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Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965

August 18, 2012 Comments off

Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965
Source: Morbidity and Mortality Weekly Report (CDC)

Hepatitis C virus (HCV) is an increasing cause of morbidity and mortality in the United States. Many of the 2.7–3.9 million persons living with HCV infection are unaware they are infected and do not receive care (e.g., education, counseling, and medical monitoring) and treatment. CDC estimates that although persons born during 1945–1965 comprise an estimated 27% of the population, they account for approximately three fourths of all HCV infections in the United States, 73% of HCV-associated mortality, and are at greatest risk for hepatocellular carcinoma and other HCV-related liver disease. With the advent of new therapies that can halt disease progression and provide a virologic cure (i.e., sustained viral clearance following completion of treatment) in most persons, targeted testing and linkage to care for infected persons in this birth cohort is expected to reduce HCV-related morbidity and mortality. CDC is augmenting previous recommendations for HCV testing (CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47[No. RR–19]) to recommend one-time testing without prior ascertainment of HCV risk for persons born during 1945–1965, a population with a disproportionately high prevalence of HCV infection and related disease. Persons identified as having HCV infection should receive a brief screening for alcohol use and intervention as clinically indicated, followed by referral to appropriate care for HCV infection and related conditions. These recommendations do not replace previous guidelines for HCV testing that are based on known risk factors and clinical indications. Rather, they define an additional target population for testing: persons born during 1945–1965. CDC developed these recommendations with the assistance of a work group representing diverse expertise and perspectives. The recommendations are informed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, an approach that provides guidance and tools to define the research questions, conduct the systematic review, assess the overall quality of the evidence, and determine strength of the recommendations. This report is intended to serve as a resource for health-care professionals, public health officials, and organizations involved in the development, implementation, and evaluation of prevention and clinical services. These recommendations will be reviewed every 5 years and updated to include advances in the published evidence.

Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Pra ctices (ACIP) — United States, 2012–13 Influenza Season

August 16, 2012 Comments off

Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) — United States, 2012–13 Influenza Season

Source: Morbidity and Mortality Weekly Report (CDC)

In 2010, the Advisory Committee on Immunization Practices (ACIP) first recommended annual influenza vaccination for all persons aged ≥6 months in the United States (1). Annual influenza vaccination of all persons aged ≥6 months continues to be recommended. This document 1) describes influenza vaccine virus strains included in the U.S. seasonal influenza vaccine for 2012–13; 2) provides guidance for the use of influenza vaccines during the 2012–13 season, including an updated vaccination schedule for children aged 6 months through 8 years and a description of available vaccine products and indications; 3) discusses febrile seizures associated with administration of influenza and 13-valent pneumococcal conjugate (PCV-13) vaccines; 4) provides vaccination recommendations for persons with a history of egg allergy; and 5) discusses the development of quadrivalent influenza vaccines for use in future influenza seasons. Information regarding issues related to influenza vaccination that are not addressed in this update is available in CDC’s Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010 and associated updates (1,2).

Prevalence of Uncontrolled Risk Factors for Cardiovascular Disease: United States, 1999–2010

August 15, 2012 Comments off

Prevalence of Uncontrolled Risk Factors for Cardiovascular Disease: United States, 1999–2010

Source: National Center for Health Statistics

Key findings

Data from the National Health and Nutrition Examination Survey

  • In 2009–2010, about 47% of adults had at least one of three risk factors for cardiovascular disease—uncontrolled high blood pressure, uncontrolled high levels of low-density lipoproteins (LDL) cholesterol, or current smoking.
  • Men were more likely than women to have at least one of the three cardiovascular disease risk factors.
  • From 1999–2000 through 2009–2010, a decrease was observed in the percentage of non-Hispanic white and Mexican-American adults who had at least one of the three risk factors for cardiovascular disease. However, this decrease was not found among non-Hispanic black adults.
  • The prevalence of uncontrolled high blood pressure and of uncontrolled high LDL cholesterol declined between 1999–2000 and 2009–2010, but no significant change occurred in the percentage of adults who smoke cigarettes.

CDC — 2011 State Obesity Map Now Available

August 14, 2012 Comments off

2011 State Obesity Map Now Available

Source: Centers for Disease Control and Prevention

In 2011, rates of adult obesity remain high, with state estimates ranging from 20.7 percent in Colorado to 34.9 percent in Mississippi. No state had a prevalence of adult obesity less than 20 percent, and 12 states (Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Texas, and West Virginia) had a prevalence of 30 percent or more. The South had the highest prevalence of adult obesity (29.5 percent), followed by the Midwest (29 percent), the Northeast (25.3 percent) and the West (24.3 percent).

Vital Signs: Walking Among Adults — United States, 2005 and 2010

August 13, 2012 Comments off

Vital Signs: Walking Among Adults — United States, 2005 and 2010
Source: Morbidity and Mortality Weekly Report (CDC)

Background: Physical activity has numerous health benefits, including improving weight management. The 2008 Physical Activity Guidelines for Americans recommend ≥150 minutes/week of moderate-intensity aerobic physical activity (e.g., brisk walking) for substantial health benefits. Walking is the most commonly reported physical activity by U.S. adults.

Methods: CDC used data from the 2005 and 2010 National Health Interview Surveys to assess changes in prevalence of walking (defined as walking for transportation or leisure in at least one bout of 10 minutes or more in the preceding 7 days) by sex, age group, race/ethnicity, education, body mass index category, walking assistance status, region, and physician-diagnosed chronic disease. CDC also assessed the association between walking and meeting the aerobic physical activity guideline.

Results: Overall, walking prevalence increased significantly from 55.7% in 2005 to 62.0% in 2010. Significantly higher walking prevalence was observed in most demographic and health characteristic categories examined. In 2010, the adjusted odds ratio of meeting the aerobic physical activity guideline among walkers, compared with non-walkers, was 2.95 (95% confidence interval = 2.73–3.19).

Conclusions and Implications for Public Health Practice: To sustain increases in the prevalence of walking, communities can implement evidence-based strategies such as creating or enhancing access to places for physical activity, or using design and land use policies and practices that emphasize mixed-use communities and pedestrian-friendly streets. The impact of these strategies on both walking and physical activity should be monitored systematically at the national, state, and local levels. Public health efforts to promote walking as a way to meet physical activity guidelines can help improve the health of U.S. residents.

Interim Guidance for Clinicians Considering the Use of Preexposure Prophylaxis for the Prevention of HIV Infection in Heterosexually Active Adults

August 12, 2012 Comments off

Interim Guidance for Clinicians Considering the Use of Preexposure Prophylaxis for the Prevention of HIV Infection in Heterosexually Active Adults
Source: Morbidity and Mortality Weekly Report (CDC)

In the United States, an estimated 48,100 new human immunodeficiency virus (HIV) infections occurred in 2009 (1). Of these, 27% were in heterosexual men and women who did not inject drugs, and 64% were in men who have sex with men (MSM), including 3% in MSM who inject drugs. In January 2011, following publication of evidence of safety and efficacy of daily oral tenofovir disoproxil fumarate 300 mg (TDF)/emtricitabine 200 mg (FTC) (Truvada, Gilead Sciences) as antiretroviral preexposure prophylaxis (PrEP) to reduce the risk for HIV acquisition among MSM in the iPrEx trial, CDC issued interim guidance to make available information and important initial cautions on the use of PrEP in this population. Those recommendations remain valid for MSM, including MSM who also have sex with women (2). Since January 2011, data from studies of PrEP among heterosexual men and women have become available, and on July 16, 2012, the Food and Drug Administration (FDA) approved a label indication for reduction of risk for sexual acquisition of HIV infection among adults, including both heterosexuals and MSM.* This interim guidance includes consideration of the new information and addresses pregnancy and safety issues for heterosexually active adults at very high risk for sexual HIV acquisition that were not discussed in the previous interim guidance for the use of PrEP in MSM.

Current Tobacco Use Among Middle and High School Students — United States, 2011

August 11, 2012 Comments off

Current Tobacco Use Among Middle and High School Students — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)

Tobacco use continues to be the leading preventable cause of death and disease in the United States, with nearly 443,000 deaths occurring annually because of cigarette smoking and exposure to secondhand smoke (1). Moreover, nearly 90% of adult smokers begin smoking by age 18 years (2). To assess current tobacco use among youths, CDC analyzed data from the 2011 National Youth Tobacco Survey (NYTS). This report describes the results of that analysis, which indicated that, in 2011, the prevalence of current tobacco use among middle school and high school students was 7.1% and 23.2%, respectively, and the prevalence of current cigarette use was 4.3%, and 15.8%, respectively. During 2000–2011, among middle school students, a linear downward trend was observed in the prevalence of current tobacco use (14.9% to 7.1%), current combustible tobacco use (14.0% to 6.3%), and current cigarette use (10.7% to 4.3%). For high school students, a linear downward trend also was observed in these measures (current tobacco use [34.4% to 23.2%], current combustible tobacco use [33.1% to 21.0%], and current cigarette use [27.9% to 15.8%]). Interventions that are proven to prevent and reduce tobacco use among youths include media campaigns, limiting advertisements and other promotions, increasing the price of tobacco products, and reducing the availability of tobacco products for purchase by youths. These interventions should continue to be implemented as part of national comprehensive tobacco control programs and should be coordinated with Food and Drug Administration (FDA) regulations restricting the sale, distribution, and marketing of cigarettes and smokeless tobacco products to youths (2–4).

Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections

August 10, 2012 Comments off

Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections
Source: Morbidity and Mortality Weekly Report (CDC)

Gonorrhea is a major cause of serious reproductive complications in women and can facilitate human immunodeficiency virus (HIV) transmission (1). Effective treatment is a cornerstone of U.S. gonorrhea control efforts, but treatment of gonorrhea has been complicated by the ability of Neisseria gonorrhoeae to develop antimicrobial resistance. This report, using data from CDC’s Gonococcal Isolate Surveillance Project (GISP), describes laboratory evidence of declining cefixime susceptibility among urethral N. gonorrhoeae isolates collected in the United States during 2006–2011 and updates CDC’s current recommendations for treatment of gonorrhea (2). Based on GISP data, CDC recommends combination therapy with ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days as the most reliably effective treatment for uncomplicated gonorrhea. CDC no longer recommends cefixime at any dose as a first-line regimen for treatment of gonococcal infections. If cefixime is used as an alternative agent, then the patient should return in 1 week for a test-of-cure at the site of infection.

The Health of Male Veterans and Nonveterans Aged 25–64: United States, 2007–2010

August 8, 2012 Comments off

The Health of Male Veterans and Nonveterans Aged 25–64: United States, 2007–2010

Source: National Center for Health Statistics

A snapshot view of the health of nonelderly veterans reveals a mixed picture of their health and functioning. Overall, veterans aged 25–64 appear to be in poorer health than nonveterans, although not all differences in health are significant for all age groups. When age differences are examined, only veterans aged 45–54 are significantly more likely than nonveterans to report fair or poor health and serious psychological distress. Other health disadvantages for veterans (e.g., the prevalence of two or more chronic conditions) appear at age 45 and over. Differences in work limitations between veterans and nonveterans are seen beginning at age 35. However, the measures presented here do not reveal major health differences between male veterans and nonveterans aged 25–34.

The health differences that appear at older ages suggest that the effects of military service on health may appear later in life. Veterans also differ from nonveterans in some sociodemographic characteristics, and these characteristics may be related to observed differences in their health and functioning. Veterans are more likely to have health insurance, which may influence their access to health care and the likelihood of being diagnosed with various conditions.

The health measures presented here are not inclusive of all possible differences in health and functioning. Specifically, the measure of mental health in this report, although associated with anxiety disorders and depression, identifies only people with the most severe psychological distress (4–6). Other measures of mental health that capture a wider range of mental disorders might show more differences between veterans and nonveterans.

The sampling universe of NHIS does not include homeless people or the institutionalized population (e.g., people in long-term care facilities or in prison), which excludes some severely ill people (veterans and nonveterans) from our analysis. Addressing the problem of homelessness among veterans is a priority of the Veterans Administration (7).

This analysis is also limited in that it excludes certain other groups. The suffering of younger veterans returning from overseas with significant injuries and stress-related disorders is the focus of increased public attention. However, the number of veterans aged 18–24 included in NHIS was not large enough to support estimates for this age group. Although the percentage of women serving in the military has been steadily increasing, the relatively small numbers of female veterans also precluded their inclusion in this report.

Consumption of Cigarettes and Combustible Tobacco — United States, 2000–2011

August 6, 2012 Comments off

Consumption of Cigarettes and Combustible Tobacco — United States, 2000–2011
Source: Morbidity and Mortality Weekly Report (CDC)

Smoking cigarettes and other combustible tobacco products causes adverse health outcomes, particularly cancer and cardiovascular and pulmonary diseases (1). A priority of the U.S. Department of Health and Human Services is to develop innovative, rapid-response surveillance systems for assessing changes in tobacco use and related health outcomes (2). The two standard approaches for measuring smoking rates and behaviors are 1) surveying a representative sample of the public and asking questions about personal smoking behaviors and 2) estimating consumption based on tobacco excise tax data (3). Whereas CDC regularly publishes findings on national and state-specific smoking rates from public surveys (4), CDC has not reported consumption estimates. The U.S. Department of Agriculture (USDA), which previously provided such estimates, stopped reporting on consumption in 2007 (5). To estimate consumption for the period 2000–2011, CDC examined excise tax data from the U.S. Department of Treasury’s Alcohol and Tobacco Tax and Trade Bureau (TTB); consumption estimates were calculated for cigarettes, roll-your-own tobacco, pipe tobacco, and small and large cigars. From 2000 to 2011, total consumption of all combustible tobacco decreased from 450.7 billion cigarette equivalents to 326.6, a 27.5% decrease; per capita consumption of all combustible tobacco products declined from 2,148 to 1,374, a 36.0% decrease. However, while consumption of cigarettes decreased 32.8% from 2000 to 2011, consumption of loose tobacco and cigars increased 123.1% over the same period. As a result, the percentage of total combustible tobacco consumption composed of loose tobacco and cigars increased from 3.4% in 2000 to 10.4% in 2011. The data suggest that certain smokers have switched from cigarettes to other combustible tobacco products, most notably since a 2009 increase in the federal tobacco excise tax that created tax disparities between product types.

Trends in HIV-Related Risk Behaviors Among High School Students — United States, 1991–2011

July 26, 2012 Comments off

Trends in HIV-Related Risk Behaviors Among High School Students — United States, 1991–2011
Source: Morbidity and Mortality Weekly Report (CDC)

One of the three primary goals of the National HIV/AIDS Strategy for the United States is to reduce the number of persons who become infected with human immunodeficiency virus (HIV) (1). In 2009, persons aged 15–29 years comprised 21% of the U.S. population but accounted for 39% of all new HIV infections (2). Sexual intercourse, sexual intercourse with multiple partners, sexual intercourse without using a condom, and injection drug use are behaviors that increase risk for HIV infection. To describe trends in the prevalence of HIV-related risk behaviors among high school students, CDC analyzed data from the biennial national Youth Risk Behavior Survey (YRBS) for the period 1991–2011. The results of that analysis indicated that, although the percentage of students overall who had ever had sexual intercourse decreased significantly from 54.1% in 1991 to 47.4% in 2011, the prevalence of ever having had sexual intercourse did not change significantly after reaching 45.6% in 2001. Similarly, although the percentage of students who had four or more sex partners decreased significantly from 18.7% in 1991 to 15.3% in 2011, the prevalence of having four or more sex partners did not change significantly after reaching 14.2% in 2001. Condom use at most recent sexual intercourse among students currently having sexual intercourse increased from 46.2% in 1991 to 60.2% in 2011. However, the prevalence of condom use did not change significantly beginning in 2003 (63.0%). The prevalence of injection drug use among students overall did not change significantly from 1995 (2.1%) to 2011 (2.3%). The results suggest that progress in reducing some HIV-related risk behaviors among high school students overall and in certain populations stalled in the past decade. To reduce the number of young persons who become infected with HIV, renewed educational efforts and other risk reduction interventions are warranted.

Alcohol Use and Binge Drinking Among Women of Childbearing Age — United States, 2006–2010

July 23, 2012 Comments off

Alcohol Use and Binge Drinking Among Women of Childbearing Age — United States, 2006–2010
Source: Morbidity and Mortality Weekly Report (CDC)

Alcohol use during pregnancy is a leading preventable cause of birth defects and developmental disabilities. Alcohol-exposed pregnancies (AEPs) can lead to fetal alcohol syndrome and other fetal alcohol spectrum disorders (FASDs), which result in neurodevelopmental deficits and lifelong disability (1). In 2005, the Surgeon General issued an advisory urging women who are pregnant or who might become pregnant to abstain from alcohol use (2). Healthy People 2020 set specific targets for abstinence from alcohol use (MICH-11.1) and binge drinking (MICH-11.2) for pregnant women (3). To estimate the prevalence of any alcohol use and binge drinking in the past 30 days among women aged 18–44 years, CDC analyzed 2006–2010 Behavioral Risk Factor Surveillance System (BRFSS) data. Based on their self-reports, an estimated 51.5% of nonpregnant women used alcohol, as did 7.6% of pregnant women. The prevalence of binge drinking was 15.0% among nonpregnant women and 1.4% among pregnant women. Among pregnant women, the highest prevalence estimates of reported alcohol use were among those who were aged 35–44 years (14.3%), white (8.3%), college graduates (10.0%), or employed (9.6%). Among binge drinkers, the average frequency and intensity of binge episodes were similar, approximately three times per month and six drinks on an occasion, among those who were pregnant and those who were not. Clinical practices that advise women about the dangers associated with drinking while pregnant, coupled with community-level interventions that reduce alcohol-related harms, are necessary to mitigate AEP risk among women of childbearing age and to achieve the Healthy People 2020 objectives.

Motor Vehicle Crash Deaths in Metropolitan Areas — United States, 2009

July 21, 2012 Comments off

Motor Vehicle Crash Deaths in Metropolitan Areas — United States, 2009
Source: Morbidity and Mortality Weekly Report (CDC)

Although rates have declined in recent years, motor vehicle crashes (MVCs) remain a leading cause of injury death in the United States (1). In 2009, a total of 34,485 MVC deaths were reported among U.S. residents, and 22% of those who died were aged 15–24 years. MVCs were the leading cause of death for that age group, which represents approximately 14% of the total U.S. population (1). To assess patterns in MVC death rates for persons of all ages and for those aged 15–24 years, in recognition of the elevated risk for this age group, CDC used data from the National Vital Statistics System (NVSS) and the U.S. Census Bureau for 2009 representing the 50 most populous U.S. metropolitan statistical areas (MSAs). The overall MVC death rate (age-adjusted) for all 50 MSAs combined was 8.2 per 100,000 residents, compared with a national rate of 11.1; among MSAs, rates ranged from 4.4 to 17.8. For persons aged 15–24 years, the MVC death rate was 13.0 per 100,000 residents for all MSAs combined (range: 7.3–25.8), compared with a national rate of 17.3. Although rates for the MSAs generally were lower than the rate for the nation as a whole, higher rates for persons aged 15–24 years were observed both in the MSAs and nationally. The wide variation in rates among MSAs suggests a need to better understand how urban development patterns might relate to MVC deaths and to identify and implement effective strategies to reduce the number of such deaths.

West Nile Virus Disease and Other Arboviral Diseases — United States, 2011

July 13, 2012 Comments off

West Nile Virus Disease and Other Arboviral Diseases — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)

Arthropodborne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. Symptomatic infections most often manifest as a systemic febrile illness and, less commonly, as neuroinvasive disease (e.g., meningitis, encephalitis, or acute flaccid paralysis). West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the United States (1). However, several other arboviruses also cause seasonal outbreaks and sporadic cases (1). In 2011, CDC received reports of 871 cases of nationally notifiable arboviral diseases (excluding dengue); etiological agents included WNV (712 cases), La Crosse virus (LACV) (130), Powassan virus (POWV) (16), St. Louis encephalitis virus (SLEV) (six), Eastern equine encephalitis virus (EEEV) (four), and Jamestown Canyon virus (JCV) (three). Of these, 624 (72%) were classified as neuroinvasive disease, for a national incidence of 0.20 per 100,000 population. WNV and other arboviruses continue to cause focal outbreaks and severe illness in substantial numbers of persons in the United States.

Updated CDC Recommendations for the Management of Hepatitis B Virus–Infected Health-Care Providers and Students

July 6, 2012 Comments off

Updated CDC Recommendations for the Management of Hepatitis B Virus–Infected Health-Care Providers and Students
Source: Morbidity and Mortality Weekly Report (CDC)

This report updates the 1991 CDC recommendations for the management of hepatitis B virus (HBV)–infected health-care providers and students to reduce risk for transmitting HBV to patients during the conduct of exposure-prone invasive procedures (CDC. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR 1991;40[No. RR-8]). This update reflects changes in the epidemiology of HBV infection in the United States and advances in the medical management of chronic HBV infection and policy directives issued by health authorities since 1991.

The primary goal of this report is to promote patient safety while providing risk management and practice guidance to HBV-infected health-care providers and students, particularly those performing exposure-prone procedures such as certain types of surgery. Because percutaneous injuries sustained by health-care personnel during certain surgical, obstetrical, and dental procedures provide a potential route of HBV transmission to patients as well as providers, this report emphasizes prevention of operator injuries and blood exposures during exposure-prone surgical, obstetrical, and dental procedures.

These updated recommendations reaffirm the 1991 CDC recommendation that HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields. The previous recommendations have been updated to include the following changes: no prenotification of patients of a health-care provider’s or student’s HBV status; use of HBV DNA serum levels rather than hepatitis B e-antigen status to monitor infectivity; and, for those health-care professionals requiring oversight, specific suggestions for composition of expert review panels and threshold value of serum HBV DNA considered “safe” for practice (<1,000 IU/ml). These recommendations also explicitly address the issue of medical and dental students who are discovered to have chronic HBV infection. For most chronically HBV-infected providers and students who conform to current standards for infection control, HBV infection status alone does not require any curtailing of their practices or supervised learning experiences. These updated recommendations outline the criteria for safe clinical practice of HBV-infected providers and students that can be used by the appropriate occupational or student health authorities to develop their own institutional policies. These recommendations also can be used by an institutional expert panel that monitors providers who perform exposure-prone procedures.

Vital Signs: Risk for Overdose from Methadone Used for Pain Relief — United States, 1999–2010

July 5, 2012 Comments off

Vital Signs: Risk for Overdose from Methadone Used for Pain Relief — United States, 1999–2010
Source: Morbidity and Mortality Weekly Report (CDC)

Background:
Vital statistics data suggest that the opioid pain reliever (OPR) methadone is involved in one third of OPR-related overdose deaths, but it accounts for only a few percent of OPR prescriptions.

Methods:
CDC analyzed rates of fatal methadone overdoses and sales nationally during 1999–2010 and rates of overdose death for methadone compared with rates for other major opioids in 13 states for 2009.

Results:
Methadone overdose deaths and sales rates in the United States peaked in 2007. In 2010, methadone accounted for between 4.5% and 18.5% of the opioids distributed by state. Methadone was involved in 31.4% of OPR deaths in the 13 states. It accounted for 39.8% of single-drug OPR deaths. The overdose death rate for methadone was significantly greater than that for other OPR for multidrug and single-drug deaths.

Conclusions:
Methadone remains a drug that contributes disproportionately to the excessive number of opioid pain reliever overdoses and associated medical and societal costs.

Implications for Public Health Practice:
Health-care providers who choose to prescribe methadone should have substantial experience with its use and follow consensus guidelines for appropriate opioid prescribing. Providers should use methadone as an analgesic only for conditions where benefit outweighs risk to patients and society. Methadone and other extended-release opioids should not be used for mild pain, acute pain, “breakthrough” pain, or on an as-needed basis. For chronic noncancer pain, methadone should not be considered a drug of first choice by prescribers or insurers.
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Injuries from Ingestion of Wire Bristles from Grill-Cleaning Brushes — Providence, Rhode Island, March 2011–June 2012

July 4, 2012 Comments off

Injuries from Ingestion of Wire Bristles from Grill-Cleaning Brushes — Providence, Rhode Island, March 2011–June 2012
Source: Morbidity and Mortality Weekly Report (CDC)

Foreign object ingestion is a common reason for visiting an emergency department (ED), particularly for children (1–3). In recent years, internal injuries have been reported following unintentional ingestions of wire grill-cleaning brush bristles by both children and adults (4–6). A series of six cases from a single hospital system with two EDs during July 2009–November 2010 was reported previously (4). This report describes a series of six more cases identified at the same hospital system during March 2011–June 2012. The six patients ranged in age from 31 to 64 years; five were men. Like the patients in the previous series (4), all six reported outdoor residential food grilling and use of commercially available wire grill-cleaning brushes. The severity of injury ranged from puncture of the soft tissues of the neck, causing severe pain on swallowing, to perforation of the gastrointestinal tract requiring emergent surgery. Awareness of this potential injury among health-care professionals is critical to facilitate timely diagnosis and treatment. Additionally, awareness among the public, manufacturers who make wire grill-cleaning brushes, and retailers who sell these products can reduce exposures and decrease the likelihood of further occurrences. Before cooking, persons should examine the grill surface carefully for the presence of bristles that might have dislodged from the grill brush and could embed in cooked food. Alternative residential grill-cleaning methods or products might be considered.

The first of the six most recent cases was identified on March 14, 2011, and the latest on June 3, 2012. Medical staff members continue to conduct surveillance for additional cases of injury from ingested wire grill-cleaning brush bristles treated in the hospital system.

Youth Risk Behavior Surveillance — United States, 2011

June 25, 2012 Comments off

Youth Risk Behavior Surveillance — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)

Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable.

Reporting Period Covered: September 2010–December 2011.

Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2011 national survey, 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9–12.

Results: Results from the 2011 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. During the 30 days before the survey, 32.8% of high school students nationwide had texted or e-mailed while driving, 38.7% had drunk alcohol, and 23.1% had used marijuana. During the 12 months before the survey, 32.8% of students had been in a physical fight, 20.1% had ever been bullied on school property, and 7.8% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors associated with unintended pregnancies and STDs, including HIV infection. Nearly half (47.4%) of students had ever had sexual intercourse, 33.7% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.3% had had sexual intercourse with four or more people during their life. Among currently sexually active students, 60.2% had used a condom during their last sexual intercourse. Results from the 2011 national YRBS also indicate many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥25 years in the United States. During the 30 days before the survey, 18.1% of high school students had smoked cigarettes and 7.7% had used smokeless tobacco. During the 7 days before the survey, 4.8% of high school students had not eaten fruit or drunk 100% fruit juices and 5.7% had not eaten vegetables. Nearly one-third (31.1%) had played video or computer games for 3 or more hours on an average school day.

Interpretation: Since 1991, the prevalence of many priority health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Variations were observed in many health-risk behaviors by sex, race/ethnicity, and grade. The prevalence of some health-risk behaviors varied substantially among states and large urban school districts.

Public Health Action: YRBS data are used to measure progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; to assess trends in priority health-risk behaviors among high school students; and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.

Recommended Use of Aspirin and Other Antiplatelet Medications Among Adults — National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, United States, 2005–2008

June 25, 2012 Comments off

Recommended Use of Aspirin and Other Antiplatelet Medications Among Adults — National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, United States, 2005–2008
Source: Morbidity and Mortality Weekly Report (CDC)

Cardiovascular disease (CVD) is the most highly prevalent disease in the United States and remains the leading cause of death among adults aged ≥18 years despite advancements in treatment and prevention in recent decades (1). Each year, approximately 800,000 persons die from CVD, which includes coronary heart disease (CHD) (1,2); the majority of those persons who die from CVD had underlying atherosclerosis. Approximately 7.9 million U.S. adults have a history of heart attack, approximately 7 million U.S. adults have a history of stroke (1), and, approximately 16 million U.S. adults have received a diagnosis of CHD (2). CVD and CHD cause a substantial economic burden in the United States. In 2010, the estimated annual cost (direct and indirect) of CVD in the United States was approximately $450 billion, including $109 billion for CHD and $54 billion for stroke alone (3).

Preventive care and lifestyle interventions have proven to be effective in reducing atherosclerotic CVD (4,5). Taking aspirin or other antiplatelet medications is one of several preventive interventions that can provide substantial benefit for patients with ischemic vascular disease and is strongly recommended in practice guidelines (6,7). This report summarizes the estimated prevalence of physician prescription of aspirin and other antiplatelet medications for patients with or without ischemic vascular disease as recommended by the U.S. Preventive Services Task Force (USPSTF) and other major guidelines (8–15). Previous research has indicated that the use of aspirin among eligible patients is suboptimal, even for those patients at highest risk (16). In persons who do not have a history of ischemic vascular disease, the net benefit is dependent upon the patient’s risk for suffering a stroke or myocardial infarction compared with their chances of harm from treatment.

The information in this report is intended for clinicians who treat patients with ischemic vascular disease and patients who are at high risk for suffering cardiovascular disease and stroke. In addition, this information can serve as a baseline to monitor progress and measure the impact of use of recommended clinical preventive services.

Estimated Pregnancy Rates and Rates of Pregnancy Outcomes for the United States, 1990–2008

June 21, 2012 Comments off

Estimated Pregnancy Rates and Rates of Pregnancy Outcomes for the United States, 1990–2008 (PDF)
Source: National Center for Health Statistics

Objectives
This report presents detailed pregnancy rates for 1990–2008, updating a national series of rates extending since 1976.

Methods
Tabular and graphical data on pregnancy rates by age, race, and Hispanic origin, and by marital status are presented and described.

Results
In 2008, an estimated 6,578,000 pregnancies resulted in 4,248,000 live births, 1,212,000 induced abortions, and 1,118,000 fetal losses. The 2008 pregnancy rate of 105.5 pregnancies per 1,000 women aged 15–44 is 9 percent below the 1990 peak of 115.8. The teen pregnancy rate dropped 40 percent from 1990 to 2008, reaching a historic low of 69.8 per 1,000 women aged 15–19. Pregnancy rates have declined significantly for non-Hispanic white, non-Hispanic black, and Hispanic teenagers. Rates in 2008 for non-Hispanic black and Hispanic teenagers were two to three times higher than the rates for non-Hispanic white teenagers. Pregnancy rates for women in their early 20s declined to the lowest level in more than three decades, although the declines have been more modest than for teenagers. Pregnancy rates for women aged 25–29 have changed relatively little since 1990, while rates for women in their 30s and early 40s increased.

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