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Is Rinsing Your Sinuses Safe?

September 4, 2012 Comments off

Is Rinsing Your Sinuses Safe?

Source: U.S. Food and Drug Administration

Little teapots with long spouts have become a fixture in many homes for reasons that have nothing to do with tea.

Called neti pots, they are used to rinse the nasal passages with a saline (salt-based) solution, and have become popular as a treatment for congested sinuses, colds and allergies, and for moistening nasal passages exposed to dry indoor air.

However, the Food and Drug Administration (FDA) has concerns about the risk of infection tied to the improper use of neti pots and other nasal rinsing devices. The agency is informing consumers, manufacturers and health care professionals about safe practices for using all nasal rinsing devices, which include bulb syringes, squeeze bottles, and battery-operated pulsed water devices.

These devices are generally safe and useful products, says Steven Osborne, M.D., a medical officer in FDA’s Center for Devices and Radiological Health (CDRH). But they must be used and cleaned properly.

Most important is the source of water that is used with nasal rinsing devices. Tap water that is not filtered, treated, or processed in specific ways is not safe for use as a nasal rinse.

National and State Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2011

September 4, 2012 Comments off

National and State Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)

Since 2005, the Advisory Committee on Immunization Practices (ACIP) has expanded the routine adolescent vaccination schedule with administration of the following vaccines at ages 11 or 12 years: meningococcal conjugate (MenACWY), 2 doses*; tetanus, diphtheria, acellular pertussis (Tdap), 1 dose; human papillomavirus (HPV), 3 doses; and influenza, 1 dose annually (1). To assess vaccination coverage among adolescents aged 13–17 years,† CDC analyzed data from the National Immunization Survey-Teen (NIS-Teen). This report summarizes the results of that assessment, which indicated that, from 2010 to 2011, vaccination coverage increased for ≥1 dose Tdap on or after age 10 years (from 68.7% to 78.2%), ≥1 dose MenACWY (from 62.7% to 70.5%), and, among females, for ≥1 dose of HPV (from 48.7% to 53.0%) and ≥3 doses of HPV§ (from 32.0 to 34.8%) (2). Vaccination coverage varied widely among states. Interventions that increase adolescent vaccination coverage include strong recommendations from health-care providers, urging consideration of every health visit as an opportunity for vaccination, reducing out-of-pocket costs, and using reminder/recall systems. Despite increasing adolescent vaccination coverage, the percentage point increase in ≥1 dose HPV coverage among adolescent females was less than half that of the increase in ≥1 dose of Tdap or MenACWY. The causes of lower coverage with HPV vaccine are multifactorial; addressing missed opportunities for vaccination, as well as continued evaluation of vaccination-promoting initiatives, is needed to protect adolescents against HPV-related cancers.

FAA Has Not Effectively Implemented its Wildlife Hazard Mitigation Program

September 4, 2012 Comments off

FAA Has Not Effectively Implemented its Wildlife Hazard Mitigation Program
Source: U.S. Department of Transportation, Office of Inspector General

On August 22, we issued a report on the Federal Aviation Administration’s (FAA) Wildlife Hazard Mitigation Program, which aims to reduce the risk of wildlife strikes to aviation. Under the Program, FAA requires airports to create and implement wildlife hazard management plans to assess and minimize the risk of future strikes. However, we found that FAA’s oversight and enforcement activities are not sufficient to ensure airports fully adhere to Program requirements or effectively implement their wildlife hazard plans. In addition, FAA’s policies and guidance for monitoring, reporting, and mitigating wildlife hazards are mostly voluntary, thereby limiting their effectiveness. For example, FAA recommends but does not mandate that airports and aircraft operators report all wildlife strikes to FAA’s strike database. As a result, FAA’s strike data are incomplete, which impacts the Agency’s ability to evaluate the effectiveness of its Program in reducing wildlife hazards. Finally, FAA coordinates effectively with the U.S. Department of Agriculture Wildlife Services, its main partner in wildlife hazard mitigation, but its efforts to coordinate with other relevant Government agencies are limited and infrequent. We made 10 recommendations intended to improve FAA’s management and oversight of the Program. FAA concurred with six, partially concurred with three, and did not concur with one. We are requesting additional information or revised responses for five recommendations—particularly related to improving the quality and quantity of the Agency’s wildlife strike data.

Provider 2020: Strategies for strategic differentiation in an uncertain environment

September 1, 2012 Comments off

Provider 2020: Strategies for strategic differentiation in an uncertain environment
Source: Deloitte

A number of factors are converging to make the next decade likely one of the most tumultuous in the history of the health care industry. While it may seem premature or even risky to begin planning for a future that is uncertain, the greater risk is failing to take decisive action now.

“Provider 2020: Strategies for strategic differentiation in an uncertain environment” takes a closer look at a strategic response to the path forward. In this article, Deloitte reviews:

  • Potential strategic destinations for hospitals and health systems
  • The evolving journey of strategic differentiation
  • “False positives” in the current market
  • Where to start: Selecting the suitable path for strategic differentiation

The Role of Herd Immunity in Parents’ Decision to Vaccinate Children: A Systematic Review

September 1, 2012 Comments off

The Role of Herd Immunity in Parents’ Decision to Vaccinate Children: A Systematic Review
Source: Pediatrics

BACKGROUND AND OBJECTIVE: Herd immunity is an important benefit of childhood immunization, but it is unknown if the concept of benefit to others influences parents’ decisions to immunize their children. Our objective was to determine if the concept of “benefit to others” has been found in the literature to influence parents’ motivation for childhood immunization.

METHODS: We systematically searched Medline through October 2010 for articles on parental/guardian decision-making regarding child immunization. Studies were included if they presented original work, elicited responses from parents/guardians of children <18 years old, and addressed vaccinating children for the benefit of others.

RESULTS: The search yielded 5876 titles; 91 articles were identified for full review. Twenty-nine studies met inclusion criteria. Seventeen studies identified benefit to others as 1 among several motivating factors for immunization by using interviews or focus groups. Nine studies included the concept of benefit to others in surveys but did not rank its relative importance. In 3 studies, the importance of benefit to others was ranked relative to other motivating factors. One to six percent of parents ranked benefit to others as their primary reason to vaccinate their children, and 37% of parents ranked benefit to others as their second most important factor in decision-making.

CONCLUSIONS: There appears to be some parental willingness to immunize children for the benefit of others, but its relative importance as a motivator is largely unknown. Further work is needed to explore this concept as a possible motivational tool for increasing childhood immunization uptake.

Injuries from Batteries Among Children Aged <13 Years — United States, 1995–2010

September 1, 2012 Comments off

Injuries from Batteries Among Children Aged <13 Years — United States, 1995–2010
Source: Morbidity and Mortality Weekly Report (CDC)

Injuries to children caused by batteries have been documented in the medical literature and by poison control centers for decades (1,2). Of particular concern is the ingestion of button batteries,* especially those ≥20 mm in diameter (coin size), which can lodge in the esophagus, leading to serious complications or death (3–5). To estimate the number of nonfatal battery injuries among children aged <13 years, U.S. Consumer Product Safety Commission (CPSC) staff analyzed 1997–2010 data from the National Electronic Injury Surveillance System (NEISS). To identify fatal battery exposures, other CPSC databases covering 1995–2010 were examined, including the 1) Injury and Potential Injury Incident File; 2) Death Certificate Database (DTHS); and 3) In-Depth Investigation File (INDP). From 1997 to 2010, an estimated 40,400 children aged <13 years were treated in hospital emergency departments (EDs) for battery-related injuries, including confirmed or possible battery ingestions. Nearly three quarters of the injuries involved children aged ≤4 years; 10% required hospitalization. Battery type was reported for 69% of cases, and of those, button batteries were implicated in 58%. Fourteen fatal injuries were identified in children ranging in age from 7 months to 3 years during 1995–2010. Battery type was reported in 12 of these cases; all involved button batteries. CPSC is urging the electronics industry and battery manufacturers to develop warnings and industry standards to prevent serious injuries and deaths from button batteries. Additionally, public health and health-care providers can encourage parents to keep button batteries and products containing accessible button batteries (e.g., remote controls) away from young children.

Human blood metabolite timetable indicates internal body time

August 31, 2012 Comments off
Source:  Proceedings of the National Academy of Sciences
A convenient way to estimate internal body time (BT) is essential for chronotherapy and time-restricted feeding, both of which use body-time information to maximize potency and minimize toxicity during drug administration and feeding, respectively. Previously, we proposed a molecular timetable based on circadian-oscillating substances in multiple mouse organs or blood to estimate internal body time from samples taken at only a few time points. Here we applied this molecular-timetable concept to estimate and evaluate internal body time in humans. We constructed a 1.5-d reference timetable of oscillating metabolites in human blood samples with 2-h sampling frequency while simultaneously controlling for the confounding effects of activity level, light, temperature, sleep, and food intake. By using this metabolite timetable as a reference, we accurately determined internal body time within 3 h from just two anti-phase blood samples. Our minimally invasive, molecular-timetable method with human blood enables highly optimized and personalized medicine.

 

A Systematic Review of Vocational Interventions for Young Adults With Autism Spectrum Disorders

August 31, 2012 Comments off

A Systematic Review of Vocational Interventions for Young Adults With Autism Spectrum Disorders
Source: Pediatrics

BACKGROUND AND OBJECTIVE: Many individuals with autism spectrum disorders (ASDs) are approaching adolescence and young adulthood; interventions to assist these individuals with vocational skills are not well understood. This study systematically reviewed evidence regarding vocational interventions for individuals with ASD between the ages of 13 and 30 years.

METHODS: The Medline, PsycINFO, and ERIC databases (1980–December 2011) and reference lists of included articles were searched. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes, and assigned overall quality and strength of evidence ratings based on predetermined criteria.

RESULTS: Five studies were identified; all were of poor quality and all focused on on-the-job supports as the employment/vocational intervention. Short-term studies reported that supported employment was associated with improvements in quality of life (1 study), ASD symptoms (1 study), and cognitive functioning (1 study). Three studies reported that interventions increased rates of employment for young adults with ASD.

CONCLUSIONS: Few studies have been conducted to assess vocational interventions for adolescents and young adults with ASD. As such, there is very little evidence available for specific vocational treatment approaches as individuals transition to adulthood. All studies of vocational approaches were of poor quality, which may reflect the recent emergence of this area of research. Individual studies suggest that vocational programs may increase employment success for some; however, our ability to understand the overall benefit of supported employment programs is limited given the existing research.

Health and wellbeing at work in the United Kingdom

August 31, 2012 Comments off

Health and wellbeing at work in the United Kingdom

Source:  RAND Corporation

In 2009, the Work Foundation led a partnership with RAND Europe and Aston Business School undertaking the research and analysis to support the Boorman review. RAND Europe led the study on whether health workplace interventions could be useful to mitigate health risk factors and to reduce the work-related costs associated with poor health and wellbeing in British workplaces and the NHS in England. This report, prepared for the Department of Health, presents the main findings of the research.

Interventions for Adolescents and Young Adults With Autism Spectrum Disorders

August 30, 2012 Comments off

Interventions for Adolescents and Young Adults With Autism Spectrum Disorders (PDF)

Source: Agency for Healthcare Research and Quality

Few studies have been conducted to assess treatment approaches for adolescents and young adults with ASD, and as such there is very little evidence available for specific treatment approaches in this population; this is especially the case for evidence-based approaches to support the transition of youth with autism to adulthood. Of the small number of studies available, most were of poor quality, which may reflect the relative recency of the field. Five studies, primarily of medical interventions, had fair quality. Behavioral, educational, and adaptive/life skills studies were typically small and short term and suggested some potential improvements in social skills and functional behavior. Small studies suggested that vocational programs may increase employment success for some individuals. Few data are available to support the use of medical or allied health interventions in the adolescent and young adult population. The medical studies that have been conducted focused on the use of medications to address specific challenging behaviors, including irritability and aggression, for which effectiveness in this age group is largely unknown and inferred from studies including mostly younger children.

Educational differences in chronic conditions and their role in the educational differences in overall mortality

August 30, 2012 Comments off

Educational differences in chronic conditions and their role in the educational differences in overall mortality
Source: Demographic Research

Demographers use different models to decompose the prevalence of given health conditions. This article discusses how these models can help us understand the ways in which these conditions affect overall mortality. In particular, this framework can be used to understand the role that any given condition plays in producing differences in overall mortality across populations. The empirical analysis in this study focuses on chronic conditions as factors behind elderly US citizens’ differences in overall mortality across educational levels. The analysis of differences by education level shows that while the prevalence differences of chronic conditions is mostly the outcome of incidence differences, regarding overall mortality differences, the role of chronic conditions is equally channelled through incidence and excess mortality differences.

Challenges for HIV Pre-Exposure Prophylaxis among Men Who Have Sex with Men in the United States

August 29, 2012 Comments off

Challenges for HIV Pre-Exposure Prophylaxis among Men Who Have Sex with Men in the United States
Source: PLoS Medicine

Summary Points
+ Pre-exposure prophylaxis (PrEP) with anti-retroviral (ARV) medications is partially efficacious for preventing HIV infection among men who have sex with men (MSM) and heterosexuals.
As PrEP becomes available and prescribed for use among MSM a better understanding of willingness to use PrEP and avoidance of condom use are needed so that behavioral programs and counseling may be enhanced for maximum benefit.
+ Targeted messaging will be needed about ARV prophylaxis for various at risk populations, but the general message should be that condoms continue to be the most effective way to prevent HIV transmission through sex and that PrEP is an additional biomedical intervention.
+ As new effective biomedical intervention methods, such as PrEP, become available language about “protected” and “unprotected” sex, which used to exclusively mean condom use, will need to adapt.

Where do American Cities Rank in Eighth Annual “Allstate America’s Best Drivers Report™?”

August 29, 2012 Comments off

Where do American Cities Rank in Eighth Annual "Allstate America’s Best Drivers Report™?"

Source: Allstate

The Allstate Insurance Company (NYSE: ALL) today released its eighth annual "Allstate America’s Best Drivers Report™." The report, based on Allstate claims data, ranks America’s 200* largest cities in terms of car collision frequency to identify which cities have the safest drivers.

This year’s top honor of "America’s Safest Driving City" is Sioux Falls, South Dakota, the fifth time in the history of the report that the city has held the top spot. According to the report, the average driver in Sioux Falls will experience an auto collision every 13.8 years, which is 27.6 percent less likely than the national average of 10 years.

Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population

August 29, 2012 Comments off

Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population
Source: Archives of Internal Medicine

Background
Despite extensive data about physician burnout, to our knowledge, no national study has evaluated rates of burnout among US physicians, explored differences by specialty, or compared physicians with US workers in other fields.

Methods
We conducted a national study of burnout in a large sample of US physicians from all specialty disciplines using the American Medical Association Physician Masterfile and surveyed a probability-based sample of the general US population for comparison. Burnout was measured using validated instruments. Satisfaction with work-life balance was explored.

Results
Of 27 276 physicians who received an invitation to participate, 7288 (26.7%) completed surveys. When assessed using the Maslach Burnout Inventory, 45.8% of physicians reported at least 1 symptom of burnout. Substantial differences in burnout were observed by specialty, with the highest rates among physicians at the front line of care access (family medicine, general internal medicine, and emergency medicine). Compared with a probability-based sample of 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%) (P < .001 for both). Highest level of education completed also related to burnout in a pooled multivariate analysis adjusted for age, sex, relationship status, and hours worked per week. Compared with high school graduates, individuals with an MD or DO degree were at increased risk for burnout (odds ratio [OR], 1.36; P < .001), whereas individuals with a bachelor's degree (OR, 0.80; P = .048), master's degree (OR, 0.71; P = .01), or professional or doctoral degree other than an MD or DO degree (OR, 0.64; P = .04) were at lower risk for burnout.

Conclusions
Burnout is more common among physicians than among other US workers. Physicians in specialties at the front line of care access seem to be at greatest risk.

From the American Academy of Pediatrics: Circumcision Policy Statement

August 29, 2012 Comments off

From the American Academy of Pediatrics: Circumcision Policy Statement
Source: Pediatrics

Male circumcision is a common procedure, generally performed during the newborn period in the United States. In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academy’s 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement.

National Federation of Independent Business v. Sebelius: Five Takes

August 28, 2012 Comments off

National Federation of Independent Business v. Sebelius: Five Takes
Source: Social Science Research Network

In this article, following our now-famous “Five Takes” format, we will look at some possible meanings and implications of the Supreme Court’s decision.

We first consider possible analogies between NFIB and two other famous cases whose opinions are held out as deftly straddling the line between principle and prudence: Marbury v. Madison and the Bakke case (Takes One and Two). Takes Three and Four examine the opinion though the lens of constitutional theory. We consider whether the decision, Chief Justice Roberts’s opinion especially, served what Charles Black called the Court’s “legitimating” function, quelling doubts about the Act’s constitutionality and, thus, its legitimacy. We further consider whether, in ultimately upholding the Act despite its relative unpopularity, Chief Justice Roberts’s opinion could be seen as an example of judicial restraint a la James Bradley Thayer. Finally, in Take Five, we consider that the peculiar construction of the opinion handed the Administration a somewhat Pyrrhic victory while laying the foundation for robust judicially-enforced limits on congressional power. A brief conclusion follows.

Tattoo-Associated Nontuberculous Mycobacterial Skin Infections — Multiple States, 2011–2012

August 28, 2012 Comments off

Tattoo-Associated Nontuberculous Mycobacterial Skin Infections — Multiple States, 2011–2012
Source: Morbidity and Mortality Weekly Report (CDC)

Permanent tattoos have become increasingly common, with 21% of adults in the United States reporting having at least one tattoo (1). On rare occasions, outbreaks of nontuberculous mycobacterial (NTM) skin infections have been reported after tattooing (2,3). In January 2012, public health officials in New York received reports of Mycobacterium chelonae skin infections in 14 New York residents who received tattoos during September–December 2011. All infections were associated with use of the same nationally distributed, prediluted gray ink manufactured by company A. CDC disseminated an Epi-X public health alert to identify additional tattoo-associated NTM skin infections; previously identified cases were reported from three states (Washington, Iowa, and Colorado). Public health investigations by CDC, state and local health departments, and the Food and Drug Administration (FDA) found NTM contamination in tattoo inks used in two of five identified clusters. All infected persons were exposed to one of four different brands of ink. NTM contamination of inks can occur during the manufacturing process as a result of using contaminated ingredients or poor manufacturing practices, or when inks are diluted with nonsterile water by tattoo artists. No specific FDA regulatory requirement explicitly provides that tattoo inks must be sterile. However, CDC recommends that ink manufacturers ensure ink is sterile and that tattoo artists avoid contamination of ink through dilution with nonsterile water. Consumers also should be aware of the health risks associated with getting an intradermal tattoo.

Lead Poisoning in Pregnant Women Who Used Ayurvedic Medications from India — New York City, 2011–2012

August 26, 2012 Comments off

Lead Poisoning in Pregnant Women Who Used Ayurvedic Medications from India — New York City, 2011–2012
Source: Morbidity and Mortality Weekly Report (CDC)

Lead poisoning still occurs in the United States despite extensive prevention efforts and strict regulations. Exposure to lead can damage the brain, kidneys, and nervous and reproductive systems. Fetal exposure to lead can adversely affect neurodevelopment, decrease fetal growth, and increase the risk for premature birth and miscarriage (1). During 2011–2012, the New York City Department of Health and Mental Hygiene (DOHMH) investigated six cases of lead poisoning associated with the use of 10 oral Ayurvedic medications made in India. All six cases were in foreign-born pregnant women assessed for lead exposure risk by health-care providers during prenatal visits, as required by New York state law. Their blood lead levels (BLLs) ranged from 16 to 64 µg/dL. Lead concentrations of the medications were as high as 2.4%; several medications also contained mercury or arsenic, which also can have adverse health effects. DOHMH distributed information about the medications to health-care providers, product manufacturers, and government agencies in the United States and abroad, via postal and electronic mail. DOHMH also ordered a local business selling contaminated products to cease sales. Health-care providers should ask patients, especially foreign-born or pregnant patients, about any use of foreign health products, supplements, and remedies such as Ayurvedic medications. Public health professionals should consider these types of products when investigating heavy metal exposures and raise awareness among health-care providers and the public regarding the health risks posed by such products.

Retirees Underestimate Life Expectancy, Risk Underfunding Retirement

August 25, 2012 Comments off

Retirees Underestimate Life Expectancy, Risk Underfunding Retirement
Source: Society of Actuaries

With life expectancy rates on the rise, more than half of retirees and pre-retirees underestimate the age to which a person of his or her age and gender can expect to live, which can have significant implications on retirement planning, according to a new report from the Society of Actuaries (SOA).

This SOA highlights report released today illustrates findings on longevity from the “2011 Risks and Process of Retirement Survey Report,” such as approximately four in 10 underestimate their life expectancy by five or more years.

“Underestimation of life expectancy, combined with having too short of a planning horizon can result in inadequate funds for retirement needs,” said actuary and retirement expert Cindy Levering, ASA, MAAA, EA. “There is a general misunderstanding of what ‘average life expectancy’ means, and when people are told they will live to an age such as 80 or 85, they don’t realize that this means there is a 50 percent chance that they could live past that age.”

Hat tip: PW

Treatment Strategies for Women With Coronary Artery Disease

August 24, 2012 Comments off

Treatment Strategies for Women With Coronary Artery Disease (PDF)
Source: Agency for Healthcare Research and Quality

Objectives. Although coronary artery disease (CAD) is the leading cause of death for women in the United States, treatment studies to date have primarily enrolled men and may not reflect the benefits and risks that women experience. Our systematic review of the medical literature assessed the comparative effectiveness of major treatment options for CAD specifically in women. The comparisons were (1) percutaneous coronary intervention (PCI) versus fibrinolysis/supportive pharmacologic therapy in ST elevation myocardial infarction (STEMI), (2) early invasive versus initial conservative management in non-ST elevation myocardial infarction (NSTEMI) or unstable angina, and (3) PCI versus coronary artery bypass surgery (CABG) versus optimal medical therapy in stable or unstable angina. The endpoints assessed were clinical outcomes, modifiers of effectiveness by demographic and clinical factors, and safety outcomes.

From a limited number of studies reporting results for women separately from the total study population, our findings confirm current practice and evidence for care in one of the three areas evaluated. For women with STEMI, we found that an invasive approach with immediate PCI is superior to fibrinolysis for reducing cardiovascular events, which is similar to findings in previous meta-analyses combining results for both women and men. For women with NSTEMI or unstable angina, evidence suggested that an early invasive approach reduces cardiovascular events; however, it was not statistically significant. Previous meta-analyses of studies comparing early invasive with initial conservative strategies on a combined population of men and women showed a significant benefit of early invasive therapy. We also found that the few trials reporting sex-specific data on revascularization compared with optimal medical therapy for stable angina showed a greater benefit with revascularization for women, while the men in the study fared equally well with either treatment. In contrast, previous meta-analyses that combined results for men and women found similar outcomes for either treatment.

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