital admissions for HIV infection in the United States declined from a high of 149,000 in 1995just before approval of life-prolonging protease inhibitor drugs known as the "AIDS cocktail"to 70,000 admissions in 2003, according to statistics released by HHS' Agency for Healthcare Research and Quality. During the same period, the percentage of AIDS patients who died in the hospital dropped by 32 percentfrom a death rate of 12.5 percent in 1995 to 8.5 percent in 2003.

"This information clearly highlights the benefits of quickly putting new, potentially life-saving medical advances into everyday clinical practice," said AHRQ Director Carolyn M. Clancy, M.D. "We anticipate that by World AIDS Day next year, we will see continued improvements."

The data also show that the percentage of female HIV patients increased during this time period. In 1995, 26 percent of HIV hospital patients were women, but this increased to nearly 34 percent in 2003.

The burden of payment shifted during this time as well. Medicaid's share of the bill declined from 53 percent of all HIV hospital stays in 1995 to 49 percent in 2003. The share of HIV stays billed to commercial insurers also declinedfrom 22 percent to 17 percent. On the other hand, Medicare's share increased from 11 percent of HIV stays in 1995 to nearly 17 percent in 2003. And the percent of HIV hospital stays that were uninsured increased from 8 percent to nearly 11 percent.

Hospitalization Rates For Infectious Diseases Increase Among Older Adults

Tue, 29 Nov 2005 19:16:00 PST

( from http://www.rxpgnews.com ) Due in part to a growing population of older adults, there was a 13 percent increase in the infectious disease hospitalization rate between 1990 through 1992 and 2000 through 2002, according to a study in the November 28 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

"Adults 65 years or older (older adults) account for a disproportionate share of patients with infectious disease (ID)ârelated hospitalizations and all-cause hospitalizations in the United States," according to background information in the article. From 1980 through 1994, rates of infectious disease hospitalizations increased among older adults, while rates for those younger than 65 years decreased. The number of older adults is expected to increase from 35 million in 2000 to 69 million by 2030, accounting for approximately one fifth of the total U.S. population.

Aaron T. Curns, M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues, examined the National Hospital Discharge Survey (NHDS) to estimate older adult hospitalization rates from 1990 through 2002. The NHDS is a national probability survey that collects data annually from a sample of about 270,000 inpatient records from approximately 500 hospitals.

From 1990 through 2002, there were approximately 21.4 million ID hospitalizations among older adults, 48 percent of which had an ID as the primary diagnosis. Between 1990 through1992 and 2000 through 2002, there was a 13 percent increase in the ID hospitalization rate, from 449.4 to 507.9 hospitalizations per 10,000 older adults. Nearly half of ID hospitalizations (46 percent) and ID-related hospitalization deaths (48 percent) were associated with lower respiratory tract infections from 2000 through 2002. The hospitalization rates for lower respiratory tract infections and kidney, urinary tract, and bladder infections did not change significantly. The rate for septicemia (infection of the bloodstream), however, increased 22 percent from 50.4 to 61.7 hospitalizations per 10,000 older adults from 1990 through 1992 to 2000 through 2002. Rates for infections of the heart, infections and inflammatory reactions to prosthetic devices, and postoperative infections had the most dramatic growths, with increases of approximately 240 percent, 130 percent and 80 percent, respectively.

"The hospitalization rate for IDs increased slightly among the older adult U.S. population during the 13-year study and was associated with the aging of the older adult population," the authors write. "The reduction of ID hospitalization rates among older adults could help attenuate the anticipated increase in the number of hospitalizations among older adults and should be a high priority given the projected population growth among older adults in the United States."

Swine Workers at Increased Risk of Infection with Swine Influenza Virus

Fri, 25 Nov 2005 06:33:00 PST

( from http://www.rxpgnews.com ) With national attention focused on the avian flu threat, other infections that could be transmitted from animals to people are also coming under scrutiny. People with work exposure to pigs, such as farmers, veterinarians and meat processing workers, are at heightened risk of contracting swine influenza, according to a study in the Jan. 1 issue of Clinical Infectious Diseases, now available online.

Pigs physical makeup allows them to contractand to spreadinfluenza viruses to and from other species, such as humans and birds. Due to their susceptibility to influenza virus infections from other species, pigs can also serve as mixing vessel hosts that can produce new influenza virus strains that could pose a risk to human health.

In Iowa, the state with the highest swine production, researchers examined farmers, veterinarians, meat processing workers and a control group of people who had no occupational contact with pigs. They discovered that, of the four groups, farmers were most likely to be seropositivethat is, to have antibodies in their blood against swine influenza, indicating previous infection with the virus. Veterinarians also had increased odds of seropositivity. Meat processing workers had elevated antibody levels as well, though the odds were not as high, perhaps due to the workers limited exposure to live pigs.

Despite the possibility for human infection with swine influenza, people shouldnt panic, according to authors Gregory Gray, MD, and Kendall Myers, MS, of the University of Iowa. While severe swine influenza virus infections in humans have been reported, we expect that the normal clinical course of swine influenza infections [in humans] is mild or without symptoms, said Dr. Gray.

Pork consumption shouldnt pose a problem, either. Theres no evidence to suggest that swine influenza can be transmitted to humans through meat, Ms. Myers said, so as long as people cook pork thoroughly and practice good handwashing, then pork chops, bacon and ham can stay on the menu.

Because pigs are susceptible to human infections, both the pork industry and swine workers could benefit from the establishment of a human influenza vaccination program. There is no human vaccine against swine influenza at this point, but increasing surveillance for influenza among swine workers is one key component of helping to prevent an epidemic. Right now, [swine workers] are not included in the national pandemic plan, nor are they closely monitored for influenza, Dr. Gray said. Should pandemic influenza virus strains enter the United States and these workers not be given special attention, we think it could be a really big problem for Iowa.

Antibiotics Overprescribed For Pharyngitis

Wed, 09 Nov 2005 20:32:00 PST

( from http://www.rxpgnews.com ) Physicians prescribe antibiotics for more than half of children with sore throat, exceeding the expected prevalence of strep throat, and used nonrecommended antibiotics for 27 percent of children who received an antibiotic prescription, according to a study in the November 9 issue of JAMA.

Pharyngitis (inflammation of the throat) accounts for 6 percent of visits by children to family medicine physicians and pediatricians, according to background information in the article. The most common manifestation of acute pharyngitis is sore throat. The main bacterial cause of sore throat and the only common cause of sore throat warranting antibiotic treatment is group A beta-hemolytic streptococci (GABHS). GABHS are cultured from 15 percent to 36 percent of children with sore throat. To improve diagnostic accuracy and reduce unnecessary antibiotic treatment, it is recommended that a GABHS test be conducted prior to treating children with an antibiotic. Penicillin is the recommended antibiotic, but acceptable alternatives include amoxicillin, erythromycin (for penicillin-allergic patients), and first-generation cephalosporins.

Jeffrey A. Linder, M.D., M.P.H., of Brigham and Womens Hospital and Harvard Medical School, Boston, and colleagues conducted a study to determine the change in the rate and type of antibiotics prescribed to children with a chief complaint of sore throat, and the frequency of GABHS testing.

The researchers used data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1995 to 2003. The study included an analysis of visits by children aged 3 to 17 years with sore throat to office-based physicians, hospital outpatient departments, and emergency departments (n = 4,158), and of a subset of visits with GABHS testing data (n = 2,797).

The researchers found that physicians prescribed antibiotics in 53 percent of an estimated 7.3 million annual visits for sore throat and nonrecommended antibiotics to 27 percent of children who received an antibiotic. Antibiotic prescribing decreased from 66 percent of visits in 1995 to 54 percent of visits in 2003. This decrease was attributable to a decrease in the prescribing of recommended antibiotics (49 percent to 38 percent). Physicians performed a GABHS test in 53 percent of visits and in 51 percent of visits at which an antibiotic was prescribed. GABHS testing was not associated with a lower antibiotic prescribing rate overall (48 percent tested vs. 51 percent not tested), but testing was associated with a lower antibiotic prescribing rate for children with diagnosis codes for pharyngitis, tonsillitis, and streptococcal sore throat (57 percent tested vs. 73 percent not tested).

"In conclusion, we found that physicians prescribed antibiotics less frequently over time to children with sore throat. However, the overall antibiotic prescribing rate continues to exceed the expected prevalence of GABHS, and physicians continue to select unnecessarily broad-spectrum antibiotics. Unnecessary antibiotic prescriptions are not benign: they increase the prevalence of antibiotic-resistant bacteria, expose patients to adverse drug events, and increase costs. Perhaps unique among upper respiratory tract infections, clinicians have good, objective criteria in the form of GABHS testing to guide the antibiotic treatment of children with sore throat. Limiting antibiotic prescribing to children with a positive GABHS test result is a feasible goal for primary care physicians and an important step toward judicious use of antibiotics overall," the authors write.

Low Birth Weight Rates Vary Widely

Tue, 08 Nov 2005 21:32:00 PST

( from http://www.rxpgnews.com ) Low birth weight, an important risk factor of infant mortality and childhood developmental disorders, varies more than 3-fold in regions across the U.S., according to national research conducted at Dartmouth Medical School. The study offers promise for health care experts in an area of prenatal health where progress has been elusive.

Published in the November 7 issue of Pediatrics, the study is the first to investigate regional low birth weight rates on a national scale, and identifies regions that have significantly low or high low birth weight rates. The authors, based at the Center for the Evaluative Clinical Sciences at Dartmouth Medical School, concluded that birthplace is as important for neonatal outcomes as the race or prenatal health of the mother.

A low birth weight baby is defined as a newborn weighing less than 5.5 pounds. Although researchers have long known that low birth weight can be influenced by many factors including the biological interaction of the mother and the fetus, the parent's socioeconomic status, and medical care, these factors are little understood and public health initiatives aimed at reducing the incidence of low birth weight have been largely unsuccessful. National rates of low birth weight have actually increased over the past decade, a trend that has both economic and health consequences.

This study confirmed established knowledge that race plays a role in low birth weight, with an incidence of over 11 % of births to black mothers compared to less than 5 % of births to white mothers. Smoking or drinking during pregnancy approximately doubles the likelihood of low birth weight, as does a weight gain of less than 20 lbs. during pregnancy. Even after controlling for these established risk factors, the research team found that babies born in some regions of the U.S. were still more than 3 times as likely to be low birth weight compared to others.

"I was surprised that the regional variation across the country was still so high after accounting for other known factors," said Dr. Lindsay Thompson, who led the research at Dartmouth Medical School. "It is clear that place of residence is an important factor in neonatal outcomes," she said. "This is encouraging because these regions are linked to social and healthcare systems, and these are amenable to improvement."

Using a study population of 3,816,535 U.S. singleton births in 1998, and controlling for different characteristics that could predispose a child to being low birth weight, researchers then split the country into three groups that were above, the same, or below the national average of 6 low birth weight babies out of every 100 born. They found that of the 246 regions of the country used, 98 regions were higher than the national average and 67 were lower than the national rate by a significant degree. [see map]

While they do not know exactly why these regions vary to such a large degree, researchers hope that these data serve as a foundation for future studies and comparisons. They anticipate that regions with lower adjusted rates could serve as benchmarks for regions that need to improve through additional research and prevention efforts.

"The next research step is to look more closely at the types of available care and the services received by women in these regions," said co-author Dr. David Goodman, professor of pediatrics and of community and family medicine at Dartmouth Medical School and a pediatrician at Dartmouth-Hitchcock Medical Center. "The areas with better than expected rates of low birth weight may be regions with better reproductive and perinatal services."

Cervical Cancer Screening Programs For Low-Resource Areas Appear Effective And Safe

Wed, 02 Nov 2005 03:21:00 PST

( from http://www.rxpgnews.com ) Two "screen and treat" cervical cancer prevention programs developed for high-risk women in low-resource settings resulted in a lower prevalence of precancerous cervical lesions and cervical cancer, according to a study in the November 2 issue of JAMA.

Each year 471,000 cases and 233,000 deaths occur from cervical cancer worldwide, of which 80 percent occur in less-developed countries that have access to less than 5 percent of global cancer treatment resources, according to background information in the article. The lifetime risk of a woman developing cervical cancer in a low-resource setting is approximately 2 percent to 4 percent. Cytology (cell) -based screening programs have markedly reduced the incidence of cervical cancer in developed countries that have the infrastructure to support these programs. However, these screening programs have been difficult to implement in low-resource settings.

Recently, a novel approach to cervical cancer prevention has been proposed that avoids the complex health infrastructure required by traditional approaches. This approach incorporates noncytology-based screening methods such as human papillomavirus (HPV) DNA testing or visual inspection with acetic acid (VIA; a weak acidic solution) followed by treatment of lesions using cryotherapy (medical treatment that involves application of nitrous oxide to lesions and a device using very low temperatures) of all eligible women with positive test results. Cryotherapy is a relatively low-technology treatment method. These approaches have advantages for low-resource settings because they are not cytology-based screening programs and do not require colposcopy (specialized equipment for examination of the vagina and the cervix), which overcome two of the greatest barriers to cervical cancer prevention. However, the efficacy of these screen-and-treat approaches has not been established, and there has been only limited safety data.

Lynette Denny, M.D., Ph.D., of the University of Cape Town, South Africa, and colleagues conducted a study to determine the safety and efficacy of two screen-and-treat approaches for cervical cancer prevention. The randomized clinical trial included 6,555 nonpregnant women, aged 35 to 65 years, and was conducted between June 2000 and December 2002 at ambulatory womens health clinics in Khayelitsha, South Africa. All patients were screened using human papillomavirus (HPV) DNA testing and visual inspection with VIA. Women were subsequently randomized to 1 of 3 groups: cryotherapy if she had a positive HPV DNA test result; cryotherapy if she had a positive VIA test result; or to delayed evaluation.

The researchers found that compared with the delayed evaluation group, the prevalence of biopsy-confirmed high-grade cervical intraepithelial neoplasia and cancer (CIN 2+) at 6 months was significantly less in both the HPV DNA and VIA groups. At 6 months, CIN grade 2+ was diagnosed in 0.80 percent of the women in the HPV DNA group and 2.23 percent in the VIA group compared with 3.55 percent in the delayed evaluation group. "Thus, the screen-and-treat approach using HPV DNA testing was associated with a 77 percent lower prevalence of CIN 2+ than in the delayed evaluation group at 6 months, whereas the screen-and-treat approach using VIA was associated with a 37 percent lower prevalence," the authors write.

Data were obtained from 2,708 women (74 percent of those scheduled to be examined) and the cumulative prevalence of CIN 2+ by 12 months in both screen-and-treat groups continued to be lower than in the delayed evaluation group. In the HPV DNA group, 1.42 percent had CIN 2+ by 12 months compared with 2.91 percent in the VIA group and 5.41 percent in the delayed evaluation group. "This translates into 1 case of CIN 2+ being averted for every 25 women enrolled in the HPV DNA group and 1 case being averted for every 40 women enrolled in the VIA group," the researchers write.

Although minor complaints, such as discharge and bleeding, were common after cryotherapy, major complications were rare.

"This trial has shown that screening and treating women based on the results of two alternative screening tests to cytology, HPV DNA testing and VIA, is safe and has a significant impact on the prevalence of CIN 2+ among women participating in such a program. In low-resource settings, screen-and-treat approaches may be able to reduce the risk of a common and easily preventable cancer in women," the authors conclude.

In an accompanying editorial, Paul D. Blumenthal, M.D., M.P.H., of Johns Hopkins University, Baltimore, and Lynne Gaffikin, Dr.P.H., of Evaluation and Research Technologies for Health Inc., Oakland, Calif., comment on the studies in this weeks JAMA on screening for cervical cancer.

"When faced with a challenge, identifying and seizing an opportunity can be the first step toward triumph. That is what public health approaches are often about. An important lesson from the work of Brewster et al and Denny et al is that whether in southern California or southern Africa, safe, acceptable, effective, and pragmatic public health approaches to cervical cancer prevention can be designed."

"The advent of a vaccine to prevent human papillomavirus infection, widely perceived to be just around the corner, is eagerly awaited to advance preventive capabilities. Recent data reported by Skjeldstad and colleagues made this development increasingly likely. However, even if a vaccine became available tomorrow, several generations of women worldwide would still need conventional care. To provide care to all women, future cervical cancer prevention programs worldwide will need to be designed to reach women who are at highest risk for disease and to ensure that the critical components of testing, treatment, and follow-up are realized as appropriate for every woman. Programs that build on the experience reported in these articles will have a good start in achieving those goals," they write.

US Health Care Cuts Are Costing Lives

Sat, 29 Oct 2005 14:49:00 PST

( from http://www.rxpgnews.com ) Health care cuts in the US are costing lives, argues one American citizen in this weeks BMJ. Lori Smith, a representative of the Poor Peoples Economic Human Rights Campaign in Tennessee, believes that plans to dismantle national social programmes for sick and poor people throughout the US are leading to suffering and death.

There has been a tendency to believe that poverty, hunger, homelessness, and lack of health care are nearly non-existent in the US, she writes. After all, the US is the richest country in the world. However, human rights violations and suffering are prevalent and growing rapidly.

She describes how, after losing her job and accompanying health insurance through illness, she was one of 150,000 people removed from Tennessees medical programme (TennCare) under government plans to cut health spending.

These are the largest cuts in US history, and deaths have already occurred as a result, she says. For the 1.1 million who remain on the programme, only the cheapest medical care will be available, without regard to professional medical standards.

There is enough money to provide health care for all, she argues. The US government knows it, yet it is allowing this to happen at the expense of human lives, while the healthcare industry is reaping record profits.

She is committed to breaking the silence over these cuts and taking action. She calls on others around the world to join her in bringing national and international attention to human rights violations in the US.

CDC Advises Broadening of Influenza's Vaccination Efforts

Thu, 27 Oct 2005 00:26:00 PST

( from http://www.rxpgnews.com ) The Centers for Disease Control and Prevention (CDC) today said that the supply of vaccine for this flu season is good and it is time to broaden vaccinations beyond the high-risk groups. The CDC advised that flu shot providers who have sufficient supplies of vaccine should broaden their vaccination efforts to include other people, especially 50-to-64 year olds, who are interested in getting an influenza vaccination.

The CDC had recommended that until October 24, health care providers focus their vaccination efforts on people who are at highest risk of serious complications from influenza. These include people 65 years old and older, health care workers who provide patient care, pregnant women, 6 to 23-month old children, and people with chronic health conditions (e.g., diabetes, asthma, and heart conditions).

It is always a priority for us to want to reach people who are at the highest risk of complications from influenza and get them vaccinated, said CDC Director Dr. Julie Gerberding. Those efforts should continue, but we also recognize that many health care providers have enough vaccine to expand their efforts, and overall, more vaccine is becoming available weekly.

So far eight states are reporting very mild influenza activity. This level of activity is typical for this time of year. Influenza peeks most often in January and February so the coming weeks on into December afford excellent opportunities for vaccination.

Gerberding noted that not all health-care providers have received their influenza vaccine, but are expecting to be receiving it in the coming weeks. These localized shortages are the result of distribution anomalies that are expected to be resolved soon.

In those situations, we ask people to check with their doctor first to make sure they have a supply, said Gerberding. Were early into the time when people should get flu vaccinations and many doctors will be receiving vaccine shortly. Millions of more doses of vaccine are on the way, and November and December are also fine when it comes to getting your flu vaccination.

Local health care providers or public health officials will know about the availability of vaccine in specific communities. Getting a flu shot is important. Wellness and prevention should be the first priority for families across the country as this flu season begins.

A Virtual Katrina of deaths every week in US due to racial health gap

Fri, 21 Oct 2005 15:51:00 PST

( from http://www.rxpgnews.com ) Research estimates that health inequalities between white and black Americans cause 84,000 extra deaths every year equating to a virtual hurricane Katrina every week, says an editorial in this weeks BMJ. But because the victims die gradually from diseases such as diabetes, heart disease, cancer, HIV, and from drug and alcohol abuse, the public are generally unaware of the scale of the fatalities.

Hurricane Katrina has exposed US health inequalities, though these are not unique to Americas racial legacy, argue the authors. Poverty, unemployment, alienation and neglect all contribute to the health divide for the poorest and for minority communities across the US, the UK and other western countries.

In America, however, the result is a health gap which has endured despite years of health developments and economic growth, and progress on race issues.

The hurricanes devastating aftermath exposes the policy changes from both government and the private sector which must be introduced to tackle the health divide, say the authors. These include investing in prevention not just rescue strategies, strengthening public health systems, and supporting responsible choices by individuals. For instance, promoting healthy eating and exercise is only of limited benefit in poor communities where parks and supermarkets are less common than fast food chains and stores selling alcohol.

As the US rushes to rebuild its southern states, Americans should think carefully about how they could create healthier and more equal communities. It is even more important that we and others apply these lessons to help the many other individuals and communities with poor health who continue to languish out of the public eye, they conclude.

Number of bariatric surgical procedures increased considerably

Wed, 19 Oct 2005 20:24:00 PST

( from http://www.rxpgnews.com ) The number of bariatric surgical procedures performed in the U.S. from 1998 to 2003 increased considerably, according to a study in the October 19 issue of JAMA.

Morbid obesity is an increasing health problem in the United States, according to background information in the article. In 2002, 5.1 percent of U.S. adults had a body mass index (BMI) higher than 40. The prevalence of individuals with a BMI higher than 40 quadrupled from 1:200 in 1986 to 1:50 in 2000; the prevalence of individuals with a BMI higher than 50 quintupled from 1:2000 to 1:400. The increasing prevalence and associated sociodemographic disparities of morbid obesity are serious public health concerns. Bariatric surgical procedures provide greater and more durable weight reduction than behavioral and pharmacological interventions for morbid obesity.

Heena P. Santry, M.D., of the University of Chicago, and colleagues examined recent national population-based trends in bariatric surgical procedures, patient characteristics, and in-hospital complications to determine trends in newer techniques, in sociodemographic disparities, in co-existing illnesses, and in surgical complications due to these procedural and patient population changes. The researchers used the Nationwide Inpatient Sample to identify U.S. bariatric surgery admissions from 1998-2002 (with preliminary data for 12 states for 2003).

The researchers found that the estimated number of bariatric surgical procedures increased from 13,365 in 1998 to 72,177 in 2002. Based on preliminary state-level data (1998-2003), the number of bariatric surgical procedures is projected to be 102,794 in 2003. Gastric bypass procedures accounted for more than 80 percent of all bariatric surgical procedures. From 1998 to 2002, there were upward trends in the proportion of females (81 percent to 84 percent), privately insured patients (75 percent to 83 percent), patients from ZIP code areas with highest annual household income (32 percent to 60 percent), and patients aged 50 to 64 years (15 percent to 24 percent). Length of stay decreased from 4.5 days in 1998 to 3.3 days in 2002. The adjusted in-hospital death rate ranged from 0.1 percent to 0.2 percent. The rates of unexpected reoperations for surgical complications ranged from 6 percent to 9 percent and pulmonary complications ranged from 4 percent to 7 percent. Rates of other in-hospital complications were low.

"If our observed rate of growth continues, there will be approximately 130,000 bariatric procedures in 2005 and as many as 218,000 in 2010. The cost to the U.S. health care system will be substantial. However, in the absence of a nonsurgical option for morbid obesity, our findings regarding in-hospital safety of bariatric surgery are promising while our findings regarding worsening sociodemographic disparities are worrisome," the authors write.

"Disproportionate sociocultural pressures to be thin may explain the imbalance between men and women undergoing an elective procedure for weight loss. Type of insurance coverage also may play a role in socioeconomic disparities," the researchers write. "Other sources of disparities include the possibility that cultural attitudes toward morbid obesity may differ by socioeconomic status, that primary care physicians may be less likely to refer patients of lower socioeconomic status for bariatric surgery, or that hospitals providing bariatric surgery may be less accessible to lower socioeconomic groups."

The researchers add that public health campaigns focusing on the health dangers of obesity may help shift thinking about obesity from a cosmetic concern of women to a health concern for both sexes.

"With increased knowledge of bariatric surgery indications, risks, and benefits among health care professionals, bariatric surgery is likely to become the standard of care for morbidly obese individuals. Together, these changes should lead to more morbidly obese patients of both sexes and all socioeconomic groups seeking surgery. Although preventing obesity should remain the focus of U.S. health care, efforts must be made to ensure equal access to bariatric surgery irrespective of sex and socioeconomic status for those who are morbidly obese, have an indication for surgical intervention, and wish to undergo an elective surgical procedure to improve health, longevity, and quality of life," the authors conclude.

In an accompanying editorial, Bruce M. Wolfe, M.D., of Oregon Health & Science University, Portland, and John M. Morton, M.D., M.P.H., of Stanford University, Stanford, Calif., comment on the studies in this week's JAMA on bariatric surgery.

"These studies contribute important information regarding morbid obesity and its treatment. Morbid obesity is a significant health concern and bariatric surgery offers a potentially effective and enduring treatment for weight reduction. Bariatric surgery results in long-term weight loss, helps resolve comorbidities, provides a survival benefit, and has increased substantially as a direct consequence of its success in treating morbid obesity. These studies demonstrate that there are vulnerable patient populations and potential additional costs associated with surgery but suggest that surgical volume helps mitigate these risks and costs. Bariatric surgery may be a potentially life-saving intervention in the right patients and in the right surgeons' hands. The studies presented in this issue indicate that experience and technique count."

"Given that obesity is a societal concern, there must be societal solutions and perspective. Prevention initiatives, medical alternatives, and new technologies may emerge in the future to help combat obesity. However, bariatric surgery today remains a fundamental therapy for morbidly obese patients. The studies by Santry et al, Zingmond et al, and Flum et al must be seen as opportunities for improvement in bariatric surgery, not as support for exclusionary practices by payors for patients in dire need. Instead, bariatric surgeons must meet the challenge of safely and efficiently providing this essential therapy for the most imperiled patients," the authors write.

Medicare patients have higher risk of death after bariatric surgery

Wed, 19 Oct 2005 20:09:00 PST

( from http://www.rxpgnews.com ) Medicare patients have a substantially higher risk of early death following bariatric surgery than previously suggested, and the risk of death is higher among men, older patients, and patients of surgeons who perform lower numbers of bariatric procedures, according to a study in the October 19 issue of JAMA.

In the United States, most adults are overweight or obese, and obesity is soon to become the leading cause of death, according to background information in the article. Bariatric surgical procedures (surgery on the stomach and/or intestines designed to promote weight loss) are the only interventions that consistently help patients achieve significant and sustained weight loss and improvements with co-existing medical conditions. As a result, there has been dramatic growth in bariatric surgery over the last decade. Balanced against these beneficial effects, however, are the risks of perioperative death and short-term adverse outcomes, which have been poorly defined in the community at large.

David R. Flum, M.D., M.P.H., of the University of Washington, Seattle, and colleagues conducted a study to determine the risk of all-cause early postsurgical death among Medicare beneficiaries undergoing open bariatric surgery. The study examined early (30-day, 90-day, and 1-year) death figures for all U.S. fee-for-service Medicare beneficiaries who underwent bariatric procedures from 1997-2002.

A total of 16,155 patients underwent bariatric surgical procedures (average age, 48 years; 75.8 percent women, with 90.6 percent younger than 65 years). A total of 61.2 percent of cases were claims for the bariatric surgical procedure Roux-en-y gastroenterostomy (RYGB) and 19.9 percent were for RYGB with small intestine reconstruction to limit absorption. There was more than a 3-fold increase in the number of procedures performed from 1997 (n=1,464) to 2002 (n=4,814).

The researchers found that among all patients, the rates of 30-day, 90-day, and 1-year death were 2.0 percent, 2.8 percent, and 4.6 percent, respectively. Advancing age and male sex were associated with early death after bariatric surgery, with the highest rates of early death among older men. Overall, men were more likely to die after bariatric surgery than women (3.7 percent vs. 1.5 percent, 4.8 percent vs. 2.1 percent, and 7.5 percent vs. 3.7 percent for men and women at 30 days, 90 days, and 1 year, respectively). Death rates were greater for those aged 65 years or older (n=1,517) compared with younger patients (4.8 percent vs. 1.7 percent, 6.9 percent vs. 2.3 percent, and 11.1 percent vs. 3.9 percent at 30 days, 90 days, and 1 year, respectively).

After adjustment for sex and co-existing illness index, the odds of death within 90 days were 5-fold greater for older Medicare beneficiaries (aged 75 years or older; n=136) than for those aged 65 to 74 years (n=1,381). The odds of death at 90 days were 1.6 times higher for patients of surgeons with less than the median surgical volume of bariatric procedures (among Medicare beneficiaries during the study period) after adjusting for age, sex, and co-existing illness index.

"There may be several reasons for these findings. Older patients do not tolerate surgical stress as well as younger patients and may also have less benefit after surgery than younger patients because much of the impact of obesity on organ systems, such as the heart, may have occurred by the time of the operation. It also remains to be seen if surgical weight loss in older patients decreases utilization of health care resources, improves functional status and quality of life, or extends survival as has been suggested in studies of younger patients," the authors write.

"In conclusion, this study found that the risk of early postsurgical death among Medicare beneficiaries undergoing bariatric surgery was considerably higher than prior case series have suggested and was strongly associated with advancing age, male sex, and lower surgeon volume. Those considering the role of bariatric procedures in older patients should balance this population-level risk of adverse outcomes against the anticipated benefits of the procedure. Directing care of older patients to surgeons who perform higher volume of bariatric procedures in Medicare beneficiaries might be expected to improve outcomes in this high-risk population," the researchers write.

Little Gain from Physicians Pay-For-Performance Programs

Sat, 15 Oct 2005 20:02:00 PST

( from http://www.rxpgnews.com ) Paying clinicians to reach a common, fixed performance target may produce little gain in overall quality, and may largely reward those with higher performance at baseline, according to a study in the October 12 issue of JAMA.

The number of health plans and purchasers in the United States that have adopted pay-for-performance mechanisms for quality improvement is growing rapidly, according to background information in the article. However, most of these programs are in the early stages of trial, evaluation, and adjustment. Although there is intense interest in and optimism about pay-for-performance programs among many policy makers and payers, there is little published research on pay-for-performance in health care. There have been a few studies demonstrating that pay-for-performance leads to improved quality of care.

Meredith B. Rosenthal, Ph.D., of the Harvard School of Public Health, Boston, and colleagues conducted a study on the impact of a prototypical physician pay-for-performance on quality of care within one of the nation's largest health plans, PacifiCare Health Systems. In 2003, PacifiCare began paying its California medical groups bonuses according to meeting or exceeding 10 clinical and service quality targets. The researchers examined the performance of California medical groups that were subject to pay-for-performance, and a comparison group in the Pacific Northwest (Oregon and Washington). Quality improvement reports were included from October 2001 through April 2004 issued to approximately 300 large physician organizations. There were three process measures of clinical quality: cervical cancer screening, mammography, and hemoglobin A1c testing.

The researchers found that clinical quality scores improved as follows: for cervical cancer screening, 5.3 percent for California vs. 1.7 percent for Pacific Northwest; for mammography, 1.9 percent vs. 0.2 percent; and for hemoglobin A1c testing, 2.1 percent vs. 2.1 percent. Compared with physician groups in the Pacific Northwest, the California network demonstrated greater quality improvement after the pay-for-performance intervention only in cervical cancer screening (a 3.6 percent difference in improvement). For all 3 measures, physician groups with baseline performance at or above the performance threshold for receipt of a bonus improved the least but garnered the largest share of the bonus payments.

"In the first year of its quality incentive program (QIP), the plan paid $3.4 million of a potential bonus pool of $12.9 million. Three quarters of the 172 physician groups eligible at some point during the year for the program received some funds from the bonus pool. We also observed that few groups reached a majority of targets, consistent with the low correlation in performance across clinical areas that has been observed in other studies. Physician groups whose performance was initially lowest improved the most, whereas physician groups that had previously achieved the targeted level of performance improved the least. Unlike quality improvement, which followed an inverse relationship to baseline performance, bonus dollars were garnered in direct proportion to baseline performance. Physician groups whose performance was above the bonus threshold at baseline captured 75 percent of bonus payments on average across the 3 quality domains we examined, despite their limited improvement," the authors write.

"Our findings give rise to a number of speculations about the effects of pay-for-performance. First, groups with baseline performance already above the targeted threshold appeared to understand that they needed only to maintain the status quo to receive the bonus payments. More surprising, perhaps, is that low-performing groups improved as much as they did, given that their short-run chances of receiving a bonus were likely to be low. One possibility is that the groups viewed the QIP as a larger signal of a changing environment in which they would face increasing pressure to improve their care systems and decided to begin moving in that direction. Paying explicitly for quality improvement might alter the incentives for high-performing and low-performing groups, distribute bonus dollars more toward the latter group, and possibly increase the overall impact of pay-for-performance."

The authors add that one possible reason that the QIP failed to yield a greater response is that the financial rewards for quality were too low to motivate substantial departures from the underlying trend in quality improvement. Per enrollee, the maximum annual bonus was a relatively modest $27, or about 5 percent of the professional capitation amount. Moreover, PacifiCare accounts for only about 15 percent of the average group's revenue.

"PacifiCare's QIP, like most current pay-for-performance programs, should be viewed as a first step in the direction of aligning payment incentives with health system quality goals. Realization of the full potential of pay-for-performance to reduce the persistent gap between evidence-based and actual practice will require that payers adapt their incentive strategies as evidence to support best practices accumulates. The principal lesson we derive from this experience is that incentive design matters. The accumulating evidence from the continuing experimentation with pay-for-performance in the market will highlight these initial findings and other potential design lessons," the researchers conclude.

In an accompanying editorial, R. Adams Dudley, M.D., M.B.A., of the University of California, San Francisco, comments on the study on pay-for-performance and discusses implications for future research in this area.

"While the study by Rosenthal et al is well designed, much more is needed. Pay-for-performance involves a common problem in health services research: despite little evidence, clinicians and policy makers are responding to a major policy trend, while researchers determine how to inform those decision makers. In this context, investigators and research funders need to develop strategies that address 4 fundamental aspects of research: study design, selecting theory-driven hypotheses, reporting research findings in a complete and informative manner, and setting research priorities. Until these issues are clearly addressed, clinicians should be skeptical of any research that purports to describe the impact of pay-for-performance," Dr. Dudley writes.

Total cholesterol level among older adults declining in U.S.

Sat, 15 Oct 2005 19:53:00 PST

( from http://www.rxpgnews.com ) The total cholesterol level among older adults has declined significantly, while there has been little change among younger adults, according to a study in the October 12 issue of JAMA.

Serum total and low-density lipoprotein (LDL) cholesterol contribute significantly to atherosclerosis and its related adverse effects, according to background information in the article. Previous analyses of data from the National Health and Nutrition Examination Surveys (NHANES) showed that mean (average) levels of total cholesterol of U.S. adults had declined from 1960-1962 to 1988-1994, and average levels of LDL cholesterol (available beginning in 1976) had declined between 1976-1980 and 1988-1994.

Margaret D. Carroll, M.S.P.H., of the Centers for Disease Control and Prevention, Hyattsville, Md., and colleagues evaluated trends in lipids between 1960 and 2002 and examined potential contributing factors to the trends observed. The researchers analyzed data from 5 distinct cross-sectional surveys (National Health Examination Survey [NHES] and NHANES) of the U.S. population during 1960-1962, 1971-1974, 1976-1980, 1988-1994, and 1999-2002 that included blood lipid measurements taken from 6,098 to 15,719 adults.

The researchers found: "The age-adjusted [average] total cholesterol level of adults 20 years or older decreased from 206 mg/dL (5.34 mmol/L) in 1988-1994 to 203 mg/dL (5.26 mmol/L) in 1999-2002 and the age-adjusted [average] LDL cholesterol level decreased from 129 mg/dL (3.34 mmol/L) to 123 mg/dL (3.19 mmol/L) during this same period. Significant and substantial declines in [average] total and LDL cholesterol levels were observed in men 60 years or older and women 50 years or older but not in younger adults. In general, [average] high-density lipoprotein (HDL) cholesterol levels did not change during this period. The age-adjusted geometric [average] serum triglyceride level of adults 20 years or older increased from 118 mg/dL (1.33 mmol/L) in 1988-1994 to 123 mg/dL (1.39 mmol/L) in 1999-2002 but was not statistically significant. The age-adjusted percentage of adults 20 years or older with serum total cholesterol level of at least 240 mg/dL (6.22 mmol/L or greater) decreased from 20 percent to 17 percent, thereby achieving one of the Healthy People 2010 objectives."

The authors say that a factor that likely contributed to the decrease in total and LDL cholesterol observed predominantly in the older age groups is the use of cholesterol-lowering medication. Between 1995-1996 and 2001-2002, there was an increase in the number of physician-office visits and hospital visits of men and women aged 45 years or older with statins prescribed. The researchers add that dietary data from NHANES 1999-2002 demonstrated only a small change in the overall intake of saturated fat or cholesterol.

"The continued decrease of total and LDL cholesterol levels in older adults is a positive trend. Clinical trial results suggest that a 1 percent decrease in LDL cholesterol translates into a 1 percent decrease in relative risk for coronary heart disease (CHD)," the authors write. "It appears that the decreases in total and LDL cholesterol may have been influenced more by increased medication use rather than by positive lifestyle changes. Increasing prevalence of obesity among adults may have contributed to a blunting in the decrease in total and LDL cholesterol levels, as reflected in the observed trend toward increased triglyceride levels. However, further research is needed to assess simultaneously the effects of lipid-lowering medications and other lifestyle factors on lipids."

"The National Heart, Lung, and Blood Institute's National Cholesterol Education Program recommends a healthy lifestyle, which includes reducing intake of saturated fat and cholesterol, achieving and maintaining healthy weight, and increasing physical activity for all adults, and regards additional efforts to promote such lifestyle changes to be important for achieving further improvements in the population's lipid levels. Additional analyses of these critical population lifestyle factors and lipid data are important. NHANES continues to monitor lipids and related lifestyle factors of CHD in the U.S. adult population," the authors conclude.

Florida physicians continue to decrease or eliminate important health services

Tue, 11 Oct 2005 19:23:00 PST

( from http://www.rxpgnews.com ) Florida physicians reportedly continued to decrease or eliminate important health services in 2004 in response to difficulties in finding or paying for professional liability insurance, according to a study in the October 10 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

Despite growing concern about possible effects of instability in the professional liability insurance (PLI) market on patient access to health care, there has been little formal, systematic assessment of how physicians may be changing their services to adapt, according to background information in the article. Understanding the impact of professional liability insurance market instability on health service delivery is important to clinicians and policymakers concerned with patients' access to needed medical care, the authors suggest.

Robert G. Brooks, M.D., of Florida State University, Tallahassee, and colleagues surveyed rural and urban/suburban physicians in Florida in 2004 to determine recent changes in services offered, professional liability insurance premium changes, satisfaction with practice and future practice plans.

Overall, 727 (54.4 percent) of the 1,346 responding physicians (380/685 rural and 347/661 urban/suburban physicians) stated that they had decreased or eliminated the delivery of patient services in the previous year, the researchers report. "The most common services eliminated were nursing home coverage (42.1 percent), vaginal deliveries (29.1 percent) cesarean deliveries (26.0 percent), emergency department coverage (22.8 percent) and mental health services (21.2 percent). In addition to outright elimination, a number of physicians responded that they had decreased services in these areas as well. ...Surgical specialists (70.2 percent) and general surgeons (68.5 percent) respectively, had the highest number of decreased or eliminated services. Obstetricians/gynecologists (63.6 percent) and family medicine physicians (60.2 percent) were also commonly represented in this group."

"Changes in health care services seemed to be related to changes in PLI premiums," the authors write. "Overall, physicians who had premium changes in the highest quartile (increase > 50 percent) (61.1 percent) were more likely to indicate that they had decreased or eliminated services compared with those in the lowest quartile (increase < 15 percent) (51.4 percent). ...Similarly, we noted statistically significant relationships between increases in PLI premiums and decrease in or elimination of services for rural physicians (66.2 percent vs. 48.1 percent) and for actual premiums for urban/suburban physicians (64.7 percent vs. 43.0 percent.)"

The authors conclude that the findings presented in the study "strongly suggest that physicians across Florida have continued to decrease or eliminate important health care services. This trend seems to be affecting a broad array of services and types of physicians, both generalists and specialists. Given the importance of access to health care for vulnerable populations, these statewide trends suggest the need for additional attention by physician leaders and policy-makers to the ongoing effects of the PLI market."

Inappropriate Prescribing of Antibiotics by NPs and MDs Continues

Thu, 06 Oct 2005 21:55:00 PST

( from http://www.rxpgnews.com ) Both nurse practitioners and physicians are prescribing inappropriate antibiotics to patients with viral upper-respiratory tract infections, a practice that may lead to increased rates of antimicrobial resistance. Researchers also found that highly marketed broad-spectrum antibiotics are being prescribed excessively, by both NPs and MDs, to patients with diagnoses of viral illnesses. It is well accepted that antibiotics have no clinical effect in the treatment of these illness.

The study, published in the Journal of the American Academy of Nurse Practitioners, further found that antibiotic prescribing by nurse practitioners to patients with Medicaid insurance was more appropriate than that of physician prescribing for the same category of patients. This may suggest a difference in response, by NPs, to patient demand among this population and/or a keener awareness among NPs of the budget constraints that are affecting state Medicaid programs.

According to the study, increased adherence, especially by nurse practitioners, to well accepted clinical guidelines and involvement in system-based quality assurance programs are needed to decrease this excessive use of antibiotics.

Aetna Workers Comp access growing in 17 markets

Thu, 06 Oct 2005 21:22:00 PST

( from http://www.rxpgnews.com ) Aetna (NYSE: ΑET) announced today that it is expanding its Aetna Workers Comp Access® (AWCA) network into six additional markets, adding to the more than 190,000 physicians and health care professionals and 900 hospitals currently participating in 11 other markets. The expansion advances Aetnas ability to offer its customers a market-leading national network for injured workers.

AWCA offers a network access product for workers compensation services. The AWCA network includes primary care physicians, occupational medical centers, urgent care centers, physical therapy providers, chiropractors, radiology centers, orthopedists, orthopedic surgeons and facilities.

"The network helps workers compensation insurance carriers and employers manage the rising cost of workplace injuries while providing access to care that can help injured workers return to work quickly and productively," said Greta Montes, network market head for AWCA.

Claimants get access through their employers, who have contracts with workers compensation carriers and administrators who have a relationship with AWCA, or employers who self-insure their workers compensation coverage and are customers of AWCA.

The new markets where AWCA is expanding are Delaware, Florida, Illinois, North Carolina, New York and the District of Columbia. The latest expansion complements the existing AWCA network available in Arizona, Colorado, Connecticut, Missouri, New Jersey, Pennsylvania, Tennessee, Texas, Virginia, and most recently Michigan and Indiana, which were added to AWCAs network portfolio with Aetnas acquisition of HMS Healthcare.

"The introduction of AWCA remains a tremendous opportunity for Aetna to develop a new line of business and expand our core capabilities to serve new markets," Montes said. "We expect a high percentage of participation from physicians, other health care professionals and hospitals currently participating in an Aetna network in states where we are building the AWCA network."

Aetna urges vaccination for members in high risk groups

Thu, 29 Sep 2005 21:14:00 PST

( from http://www.rxpgnews.com ) Aetna (NYSE: ΑET) today announced a convenient option for members to receive influenza vaccinations (flu shots) this season. Aetna has contracted with Maxim Health Systems to administer flu shots to Aetna members. Maxim Health Systems administers the flu shot to people over 9 years old at over 24,000 retail facilities and corporations across the nation using their own staff.

This broadened access is available to members in addition to the option of receiving the vaccination from their physician. As with visits to any healthcare provider, members should take their Aetna ID card with them when visiting a Maxim flu clinic.

"We want to make it as easy as possible for our members, especially those in the high risk groups for influenza, to get a flu shot this year," said Charles M. Cutler, M.D., Aetnas national medical director for Quality Management. "Getting vaccinated is the most important step a member can take to improve their chances of avoiding the flu. If a member cant get to their doctors office for the shot, then we hope they will receive a flu shot at one of the conveniently located Maxim flu clinics."

Online Training Can Greatly Improve Physician Readiness To Diagnose Bioterrorism Diseases

Wed, 28 Sep 2005 13:54:00 PST

( from http://www.rxpgnews.com ) More than one-half of 631 physicians tested were unable to correctly diagnose diseases caused by agents most likely to be used by bioterrorists, such as smallpox, anthrax, botulism and plague, according to a Johns Hopkins study published in the Sept. 26 issue of Archives of Internal Medicine.

However, test scores improved dramatically for the same physicians after they completed an online training course in diagnosing and managing these diseases caused by bioterrorism agents, according to the Hopkins research team, led by Stephen Sisson, M.D., assistant professor of medicine.

The Internet offers many resources on bioterrorism training, including the Centers for Disease Control and Preventions website as well as the Hopkins curriculum, and physicians who want to be prepared should take the initiative to familiarize themselves with this information, Sisson noted.

Most American physicians in practice today have never seen any cases of these diseases in their practice, explained Sara Cosgrove, M.D., M.S., a faculty member in Hopkins Division of Infectious Diseases. Preparation will be key to dealing with a major catastrophe, such as a major bioterrorist attack. Education and training healthcare providers in disease recognition, treatment and prevention strategies have the potential to significantly limit the effects of a bioterrorism attack.

In the study, 631 physicians at 30 internal medicine residency programs in 16 states and Washington, D.C. were tested on how to recognize and treat bioterrorism-related diseases before and after taking an online course in bioterrorism disease. On the pretest, correct diagnosis of diseases due to bioterrorism agents was smallpox, 50.7 percent; anthrax, 70.5 percent; botulism, 49.6 percent; and plague, 16.3 percent (average 46.8 percent), the researchers report. Correct diagnosis averaged 79.0 percent after completion of the course. Correct management of smallpox in the pretest was 14.6 percent; anthrax, 17.0 percent; botulism, 60.2 percent; and plague 9.7 percent (average 25.4 percent). Correct management averaged 79.1 percent after course completion.

Surgeons lack training in palliative surgical options

Mon, 26 Sep 2005 21:14:00 PST

( from http://www.rxpgnews.com ) A survey of general surgeons suggests that the amount of education and training they receive in palliative care is limited, according to a study in the September issue of Archives of Surgery, one of the JAMA/Archives journals.

Previous studies have indicated that surgeons receive little training in palliative surgical intervention, the objective of which is to relieve symptoms and improve quality of life rather than cure disease or extend survival, according to background information in the article. Because the goals of surgical palliation must be balanced with the associated risks of surgery, the decision to operate can be challenging for even the most experienced surgeon. Deficiencies in training during residencies and insufficient education in the evaluation of surgical options when there is not much hope of cure may contribute to a lack of consensus treatment recommendations for patients with advanced cancer and a variety of common symptoms, the authors suggest.

Joseph M. Galante, M.D., of the University of California, Davis, Medical Center, Sacramento, Calif., and colleagues surveyed 124 surgeons in Sacramento and the surrounding area about the type and extent of their postgraduate education in palliative surgery. The surgeons were also asked to select the single best treatment option from a preset list for four clinical scenarios and to identify the goals of the intervention and the three most important factors influencing their decision.

"Significant deficiencies in education were identified; 59 (84 percent) of the [70] respondents did not receive any education in palliative surgical care during residency and 28 (44 percent) lacked continuing medical education," the authors report. "A consensus treatment recommendation was not selected in three of the four clinical vignettes, but the respondents used similar clinical factors and goals of treatment for selection of the specific recommendation.

"Part of the lack of a standard approach to palliative surgical care in patients we identified may be based on the fact that physicians receive their training and experience in palliative care from diverse sources at various stage in their careers," the authors write.

"In conclusion, although most surgeons have similar goals in providing palliative care, treatments recommended may vary significantly," the authors write. "Furthermore, prior education clearly affects the recommended treatment option to achieve palliation of disease-related symptoms in patients with advanced malignancies. Thus, we advocate a continued effort to train surgeons in palliation and recommend that the training be part of a nationwide program to standardize palliative surgical care."

Black immigrants' health erodes the longer they live in the U.S.

Mon, 19 Sep 2005 12:49:00 PST

( from http://www.rxpgnews.com ) In the first national study of its kind, sociologists from Rice University and University of California (UC)-Irvine find that black immigrants who arrive in America from black-majority regions of the world are healthier than those from white-majority regions; but regardless of how healthy blacks immigrants are when they come to the U.S., the longer they stay, the more their health erodes. The findings suggest racial discrimination is a major cause of poor health for American blacks -- native and foreign-born alike.

Rice's Michael Emerson and UC-Irvine's Jen'nan Read examined the health of about 3,000 black immigrants coming from the top regions of black emigration: The Caribbean, Africa, South America and Europe. The researchers focused on three measures of health: self-rated health, disability and hypertension.

Compared to U.S.-born blacks, those born in Europe -- a majority-white region that most closely resembles the U.S.'s racial structure -- are the least healthy, faring no better than American-born blacks. Blacks born in Africa and South America, where whites are the small minority, are much healthier than U.S.-born blacks. Those born in the Caribbean, a racially mixed region, are healthier than U.S.-born blacks but less healthy than those from Africa and South America. According to Emerson and Read, racial minorities are exposed to more stressful life events caused by discrimination. Stress, a key risk factor for many ailments, accumulates over the life course to harm health.

The study, published in the September issue of Social Forces, is the first to look at the health of black immigrants by their region of origin. Prior to 2000, national-level health data combined all black immigrants into a single category, which obscured the differences among them. This study shows the value of breaking them out as individual groups by home region.

"These findings point to the persistent black/white health gap in the United States," said Emerson, the Allyn R. and Gladys M. Cline Professor of Sociology and director of the new Center on Race, Religion and Urban Life. "Whatever health advantage black immigrants have when they arrive is lost as they, and then their children, become part of the U.S. racial landscape and experience the consequences of being black in America."

Emerson and Read reported that European-born blacks' health was more similar to American-born blacks' than to other black immigrants'. Previous studies have shown that immigrants are healthier than their U.S. counterparts when they come to America, primarily because of the selective nature of immigration: those who immigrate are in good health and/or have the financial resources to make such a move. "European countries have a much higher standard of living than African and Caribbean countries," Emerson said. "At the same time, the racial dynamics in many European countries are similar to those in the U.S., and we know from studies here that blacks are exposed to more stressful life events that have negative consequences for their mental and physical health."

Emerson and Read noted that although this study does not provide the definitive explanation for the black/white health gap in the U.S., it encourages researchers and policy-makers to take a much harder look at how racial discrimination harms health.
Primary data on health assessment for the study came from the 2000-2002 National Health Interview Surveys, which were conducted by the National Center for Health Statistics and the Centers for Disease Control and Prevention. Additional data for the study came from the U.S. Census Bureau, the Office of Immigration Statistics and the Central Intelligence Agency's World Factbook.

Warning Of Spread Of Rocky Mountain Spotted Fever

Wed, 14 Sep 2005 03:27:00 PST

( from http://www.rxpgnews.com ) An infectious disease expert at Johns Hopkins who has spent nearly three decades studying the life-threatening, tick-borne infection known as Rocky Mountain spotted fever warns that the first widespread outbreak of the bacterial disease in Arizona is a growing and dangerous sign of how humans can inadvertently help spread infectious organisms beyond traditional state boundaries.

In an article to be published in The New England Journal of Medicine, the Hopkins pathologist and microbiologist J. Stephen Dumler, M.D., a professor at The Johns Hopkins University School of Medicine, highlights the importance of the recent outbreak in Arizona as the first confirmed cases that could be traced back to ticks carried into to the state on feral dogs, an animal group whose population has markedly increased. And, as the number of dogs has increased, so have the number of ticks. A detailed study of this latest outbreak by the United States Centers for Disease Control and Prevention (CDC) is featured in the same edition of the NEJM online Aug. 11.

According to Dumler, the disease, most often marked by a telltale spotty rash that appears five to 10 days after the first signs of infection, has been largely confined to the South Central and Southeastern United States, although sporadic cases have been reported in all 48 continental states, mostly North Carolina. (Hopkins home state of Maryland is among the top 10 states for the disease, with at least 79 cases reported in 2004, up from 19 in 2000.)

The scientist also reports that the number of people infected with Rocky Mountain spotted fever, which is fatal in up to 10 percent of those who contract it, has peaked for the third known time this century, with more than 1,800 cases reported nationally in 2003 and 2004. However, scientists believe the number of unreported cases is much greater.

Dumlers opinion is that growing awareness among physicians about the diseases early signs and symptoms may be the best means of curbing the potentially deadly impact of the disease, which can be effectively treated with specific antibiotics if caught early.

Rocky Mountain spotted fever is a dangerous and potentially fatal disease, unlike its more widespread cousin, Lyme disease, which is almost never fatal, he says. In the latest study, researchers at the U.S. Centers for Disease Control report on 16 cases in which two children contracted the fever and died. Because its first symptoms are very hard to distinguish from many other illnesses, it is often hard to diagnose unless you are looking out for it, he adds.

The first signs of Rocky Mountain spotted fever, the scientist says, are body-wide aches and pains accompanied by headache and a sudden high fever, sometimes as high as 105 degrees Fahrenheit (or 40.5 degrees Celsius). Symptoms may also include sore throat and nausea. The spotty rash, which occurs in at least 85 percent of patients, does not appear until later in the infection and resembles a pinpoint pattern of pink-to-red spots over the entire body, or parts thereof. The rash is also noticeable on the soles of the feet and palms of the hands, where rashes do not usually appear. At this later stage of infection, antibiotic therapy becomes somewhat less effective.

In the CDC-led study, government researchers took blood and skin tissue samples from 16 patients across Southeastern Arizona suspected of having the infection. Laboratory tests, including immunohistochemical staining, confirmed that 11 had the disease, while the remaining five were still probable cases.

When the researchers examined the patients home environments for possible clues to the source of infection, they found fever-infected ticks in all patients yards. Ticks were found in the cracks of stucco walls on patients homes, in crawl spaces under these homes and on furniture placed outside for children and pets. All patients owned and had come in contact with dogs with the infected ticks. Four of the patients had a recent history of tick bite.

Tests of the dogs blood confirmed their infection with the spotted fever bacterium. Feral dogs and brown dog ticks are not a species found naturally in the Arizona region, but were introduced to the state as domesticated dogs that moved with their owners into the area.

This study shows that Rocky Mountain spotted fever can show up in unexpected places, and the study should put physicians on alert for the earliest signs and symptoms of the disease, says Dumler. Our next step is to develop faster and more reliable tests to detect the disease so that physicians can more readily make a diagnosis and begin treatment as early as possible.

Initial treatment for adults, he says, involves immediate, twice daily 100-milligram doses of the oral antibiotic doxycycline (a version of the common tetracycline) until the patients fever subsides. Patients continue to take the medication for an additional five days to prevent the disease from rebounding. Infected children would receive the same drug, but at a lower dose.

Prevalence Of Cataract Causing Vision Problems Appears High Among U.S. Hispanics

Tue, 13 Sep 2005 13:55:00 PST

( from http://www.rxpgnews.com ) Prevalence of cataracts causing significant visual problems appears high among older U.S. Hispanics who also often encounter barriers to access to care, according to a study in the September issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.

Although cataract is the leading cause of visual impairment in the Hispanic community, there has been little research on the prevalence of cataract, cataract surgery or factors that may affect whether Hispanic individuals are able to obtain cataract surgery, according to background information in the article.

Aimee Teo Broman, M.A., of the Johns Hopkins School of Medicine, Baltimore, and colleagues conducted a survey of visual impairment and blindness of Hispanic individuals 40 years or older living in southern Arizona between April 1997 and September 1999. Individuals completed a questionnaire, in either English or Spanish, to determine their history of visual problems and eye care as well as their socio-economic status, medical history and preferred language, country of birth and other questions relating to adapting to U.S. culture. Participants' visual acuity was then assessed.

Of the 4,774 people who participated in the interview and examination, 2.8 percent (135) had visually significant cataract and 5.1 percent (244) had undergone bilateral cataract surgery. The researchers found two factors were important in determining whether individuals received cataract surgery: whether they spoke English and whether they had medical insurance.

"Our data suggest that even after adjusting for high rates of diabetes mellitus, U.S. Hispanic individuals are at a greater risk of having a visually impairing cataract than either African American or white individuals," the authors report. "Cataract is the leading cause of visual impairment in this population and is associated with lower levels of self-reported quality of life; however, a significant percentage of those who likely need cataract removal have never obtained surgery in the population."

"In summary, visually significant cataract appears to be high among U.S. Hispanic individuals of Mexican descent, as evidenced by rate of cataract and rate of surgery," the authors conclude. "Language and financial barriers in this population impede access to surgery. Further work to remove these barriers and provide sight restoration is warranted among Hispanic individuals living in the United States."

Aetna Introduces Medicare Advantage Plans in Arizona

Fri, 09 Sep 2005 17:32:00 PST

( from http://www.rxpgnews.com ) Medicare beneficiaries in Arizona now have new options from Aetna (NYSE: ΑET) for health care coverage that provides them with additional choices, flexibility and value. Aetna has introduced individual Medicare Advantage plan options, including the Aetna Golden Medicare Plan® (HMO) and Golden Choice Plan (PPO), in Maricopa County and parts of Pinal County.

The announcement of these new plans marks Aetnas return to Arizonas Medicare Advantage market. Aetna currently offers three Medicare supplement insurance policies under the Aetna Individual Medicare Supplement PlanSM in Arizona.

"Aetna is continuing to expand its participation in the Medicare Advantage program in 2005," said Frank G. McCauley, head of Aetnas Retiree Markets. "We are committed to offering a broad portfolio of health benefits solutions for retirees, and we are pleased to have the opportunity to expand our coverage into Arizona." Aetna expects to more than double the number of states in which it plans to offer its Medicare Advantage plans, from 5 today to 13 by 2006, pending federal approval.

"Aetna is very pleased to be able once again to offer Medicare Advantage plans to beneficiaries living in Arizona," said Gary Culp, head of Aetnas Medicare business in the West Region. "The addition of the Medicare Advantage plans broadens Aetnas portfolio of health benefits products available to Medicare eligible beneficiaries in Arizona, providing them with additional choices and price options."

The Aetna Golden Medicare Plan (HMO) plan in Maricopa County features:

* No additional plan premium.
* Unlimited coverage of generic drugs.
* Optional supplemental brand-name prescription drug coverage. Beneficiaries have the option to increase their coverage for standard (formulary) brand-name drugs and nonformulary brand prescription drugs for an additional monthly premium.
* Optional supplemental dental benefits. For an additional monthly premium, beneficiaries have a choice of two dental plans, one that covers preventive services and one that provides more comprehensive coverage.

The Aetna Golden Medicare Plan in Pinal County features:

* No copayments for preventive services. Members can obtain routine physicals and other preventive care services including cancer screenings without copayments.
* Optional prescription drug coverage.

The Aetna Golden Choice Plan (PPO) in both Maricopa and Pinal counties provides beneficiaries with greater flexibility, enabling them to go to doctors, specialists and hospitals in or out of network. Referrals are not needed for in-network services.

In addition, Aetna has filed applications with the Centers for Medicare & Medicaid Services (CMS) to offer the new Medicare Part D prescription drug plan (PDP) to individuals and employers on a national basis, except the territories, in 2006. Application and bid filings for each PDP region are subject to CMS approval with contracts to be awarded in September.

Aetna Introduces Medicare Advantage Plan in Fresno County

Fri, 09 Sep 2005 17:32:00 PST

( from http://www.rxpgnews.com ) Aetna (NYSE: ΑET) announced today that it is offering new health care coverage options for Medicare beneficiaries in Fresno County, Calif. Aetna is selling Medicare Advantage plans that provide both medical and prescription drug benefits, including preventive care services with no copayment, broadening the Medicare Advantage plan options for beneficiaries.

The Aetna Golden Medicare Plan (HMO) options available in Fresno County include:

* Unlimited coverage of generic drugs.
* No copayments for preventive services. Members can obtain routine physicals and other preventive care services including cancer screenings without copayments.
* Full coverage of health education and disease management services. Services available to beneficiaries at no additional charge include health education classes, nutritional training, smoking cessation, and disease management programs including a congestive heart failure program.
* Optional supplemental prescription drug coverage. Beneficiaries have the option to purchase coverage for Formulary Preferred Brand and Non-formulary Brand drugs for an additional monthly premium.
* Optional supplemental dental benefits. For an additional monthly premium, beneficiaries have a choice of two dental plans, one that covers preventive services and one that provides more comprehensive coverage.
* Instant access to health information 24 hours a day through toll-free phone and online resources.

"Aetna is very excited to be able to offer Medicare Advantage plans to beneficiaries living in Fresno County," said Gary Culp, head of Aetnas Medicare business in Aetnas West region. "Our Medicare plans offer choices that do not exist with traditional Medicare, including prescription drug coverage and full coverage of preventive health care services."

Aetna currently offers the Aetna Golden Medicare Plan in five California counties: Kern, Los Angeles, Orange, Riverside and San Bernardino.

In addition, Aetna has filed applications with the Centers for Medicare & Medicaid Services (CMS) to offer the new Medicare Part D prescription drug plan (PDP) to individuals and employers on a national basis, except the territories, in 2006. Application and bid filings for each PDP region are subject to CMS approval with contracts to be awarded in September.

Aetna Introduces Medicare Advantage Plans in Bexar County

Fri, 09 Sep 2005 17:32:00 PST

( from http://www.rxpgnews.com ) Aetna (NYSE: ΑET) announced today that it is offering new health care coverage options for Medicare beneficiaries in Bexar County, Texas. Aetna is offering Medicare Advantage plans that provide beneficiaries with additional choices, flexibility and value.

Plans currently being marketed include the Aetna Golden Medicare Plan® (HMO) and Aetna Golden Choice Plan.

"Aetna is continuing to expand its participation in the Medicare Advantage program in 2005," said Frank G. McCauley, head of Aetnas Retiree Markets. "We are committed to offering a broad portfolio of health benefits solutions for retirees, and we are pleased to have the opportunity to expand our coverage into Texas." Aetna expects to more than double the number of states in which it plans to offer its Medicare Advantage plans, from 5 today to 13 by 2006, pending federal approval.

The Aetna Golden Medicare Plan (HMO) in Bexar County features:

* No additional plan premium.
* Prescription drug coverage.
* No copayments for preventive services. Members can obtain routine physicals and other preventive care services, including cancer screenings, without copayments.

The Aetna Golden Choice Plan (PPO) provides beneficiaries with greater flexibility, enabling them to go to doctors, specialists and hospitals in or out of network. Referrals are not needed for in-network services.

"Aetna is very pleased to be able to offer Medicare Advantage plans to beneficiaries living in Bexar County," said Gary Culp, head of Aetnas Medicare business in Aetnas Southwest Region. "Our Medicare Advantage plans offer choices that do not exist with original Medicare, including prescription drug coverage and full coverage of preventive health care services."

In addition, Aetna has filed applications with the Centers for Medicare & Medicaid Services (CMS) to offer the new Medicare Part D prescription drug plan (PDP) to individuals and employers on a national basis, except the territories, in 2006. Application and bid filings for each PDP region are subject to CMS approval with contracts to be awarded in September.

FDA asked to Monitor Youth SSRI Prescription Drop

Fri, 09 Sep 2005 15:57:00 PST

( from http://www.rxpgnews.com ) A new analysis on prescription patterns, based on a two-year dataset by NDC Health Inc., shows a statistically significant drop in the prescription of antidepressents of nearly 20 percent for youth aged 18 and under. This dramatic shift raises the question of whether those children and adolescents with depression who are no longer taking medication are receiving any care at allor are receiving the most effective care. Several studies, including the Treatment of Adolescents with Depression Study (TADS), led by AACAP Member John March, M.D. and funded by the NIMH, have shown a combination treatment approach (medication with talk therapy) as being the most effective, a course of treatment that appears endangered by such a sharp decrease in the medication portion of treatment.

On June 21, 2005, the American Medical Association (AMA) joined the AACAP and the APA in urging the FDA to evaluate the impact of its regulatory action on treatment patterns, patient compliance, and patient access to quality mental health care. The FDA has acknowledged that it has not systematically tracked antidepressant prescribing in the pediatric population.

The AACAP and APA expressed their interest to F.D.A. Commissioner Lester Crawford, D.V.M., Ph.D. in developing a sound methodology for measuring the effects of the warning. Both organizations appealed to the FDA, in order to remind the agency about the documented, pervasive undertreatment of child and adolescent depression, and that the most dangerous course of treatment is no treatment at all.

Genetic Testing For Cancer Recommended Only For High-Risk Women

Thu, 08 Sep 2005 01:02:00 PST

( from http://www.rxpgnews.com ) Primary care physicians should not routinely refer all women for genetic counseling and DNA testing to detect the presence of specific BRCA1 and BRCA2 gene mutations that may be associated with breast or ovarian cancers, according to a new recommendation from the U.S. Preventive Services Task Force. However, if a woman has certain specific family history patterns that put her at risk for these gene mutations, her primary care physician should suggest counseling and possible DNA testing. This is the first time the task force has addressed the issue of genetic counseling and DNA-based genetic testing for any disease.

The task force based its conclusion on a report created for the Agency for Healthcare Research and Quality (AHRQ) by a team of researchers at the Oregon Evidence-Based Practice Center (EPC). The EPC is a collaboration among Oregon Health & Science University, the Portland Veterans Affairs Medical Center, and Kaiser Permanente's Center for Health Research. The EPC is lead by Mark Helfand, M.D., M.P.H., professor of medicine (general internal medicine and medical informatics and clinical epidemiology) in the OHSU School of Medicine.

"Public interest in genetic testing is growing, and the tests are becoming more widely available. Understanding which women may benefit from genetic counseling and mutation testing for breast and ovarian cancer susceptibility will help primary care physicians appropriately advise their female patients," said Heidi D. Nelson, M.D., M.P.H., leader of the EPC research team that created the report. Nelson is a professor of medicine (general internal medicine and medical informatics and clinical epidemiology) in the OHSU School of Medicine.

The EPC research team analyzed existing scientific literature to determine the benefits and harms associated with primary care physicians routinely referring women for genetic counseling and mutation testing for inherited breast and ovarian cancer susceptibility.

BRCA1 and BRCA2 are genes that help control normal cell growth. Women who inherit specific mutations in one or both of these genes have a greater risk of developing breast or ovarian cancer, especially if their family members have had one or both of these cancers.

Risk for the mutations is relatively small. About 2 percent of women have the specific family history patterns that can put them at increased risk for these BRCA mutations and only about 1 in 300 to 1 in 500 women actually have the mutations. Even among women who test positive, only a proportion will develop breast or ovarian cancer, depending on the type of mutation and the type of cancer.

"Clinical guidelines for referral to genetic counseling and testing have existed for some years, but their effectiveness in primary care settings is still unknown. Counseling may help women better understand their cancer risks as well as the prevention, screening, and genetic testing options available to them," said Emily L. Harris, Ph.D., M.P.H., a genetic epidemiologist who is a senior investigator at Kaiser Permanente's Center for Health Research. Members of the EPC research team include OHSU School of Medicine researchers Rongwei Fu, Ph.D., assistant professor of public health and preventive medicine, and emergency medicine; and Laurie Hoyt Huffman, M.S., senior research associate in medical informatics and clinical epidemiology.

Women who are at an increased risk of inheriting the BRCA1 or BRCA2 gene mutations include those of Ashkenazi (predominantly Eastern European) Jewish descent with a first- or second-degree relative with breast or ovarian cancer. First-degree relatives include mothers, sisters or daughters; second-degree relatives include grandmothers or aunts. Other factors that put women at increased risk are specific family history patterns involving breast and ovarian cancer and multiple first- or second-degree relatives with one or both of the diseases. Risk level for these women is determined through detailed family histories and standard risk assessment tools.

Women who do not have a family history of either breast or ovarian cancer and are unlikely to test positive for the mutations should not be referred for testing, the task force emphasized, noting that there are potential harms involved in genetic testing. Women who test positive for genetic mutations may be vulnerable to job or insurance discrimination. Federal and state laws provide a degree of protection against discrimination on the basis of genetic information, but concerns persist. In addition, cost of the test can range from several hundred to several thousand dollars, and insurance policies vary regarding coverage of genetic testing.

For those women whose specific family history puts them at increased risk for genetic mutations and possibly cancer, counseling and BRCA mutation testing may offer significant benefits. Women who test positive can begin earlier and more frequent screening. Clinical trials show that chemoprevention reduces breast cancer risk. Also, the task force found evidence that women can reduce their risk of developing breast or ovarian cancer through surgical removal of the breasts or ovaries. The task force continues to recommend that all women, starting at age 40, should be screened for breast cancer using mammography.

The task force grades the strength of its evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against), or "I" (insufficient evidence to recommend for or against). The task force recommends against routine referral for genetic counseling or BRCA testing for women whose family history does not indicate such an elevated risk (a "D" recommendation). The task force also recommends that women whose family history indicates an increased likelihood of harmful BRCA1 and BRCA2 mutations be referred for genetic counseling and evaluation for BRCA testing (a "B" recommendation).

BRCA gene testing not recommended as a routine test

Tue, 06 Sep 2005 20:04:00 PST

( from http://www.rxpgnews.com ) BRCA1 and BRCA2 are genes that help control normal cell growth. Women who inherit specific changes or mutations in one or both of these genes have a greater risk of developing breast and/or ovarian cancer, especially if their family members have had one or both of these cancers. However, only a small number of womenabout 2 percenthave the specific family history patterns that put them at risk for BRCA mutations. In the general population, only about 1 in 300 to 1 in 500 women are believed to have these harmful genetic mutations. Even among women with these mutations, not everyone will actually develop breast or ovarian cancer.

Women who are at an increased risk of inheriting the BRCA1 or BRCA2 gene mutations include those of Ashkenazi (predominantly Eastern European) Jewish descent with a first- or second-degree relative with breast or ovarian cancer. A first-degree relative could be a mother, sister, or daughter; a second-degree relative might be a grandmother or an aunt. Risk factors for women not of Ashkenazi Jewish background include having specific family history patterns, for example, multiple first- or second-degree relatives with breast and/or ovarian cancer. The level of risk for these women is best determined by obtaining a detailed family history and making use of standardized risk assessment tools.

Women who do not have a family history of either breast or ovarian cancer and are unlikely to test positive for the mutations should not be referred for testing, the Task Force emphasized, noting that there are potential harms involved in genetic testing, including false-positive test results. The Task Force does recommend that, starting at age 40, all women should be screened for breast cancer using mammography. This recommendation can be found on the AHRQ Web site at http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm.

Testing entails risks. A woman who tests positive for BRCA1 and BRCA2 gene mutations may choose to undergo a procedure such as a preventive mastectomy or oophorectomyremoval of the breast or ovarieswhich might be unnecessary if a given mutation would not lead to cancer. Women who test positive for genetic mutations may also be vulnerable to job or insurance discrimination. Federal and state laws provide a degree of protection against discrimination on the basis of genetic information, but concerns persist. In addition, the cost of DNA testing for BRCA mutations can range from several hundred to several thousand dollars, and insurance policies vary regarding coverage of genetic testing.

For those women whose specific family history puts them at risk for genetic mutations and possibly cancer, counseling and BRCA testing may offer significant benefits. "A woman who gains an understanding of the risk she faces may feel less anxious and have a sense of better control of her future," said Task Force Chair Ned Calonge, M.D., who is also Chief Medical Officer and State Epidemiologist for the Colorado Department of Public Health and Information. "If the DNA test result is positive, the patient and her physician should take a shared decision making approach in deciding which preventive measures are appropriate."

The Task Force found evidence in the scientific literature that women with BRCA1 and BRCA2 mutations can reduce their risk of developing breast or ovarian cancer by mastectomy or oophorectomy. Women may also choose to undergo intensive screening by frequent clinical breast examinations and mammography or preventive chemotherapy, but the benefits remain uncertain.

The Task Force, sponsored by the Agency for Healthcare Research and Quality, is the leading independent panel of private-sector experts in prevention and primary care and conducts rigorous, impartial assessments of the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services.

The Task Force based its conclusions on a report from a research team led by Heidi D. Nelson, M.D., M.P.H., at AHRQ's Evidence-based Practice Center at Oregon Health & Science University in Portland.

The Task Force uses letters to rate its recommendations according to the strength of the evidence it has found and the amount of net benefit (the size of the benefits minus the harms) a particular preventive service offers. Possible grades are "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against), or "I" (insufficient evidence to recommend for or against). The Task Force recommends against routine referral for genetic counseling or BRCA testing for women whose family history does not indicate an elevated risk as defined in the recommendation and accompanying review (a "D" recommendation). The Task Force does recommend that women whose family history indicates an increased likelihood of harmful BRCA1 and BRCA2 mutations be referred for genetic counseling and evaluation for BRCA testing (a "B" recommendation).

Increase fortification levels to save more babies

Tue, 06 Sep 2005 14:34:00 PST

( from http://www.rxpgnews.com ) The March of Dimes restated its longtime position in response to two articles published today in Pediatrics.

"It's so rare that we get the opportunity to save thousands of babies from being born with a disabling or fatal birth defect with such a simple, low-tech means as folic acid fortification," says Dr. Jennifer L. Howse, president of the March of Dimes. "Studies have shown that adequate daily folic acid intake beginning before pregnancy can reduce the incidence of these tragic birth defects by up to 70 percent, and we should not settle for anything less than maximum prevention."

Since 1996, the March of Dimes has recommended that the U.S. Food and Drug Administration set the level of folic acid required in enriched grain foods at 350 micrograms per 100 grams of grain to prevent as many neural tube defects (NTDs) as possible, said Dr. Howse.

A team of researchers led by Laura J. Williams, M.P.H., of the National Center on Birth Defects and Developmental Disabilities at the U.S. Centers for Disease Control and Prevention (CDC) reported that folic acid fortification accounted for a 36 percent decline in NTDs in the Hispanic population and a 34 percent drop among the white, non-Hispanic population between 1995 and 2002. The prevalence of NTDs in the black, non-Hispanic population did not decrease significantly, the CDC researchers said.

In an accompanying editorial, Robert L. Brent, M.D., Ph.D., and Godfrey P. Oakley, Jr., M.D., MSPM, call on FDA to at least double the amount of folic acid required in enriched grain foods (currently set at 140 micrograms of folic acid per 100 grams of grain). They also urged FDA to require grain suppliers to add vitamin B12 to enriched products to optimize health effects from fortification. The authors also urged the manufacturers of corn flour to make all their products enriched with folic acid, in order to prevent more NTDs among Hispanic babies.

Dr. Howse said the March of Dimes also supports the idea of enriching corn flour with folic acid to help prevent more NTDs among Hispanics and other populations for whom corn products are a dietary staple.

Before fortification, about 4,000 pregnancies annually were affected by an NTD, some of which resulted in miscarriage or stillbirth. Currently, about 1,000 fewer babies annually develop one of these devastating conditions in which the neural tube, the embryonic structure from which the brain and spinal cord are created, fails to close properly before birth.

To help prevent NTDs, the March of Dimes says, all women capable of becoming pregnant should consume a multivitamin with at least 400 micrograms of folic acid every day starting before pregnancy, as part of a healthy diet containing foods fortified with folic acid and foods that naturally contain folic acid, such as leafy green vegetables, and beans. Daily consumption is crucial because NTDs occur in the early weeks following conception, often before a woman knows she is pregnant.

Quality of care may vary in association with the characteristics of individual physicians

Fri, 29 Jul 2005 04:47:00 PST

( from http://www.rxpgnews.com ) Certain physician characteristics and practice-setting characteristics are associated with Medicare beneficiaries receiving routine preventive services below the national goals, according to a study in the July 27 issue of JAMA.

An emerging body of literature suggests that quality of care may vary in association with the characteristics of individual physicians and their practices, according to background information in the article.

Hoangmai H. Pham, M.D., M.P.H., of the Center for Studying Health System Change, Washington, D.C., and colleagues examined the relationship between attributes of physicians and their practices and the extent to which their Medicare patients received preventive services. The researchers analyzed data from 3,660 U.S. physician respondents to the 2000-2001 Community Tracking Study Physician Survey linked to claims data on 24,581 Medicare beneficiaries 65 years and older who were treated in 2001. Physician variables included training and qualifications and sex. Practice setting variables included practice type, size, sources of revenue, and access to information technology. Analyses were adjusted for patient demographics and multiple diseases, as well as community characteristics.

The researchers determined the proportion of eligible beneficiaries who received each of 6 preventive services: diabetic monitoring with hemoglobin A1c measurement, eye examinations, screening for colon or breast cancer, and vaccination for influenza or pneumococcus.

The researchers found that overall, the proportion of beneficiaries receiving services was below national goals. Physician and, more consistently, practice-level characteristics were both associated with differences in the delivery of services. The strongest associations were with practice type and the percentage of practice revenue derived from Medicaid. For instance, beneficiaries receiving usual care in practices with less than 6 percent of revenue from Medicaid were more likely than those with more than 15 percent of revenue derived from Medicaid to receive diabetic eye examinations (48.9 percent vs. 43 percent), hemoglobin A1c monitoring (61.2 percent vs. 48.4), mammograms (52.1 percent vs. 38.9 percent), colon cancer screening (10.0 percent vs. 8.5 percent), and influenza (50.2 percent vs. 39.2 percent) and pneumococcal (8.2 percent vs. 6.4 percent) vaccinations.

Other variables associated with delivery of preventive services after adjustment for patient and geographic factors included obtaining usual health care from a physician who worked in group practices of 3 or more, who was a graduate of a U.S. or Canadian medical school, or who reported availability of information technology to generate preventive care reminders or access treatment guidelines.

"We found that this shortfall is neither uniform for all beneficiaries nor explained entirely by characteristics of the beneficiaries such as their race or income level. Rather, it appears that some beneficiaries are treated in practice settings or by physicians who deliver preventive services at particularly low rates. Our results suggest that these variations in quality are substantial and seem to be greatly influenced by the structure and revenue sources of physician practices. If we can understand the mechanisms underlying these relationships, it would be much easier to identify the key leverage points for quality improvement," the authors conclude.

Rates of blood pressure control in the community are low

Fri, 29 Jul 2005 04:47:00 PST

( from http://www.rxpgnews.com ) Compared to current national guidelines, rates of blood pressure control in the community are low, especially among older women, according to a new study in the July 27 issue of JAMA.

"Elderly persons are among the fastest growing segments of the U.S. population and they have the highest prevalence of hypertension [high blood pressure]," according to the authors of the study. "Despite numerous trials demonstrating the benefits of blood pressure lowering among older individuals with hypertension, available data suggest that rates of treatment and control are suboptimal."

Donald M. Lloyd-Jones, M.D., Sc.M., from the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues from the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass., analyzed data collected between January 1, 1990 and December 31, 1999 from that community-based cohort study to determine the current prevalence, patterns, treatment, control, and risks of hypertension in persons aged 80 years or older compared with younger individuals. There were 5,296 participants (2,317 men and 2,979 women) who were categorized by age: younger than 60 years, 60 to 79 years, or 80 years or older. Hypertension was defined as systolic blood pressure greater than or equal to 140 mm Hg (millimeters of mercury) or diastolic blood pressure greater than or equal to 90 mm Hg. Current national guidelines define normal blood pressure as systolic blood pressure 120 or less and diastolic blood pressure of 80 or less mm Hg. Patients were followed for up to 6 years for development of cardiovascular disease events.

"Prevalence of hypertension and drug treatment increased with advancing age, whereas control rates were markedly lower in older women (systolic < 140 and diastolic < 90 mm Hg)," the researchers found. "For ages younger than 60 years, 60 to 79, and 80 years and older, respectively, control rates were 38 percent, 36 percent, and 38 percent in men and 38 percent, 28 percent, and 23 percent in women." The researchers note that "the overall prevalence of treatment among participants with hypertension was 68.9 percent."

Among participants 80 years of age or older, major cardiovascular events occurred in 9.5 percent of those with normal blood pressure, 19.8 percent of the prehypertension group, 20.3 percent of the stage 1 hypertension group, and 24.7 percent of the stage 2 or treated hypertension group.

"Despite a wealth of evidence suggesting that thiazide diuretics (a type of medication) are the most cost effective agents for blood pressure reduction, and that they are particularly efficacious among the elderly, we found overall low rates of thiazide use, particularly among men," the researchers write. "We observed high prevalence of use of more expensive agents such as ACE inhibitors and other classes of drugs (e.g., alpha blockers), although data supporting their efficacy in older hypertensive patients are limited."

"With the aging of the population, the burden of hypertension is expected to increase significantly," the authors write. "It is rare to escape the development of hypertension with aging; even for individuals free of hypertension at age 65 years, the remaining lifetime risk of developing hypertension is approximately 90 percent." The authors conclude: "Short-term risks for cardiovascular disease are substantial, indicating the need for greater efforts at safe, effective risk reduction among the oldest patients with hypertension."

Rate of new illnesses associated with pesticide exposure at schools increased significantly

Fri, 29 Jul 2005 01:31:00 PST

( from http://www.rxpgnews.com ) The rate of new illnesses associated with pesticide exposure at schools increased significantly in children from 1998 to 2002, according to an article in the July 27 issue of JAMA.

"Exposure to pesticides in the school environment is a health risk facing children and school employees," background information in the article states. Pesticides continue to be used both on and around school property, with some schools at risk of pesticide exposure from neighboring farms. Currently, no specific federal requirements on limiting pesticide exposures at schools exist. In the U.S. today, pesticide poisoning is often underdiagnosed.

Walter A. Alarcon, M.D., from the National Institute for Occupational Safety and Health, and the U.S Centers for Disease Control and Prevention, Cincinnati, and colleagues examined 1998 - 2002 data from 2,593 people with acute pesticide-related illnesses associated with school exposure. Information was collected from the National Institute for Occupational Safety and Health's Sentinel Event Notification System for Occupational Risks pesticides program (SENSOR) pesticides program, the California Department of Pesticide Regulation (CDPR), and the Toxic Exposure Surveillance System (TESS). Cases were included if illness developed after exposure to pesticide and illness was consistent with known toxicology of the pesticide.

The overall annual rates of new cases for 1998 - 2002 was 7.4 cases per million children, and was 27.3 cases per million school employee (adult) full-time equivalents. New case rates among children increased significantly from 1998 to 2002. Three cases (.1 percent) of high severity were found, 275 cases (11 percent) of moderate severity, and 2,315 cases (89 percent) of low severity were found. The majority of illnesses reported were associated with insecticides (n = 895, 35 percent), disinfectants (n = 830, 32 percent), repellents (n = 335, 13 percent), or herbicides (n = 279, 11 percent). Of 406 cases with detailed source information, 281 (69 percent) were associated with pesticides used at schools and 125 (31 percent) were associated with pesticide drift from farmland.

"These findings indicate that pesticide exposures at schools continue to produce acute illnesses among school employees and students in the United States, albeit mainly of low severity and with relatively low incidence rates," the authors write. "To prevent pesticide-related illnesses at schools, implementation of integrated pest management programs in schools, practices to reduce pesticide drift, and adoption of pesticide spray buffer zones around schools are recommended."

Hospital "report cards" not effective for quality improvement

Wed, 20 Jul 2005 16:09:00 PST

( from http://www.rxpgnews.com ) Hospitals that were given feedback on their performance on certain quality indicators for treating heart attack patients did not show more improvement in those areas than hospitals that were provided with the feedback at a later date, according to a study in the July 20 issue of JAMA.

Acute myocardial infarction (AMI; heart attack) patients often do not receive recommended evidence-based treatments, according to background information in the article. There is increasing interest in implementing quality improvement strategies for AMI care. One quality improvement strategy that has been suggested is feedback on "quality indicators" to hospitals and clinicians treating AMI patients. Quality indicators are defined as a summary of clinical performance over a specified time. It is suggested that "report cards" presenting a summary of quality indicators relevant to care provided by individual hospitals can catalyze quality improvement at these hospitals. Ideally, hospital report cards provide clinicians with an accurate picture of the care they deliver and provide benchmarks for comparison, such as the care delivered at other hospitals or recommended target rates. Hospital report cards are increasingly being implemented in the United States and some parts of Canada as a strategy for quality improvement in many areas of health care, despite lack of strong evidence to support their use.

Christine A. Beck, M.Sc., of McGill University Health Centre, Montreal, and colleagues conducted a study to determine whether hospital report cards produced using linked administrative databases are effective for improving AMI care. The study included patients with AMI who were admitted to 76 acute care hospitals in Quebec that treated at least 30 AMI patients per year between April 1, 1999, and March 31, 2003. The hospitals were randomly assigned to receive rapid (immediate; n = 38 hospitals and 2,533 patients) or delayed (14 months; n = 38 hospitals and 3,142 patients) confidential feedback on quality indicators developed using administrative data. The quality indicators pertained to processes of care and outcomes of patients admitted between 4 and 10 months after randomization. The primary indicator was the proportion of elderly survivors of AMI at each study hospital who filled a prescription for a beta-blocker within 30 days after discharge.

The researchers found that at follow-up, adjusted prescription rates within 30 days after discharge were similar in the early vs. late groups for beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, lipid-lowering drugs and aspirin. In addition, the adjusted death rate was similar in both groups, as were length of in-hospital stay, physician visits after discharge, waiting times for invasive cardiac procedures, and readmissions for cardiac complications.

"In this cluster randomized controlled trial, confidential feedback provided to hospitals in the form of report cards constructed using linked administrative data was not effective in improving quality of AMI care. Our results suggest that even if the United States eventually acquires these types of administrative data through the Medicare program, confidential feedback based on these data are unlikely to be a sufficient strategy for health care quality improvement," the authors write. "More intensive interventions, which could include chart review and continuous and/or public data feedback accompanied by other multimodal interventions, such as team workshops and standard orders, may be effective, but a need remains to study these interventions and their cost-benefit ratios in well-controlled randomized trials."

The researchers speculate that there could be several reasons for the lack of effectiveness of the study intervention, including "that the administrative data were perceived as invalid or irrelevant to practice. It is possible that report cards constructed using chart review data may be more effective than those constructed using administrative data because physicians are less skeptical of their data quality."

Simple communication intervention can improve the quality of end-of-life care

Wed, 13 Jul 2005 12:15:00 PST

( from http://www.rxpgnews.com ) A simple information and communication intervention between a patient and physician can increase hospice referral rates among nursing home residents, increase their families' ratings of end-of-life care, and may decrease use of acute care resources, according to an article in the July 13 issue of JAMA.

"At least one in four Americans dies in a nursing home, and considerable evidence indicates that nursing home residents do not receive optimal end-of-life care," background information in the article states. Approximately 25 percent of residents with daily cancer pain receive no pain medications, and residents are often transferred to an acute care setting to receive aggressive treatment in the last weeks of life. Families often express dissatisfaction with the end-of-life care their relative receives in nursing homes. Nursing home residents receiving hospice care are more likely to receive better pain management, have their pain assessed and have lower rates of inappropriate medications and physical restraint use. Despite its benefits, however, only one in four nursing home residents enrolls in hospice care before death.

David Casarett, M.D., M.A., from the Philadelphia Veterans Affairs Medical Center, Philadelphia, and colleagues conducted a randomized trial of nursing home residents and their decision makers to determine whether promoting communication about hospice would increase hospice enrollment and improve the quality of end-of-life treatment. For the intervention, the researchers interviewed residents and/or their surrogate decision-makers to identify those whose goals and needs for care, and treatment preferences made them appropriate for hospice. The physicians of residents classified as appropriate for hospice were notified and asked to authorize a hospice informational visit. The trial was conducted from December 2003 to December 2004. Residents were followed up for six months or until death.

One-hundred seven of the 205 residents in the study were randomly assigned to receive the intervention, and 98 received usual care. Those in the intervention group were more likely than usual care residents to enroll in hospice within 30 days (20 percent vs. 1 percent) and to enroll in hospice during the follow-up period (25 percent vs. 6 percent). Intervention residents received more hospice care than usual care residents (average: 64 vs. 14 days), although intervention residents were not more likely to be enrolled in hospice at the time of their death (36 percent vs. 38 percent). These intervention residents had fewer acute care admissions and spent fewer days in the acute care setting. Families of intervention residents rated the resident's care more highly than the families of usual care residents did (on a 1-5 scale, average: 4.1 vs. 2.5).

"The results reported herein show that a simple communication intervention can improve the quality of end-of-life care and decrease resource utilization by promoting earlier access to hospice care in nursing homes," the authors write. "If there is a surprise in these findings, it is that such a simple, inexpensive, and easily exportable intervention can contribute so much to improving care. As Americans spend more time in nursing homes near the end of life, it will becomes increasingly important to emphasize simple, low-cost interventions like this one that can help to ensure that residents and their families have access to the best possible quality of care."

Hepatitis A in U.S. declined by 76 % after implementation of vaccination program

Wed, 13 Jul 2005 12:15:00 PST

( from http://www.rxpgnews.com ) Following implementation of an expanded program of hepatitis A vaccination of children, the overall hepatitis A rate in the U.S. has declined by 76 percent, according to a study in the July 13 issue of JAMA.

In the United States, an average of 26,000 hepatitis A cases were reported annually to public health agencies during the 1980s and 1990s, representing an estimated 270,000 infections per year when anicteric (without jaundice) disease and asymptomatic infections are taken into account, according to background information in the article. More than half of the estimated infections occurred among children. In 1995, highly effective hepatitis A vaccines became available in the United States for use among persons aged 2 years or older, providing an opportunity to substantially reduce hepatitis A incidence. In 1996 the Advisory Committee on Immunization Practices recommended targeted hepatitis A vaccination of selected high-risk populations and routine vaccination for children living in communities with the highest hepatitis A rates. In 1999, this committee expanded its recommendations for routine vaccination of children to include children living in 17 states that had consistently elevated hepatitis A rates and a distinctive pattern of hepatitis A epidemiology.

Annemarie Wasley, Sc.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues analyzed data from a national hepatitis A surveillance to determine changes in the incidence and epidemiology of hepatitis A in the United States since 1990 and following implementation of recommendations for hepatitis A vaccination.

The researchers found that between the baseline period (1990-1997) and 2003, overall hepatitis A rates declined 76 percent to 2.6 per 100,000, significantly lower than previous lows in 1983 (9.2/100,000) and 1992 (9.1/100,000). The rate of hepatitis A in vaccinating states declined 88 percent to 2.5 per 100,000 compared with 53 percent elsewhere (to 2.7/100,000). In 2003, cases from vaccinating states accounted for 33 percent of the national total vs. 65 percent during baseline period. Declines were greater among children aged 2 to 18 years (87 percent) than among persons older than age 18 years (69 percent); the proportion of cases in children dropped from 35 percent to 19 percent. Since 2001, rates in adults have been higher than among children, with the highest rates now among men aged 25 through 39 years.

"In summary, we report early apparent impact of implementation of a novel, and to our knowledge, unique vaccination strategy. This strategy is based on distinctive features of hepatitis A epidemiology, including the geographic clustering of areas with consistently elevated rates, the important role of children in sustaining transmission, and the hypothesized large effect of herd immunity. These features lent themselves to a geographically focused strategy using a vaccine that could not be readily integrated into the routine vaccination schedule, and maximized the impact of limited vaccination. The changes we describe represent a transformation in hepatitis A epidemiology in the United States. However, because hepatitis A incidence has historically exhibited a pattern of periodic increases, further monitoring is needed to determine the extent to which the declines that have occurred will be sustained and are attributable to vaccination. In addition, more data on vaccine coverage levels are needed to better describe the relationship between hepatitis A vaccine usage and disease rates," the authors write.

"Sustaining and further reducing hepatitis A incidence can be achieved by improving vaccination coverage in groups for which it is currently recommended, including children living in the historically higher-rate states and children and adults in high-risk groups. Elimination of hepatitis A virus transmission will require expansion of existing recommendations to include routine vaccination of all U.S. children," the researchers conclude.

Two million Americans are treated for eye injuries per year

Tue, 12 Jul 2005 12:33:00 PST

( from http://www.rxpgnews.com ) Nearly two million Americans are treated for eye injuries per year, with males experiencing twice the rate of injury than that of females, according to a study in the July issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.

Because eye injuries are rarely serious enough to require hospitalization, to understand the extent of eye injuries in the U.S., inpatient and outpatient facilities, in addition to other settings, must be considered, according to background information in the article.

Gerald McGwin, Jr., M.S., Ph.D., from the University of Alabama at Birmingham, and colleagues combined data from the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the National Hospital Discharge Survey for 2001, to estimate eye injuries in the U.S. Eye injuries treated in emergency departments, inpatient and outpatient facilities, and private physicians' offices, as well as their causes and characteristics, were included in the study.

The researchers found that in 2001 an estimated 1,990,872 individuals (6.98 per 1,000) experienced an eye injury in the U.S. Most of the eye injuries were treated in emergency departments (50.7 percent); 38.7 percent were treated in private physicians' offices, 8.1 percent in outpatient facilities, and 2.5 percent in inpatient facilities. Overall, males had more than twice the eye injury rate than that of females (9.5 injuries per 1,000 compared with 4.5 injuries per 1,000). White males in their 20s had the highest rate of eye injury (more than 20 injuries per 1,000). Injury rates were highest for superficial injuries, foreign bodies, contusions, and open wounds.

The authors state: "While the epidemiologic pattern of eye injury presented in this article is consistent with previous research from other settings, some important differences emerged. Private physicians represent an important source of care for eye injury in the United States, particularly for middle-aged adults. Future research should focus on a more detailed documentation of the causes of eye injuries as well as long-term functional outcomes as, despite the relatively frequent nature of eye injury documented in this study, injuries with potential visual significance more accurately reflect the public health impact of eye injury in the United States."

Cost of CABG is higher in the U.S. than in Canada

Tue, 12 Jul 2005 12:33:00 PST

( from http://www.rxpgnews.com ) Although there are no differences in clinical outcome, the in-hospital cost of coronary artery bypass graft surgery (CABG) in the U.S. is 82.5 percent higher in the U.S. than in Canada, according to a study in the July 11 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

Cardiovascular disease is a leading cause of illness and death in the U.S. and Canada, with an estimated direct cost in the U.S. of $209.3 billion in 2003, including $94.1 billion in in-hospital costs alone, according to background information in the article. In 2000, more than 500,000 CABGs were performed in the U.S.

Mark J. Eisenberg, M.D., M.P.H., of Jewish General Hospital, Montreal, and colleagues compared the outcomes and costs of treatment of 12,017 consecutive patients (4,698 U.S. and 7,319 Canadian patients) undergoing CABG at five U.S. and four Canadian hospitals.

"In-hospital costs of treatment were substantially higher in the United States than in Canada [an average cost of $20,673 vs. $10,373]," the authors report. "After controlling for demographic and clinical differences, length of stay in Canada was 16.8 percent longer than in the United States; there was no difference in in-hospital mortality [death]; and the cost in the United States was 82.5 percent higher than in Canada."

"Coronary artery bypass graft surgery requires substantial resources in Canada and the United States," the authors conclude. "However, patients undergoing CABG at U.S. hospitals incur approximately twice as much cost compared with those at Canadian hospitals, with little difference in clinical outcome and despite shorter average LOS [length of stay]. The difference in total in-hospital costs is almost equally attributable to differences in direct and overhead costs between the Canadian and U.S. hospitals. This cost differential primarily reflects higher resource prices for products and labor and higher overhead costs in the United States resulting from a nonsocialized medical system. However, U.S. hospitals also appear to streamline services better to reduce LOS, a strategy Canadian hospitals might emulate to further reduce treatment costs."

Viral Deaths due to hamsters?

Wed, 25 May 2005 23:13:00 PST

( from http://www.rxpgnews.com ) Today, the RI Department of Health announced the preliminary results of an investigation into theunfortunate deaths of three recent recipients of organ transplants (2-MA/1-RI). The following investigation of the cause of death, by the Rhode Island Department of Health, the Massachusetts Department of Public Health, the CDC, the New England Organ Bank and the transplant centers, pointed to a viral infection (known as LCMV).

In cooperation with the New England Organ Bank and the CDC, the infection was traced back to a RI donor who died from unrelated causes. The source of the infection appears to involve exposure to the urine or feces of common house mice or rodent pets (such as hamsters). At least one pet at the donors residence tested positive for LCMV.

We continue to investigate the source of infection and events leading to this sad outcome, said David R. Gifford, MD, MPH, Director of Health. Also, because LCMV infection has been associated with miscarriage and neurological illness in the newborn, we are taking the precaution of advising pregnant women in the first and second trimester of pregnancy to avoid exposure to rodent urine or fecesincluding household pets such as hamsters.

This chain of events represents only the second time transmission of LCMV through organ transplant has ever been seen.

The RI Department of Health is working collaboratively with the Department of Environmental Management (DEM) and CDC to evaluate the risk to the public from LCMV in pet hamsters. HEALTH is also disseminating information to the general public and the medical community on how to prevent exposure to LCMV and other rodent associated infections.

America's Diabetes Health is in Jeopardy

Thu, 19 May 2005 12:47:00 PST

( from http://www.rxpgnews.com ) A first-of-its-kind Report released today by the American Association of Clinical Endocrinologists (AACE) revealed that from 2003 to 2004, two out of three Americans with type 2 diabetes, analyzed in a study of more than 157,000 patients, were not in control of their blood sugar, failing to meet AACEs target A1C goal of 6.5% or less.

In addition, a state-by-state ranking of blood sugar control contained in the new State of Diabetes in America Report shows that there is significant room for improvement in diabetes management as the majority of people studied in every state, including the District of Columbia, were not in control of their blood sugar levels. The new Report was presented at AACEs 14 th Annual Meeting and Clinical Congress.

Despite the new Report findings, the vast majority (84%) of Americans with type 2 diabetes who were polled as part of a national survey agree that they are doing a good job of managing their diabetes by controlling their blood sugar. More than 18 million Americans are affected by diabetes. Type 2 diabetes, the most common form of diabetes, accounts for 90 to 95% of all diagnosed diabetes cases.

Despite major advances in diabetes care and the variety of tools available to help people with type 2 diabetes manage the condition, this Report suggests that Americas type 2 diabetes population is struggling to control their blood sugar levels and affirms the outcomes from our recent Implementation Consensus Conference, said Carlos R. Hamilton , Jr., M.D., FACE, President of AACE, an organization of endocrinologists who are medical experts in treating diabetes. Type 2 diabetes is of urgent concern and these findings must serve as a wake-up call for America that more needs to be done to help lower A1C levels across the country and ultimately, manage this epidemic.

Balancing Antiretroviral Therapy in Children

Thu, 12 May 2005 18:02:00 PST

( from http://www.rxpgnews.com ) There often is a short lag between the release of a new treatment for pediatric HIV infection and its implementation in the community, according to a study in the May 11 issue of JAMA.

Antiretroviral therapy (ART) for pediatric human immunodeficiency virus (HIV) infection has evolved from the single or dual nucleoside reverse transcriptase inhibitor (NRTI) regimens of the 1980s and early 1990s to today's complex regimens of NRTI in combination with protease inhibitors (PIs) and/or nonnucleoside reverse transcriptase inhibitors (NNRTIs), according to background information in the article. No previous studies have examined how novel therapies have been integrated into the clinical care of pediatric HIV infection, or if there is concordance between recommended guidelines and treatment in clinical practice.

Susan Brogly, Ph.D., of the Harvard School of Public Health, Boston and colleagues examined the changes in the treatment of pediatric HIV in the United States from 1987 to 2003. The study included 766 perinatally HIV-infected children from the Pediatric AIDS Clinical Trials Group 219C cohort born before January 1, 2004, who had not participated in an ART clinical trial.

The researchers found that single and dual NRTI regimens were used most frequently through 1997. In 1998, 2 years after protease inhibitors were approved for adult HIV infection and at the time pediatric guidelines were issued, regimens of highly active antiretroviral therapy including a protease inhibitor became most frequently used. From 1998-2003, 22 percent of children initiated ART with a regimen not recommended by pediatric guidelines. In additional analysis, the risk of switching decreased with age at ART initiation and increased with year of initiation. The risk of switching was higher in children who started with 1 or 2 NRTIs or an unconventional regimen vs. children who started on a protease inhibitor-containing regimen.

"The use of unorthodox regimens not recommended by the U.S. pediatric guidelines was relatively common, and was related to a shorter time to first regimen switch," the authors write. "Monitoring and documenting ART use in HIV-infected children can provide important insight regarding the clinical care of this population."
(JAMA. 2005;293:2213-2220.)

For funding/support information, please see the JAMA article.

MORE ADVANCED, EARLIER TREATMENT OF PERINATAL HIV ASSOCIATED WITH DECREASED HIV PROGRESSION, BETTER OUTCOMES

In a related study in this week's JAMA, earlier treatment of children with HIV infection with ART is associated with less HIV progression and improved survival rates.

Worldwide, approximately 2.5 million children are infected with HIV, and approximately 1,700 new perinatal infections occur daily, according to background information in the article. In the United States, more than 9,300 HIV-infected children younger than 13 years have progressed to AIDS as of December 2003. While the Pediatric AIDS Clinical Trials Group (PACTG) 076 regimen has reduced perinatal transmission by 67 percent, prenatal combination ART has further reduced transmission to 2 percent or less. However, the impact of treatment on progression of perinatal HIV infection remains poorly characterized at the population level. Perinatal HIV infection may progress in 2 patterns: early, with a typical onset of age 4 months, or late, with a typical onset of age 6 years.

David R. Berk, M.D., of the Stanford University School of Medicine, Stanford, Calif., and colleagues conducted a study to determine the progression of HIV, survival, and distribution of category C (the most severe of three categories, dependent on symptomatic conditions) diagnoses in a perinatal population-based sample during different eras in prevention and management and in relation to early institution of any ART therapy. The researchers examined the trends in early progression of perinatal HIV infection among 205 HIV-infected children in Northern California born between January 1, 1988, and December 31, 2001, and followed up through age 3 years.

The researchers found that of 205 children, 134 (65 percent) received ART and/or prophylactic treatment against Pneumocystis jiroveci pneumonia. By age 3 years, 81 (40 percent) progressed to a category C diagnosis, 41 (51 percent) of whom died. Untreated children were significantly more likely to progress to a category C diagnosis (62 percent [44/71] untreated vs. 28 percent [37/134] treated children); none of 23 infants who received triple ART progressed to category C. However, even without triple ART, very early mono/dual ART (by age 2 months vs. 3-4 months) was associated with delayed and decreased progression to category C. Of 33 children born between January 1, 1996, and December 31, 2001, only 7 (21 percent) progressed to category C (compared with 1988-1995), 6 of 7 of whom received no therapy. More recent year of birth and more advanced therapy were associated with improved survival.

"There are few data to guide time to initiation and selection of therapy among young children with perinatal HIV infection. Our novel finding of improved outcomes even with mono/dual ART begun by age 2 months vs. 3 to 4 months, though limited by the small sample size, suggests the importance of very early diagnosis and treatment and is consistent with small clinical trials demonstrating a short-term protective effect of early vs. delayed ART among perinatally infected infants. Initiating ART within the first 2 months offers the potential to begin therapy during or near the time of primary infection," the authors write.
(JAMA. 2005;293:2221-2231.)

This study is supported by funding from the Office of AIDS, California Department of Health Services.

EDITORIAL: BALANCING THE UPSIDE AND DOWNSIDE OF ANTIRETROVIRAL THERAPY IN CHILDREN

In an accompanying editorial, Ram Yogev, M.D., of Children's Memorial Hospital, Chicago, comments on the HIV studies in this week's JAMA.

"While it is possible to celebrate the tremendous change in the outcomes of HIV-infected children treated with HAART, it is even more important to continue to prioritize research for the survivors who are now living with a chronic disease. The notion that the problem of HIV in children has been resolved is false-indeed, 15,000 to 20,000 perinatally-infected children and adolescents still need answers to problems such as salvage therapy, long-term complications from the disease or from ART, neurodevelopmental complications, and the ongoing need for new and simplified treatments. It would be a mistake to reduce funding for clinical research on HIV-infected children living in the United States, because such research might not only help these children but also contribute to the care of HIV-infected children worldwide who are starting to benefit from ART and who, in the near future, undoubtedly will develop the same problems that U.S. children are now experiencing," Dr. Yogev writes.
(JAMA. 2005;293:2272-2274.)

Mandatory CWD Testing Approved for Deer

Sun, 08 May 2005 20:09:00 PST

( from http://www.rxpgnews.com ) The Colorado Wildlife Commission has passed a regulation making Chronic Wasting Disease (CWD) testing mandatory for deer harvested in the Gunnison Basin starting with the 2005 hunting season. The regulations will help determine if wildlife feeding operations can be used to prevent significant die off during harsh winters.

"It was a particularly hard winter in the Gunnison area this year and under current Wildlife Commission policy we lacked sufficient information to know if we could feed deer if it got more severe," said Southwest Regional Manager Tom Spezze. "Mild winters for the past few years have kept this from being an issue, but it appears that more regular weather patterns are on the horizon."

To prevent the spread of disease, current Wildlife Commission policy prevents feeding of big game animals in areas where CWD is known to occur. While CWD has not been found in the Gunnison area, the number of heads submitted for testing in past years has been insufficient to provide a statistically valid biological sample.

Applicants who are successful in drawing a deer license in Game Management Units 54, 55, 551, 66, and 67 will receive a letter explaining the mandatory testing requirement. Because the testing has been made mandatory, the usual $15 fee will be waived for testing of deer heads from those units. Information will also be provided to hunters regarding the procedure for CWD testing and the hours and location of testing sites.

The mandatory testing policy will remain in effect until a scientifically sufficient sample size can be achieved.

While the DOW is permitted to feed wildlife in certain instances, it is important to mention that any other feeding of big game in Colorado is a violation of wildlife regulations and can result in criminal penalties.

Alliance to Create a Healthier Generation

Wed, 04 May 2005 17:38:00 PST

( from http://www.rxpgnews.com ) The American Heart Association and former President Bill Clinton announced plans recently to join forces to create a new generation of healthy Americans by addressing one of the nations leading public health threats - childhood obesity. They will be joined in their efforts by Gov. Mike Huckabee (R-Ark). The initiative will focus on preventing childhood obesity and creating healthier lifestyles for children overall.

The joint alliance, launched at an event at New York Citys Public School 128, aims to target several areas that the group hopes will spark change and slow the increasing rates of childhood obesity in the U.S., and encourage healthier lifestyles for young people. The effort will focus on the following three areas:

* Industry: Working with the food and restaurant industry to improve the quality of offerings and to develop marketing and promotion strategies to support environmental change within the industry; Convening key industry players in consumer packaged food, food service, and exercise/fitness to develop healthier eating and more exercise.
* Schools and Community Groups: Increasing physical activity and improving nutrition in schools across the nation; providing standards for schools to improve the food served in cafeterias and vending machines; improving opportunities for enhanced physical activity both in school and after school.
* Community Mobilization: Creating a campaign to engage kids in taking steps to make healthy lifestyle choices and providing tools and information to help parents incorporate heart-healthy activities into family routines, and creating tools and providing opportunities for health care providers to better recognize, prevent and treat obesity in children.
* Media: Exploring opportunities to work with the media to encourage healthier lifestyles for young people; activities will include using role models to promote heart healthy lifestyles among youth.

Health security has been one of the primary missions of my Foundation since we started, and Ive spent most of my life trying to help give children a better future, so I am really excited about this effort to promote healthier lifestyles for children, said President Clinton. After my personal exposure to heart disease and surgery, I wanted to find some way to use that experience to help others. With this initiative, we can help turn young peoples lives around and give them hope for a healthier future.

Id like to stress that this is not a short-term campaign, but a long-term commitment. The Clinton Foundation and the American Heart Association are striving to achieve the same goals for American children, and have many complementary assets and abilities that will serve us well as we work together over the next decade, said American Heart Association President Alice Jacobs, M.D. President Clinton and Governor Huckabee are natural advocates for this issue. President Clintons passion was evident during his administration when he worked on many levels to advance the battle against heart disease and stroke. And his personal experience with heart disease drives him even further to ensure that our nations children make wise lifestyle choices that prevent them from developing chronic diseases such as heart disease. Gov. Huckabee has been instrumental in creating policies in his state that promote healthy lifestyles and he has been an excellent personal example of what can be accomplished when one takes steps to adopt heart-healthy habits. We are honored to be working with such distinguished partners.

"The best way to prevent heart disease in adults is to cultivate healthy lifestyle habits in children, said Governor Huckabee. I hope that this effort will help American families, and especially children, to eat better, be more active, and live longer lives."

Today, more than twice as many children - and almost three times as many teens - are overweight as in 1980. Overweight children and adolescents have about a 70 percent chance of becoming overweight adults increasing their risk for heart disease. If this trend continues it could cut two to five years from the average lifespan.

Robert Eckel, M.D., President-Elect of the American Heart Association, emphasized the need to engage children as advocates for their own health. We need to go right to the source and bring kids all kids into the equation. This is not just about kids who are already overweight or obese. This is about helping kids of all shapes and sizes to control their health and to create lifelong habits that emphasize balance, better nutrition and increased activity.

According to Eckel, The new for kids, by kids campaign, which will launch later this year, will be a positive movement that will speak uniquely to this generation of young people. We are creating something we know will appeal to tweens and other kids because we have involved them in the process of developing the campaign.

Hospital-Acquired Infections Grow, Prove Costly

Mon, 02 May 2005 13:33:00 PST

( from http://www.rxpgnews.com ) Patient safety incidents at America's hospitals increased slightly, but the nation's safest hospitals grew even safer, resulting in a wider gap in patient safety incident rates among the nation's best and worst hospitals, according to a new study of 37 million patient records released today by HealthGrades, an organization that evaluates the quality of hospitals, physicians and nursing homes for consumers, corporations, hospitals and health plans.

The second annual HealthGrades Patient Safety in American Hospitals Study finds that 1.18 million patient safety incidents occurred among Medicare hospitalizations in the years 2001, 2002 and 2003, with the cost to Medicare approaching $3 billion annually. That compares with 1.14 million incidents in the three years beginning with 2000.

The study also finds that hospital-acquired infections grew by 20% and accounted for 30% of the costs of patient safety incidents.

"The reason we see the hospitals with the lowest incident rates improving the fastest is that they have what I call a 'culture of safety'," said HealthGrades Vice President of Medical Affairs Samantha Collier, M.D., who authored the study. "A 'culture of safety' requires rapid identification of errors and root causes and the successful implementation of improvement strategies, which can only be achieved with strong leadership, critical thinking, and commitment to excellence. For patients, it's important to know which hospitals meet this standard, as they are nearly 50% less likely to have an incident at hospitals in the top 10%, according to the HealthGrades study."

The study, which applies 13 patient safety indicators (PSIs) identified by the Agency for Healthcare Research and Quality (AHRQ) to Medicare hospitalizations, produced the following findings:

* There were wide, highly significant gaps in individual PSI and overall performance between the top10% and the bottom 10% ranked hospitals.

* Top 10% hospitals generally had lower incident rates across all PSIs in 2001, but also generally improved at a greater rate than the bottom 10% hospitals between 2001 and 2003.

* Overall, from 2001 through 2003, the best-performing hospitals as a group (hospitals that had the lowest overall PSI incident rates of all hospitals studied, defined as the top 10% of all hospitals studied) had 267,151 fewer patient safety incidents and 48,417 fewer deaths resulting in a lower cost of $2.3 billion associated with Medicare beneficiaries as compared to the bottom 10% of all hospitals studied.

* Patients in the top 10% hospitals had, on average, on average 50 percent lower occurrence of experiencing one or more PSIs compared to patients at the bottom 10% hospitals. Important and frequent contributors to this notable difference were significantly lower rates of hospital-acquired infections and post-operative metabolic derangements.

* If the bottom 10% hospitals improved only their hospital-acquired infection rates to the level of top 10% hospitals, 2,734 deaths associated with $792 million could have been avoided from 2001 through 2003.

* The rates of six key quality improvement focus areas (metabolic derangements, post-operative respiratory failure, decubitus ulcer, post-operative pulmonary embolus (PE) or deep vein thrombosis (DVT), and hospital-acquired infections) worsened on average by 20 percent or more over four years (2000 through 2003), while another six PSIs (death in low mortality DRGs, failure to rescue, iatrogenic pneumothorax, post-operative hip fracture, post-operative hemorrhage or hematoma, and post-operative wound dehiscence) improved on average by less than 10 percent.

* Of the total of 302,541 deaths among patients who developed one or more PSIs during 2001 through 2003, 81 percent (n=245,008) of these deaths were attributable to the patient safety incidents.

* Hospital-acquired infections correlated most highly with overall performance and performance on the other 12 PSIs, suggesting that hospital-acquired infection rates could be possibly used as a proxy of overall hospital patient safety.

* Hospital-acquired infections rates worsened by approximately 20 percent from 2000 to 2003 and accounted for 9,552 deaths and $2.60 billion, almost 30 percent of the total excess cost related to the patient safety incidents.

* The 16 PSIs studied accounted for $8.73 billion in excess inpatient cost to the Medicare system over the three years studied, or roughly $2.91 billion annually.

"We found that that highest incidence rates were in the categories of Failure to Rescue, Decubitus Ulcer and Post-Operative Sepsis," continued Dr. Collier. "Since HealthGrades' first Patient Safety study in 2004, which identified Failure to Rescue as a major source of patient safety issues, we were gratified to see the Institute for Healthcare Improvement advocate for -- and providers begin to adopt -- protocols for minimizing these events."

Distinguished Hospital Awards and Findings

Based on the study, HealthGrades identified 135 hospitals falling into the top 10% in the nation in terms of patient safety, qualifying them to receive the HealthGrades Distinguished Hospital Award for Patient SafetyTM. The award was designed to highlight hospitals with the best records of patient safety in the nation and to encourage consumers to research their local hospitals' patient-safety records before undergoing a procedure.

Methodology

The study is based on 13 of AHRQ's patient safety indicators, applied to the most recent MedPar file of Medicare admissions at nearly 5,000 hospitals covering 2001, 2002 and 2003. Teaching hospitals and non-teaching hospitals were evaluated separately, based on a recommendation from AHRQ that hospitals be compared to their peer group. All data was risk adjusted, so that hospitals with sicker patient populations could be compared equally with others.

The 13 AHRQ indicators are:

* Death in low mortality Diagnostic Related Groupings (DRGs)
* Decubitus ulcer
* Failure to rescue
* Foreign body left during procedure
* Iatrogenic pneumothorax
* Selected infections due to medical care
* Post-operative hip fracture
* Post-operative hemorrhage or hematoma
* Post-operative physiologic and metabolic derangements
* Post-operative respiratory failure
* Post-operative pulmonary embolism or deep vein thrombosis
* Post-operative sepsis
* Post-operative wound dehiscence

Emergency Regulations in Response to Discovery of Chronic Wasting Disease

Sun, 01 May 2005 21:43:00 PST

( from http://www.rxpgnews.com ) The New York State Department of Environmental Conservation (DEC) today announced it has implemented emergency regulations regarding the handling, transport and management of deer in the State. The emergency regulations are effective immediately and represent an aggressive response to the recent discovery of chronic wasting disease (CWD) in a wild deer sampled in Oneida County.

DEC's emergency regulations are designed to ensure the proper handling of deer and prevent further spread of CWD in the wild herd. The emergency regulations were filed with the Department of State today, and are effective immediately for 90 days. In addition, DEC will begin the process of developing permanent regulations, which will appear in the State Register and include a 45-day public comment period.

The positive sample for CWD was from a wild yearling white-tailed deer, and was tested as part of DEC's intensive monitoring effort in Oneida County. The sample tissue was tested at the State's Veterinary Diagnostic Laboratory at Cornell University and confirmed at the National Veterinary Services Laboratory in Ames, Iowa. This is the first known occurrence of CWD in a wild deer in New York State.

The regulations will establish a containment area in Oneida County, where CWD has been identified. The containment area will be comprised of Oneida County municipalities, including the cities of Rome, Sherrill, and Utica, as well as the towns of Augusta, Floyd, Marcy, Trenton, Whitestown, Verona, Westmoreland, Vernon, Kirkland, New Hartford, Vienna, Annsville, Lee, and Western. In addition, the Madison County towns of Stockbridge and Lenox and City of Oneida will also be included. Within the containment area, DEC's emergency regulations will:

* prohibit the movement of certain animal parts out of the containment area;
* establish mandatory DEC check stations for any deer taken by hunters in the containment area;
* prohibit possession of any deer killed by a motor vehicle in the containment area so DEC can acquire specimens for testing; individuals who see a sick or dead deer should call DEC at (315) 336-4809; and,
* prohibit the collection, sale, possession or transport of deer or elk urine taken from the containment area.

In addition to the requirements listed for the containment area, DEC's emergency regulations will include provisions to be followed by individuals and facilities across the State. The emergency regulations will also:

* establish specific record keeping and reporting requirements for taxidermists and require measures to prevent live cervids from coming in contact with any materials, including taxidermy materials, that may contain the infectious agent that causes CWD;
* prohibit rehabilitation of wild white-tailed deer at facilities that house live cervids;
* require retailers who sell deer feed to post a sign provided by DEC to advise buyers of the State prohibition on feeding wild deer; regulations will also prohibit the sale of deer feed that is packaged or labeled for wild white-tailed deer.

DEC implemented intensive monitoring efforts after CWD was found in two captive white-tailed deer herds in Oneida County the first incidents of CWD in New York State. On April 8, 2005, the State Department of Agriculture and Markets (DAM) completed testing of the captive deer and found a total of five positive results for CWD in the two captive herds.

To date, DEC, along with the U.S. Department of Agriculture's Wildlife Services program, has sampled 281 deer from Oneida County, and 25 deer from the Town of Arietta, Hamilton County. Since 2002, DEC has conducted statewide sampling of wild deer for CWD. When combined with sampling efforts in Oneida and Hamilton Counties, DEC has collected more than 3,700 samples from wild white-tailed deer.

DEC will continue intensive sampling of wild deer in Oneida County through April 30, 2005. Additionally, DEC will sample all deer killed within the containment area by motor vehicles, pursuant to nuisance deer permits, and by hunters for CWD testing. Statewide sampling for CWD which has resulted in more than 1,000 tests each year will be increased to closely monitor the distribution and prevalence of CWD in wild deer.

DEC and DAM will continue public outreach to interested parties in Oneida County to help educate citizens on CWD and to discuss next steps to be taken. The agencies will hold a public meeting on Thursday, May 12, 2005, at 7 p.m. in the Vernon-Verona-Sherrill High School Auditorium, located on State Highway 31 in the Town of Verona. In addition, DEC and DAM will conduct additional outreach and continue to aggressively pursue inspection and enforcement across the State.

DAM continues to investigate, sample and test white-tailed deer from two captive herds directly associated with the two herds that were confirmed positive for CWD in Oneida County. Results for these sampling efforts will be announced as soon as they are available. DAM also continues to review its regulations regarding the movement, surveillance and monitoring of live cervids in New York State.

New Repellent Guidance for Upcoming Mosquito Season

Fri, 29 Apr 2005 14:40:00 PST

( from http://www.rxpgnews.com ) Americans have more options than ever to use in protecting themselves from mosquito bites. Today, the Centers for Disease Control and Prevention (CDC) released new guidance about effective mosquito repellents available in the United States. The updated guidance includes addition of two active ingredients - picaridin and oil of lemon eucalyptus - which have been shown to offer long-lasting protection against mosquito bites. Repellents containing DEET continue to be a highly effective repellent option and are also included in the CDC guidelines.

Picaridin, also known as KBR 3023, is an ingredient found in many mosquito repellents used in Europe, Australia, Latin America and Asia for some time. Evidence indicates that it works very well, often comparable with DEET products of similar concentration. One product, containing 7 percent picaridin, is being distributed in the United States for the first time this year. The other repellent is oil of lemon eucalyptus (also known as p-menthane 3,8-diol or PMD), a plant-based mosquito repellent that provided protection time similar to low concentration DEET products in two recent studies. It is available in a variety of formulations throughout the United States.

"We're very excited that the number of options people have to protect themselves from mosquitoes and therefore West Nile Virus has increased," said CDC Director Julie L. Gerberding. "Products containing DEET, picaridin and oil of lemon eucalyptus are all excellent choices. The important thing is that they remember to protect themselves from mosquito bites when they're going to be outside. We want people to enjoy their spring and summer free of West Nile Virus."

Mosquito season has already begun in some parts of the country. With mosquitoes comes the risk of West Nile Virus infection and other infections spread by mosquitoes. Just one bite can lead to an infection that could cause serious illness or even death. While people over 50 are more likely to become seriously ill if infected with WNV, people of any age can become mildly to seriously ill. Most people who contract West Nile Virus do not show any symptoms. However, about 20 percent of people experience symptoms such as fever, headache, nausea and vomiting and an estimated 1 in 150 people infected with WNV will develop severe illness. The severe symptoms can include high fever, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss and paralysis.

DEET, picaridin and oil of lemon eucalyptus are all registered with the U.S. Environmental Protection Agency, which regulates these products. Repellents registered with EPA have been evaluated for both safety and efficacy when used according to label instructions.

CDC recommends that people use repellent anytime they go outside, especially during prime mosquito biting hours, between dusk and dawn. People should follow the label instructions, and if they start getting bitten re-apply repellent.

Millions of Employed Americans Unable to Get Medical Care

Thu, 28 Apr 2005 18:49:00 PST

( from http://www.rxpgnews.com ) A new study analyzing data from the Centers for Disease Control and Prevention shows that a significant number of working Americans in every state do not have health care coverage, with more than 20 million working adults not having coverage. In eight states, at least one in five working adults is uninsured. In 39 other states, at least one working adult in every 10 does not have health care coverage. The report further reveals that in all 50 states and the District of Columbia, between one-fourth and one-half of all uninsured adults were unable to see a doctor when needed in the past year because of cost.

Characteristics of the Uninsured: A View from the States was released today by the Robert Wood Johnson Foundation (RWJF) during a kickoff event for Cover the Uninsured Week, the largest nonpartisan campaign in history to focus attention on the need to secure reliable, affordable health coverage for all Americans. Some of the most influential organizations in the country, including the U.S. Chamber of Commerce and the AFL-CIO, are cosponsoring the Week, which occurs from May 1-8. Supported by nine former Surgeons General and Health and Human Services Secretaries appointed by both Republican and Democratic presidents, the effort is co-chaired by Presidents Gerald Ford and Jimmy Carter. Noah Wyle, star of the TV drama ER, serves as the campaigns national spokesperson.

More than 1,000 public events will take place from coast to coast during Cover the Uninsured Week, with events taking place in every state and the District of Columbia. The effort brings together diverse national, state, and community organizations to tell the nations leaders that health coverage for all must be a top priority. Specific events are designed to help uninsured individuals get services and provide information to small business owners who are finding it difficult to provide health insurance for their employees.

Sens. Orrin Hatch (R-Utah) and Ron Wyden (D-Ore.) joined in today's event to launch the Week. Their bipartisan "Health Care that Works for All Americans" Act passed Congress last year. It calls for convening a national discussion on health care through multiple community meetings and online discussions, followed by hearings in Congress on the views of the American people.

Cover the Uninsured Week is a nonpartisan effort to discuss this issue in Americas neighborhoods, said Hatch. Some in Washington spend too much time blaming each other for this problem, but the American people want us to work together to solve it. That is why Senator Wyden and I reached across the aisle to establish a national discussion.

Uniting Americans to call for change is the first step toward getting real action from Washington, said Wyden. Efforts like Cover the Uninsured Week help more Americans understand how toughit is for individuals and families to be without health care coverage, and how that impacts our communities, our health care system, and our economy. Working together across the aisle and across the country is the only way to build a health care system that will work for everyone.

The report released today was prepared for RWJF by researchers at the State Health Access Data Assistance Center, located at the University of Minnesota. Additional findings, of surveyed adults ages 18-64, include:

*
The problem is pervasive among workers in every state.States with the highest rates of uninsured residents among employed adults include Texas (27 percent), New Mexico (23 percent), Louisiana (23 percent), Florida (22 percent), Montana (21 percent), Oklahoma (21 percent), Nevada (20 percent), and Arkansas (20 percent). States with the lowest uninsured rates among employed adults include Minnesota (7 percent), Hawaii (9 percent), Delaware (9 percent), and the District of Columbia (9 percent).
*
Uninsured adults are unable to see a doctor when needed. Nationally, 41 percent of uninsured adults report being unable to see a doctor when needed in the past 12 months, due to cost, compared to just nine percent of adults who have health care coverage.
*
Uninsured adults are less likely to have a personal doctor or health care provider.Nationally, 56 percent of adults without health care coverage say they do not have a personal doctor or health care provider, compared with just 16 percent of people with health care coverage.
*
Adults who are uninsured are much more likely to report being in poor or fair health than are adults who are insured.Nationally, one in five uninsured adults (20 percent) say their health is fair or poor, compared with nearly one in nine adults with health coverage (12 percent).

The report uses data from the Centers for Disease Control and Preventions 2003 Behavioral Risk Factor Surveillance System Survey (BRFSS). The BRFSS is a national telephone survey of preventive and health risk behaviors. It is administered in all 50 states and D.C. to adults 18 years of age and older.

Cover the Uninsured Week has grown considerably since the campaign was first introduced in 2003. Nearly 250 national organizations and 2,500 local organizations have participated in planning events. Throughout the nation, hundreds of health and enrollment fairs will provide screenings and information to those without coverage. Business seminars will provide opportunities for small business owners to discuss ways to provide affordable health plans for their employees. Special coverage-oriented educational forums will take place on campuses nationwide before, during, and after the Week. Rabbis, pastors, priests, and imams throughout the nation will be talking about this issue and getting congregants involved in efforts to help people who are uninsured. Press conferences are being planned in cities across the country, assembling diverse groups of local leaders to demonstrate community support for action on the issue and to release new research.

Cover the Uninsured Week provides momentum and mobilization that will ultimately result in actions that benefit the millions of Americans who live without health coverage, said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation. Too many families suffer, and too many lives are lost because our nation has not taken action to address this problem. As a nation, and as individuals, we can either let 45 million of our neighbors live without health insurance, or we can come together and do something about it.

CDC Efforts to Reduce or Prevent Obesity

Thu, 21 Apr 2005 17:41:00 PST

( from http://www.rxpgnews.com ) The prevalence of overweight and obesity has increased substantially over the past several decades. The latest National Health and Nutrition Examination Survey (NHANES) data indicate 65 percent of U.S. adults aged 20 years and older are overweight with a body mass index (BMI) of 25 or higher, or obese with a BMI of 30 or higher. In addition, 16 percent of children and adolescents ages 6-19 in the United States are overweight.

Body mass index (BMI) is a measure of weight adjusted for height. Although it does not differentiate between body fat and muscle mass, BMI is a useful tool for indicating whether a person is underweight, at a healthy weight, overweight or obese.

According to The Surgeon Generals Call to Action to Prevent and Decrease Overweight and Obesity, the medical and related costs of obesity in the United States in 2000 was more than $117 billion. Overweight and obesity have been associated with a number of conditions. Among these are heart disease, stroke, diabetes, cancer (such as colon cancer, endometrial cancer, and postmenopausal breast cancer) and osteoarthritis.

Two studies in the April 20, 2005 issue of Journal of the American Medical Association (JAMA) provide more information on issues related to obesity and mortality.

Excess Deaths Associated with
Underweight, Overweight and Obesity

Using data collected from the most recent NHANES, Katherine Flegal, Ph.D., CDCs National Center for Health Statistics, and her co-authors from CDC and the National Cancer Institute, part of the National Institutes of Health, found that both obesity and being underweight are associated with excess deaths when compared with the normal weight population.

The study found:

* There were 112,000 more deaths than expected in 2000 among obese individuals (BMI of 30 or higher).

* Underweight individuals (BMI of less than 18.5) had a higher risk of death with nearly 34,000 more deaths than expected.

* Most of the excess deaths among the underweight occurred in people age 70 or older. Among the obese, the increased risk of death was most pronounced among people younger than 70.

* Being overweight (BMI of 25-29.9) was not associated with excess mortality. The study found that 87,000 fewer deaths than expected were associated with being overweight.

Secular Trends in Cardiovascular Disease Risk Factors
According to Body Mass Index in US Adults

Edward Gregg, Ph.D., of CDCs diabetes program and his CDC co-authors, analyzed NHANES data and found large decreases in many of the cardiovascular disease risk factors known to be associated with early deaths in all U.S. adults ages 20-74, regardless of their BMI. The exception was diabetes. The prevalence of total (diagnosed and undiagnosed) diabetes increased by 55 percent over the past 40 years, likely the result of the dramatic increase in obesity during this time period.

Other key findings:

* Prevalence of elevated cholesterol and blood pressure dropped by almost half in all U.S. adults ages 20-74, while smoking prevalence dropped by about a third.

* Reductions in the prevalence of high cholesterol levels were most substantial among obese people compared to lean individuals.

* Reductions in blood pressure and smoking prevalence were similar among lean and obese persons.

Secular Trends in Cardiovascular Disease Risk Factors

Thu, 21 Apr 2005 17:41:00 PST

( from http://www.rxpgnews.com ) Edward Gregg, Ph.D., of CDCs diabetes program and his CDC co-authors, analyzed NHANES data and found large decreases in many of the cardiovascular disease risk factors known to be associated with early deaths in all U.S. adults ages 20-74, regardless of their BMI. The exception was diabetes. The prevalence of total (diagnosed and undiagnosed) diabetes increased by 55 percent over the past 40 years, likely the result of the dramatic increase in obesity during this time period.

Other key findings:

* Prevalence of elevated cholesterol and blood pressure dropped by almost half in all U.S. adults ages 20-74, while smoking prevalence dropped by about a third.

* Reductions in the prevalence of high cholesterol levels were most substantial among obese people compared to lean individuals.

* Reductions in blood pressure and smoking prevalence were similar among lean and obese persons.

Human Resource crisis in HIV/AIDS

Wed, 20 Apr 2005 20:08:00 PST

( from http://www.rxpgnews.com ) The federal government should create and fund an umbrella organization called the United States Global Health Service (GHS) to mobilize the nation's best health care professionals and other experts to help combat HIV/AIDS in hard-hit African, Caribbean, and Southeast Asian countries, says a new report from the Institute of Medicine of the National Academies. Full-time, salaried professionals would make up the organization's pivotal "service corps," working side by side with other colleagues already on the ground to provide medical care and drug therapy to affected populations while offering local counterparts training and assistance in clinical, technical, and managerial areas. The proposal's goal is to build the capacity of targeted countries to fight the pandemic over the long run. The dearth of qualified health care workers in many low-income nations is often the biggest roadblock in mounting effective responses to public health needs.

In January 2003 President Bush announced the President's Emergency Plan for AIDS Relief (PEPFAR), which is directed at 15 countries that are home to half of the world's HIV-infected people. PEPFAR's "2-7-10" goals are to treat 2 million infected people with antiretroviral therapy, prevent 7 million new HIV infections, and care for 10 million people who are infected with HIV or affected by it. This comprehensive, five-year strategy is part of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act, which Congress passed in 2003. Among other measures, the legislation calls for a pilot program to test how U.S. health care professionals and others with technical expertise could help meet the "2-7-10" goals through public service abroad. The federal Office of the U.S. Global AIDS Coordinator asked the Institute of Medicine to study options for placing such workers in the 15 focus countries.

"In addition to this proposed corps of highly skilled health and management professionals, the Global Health Service would also have five other components. The individuals serving in all of these programs would constitute a critical driving force to carry out the president's plan -- and to build the developing world's capacity to control HIV/AIDS, tuberculosis, and malaria over time," said study committee chair Fitzhugh Mullan, contributing editor of the journal HEALTH AFFAIRS, and clinical professor of pediatrics and public health, George Washington University, Washington, D.C. "They would multiply essential skills and services, offering both concrete assistance and hope. In our interconnected world, such work benefits us all."

CREATING THE UNITED STATES GLOBAL HEALTH SERVICE

Today HIV/AIDS is one of the world's greatest health crises, the report emphasizes. Nearly 40 million people are infected with HIV, and 95 percent of them live in resource-poor countries. About 6 million HIV-infected people in these areas need antiretroviral treatment now. PEPFAR has provided such drug therapy in the 15 focus countries: Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam, and Zambia. However, a shortage of workers to administer medication and provide essential support could ultimately thwart PEPFAR's efforts. Preventing and treating HIV/AIDS in these developing nations will require unprecedented health systems and human resource initiatives.

GHS should be based in the federal government, but private agencies should also play supporting roles, the report says. Furthermore, an international advisory committee should be established to provide input on the development, ongoing operation, and evaluation of the proposed service.

In the first year, 150 U.S. health professionals should be selected for the GHS service corps and deployed based on several criteria, including specific priorities that have been identified by each country's health ministry in conjunction with federal PEPFAR teams already on the ground; the availability of people with the required skills; and the readiness of institutions to host corps participants. They would be assigned for at least two years to programs or geographic areas where they could have the greatest impact. Participants' ability to help combat the spread of malaria and tuberculosis -- which often overlap HIV infections in the developing world -- would also be considered. On the whole, the initial cost of the GHS is estimated at about $100 million annually, or roughly 3 percent of PEPFAR's current budget. About $35 million of this would be for the service corps, the report says.

Another component of the GHS would be a fellowship program, which should offer competitive awards of $35,000 annually for skilled professionals who want to make a difference overseas but are stymied by financial and logistical barriers. Fellows would provide health care, training, or technical assistance in a PEPFAR focus country for at least one year, the report says.

GHS also would include a loan-repayment program for student debt. Any participants who serve in a focus country could erase $25,000 of higher-education debt for each year of service completed, the report says. Given the heavy student-debt load that health professionals often carry, this incentive would expand the overall pool of candidates.

BROAD COLLABORATION NEEDED

Smooth, quick transfers of talented people to the targeted nations would be vital, the committee said. To that end, adequate funding would be needed to foster innovative, long-term partnerships between relevant institutions based in the United States and in PEPFAR countries. Such bilateral arrangements, known as "twinning," can strengthen institutional work forces in host countries by providing staff to fill vacancies and to offer specialized training and development opportunities. Partners could include hospitals, universities, nongovernmental organizations, and public health agencies.

Education and training offered by all GHS participants should encompass not only clinical and technical skills, but also management of finances, social services, and human resources. Developing effective new ways to deliver health care in impoverished regions should also be a priority, the report notes.

Education systems and health care infrastructure in developing countries are often weak and understaffed. In addition, skilled health professionals frequently accept job offers from wealthy countries that are experiencing their own shortages of health care workers. But the shortfall is dramatically worse in the developing world. Few African nations, for example, have more than one doctor per 5,000 people. Without an increase in the number of physicians, nurses, technicians, pharmacists, and other health care professionals, expanding the scope of antiretroviral drug therapy for HIV/AIDS would only exacerbate these personnel challenges.

The committee also recommended that GHS create a clearinghouse for comprehensive information about various groups that mobilize health professionals to work in PEPFAR focus countries. It would include a searchable, Internet-based directory of programs; an electronic job bank related to service in targeted countries; and information about cultural and logistical issues. To ensure that GHS participants are properly assigned, country-based teams of PEPFAR workers should collaborate with national health ministries to assess each country's health personnel needs. The assessments would generate a baseline inventory for all mobilization programs and their subsequent evaluation, and could inform each nation's human-resources plan. All assessment data should be collected the same way in each country, updated regularly, and stored in the job bank of the clearinghouse. Additionally, the report outlines several promising steps to enhance and sustain the health work force worldwide.

New York Labs Destroyed all H2N2 strain test kits

Thu, 14 Apr 2005 16:37:00 PST

( from http://www.rxpgnews.com ) Earlier this week, the New York City Department of Health and Mental Hygiene (DOHMH) was alerted by the New York State Department of Health and the Association of Public Health Laboratories (APHL) that proficiency test kits containing the H2N2 strain of influenza virus were sent to over 4,000 laboratories nationwide, including several in New York City.

The Health Department has since directly contacted the seven test kit recipient laboratories in New York City. We have confirmed that all test kits containing the H2N2 strain were destroyed.

In addition to the Health Department's response to this matter, multiple alerts have been sent to laboratories throughout New York State by the American College of Pathologists, the APHL and the New York State Department of Health.

Each of the recipient laboratories follows stringent protocols with respect to the receipt, use and destruction of samples. The Department is fully confident in their ability to properly handle these matters. We will continue to closely monitor the situation statewide and nationwide until it is resolved.

RxPG News : USA

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Obama names Indian American health researcher White House Fellow

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Nearly Half of Primary Care Doctors in US Would Like to Quit

Stem cell research to get a boost under Obama

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4.5 percent of US prisoners report sexual abuse

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Susan C. Winckler Appointed as Acting FDA Chief of Staff

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Study calls for 39 percent more family physicians in USA

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FDA Counterfeit Drug Task Force's recommendations adopted

Rapid Approval of Gardasil Marks Major Advancement in Public Health

Antiretroviral therapy saved three million life years

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Autism Costs $35 Billion Per Year to U.S.

Mammography screenings for breast cancer show ethnic disparities

Congenital rubella syndrome nearly eradicated in the US

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Media campaigns encourage parents to talk about sex

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Court upholds $79.5 mn ruling against tobacco giant

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New Prescription Drug Information Format to Improve Patient Safety

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Hospitalization Rates For Infectious Diseases Increase Among Older Adults

Swine Workers at Increased Risk of Infection with Swine Influenza Virus

Antibiotics Overprescribed For Pharyngitis

Low Birth Weight Rates Vary Widely

Cervical Cancer Screening Programs For Low-Resource Areas Appear Effective And Safe

US Health Care Cuts Are Costing Lives

CDC Advises Broadening of Influenza's Vaccination Efforts

A Virtual Katrina of deaths every week in US due to racial health gap

Number of bariatric surgical procedures increased considerably

Medicare patients have higher risk of death after bariatric surgery

Little Gain from Physicians Pay-For-Performance Programs

Total cholesterol level among older adults declining in U.S.

Florida physicians continue to decrease or eliminate important health services

Inappropriate Prescribing of Antibiotics by NPs and MDs Continues

Aetna Workers Comp access growing in 17 markets

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Aetna Introduces Medicare Advantage Plans in Arizona

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BRCA gene testing not recommended as a routine test

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Aetna Workers Comp access growing in 17 markets