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Tuesday, November 3, 2009
Swine Flu killing children
Ok its been a while since my last post and I apologize to my followers. Thank you for your understanding. It turns out I had the H1N1A influenza. I had 104 fever, lack of appetite, severe muscle aches, and intestinal issues. this disease has luckily been mild overall, yet it seems to be disproportionately affecting children. In fact there have been 55 deaths in children in the US since the outbreak began in April....although most deaths have been among those with chronic underlying conditions, the sheer bulk of those infected appear to be under forty, with most spread in the middle and high schools. We are seeinh very few cases among the elderly, partyl due to the fact that many were exposed to the original swine flu in 1976. If you visit the CDC website, www.cdc.gov, you will learn how to protect yourself. But one thing to understand is that getting vaccinated against both swine and seasonal flu is the best way to protect yourself
Monday, June 22, 2009
Lots of things happen in 2 months
Well my friends it has been a while since I have posted due to my workload. Had my hands full with getting ready for certain examinations, and of course, following swine flu. By now, anyone who reads my posts knows about swine flu, so all I am going to say about it is 1) vaccine production is under way, 2) Swine flu may be more common than 'regular' flu this winter and 3) as of now swine flu is rather mild. However, should the virus tweak slightly, it could become much more virulent and dangerous.
On another topic, the FDA recently advised that people stop using Zicam, as the Zinc that is used in the product can damage your olfactory nerves, causing you to lose your sense of smell. And of course, smell and taste are intricately linked, so of course you will lose ability to taste too. Better safe than sorry, if you have some, toss it!
Finally, wanted to say that President Obama is set to sign a massive legislation against smoking, essentially givning regulatory power to FDA. While I think that FDA does a good job, I dont know if this is the right move. However, I do know that they will tell us EVERY chemical found in the tobacco used, so that will beinteresting...we already know a few hundred carcinogens. This move will make it MUCH harder for smaller/newer tobacco companies to survive, as there is major advertising limits. Effectively, they have given Philip-Morris a monopoly, as they already have like 50% market share. New companies just wont be able to compete. Imagine that???? But if it prevents kids from taking up the habit...then im all for it. I dont care if PM gets richer. Eventually smoking (tobacco) will be a thing of the past...at least with all the nasty chemicals its treated with. Be talking to you all soon. Good to be back!
On another topic, the FDA recently advised that people stop using Zicam, as the Zinc that is used in the product can damage your olfactory nerves, causing you to lose your sense of smell. And of course, smell and taste are intricately linked, so of course you will lose ability to taste too. Better safe than sorry, if you have some, toss it!
Finally, wanted to say that President Obama is set to sign a massive legislation against smoking, essentially givning regulatory power to FDA. While I think that FDA does a good job, I dont know if this is the right move. However, I do know that they will tell us EVERY chemical found in the tobacco used, so that will beinteresting...we already know a few hundred carcinogens. This move will make it MUCH harder for smaller/newer tobacco companies to survive, as there is major advertising limits. Effectively, they have given Philip-Morris a monopoly, as they already have like 50% market share. New companies just wont be able to compete. Imagine that???? But if it prevents kids from taking up the habit...then im all for it. I dont care if PM gets richer. Eventually smoking (tobacco) will be a thing of the past...at least with all the nasty chemicals its treated with. Be talking to you all soon. Good to be back!
Thursday, April 9, 2009
Genentech Psoriasis Drug Raptiva PULLED
Raptiva is being withdrawn from the U.S. market, California-based drug maker Genentech announced Wednesday.
The move comes almost two months after U.S. health officials issued a public health advisory on the drug after confirming a link to a rare, sometimes fatal brain infection.
2,000 patients in the United States may currently be using Raptiva for chronic psoriasis. Since it was approved by the U.S. FDA in 2003, 46,000 patients worldwide have been treated with Raptiva, the Genentech said.
In February, an FDA advisory cited three deaths in people taking Raptiva. Two involved people with progressive multifocal leukoencephalopathy (PML). The third death was a person believed to have contracted the brain infection. All had been treated with Raptiva for at least three years, and none was taking other immune suppressants, which would make the body more susceptible to such infections.
Raptiva works by affecting T-cells in the immune system. The effects of Raptiva also decrease the function of the immune system and increase susceptibility to infections. Raptiva was approved for the treatment of moderate to severe plaque psoriasis in 2003.
According to the FDA; there were no cases of PML seen in the clinical trials that supported the approval of Raptiva. At the time of approval, a total of 2,764 patients had been treated with Raptiva. Of those 2,764 patients, 2400 had been treated for three months, 904 for six months, and 218 for one year or more. In October 2008, the labeling for Raptiva was changed to highlight, in a Boxed Warning, the risks of life-threatening infections, including PML.
So there was a boxed warning of potential death with Raptiva, yet they continued to sell it because the risks at the time did not outweigh the benefits of the treatment of psoriasis. While Genentech is protecting patients (and ultimately is reputation, but not so much its wallet), those who have severe psoriasis are likely NOT going to want to stop taking the medication, even if they are risking serious infection.
The move comes almost two months after U.S. health officials issued a public health advisory on the drug after confirming a link to a rare, sometimes fatal brain infection.
2,000 patients in the United States may currently be using Raptiva for chronic psoriasis. Since it was approved by the U.S. FDA in 2003, 46,000 patients worldwide have been treated with Raptiva, the Genentech said.
In February, an FDA advisory cited three deaths in people taking Raptiva. Two involved people with progressive multifocal leukoencephalopathy (PML). The third death was a person believed to have contracted the brain infection. All had been treated with Raptiva for at least three years, and none was taking other immune suppressants, which would make the body more susceptible to such infections.
Raptiva works by affecting T-cells in the immune system. The effects of Raptiva also decrease the function of the immune system and increase susceptibility to infections. Raptiva was approved for the treatment of moderate to severe plaque psoriasis in 2003.
According to the FDA; there were no cases of PML seen in the clinical trials that supported the approval of Raptiva. At the time of approval, a total of 2,764 patients had been treated with Raptiva. Of those 2,764 patients, 2400 had been treated for three months, 904 for six months, and 218 for one year or more. In October 2008, the labeling for Raptiva was changed to highlight, in a Boxed Warning, the risks of life-threatening infections, including PML.
So there was a boxed warning of potential death with Raptiva, yet they continued to sell it because the risks at the time did not outweigh the benefits of the treatment of psoriasis. While Genentech is protecting patients (and ultimately is reputation, but not so much its wallet), those who have severe psoriasis are likely NOT going to want to stop taking the medication, even if they are risking serious infection.
Monday, April 6, 2009
Today starts National Public Health Week
Yes there is a week devoted to public health. NYS health commissioner Richard Daines is celebrating by visiting 8 separate counties to commend them for their work. Organizations like APHA, the AMA, and public health schools throughout the country have a bunch of activities. I wont be partaking in any, because I dont take the time to celebrate my work...ok just kidding I just want to enjoy my vacation which happens to be this week. So if you know a public health worker, time to pat them on the back for all they do, cause Lord knows they aren't compensated for what their worth!
One in five 4 Year Olds OBESE!
Sesame Street Must Be Up In Arms! Years of public education and goverment sponsored nutrition programs just cant keep up with the alarming rise in obesity. We focus efforts one place, make an improvement, and in three other places we have new problems. How then can we possibly target interventions, or distribute public program dollars? Well given this new study, I argue that we need life long nutrition education, not just during certain periods of our lives.
We have all heard that obesity is up 30% in the last 2 decades, and that older children and teens are the fastest growing subpopulation, no pun intended....
Now we have to worry about our toddlers more so than ever before. This study backs up the need for programs like Women Infants & Children (WIC) and Food Stamps, both which supplement food costs and offer education, particularly WIC.
Out of Chicago: this new study says almost 1 in 5 American 4-year-olds is obese, and the rate is alarmingly higher among American Indian children, with nearly a third of them obese. Researchers were surprised to see differences by race at so early an age.
Overall, more than half a million 4-year-olds are obese, the study suggests.
Obesity is more common in Hispanic and black youngsters, too, but the disparity is most startling in American Indians, whose rate is almost double that of whites.
"The cumulative evidence is alarming because within just a few decades, America will become a 'minority majority' nation," he said. Without interventions, the next generation "will be at very high risk" for heart disease, high blood pressure, cancers, joint diseases and other problems connected with obesity, said Flores, who was not involved in the new research.
This is a real problem, and NEEDS to be funded to be corrected!
More on this story can be found at: http://news.yahoo.com/s/ap/20090406/ap_on_re_us/med_obese_preschoolers;_ylt=AgldHAhAi5hkXf6QLCmSfMCISbYF
We have all heard that obesity is up 30% in the last 2 decades, and that older children and teens are the fastest growing subpopulation, no pun intended....
Now we have to worry about our toddlers more so than ever before. This study backs up the need for programs like Women Infants & Children (WIC) and Food Stamps, both which supplement food costs and offer education, particularly WIC.
Out of Chicago: this new study says almost 1 in 5 American 4-year-olds is obese, and the rate is alarmingly higher among American Indian children, with nearly a third of them obese. Researchers were surprised to see differences by race at so early an age.
Overall, more than half a million 4-year-olds are obese, the study suggests.
Obesity is more common in Hispanic and black youngsters, too, but the disparity is most startling in American Indians, whose rate is almost double that of whites.
"The cumulative evidence is alarming because within just a few decades, America will become a 'minority majority' nation," he said. Without interventions, the next generation "will be at very high risk" for heart disease, high blood pressure, cancers, joint diseases and other problems connected with obesity, said Flores, who was not involved in the new research.
This is a real problem, and NEEDS to be funded to be corrected!
More on this story can be found at: http://news.yahoo.com/s/ap/20090406/ap_on_re_us/med_obese_preschoolers;_ylt=AgldHAhAi5hkXf6QLCmSfMCISbYF
Friday, April 3, 2009
The Tragedy In Binghamton
At an immigration center in Binghamton, NY, a nut-job opened fire on a peaceful group of immigrants taking a United States Citizenship Exam. At least 13 people are dead, and dozens more injured. He ended his rampage before taking his own life. The community is in shock. I am in shock. There is no reason for this, let alone no known motive. Someone just seemingly taking their aggression out on the world. This madness has got to end! Nearby students were removed from their dwellings for safe keeping, businesses closed their doors for protection. Just an absolute living nightmare for this town. Our prayers are with the family members of the victims.
Wednesday, April 1, 2009
Manhattan Anesthesiologist License Revoked
The New York State Department of Health has determined that Dr. Brian Goldweber, 62, violated appropriate infection control practices and used the medication Propofol in an inappropriate manner. He also failed to take an infection control and barrier precaution course as mandated by Public Health Law.
"Dr. Goldweber's reuse of syringes while injecting patients with anesthetics is an inappropriate and unacceptable practice that could have led to the spread of bloodborne diseases, including hepatitis B, hepatitis C and HIV," said State Health Commissioner Richard F. Daines, M.D.
The Board found Brian Goldweber, M.D., guilty of gross negligence, negligence on more than one occasion, gross incompetence, incompetence on more than one occasion, and failure to comply with provisions governing the practice of medicine.
Commissioner Daines cited Governor Paterson's signing of the 2008 Patient Safety Law, which enhanced the State's authority to take action against physicians, helping to prevent future infection control and other violations.
He had a history of violations:
Dr. Goldweber was disciplined in 1999 after he incorrectly administered anesthesia in several patients, and falsified records in one case. As part of his penalty he underwent a medical competency evaluation and more medical training.
In 2002, Dr. Goldweber was again disciplined after he admitted to the charge of violating state Public Health Law by fraudulently answering questions related to the disciplinary action taken against him by the Department on an application he submitted to Ellenville Regional Hospital.
In 2007, authorities notified 4,500 people who were patients of Dr. Goldweber, between December 2003 and May 2007, about his careless infection control methods.
This is the second physician to lose their license in a week.
"Dr. Goldweber's reuse of syringes while injecting patients with anesthetics is an inappropriate and unacceptable practice that could have led to the spread of bloodborne diseases, including hepatitis B, hepatitis C and HIV," said State Health Commissioner Richard F. Daines, M.D.
The Board found Brian Goldweber, M.D., guilty of gross negligence, negligence on more than one occasion, gross incompetence, incompetence on more than one occasion, and failure to comply with provisions governing the practice of medicine.
Commissioner Daines cited Governor Paterson's signing of the 2008 Patient Safety Law, which enhanced the State's authority to take action against physicians, helping to prevent future infection control and other violations.
He had a history of violations:
Dr. Goldweber was disciplined in 1999 after he incorrectly administered anesthesia in several patients, and falsified records in one case. As part of his penalty he underwent a medical competency evaluation and more medical training.
In 2002, Dr. Goldweber was again disciplined after he admitted to the charge of violating state Public Health Law by fraudulently answering questions related to the disciplinary action taken against him by the Department on an application he submitted to Ellenville Regional Hospital.
In 2007, authorities notified 4,500 people who were patients of Dr. Goldweber, between December 2003 and May 2007, about his careless infection control methods.
This is the second physician to lose their license in a week.
Follow-Up to Pistachios-Salmonella
A few days ago I spoke about the tainted pistachio products. They may contain salmonella. FDA has issued warning to avoid all pistachio products until they determine which products are actually tainted, which may take weeks to months. I stand by my original statement that roasted nuts and ice cream products are safe, given the process used to make these products.
Tuesday, March 31, 2009
Help protect our planet, support the landmark climate legislation
Moments ago, Congressman Henry Waxman (D-CA) fired the starting gun on the most important legislative fight of our lives, introducing draft legislation that could unleash America's green energy future and address global warming.
This is the first step toward passing landmark climate legislation this year. It will be a long hard fight.
If we succeed, we will make a critical investment in our children's ecological and economic futures.
Naturally there are numerous opponents to any bills that limit industry (emissions laws, clean water laws etc). My friends at the environmental defense fund estimate that we will be out spent 20 to 1 on this bill.
If the vote comes to your district, you know what to do. The future of our planet depends on it.
I encourage you support the environmental defense fund, who is helping to spearhead this process. Donations can be made in any amount $5 or above at http://www.edf.org/home.cfm and clicking donate
If we fail? Well, we cannot fail.
This is the first step toward passing landmark climate legislation this year. It will be a long hard fight.
If we succeed, we will make a critical investment in our children's ecological and economic futures.
Naturally there are numerous opponents to any bills that limit industry (emissions laws, clean water laws etc). My friends at the environmental defense fund estimate that we will be out spent 20 to 1 on this bill.
If the vote comes to your district, you know what to do. The future of our planet depends on it.
I encourage you support the environmental defense fund, who is helping to spearhead this process. Donations can be made in any amount $5 or above at http://www.edf.org/home.cfm and clicking donate
If we fail? Well, we cannot fail.
Monday, March 30, 2009
Pistachios may have salmonella
While investigating two people who called the FDA complaining of gastrointestinal illness that could be associated with the nuts, the link hasn't been confirmed. FDA said central California-based Setton Pistachio of Terra Bella Inc., the nation's second-largest pistachio processor, was voluntarily recalling its pistachio products. Potentially contaminated products may have been sold in 31 states so far. It will "take weeks to figure out how many products" could be affected, said Jeff Farrar, chief of the Food and Drug Branch of the California Department of Public Health.
Salmonella bacteria is the most common cause of food borne illness and typiically causes diarrhea, fever and cramping. The infection can be life-threatening for children, the elderly and people with weakened immune systems. I want to stress that the recall is voluntary, and that both roasted products and frozen products containing pistachio (ice cream) are likely safe to eat because the processing/storage of these foods kills salmonella. Infection is unlikely.
Salmonella bacteria is the most common cause of food borne illness and typiically causes diarrhea, fever and cramping. The infection can be life-threatening for children, the elderly and people with weakened immune systems. I want to stress that the recall is voluntary, and that both roasted products and frozen products containing pistachio (ice cream) are likely safe to eat because the processing/storage of these foods kills salmonella. Infection is unlikely.
Coming Soon....Visitor Polls
epidemiologyandpublichealth.blogspot.com administration is designing quick polls to gauge our audience's preferences. Depending on response, we may use this method to conduct a convenience sample for a low 'hanging fruit' publication.
Polls should be active within a week.
Polls should be active within a week.
Sunday, March 29, 2009
Who Says Soccer Isnt Violent?
In the Ivory Coast, Soccer Fans Mean Business. A stampede at a World Cup qualifying soccer match in the Ivory Coast killed at least 22 people and wounded 132 today? No, this wasn't a case of a herd of elephants infiltrating the stadium. Instead, it was unruly fans trying to fill the stadium before kickoff. Hundreds of fans at the Felix Houphouet-Boigny arena pushed against each other shortly before the game trying to get into the stadium to see a match between Ivory Coast and Malawi, setting off a panic that led to the stampede. With a lack of modern security forces, the stampede got out of control. Riot Police had to come and fire tear gas into the crowd to calm the situation. Im not sure if or how many were arrested, but with at least 22 deaths, someone will be held accountable. Those in the stadium report that a wall gave out, which crushed at least 10 people. I always thought soccer houligans were dangerous, but this is ridiculous!
Slips and Falls Among The Elderly, Accidents Waiting to Happen
At the Request of a Colleauge, I wanted to give you some information about slips and falls among the elderly. I gave a talk on this very topic, and its a much more serious problem than people realize. Unintentional falls are a threat to the lives, independence and health of adults ages 65 and older. Every 18 seconds, an older adult is treated in an emergency department for a fall, and every 35 minutes someone in this population dies as a result of their injuries. Although one in three older adults falls each year in the United States, falls are not an inevitable part of aging. There are proven strategies that can reduce falls and help older adults live better and longer. The CDC has provided a lot of information about this issue, and so I would like to share some of it with you.
The following materials courtesy CDC give an overview of the problem of older adult falls and how they can be prevented.
Fact Sheets
Falls Among Older Adults: An Overview
This fact sheet gives an overview of the problem of falls among older adults in the United States. You will also find prevention tips and links to resources developed by CDC.
Costs of Falls Among Older Adults
This fact sheet describes the costs of falls among older adults - more than $19 billion annually – and includes information on how these costs are calculated and distributed.
Hip Fractures Among Older Adults
More than 90% of hip fractures among adults 65 and older are the result of a fall. This sheet provides information on the number of hip fractures, groups at risk, and prevention tips.
Falls in Nursing Homes
Falls are more common in nursing homes than in the overall community. You can learn about the extent of falls in nursing homes, their causes, and some prevention strategies.
CDC Fall Prevention Activities
This page highlights CDC-sponsored projects aimed at preventing falls among older adults.
The following materials courtesy CDC give an overview of the problem of older adult falls and how they can be prevented.
Fact Sheets
Falls Among Older Adults: An Overview
This fact sheet gives an overview of the problem of falls among older adults in the United States. You will also find prevention tips and links to resources developed by CDC.
Costs of Falls Among Older Adults
This fact sheet describes the costs of falls among older adults - more than $19 billion annually – and includes information on how these costs are calculated and distributed.
Hip Fractures Among Older Adults
More than 90% of hip fractures among adults 65 and older are the result of a fall. This sheet provides information on the number of hip fractures, groups at risk, and prevention tips.
Falls in Nursing Homes
Falls are more common in nursing homes than in the overall community. You can learn about the extent of falls in nursing homes, their causes, and some prevention strategies.
CDC Fall Prevention Activities
This page highlights CDC-sponsored projects aimed at preventing falls among older adults.
Saturday, March 28, 2009
Will Something Finally be Done About the Out of Network/In Network Insurance Scheme?
Its only taken decades but finally the government is trying to rein in costs associated with health insurance. Ever been scared to go to another doctors office other than your own? Well part of that is probably a financial issue. You can pay up to 75% more out of pocket when you go to an out of network provider. What do I mean by out of network?...Insurers have certain doctors in their umbrella of physicians, those who usually receive more payment for controlling their costs. If you go to another doctor not on their list, you have to pay a lot more. J Rockefeller has had enough.
Courtesy yahoo health: Sen. Jay Rockefeller, chairman of the Senate Commerce, Science and Transportation Committee, wants answers from companies known to deliberately charge more for out of network services, at a hearing Tuesday from the chief executives of UnitedHealth Group Inc. and its subsidiary Ingenix Inc., a claims database used by insurers nationwide to calculate out-of-network rates.
The inquiry follows lawsuits and an investigation by New York Attorney General Andrew Cuomo alleging that UnitedHealth and Ingenix manipulated rate data so insurers had to pay less and patients more for out-of-network services.
"They're lowballing deliberately. They deliberately cut the numbers so the consumer has to pay more of the cost," Rockefeller, D-W.Va., said in an interview with The Associated Press on Friday.
"It's scamming. It's fraud," he said.
Whike some have taken steps to reduce the huge disparity in charges, Rockefeller and other lawmakers, along with doctors and consumer groups, view the matter as far from over. They say more accountability and transparency is needed in how insurance companies determine out-of-network rates, and that patients need to understand how it's done to avoid sticker shock when they get their medical bills.
Courtesy yahoo health: Sen. Jay Rockefeller, chairman of the Senate Commerce, Science and Transportation Committee, wants answers from companies known to deliberately charge more for out of network services, at a hearing Tuesday from the chief executives of UnitedHealth Group Inc. and its subsidiary Ingenix Inc., a claims database used by insurers nationwide to calculate out-of-network rates.
The inquiry follows lawsuits and an investigation by New York Attorney General Andrew Cuomo alleging that UnitedHealth and Ingenix manipulated rate data so insurers had to pay less and patients more for out-of-network services.
"They're lowballing deliberately. They deliberately cut the numbers so the consumer has to pay more of the cost," Rockefeller, D-W.Va., said in an interview with The Associated Press on Friday.
"It's scamming. It's fraud," he said.
Whike some have taken steps to reduce the huge disparity in charges, Rockefeller and other lawmakers, along with doctors and consumer groups, view the matter as far from over. They say more accountability and transparency is needed in how insurance companies determine out-of-network rates, and that patients need to understand how it's done to avoid sticker shock when they get their medical bills.
Friday, March 27, 2009
ER Physician Has Her License Revoked!
According to the New York State Department of Health site:
The New York State Board for Professional Medical Conduct has revoked the license of a Rhinebeck emergency department physician, permanently prohibiting her from practicing medicine in New York State.
In a decision handed up March 2, the Board charged Kimberly Godfrey, D.O., with gross negligence, negligence on more than one occasion, gross incompetence, incompetence on more than one occasion, and failure to maintain accurate patient records.
The Department has determined that Dr. Godfrey failed to perform adequate physical exams or take adequate histories, document medical records, and appropriately follow up when patients experienced complications.
She had agreed to an interim non-disciplinary order on August 2, 2008, precluding the practice of medicine until the investigation was complete.
The license revocation decision followed a hearing before a hearing committee of the Board for Professional Medical Conduct comprised of two physicians and a lay person. During the course of the hearing, both the physician and the state had the opportunity to offer evidence and present witnesses.
The Office of Professional Medical Conduct in the New York State Department of Health is responsible for investigating complaints about physicians, physician assistants, and special assistants. The Board for Professional Medical Conduct, comprised of some 200 physicians and lay members, is responsible for adjudicating charges of misconduct.
The New York State Board for Professional Medical Conduct has revoked the license of a Rhinebeck emergency department physician, permanently prohibiting her from practicing medicine in New York State.
In a decision handed up March 2, the Board charged Kimberly Godfrey, D.O., with gross negligence, negligence on more than one occasion, gross incompetence, incompetence on more than one occasion, and failure to maintain accurate patient records.
The Department has determined that Dr. Godfrey failed to perform adequate physical exams or take adequate histories, document medical records, and appropriately follow up when patients experienced complications.
She had agreed to an interim non-disciplinary order on August 2, 2008, precluding the practice of medicine until the investigation was complete.
The license revocation decision followed a hearing before a hearing committee of the Board for Professional Medical Conduct comprised of two physicians and a lay person. During the course of the hearing, both the physician and the state had the opportunity to offer evidence and present witnesses.
The Office of Professional Medical Conduct in the New York State Department of Health is responsible for investigating complaints about physicians, physician assistants, and special assistants. The Board for Professional Medical Conduct, comprised of some 200 physicians and lay members, is responsible for adjudicating charges of misconduct.
What clinical trials are set to begin?
I was asked by a family member today about new clinical trials going on, and how one would go about getting into them. Well there are hundreds going on right now, but some of the newer ones with paricipants currently being enrolled (courtesy centerwatch) are:
Ocular Hypertension
If you have been diagnosed with ocular hypertension or open angle glaucoma and are currently using Xalatan eye drops, you may qualify for this study.
The research site is in Clarksville, Tenn.
More information
Please see http://www.centerwatch.com/clinical-trials/listings/studylist.aspx?CatID=202.
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Diabetes Mellitus, Type 2
If you have been diagnosed with type 2 diabetes, you may be eligible for this study of a new insulin treatment.
The research site is in Idaho Falls, Idaho.
More information
Please see http://www.centerwatch.com/clinical-trials/listings/studylist.aspx?CatID=603.
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Prostate Disorders
If you are a man 45 or older with enlarged prostate, BPH symptoms and erectile dysfunction, you may qualify for this study.
The research site is in Tarzana, Calif.
More information
Please see CenterWatch. All rights reserved.
Ocular Hypertension
If you have been diagnosed with ocular hypertension or open angle glaucoma and are currently using Xalatan eye drops, you may qualify for this study.
The research site is in Clarksville, Tenn.
More information
Please see http://www.centerwatch.com/clinical-trials/listings/studylist.aspx?CatID=202.
-----
Diabetes Mellitus, Type 2
If you have been diagnosed with type 2 diabetes, you may be eligible for this study of a new insulin treatment.
The research site is in Idaho Falls, Idaho.
More information
Please see http://www.centerwatch.com/clinical-trials/listings/studylist.aspx?CatID=603.
-----
Prostate Disorders
If you are a man 45 or older with enlarged prostate, BPH symptoms and erectile dysfunction, you may qualify for this study.
The research site is in Tarzana, Calif.
More information
Please see CenterWatch. All rights reserved.
Too much salt bad for you...duh!
Accroding to a recent CDC study, 7 out of 10 Americans should restrict their salt consumption, but very few of them do. About 145 million U.S. adults are thought to be more sensitive to salt — a group that includes anyone with high blood pressure, African-Americans and everyone older than 40.
That group should eat no more than about two-thirds of a teaspoon of salt each day. But only 1 in 10 people in that targeted group are meeting that guideline, according to estimates released Yesterday by the Centers for Disease Control and Prevention.
"I don't think 'alarming' is too strong" a term for describing the results, said Dr. Darwin Labarthe, director of the CDC's Division for Heart Disease and Stroke Prevention.
Sodium increases the risk of high blood pressure, which is major cause of heart disease and stroke.
Salt is the main source of sodium for most people.
Health officials estimate that about 80 percent of the average American's salt intake occurs without them salting their food.
It comes from the salt in many packaged and processed foods and meals served in restaurants.
Processed foods are completely loaded with it, as it is the main preservative!
Salt reduction has become a recent focus of public health campaigns. New York City's health department, the American Heart Association and nearly three dozen other organizations are trying to persuade food manufacturers and chain restaurants to reduce salt content by more than 50 percent over the next 10 years. The CDC and federal health agencies also having sodium-reduction talks with food companies.
If you are hypertensive like myself, and cannot limit your salt intake, the best way to reduce risk of high blood pressure is to drink TONS of water, and get plenty of exercise.
The debate over salt and high blood pressure has been debated for decades, but its hard to ignore that hypertension prevalence has tripled in 25 years, matching the increase in salt found in many processed foods
That group should eat no more than about two-thirds of a teaspoon of salt each day. But only 1 in 10 people in that targeted group are meeting that guideline, according to estimates released Yesterday by the Centers for Disease Control and Prevention.
"I don't think 'alarming' is too strong" a term for describing the results, said Dr. Darwin Labarthe, director of the CDC's Division for Heart Disease and Stroke Prevention.
Sodium increases the risk of high blood pressure, which is major cause of heart disease and stroke.
Salt is the main source of sodium for most people.
Health officials estimate that about 80 percent of the average American's salt intake occurs without them salting their food.
It comes from the salt in many packaged and processed foods and meals served in restaurants.
Processed foods are completely loaded with it, as it is the main preservative!
Salt reduction has become a recent focus of public health campaigns. New York City's health department, the American Heart Association and nearly three dozen other organizations are trying to persuade food manufacturers and chain restaurants to reduce salt content by more than 50 percent over the next 10 years. The CDC and federal health agencies also having sodium-reduction talks with food companies.
If you are hypertensive like myself, and cannot limit your salt intake, the best way to reduce risk of high blood pressure is to drink TONS of water, and get plenty of exercise.
The debate over salt and high blood pressure has been debated for decades, but its hard to ignore that hypertension prevalence has tripled in 25 years, matching the increase in salt found in many processed foods
Thursday, March 26, 2009
New Study Shows Circumcision Prevents HPV and herpes
Circumcision not only protects against HIV in heterosexual men, but also HPV and herpes. Circumcised males reduced their risk of infection with HPV by 35 percent and herpes by 28 percent.
Earlier studies in Africa had previously shown that circumcision had a protective effect from HIV, sometimes by up to 60 percent. These most recent findings are reported in Thursday's New England Journal of Medicine
Matthew Golden, a researcher I am very familiar with said "Evidence now strongly suggests that circumcision offers an important prevention opportunity and should be widely available,"
About 30 percent of men are circumcised. In the United States, where about 80 percent of men are circumcised, but is often done for aesthetic or religous reasons, not for sexual health.
For more on the study, see todays New England Journal of Medicine (3/27) or http://news.yahoo.com/s/ap/20090325/ap_on_he_me/med_circumcision_stds;_ylt=AjhgALX.rUkwpBovkhZpyWDVJRIF
HPV can cause cervical cancer and genital warts. Herpes greatly increases the chances of infection with HIV. Preventing these diseases will have a trickle down effect of preventing other STD, most importantly HIV. It is well known that having one STD of any kind greatly increases your risk of contracting another. HOWEVER, I dont believe circumcision should be seen as an effective protection method. Condoms are the only way to fully protect, limiting number of sexual partners etc. However, in places like Sub-Saharan Africa where HIV is more common than the common cold, I think any bit of protection will go a long way, even circumcision.
Earlier studies in Africa had previously shown that circumcision had a protective effect from HIV, sometimes by up to 60 percent. These most recent findings are reported in Thursday's New England Journal of Medicine
Matthew Golden, a researcher I am very familiar with said "Evidence now strongly suggests that circumcision offers an important prevention opportunity and should be widely available,"
About 30 percent of men are circumcised. In the United States, where about 80 percent of men are circumcised, but is often done for aesthetic or religous reasons, not for sexual health.
For more on the study, see todays New England Journal of Medicine (3/27) or http://news.yahoo.com/s/ap/20090325/ap_on_he_me/med_circumcision_stds;_ylt=AjhgALX.rUkwpBovkhZpyWDVJRIF
HPV can cause cervical cancer and genital warts. Herpes greatly increases the chances of infection with HIV. Preventing these diseases will have a trickle down effect of preventing other STD, most importantly HIV. It is well known that having one STD of any kind greatly increases your risk of contracting another. HOWEVER, I dont believe circumcision should be seen as an effective protection method. Condoms are the only way to fully protect, limiting number of sexual partners etc. However, in places like Sub-Saharan Africa where HIV is more common than the common cold, I think any bit of protection will go a long way, even circumcision.
Tuesday, March 24, 2009
Health Insurers Fighting For Their Existence, Are You Kidding..
The health insurance industry has opted to potentially eliminate its controversial practice of charging higher premiums to people to those with pre-existing medical conditions. The offer from America's Health Insurance Plans and the Blue Cross and Blue Shield Association is a potentially significant shift in the debate over reforming the nation's health care system to rein in costs and cover an estimated 48 million uninsured people. In a letter to certain US Senators, the companies say they will "phase out the practice of varying premiums based on health status in the individual market" if all Americans are required to get coverage.
The major reason they are doing this? Yup, they are trying to prevent the creation of a Universal insurance plan that would compete with them, something that many democrats are working toward. To help stave off universal coverage talks, the industry has already made a number offered to end the practice of denying coverage to sick people.
More on this can be found at: http://news.yahoo.com/s/ap/20090324/ap_on_he_me/insurers_sick_people
I for one wouldn't mind seeing these major corporations roll over in this recession. They helped bring us to this point...many small businesses have had to close their doors because they cannot afford to pay salaries and health coverage.
Its so slimy how these companies will start to give 'concessions' to avoid going out of business.
Since when is caring for the sick a 'concession'? Health Insurance Companies are here to help us when we are sick. right? Thats what their commercials say....
The major reason they are doing this? Yup, they are trying to prevent the creation of a Universal insurance plan that would compete with them, something that many democrats are working toward. To help stave off universal coverage talks, the industry has already made a number offered to end the practice of denying coverage to sick people.
More on this can be found at: http://news.yahoo.com/s/ap/20090324/ap_on_he_me/insurers_sick_people
I for one wouldn't mind seeing these major corporations roll over in this recession. They helped bring us to this point...many small businesses have had to close their doors because they cannot afford to pay salaries and health coverage.
Its so slimy how these companies will start to give 'concessions' to avoid going out of business.
Since when is caring for the sick a 'concession'? Health Insurance Companies are here to help us when we are sick. right? Thats what their commercials say....
Monday, March 23, 2009
Bravo Mr. Governor
Governor David A. Paterson of New York State, signed a bill last week to ensure that New Yorkers who lost their jobs at small businesses will qualify for federal benefits that pay up to 65 percent of Consolidated Omnibus Budget Reconciliation Act (COBRA) health insurance premiums. The Governor submitted his Program Bill last week because a change in State law was needed to allow eligible workers from small businesses to access the subsidized coverage. The subsidy, part of the American Recovery and Reinvestment Act (ARRA), is available to individuals who were involuntarily terminated on or after September 1, 2008.
Taking steps in the right direction to guarantee health coverage for all, although COBRA is very expensive, so 65% may not be enough.
For more information:
http://www.ny.gov/governor/press/press_0320095.html
Taking steps in the right direction to guarantee health coverage for all, although COBRA is very expensive, so 65% may not be enough.
For more information:
http://www.ny.gov/governor/press/press_0320095.html
Congratulations to Charlotte Druschel MD, MPH
Charlotte Druschel, M.D., M.P.H., Director of the Congenital Malformations Registry and Research Section in the New York State Department of Health (DOH), has been named the 2008 recipient of the Godfrey P. Oakley Jr. Award, presented by the National Birth Defects Prevention Network to honor her lifetime contributions to the field of birth defects research.
Dr. Druschel is an amazing researcher, and a former colleague of this site's administrator. She is very deserving of this award
For more information : http://www.health.state.ny.us/press/releases/2009/2009-03-19_dr_druschel_receives_award.htm
Dr. Druschel is an amazing researcher, and a former colleague of this site's administrator. She is very deserving of this award
For more information : http://www.health.state.ny.us/press/releases/2009/2009-03-19_dr_druschel_receives_award.htm
Sunday, March 22, 2009
Injured by a vaccine, or think you were?
I was asked this question, that is how do I report a vaccine reaction:
The National Vaccine Information Center (NVIC) is a non-profit, educational organization founded in 1982 by parents of vaccine-injured children and located in Vienna, Virginia.
As a consumer vaccine safety advocacy organization, they worked on the National Childhood Vaccine Injury Act of 1986 and were responsible for urging the creation of safety provisions in that historic law.
This included a centralized vaccine reaction reporting system, called the Vaccine Adverse Events Reporting System (VAERS) that is jointly operated by the federal Food and Drug Administration and Centers for Disease Control.
Visit VAERS to report an adverse event, and contact your primary care physician. If it is an emergency (anaphylatic shock) dial 911!
The National Vaccine Information Center (NVIC) is a non-profit, educational organization founded in 1982 by parents of vaccine-injured children and located in Vienna, Virginia.
As a consumer vaccine safety advocacy organization, they worked on the National Childhood Vaccine Injury Act of 1986 and were responsible for urging the creation of safety provisions in that historic law.
This included a centralized vaccine reaction reporting system, called the Vaccine Adverse Events Reporting System (VAERS) that is jointly operated by the federal Food and Drug Administration and Centers for Disease Control.
Visit VAERS to report an adverse event, and contact your primary care physician. If it is an emergency (anaphylatic shock) dial 911!
Yellow Peas are that good?
Certain proteins found in the yellow garden pea appear to help lower blood pressure as well as delay, control or even, yes even, prevent the onset of chronic kidney disease, at least in rats, a Canadian study is suggesting; a news report on yahoo health recently covered.
This animal model lools promising. Yellow peas dont hurt, at least we know that!
The lead investigator in the study, Rotimi E. Aluko, an associate professor in the department of human nutritional sciences at the University of Manitoba in Winnipeg "What we seem to have here is sort of a natural approach to treating this disease, as opposed to the normal pharmacological approach...We're talking about an edible product, not a drug, which can help to reduce blood pressure and, at the same time, reduce the severely negative impact of kidney disease"
Kidney disease affects 13 percent of American adults and is very difficult to treat adequately, with most people developing cardiovascular complications from high blood pressure linked to kidney malfunction.
So, in essence, eat your peas, uh, that is the yellow ones (I prefer green).
This animal model lools promising. Yellow peas dont hurt, at least we know that!
The lead investigator in the study, Rotimi E. Aluko, an associate professor in the department of human nutritional sciences at the University of Manitoba in Winnipeg "What we seem to have here is sort of a natural approach to treating this disease, as opposed to the normal pharmacological approach...We're talking about an edible product, not a drug, which can help to reduce blood pressure and, at the same time, reduce the severely negative impact of kidney disease"
Kidney disease affects 13 percent of American adults and is very difficult to treat adequately, with most people developing cardiovascular complications from high blood pressure linked to kidney malfunction.
So, in essence, eat your peas, uh, that is the yellow ones (I prefer green).
Using Google Earth in Public Health Activities
So I'm taking a Geographic Information Systems Class, and we were taught to use Google Earth. This is a program that I had for about a year prior to this class, mainly for finding places of interest before travelling there. They offer a street view level which is cool, and you may remember seeing a google vehicle driving through your neigboorhood with a big 3D camera..this is how they generated such a street view. So, its cool in that sense.
However, it also has public health uses, as you can tag locations from a satellite view. For example, if you have access to such data, you can highight all hospitals in an area, find shortest routes, plug in disease rate information to target future interventions etc. While there are a lot of mapping programs used by health officials, namely map info and arcgis, which are more professional, Google Earth may be used in resource poor settings, or in situations where more specialized training in other software packages is unavailable. Developing nations could be key here, as the software is free, and requires limited training to utilize.
So, if your in public health, consider using it for basic mapping applications. If your not, consider using the program for fun, or to see your house from a street view.
FYI. I will be writing a publication with a professor in the use of such a program for public health applications--will update you on that when time comes
However, it also has public health uses, as you can tag locations from a satellite view. For example, if you have access to such data, you can highight all hospitals in an area, find shortest routes, plug in disease rate information to target future interventions etc. While there are a lot of mapping programs used by health officials, namely map info and arcgis, which are more professional, Google Earth may be used in resource poor settings, or in situations where more specialized training in other software packages is unavailable. Developing nations could be key here, as the software is free, and requires limited training to utilize.
So, if your in public health, consider using it for basic mapping applications. If your not, consider using the program for fun, or to see your house from a street view.
FYI. I will be writing a publication with a professor in the use of such a program for public health applications--will update you on that when time comes
Splitting the FDA?
I saw this on Yahoo News this morning and must say it is no suprise drug makers would like to see FDA split, because they can push through new drugs faster. However, FDA exists to ensure products are safe, and this is why it may take 7-10 years to get a drug to market. Drug makers must conduct phase 1, 2 ,3 trials successfully before a drug can be licensed for sale in the U.S. However, a patent on a particular formula may only be for 10 years, so their is pressure on company's bottom lines to get the product out quickly. It will be interesting to see if the current administration rearranges FDA under pressure from drug makers, health care CEOs, and associated lobbying groups.
Violence in Tibet
In Tibet, violence continues. As it spreads, public health activities in the region will be placed on the backburner.
A Synopsis of the latest events:
Yesterday hundreds of Tibetans attacked a police station and government officials in northwestern China despite heightened security, prompting the arrests Sunday of nearly 100 monks, state media reported.
Six of those arrested for alleged involvement in the attack were caught by police while 89 others turned themselves in, according to the official Xinhua News Agency. All but two were monks, it said.
The protest appeared to be in response to the disappearance of a Tibetan who escaped from police custody in Qinghai province, Xinhua said.
According to a Tibetan exile, the protest involved as many as 2,000 people and was sparked by the apparent suicide of a monk being investigated for unfurling a Tibetan flag.
Xinhua said several hundred people — including nearly 100 monks from the Ragya Monastery — attacked the police station in Ragya, a township in the Tibetan prefecture of Golog, on Saturday, assaulting policemen and government staff.
Some officials were injured slightly in the assault, Xinhua said, without elaborating.
A man who answered the phone at Qinghai's public security department said he had not heard about the attack or the arrests. Phone calls to other police departments and government offices in the area rang unanswered.
The violence is the latest known incidence of unrest following a bomb explosion Monday in an unoccupied police station in predominantly Tibetan Ganzi prefecture in Sichuan province. The explosion shattered the building's windows but no injuries were reported.
A Synopsis of the latest events:
Yesterday hundreds of Tibetans attacked a police station and government officials in northwestern China despite heightened security, prompting the arrests Sunday of nearly 100 monks, state media reported.
Six of those arrested for alleged involvement in the attack were caught by police while 89 others turned themselves in, according to the official Xinhua News Agency. All but two were monks, it said.
The protest appeared to be in response to the disappearance of a Tibetan who escaped from police custody in Qinghai province, Xinhua said.
According to a Tibetan exile, the protest involved as many as 2,000 people and was sparked by the apparent suicide of a monk being investigated for unfurling a Tibetan flag.
Xinhua said several hundred people — including nearly 100 monks from the Ragya Monastery — attacked the police station in Ragya, a township in the Tibetan prefecture of Golog, on Saturday, assaulting policemen and government staff.
Some officials were injured slightly in the assault, Xinhua said, without elaborating.
A man who answered the phone at Qinghai's public security department said he had not heard about the attack or the arrests. Phone calls to other police departments and government offices in the area rang unanswered.
The violence is the latest known incidence of unrest following a bomb explosion Monday in an unoccupied police station in predominantly Tibetan Ganzi prefecture in Sichuan province. The explosion shattered the building's windows but no injuries were reported.
Saturday, March 21, 2009
Considering Universal Health Care in California
First, A few facts about California and Healthcare. One in five Californians has no health insurance at all and most of these people are average working people.
Usually, their employer is one of the many who does not provide healthcare coverage and they don’t make enough to pay for an individual policy for them and their family.
Of those Californians who do have insurance, many are underinsured and are very surprised to discover that their insurance doesn’t cover a large chunk of their costs if they get sick or injured. In fact half of all the personal bankruptcies in America are caused by medical costs and three-quarters of those bankrupted had insurance at the time they became ill or injured.
People are also very worried about losing the insurance they might get at work because employers are, more and more, cutting back on health insurance and other benefits and, of course, losing or changing your job means losing your insurance.
Plenty of money is being spent on healthcare-one out of every six dollars spent in America, it’s just not spent to cover everyone. And, while spending generally has risen by 7.5%, insurance premiums have gone up by double-digits every year for the last five. Wages have increased only 1.7%. Costs are getting shifted to patients, physicians who are not getting reimbursed for their work, workers.
Insurance companies deny claims and treatments in order to save money, narrow provider networks, exclude more and more people for “pre-existing conditions” or because they take certain kinds of prescription drugs (most of the most popular ones) or work in a particular field.
A Field Poll commissioned by the California Wellness Foundation revealed that 80% of
Californians want the government to guarantee access to affordable healthcare coverage. When asked why healthcare costs are increasing, the majority pointed to excessive insurance company profits, followed by waste, fraud and inefficiency
Usually, their employer is one of the many who does not provide healthcare coverage and they don’t make enough to pay for an individual policy for them and their family.
Of those Californians who do have insurance, many are underinsured and are very surprised to discover that their insurance doesn’t cover a large chunk of their costs if they get sick or injured. In fact half of all the personal bankruptcies in America are caused by medical costs and three-quarters of those bankrupted had insurance at the time they became ill or injured.
People are also very worried about losing the insurance they might get at work because employers are, more and more, cutting back on health insurance and other benefits and, of course, losing or changing your job means losing your insurance.
Plenty of money is being spent on healthcare-one out of every six dollars spent in America, it’s just not spent to cover everyone. And, while spending generally has risen by 7.5%, insurance premiums have gone up by double-digits every year for the last five. Wages have increased only 1.7%. Costs are getting shifted to patients, physicians who are not getting reimbursed for their work, workers.
Insurance companies deny claims and treatments in order to save money, narrow provider networks, exclude more and more people for “pre-existing conditions” or because they take certain kinds of prescription drugs (most of the most popular ones) or work in a particular field.
A Field Poll commissioned by the California Wellness Foundation revealed that 80% of
Californians want the government to guarantee access to affordable healthcare coverage. When asked why healthcare costs are increasing, the majority pointed to excessive insurance company profits, followed by waste, fraud and inefficiency
Saturday, February 14, 2009
Taking steps to ensure safer surgeries
Why do we care about surgical safety?
Surgical care and its safe delivery affect the lives of millions of people. About 234 million major operations are performed worldwide every year.
The change in disease patterns worldwide is increasing the need for surgical services considerably. Epidemics and infections are giving way as leading causes of death to ischemic heart diseases, cancers, and trauma - which need surgical interventions.
Ensuring better access to surgical care and its safe delivery is crucial for its effectiveness. The available evidence suggests that as many as half of the complications and deaths arising from surgery could be avoided if certain basic standards of care were followed.
WHO is taking steps to address these issues through:
the Global Initiative for Emergency and Essential Surgical Care;
its guidelines for essential trauma care; and
the Second Global Patient Safety Challenge initiative.
Here are some interesting facts, courtesy the World Health Organization:
Globally, about 234 million major surgical operations are conducted a year. This equates to about one operation for every 25 persons. Every year 63 million people undergo surgery to treat traumatic injuries, another 10 million for pregnancy-related complications, and 31 million more for treating cancers.
Studies suggest that complications following surgery result in disability or prolonged stay in 3-25% of hospitalized patients, depending upon complexity of surgery and hospital setting. These rates would mean that at least 7 million patients annually may have post-operative complications.
Rates of death following major surgery are reported to be between 0.4% and 10%, depending on the setting. Estimating the impact of these rates, at least 1 million patients would die every year during or after an operation.
Information regarding surgical care has been standardized or systematically collected only in a few research studies globally. As a result, most surgical interventions worldwide are not recorded. It is essential to measure surgical care on a global basis for promoting surgical safety, preventing disease and improving care.
Surgical care has been shown to be cost effective in developing settings. Ensuring safe delivery of care will only improve its efficacy.
Dramatic improvements have been made in the administration of anaesthesia over the past 30 years, but not in all parts of the world. In some regions, anaesthesia-related mortality is as high as 1 in 150 patients receiving general anaesthesia.
Safety measures are inconsistently applied in surgery, even in sophisticated settings. Simple steps can reduce complication rates. For example, improving the timing and selection of antibiotics prior to skin incision can reduce the rate of surgical site infections by up to 50%.
WHO has developed guidelines for safe surgery and a checklist of surgical safety standards applicable in all countries and health settings. Preliminary results of an evaluation in eight pilot sites worldwide show that the checklist has nearly doubled the likelihood that patients will receive treatment as per standards of surgical care – such as an antibiotic before incision and confirmation that the surgery team has the correct patient for the correct operation.
The Safe Surgery Saves Lives initiative is collaborating with more than 200 ministries of health, national and international medical societies and professional organizations to reduce deaths and complications in surgical care.
I think that the most striking portion of these facts is that safety measures are applied inconsistently, and that over one million people going under die each year...how many of these could be avoided I wonder?
Friday, February 13, 2009
Should New York State Mandate Health Care Workers and Staff in Long Term Care Facilities be Vaccinated Each Year Against Influenza
This is a question currently being considerd by health professionals in New York State. This was also a panel discussion topic in one of my Advanced Epidemiology Lectures, in which my colleagues and I researched and presented on. My portion is detailed below, along with other issues to consider, which are being researched by my colleagues. This is a huge question!
Vaccination Coverage Levels
Mandating health care workers and staff in New York State Long Term Care Facilities has the potential to disrupt supply, and so annual monitoring of supply is recommended, which is also supported by ACIP.
One of the national health objectives for 2010 includes achieving an influenza vaccination coverage level of 90% for persons aged >65 years and among nursing home residents (1,2); new strategies to improve coverage are recommended as necessary to achieve these objectives (3,4) to prevent illness.
ACIP is currently recommending increasing vaccination coverage among persons who have high-risk conditions and are aged <65>
Estimated vaccination coverage levels in 2007 among persons aged >65 years was 72.1%, with a rate higher among non-Hispanic whites (74.2%) versus non-Hispanic blacks (62.3%) (5). Overall, vaccination against influenza in the general population has increased.
Vaccination of long term care residents and health workers/staff
ACIP recommends vaccination be provided to all residents of long term care facilities noting that signed consent is not required (6), which will prevent illness.
Since 2005, the Centers for Medicare and Medicaid Services (CMS) has required nursing homes participating in the Medicare and Medicaid programs to offer all residents influenza and pneumococcal vaccines. According to the requirements, each resident is to be vaccinated unless contraindicated medically, the resident or a legal representative refuses vaccination, or the vaccine is not available because of shortage. This information reported as part of the CMS Minimum Data Set, which tracks nursing home health data (7,8).
Although annual vaccination is recommended for health care workers and is a high priority for reducing morbidity associated with influenza in health-care settings and for expanding influenza vaccine use, national survey data shows vaccination coverage of only 41.8% among health care providers during the 2005--06 season (9-11).
Vaccination of health care workers has been associated with reduced work absenteeism (12) and with fewer deaths among nursing home patients (13, 14) and elderly hospitalized patients (15). Beliefs frequently cited by those who decline vaccination include doubts about the risk for influenza, the need for vaccination, concerns about effectiveness and side effects, and dislike of injections (16)
Studies show that organized campaigns can attain higher rates of vaccination among health care workers with moderate effort and by using strategies to increase vaccine acceptance (9, 11, 17).These efforts are supported by various national accrediting and professional organizations and in certain states by statute. The Joint Commission on Accreditation of Health-Care Organizations has an infection-control standard requiring accredited organizations to offer influenza vaccinations to staff, including volunteers and licensed independent practitioners with patient contact. This became an accreditation requirement January 1, 2007 (18). In addition, the Infectious Diseases Society of America recommends mandatory vaccination for health care workers and staff, with a provision for exemption based on religious or medical reasons (19).
Fifteen states have regulations regarding vaccination of health care workers in long-term care facilities (20), six states require that health-care facilities offer influenza vaccination to staff, and three states require that health workers either receive influenza vaccination or indicate a religious, medical, or philosophical reason for not being vaccinated, (AL, CA, NH) (21, 22). Other states have mandated health workers be vaccinated against varicella (ME, OK, RI), MMR (AK, IL, ME, MD, MA, NM, NY, OK, RI, WI), and HepB (AK, ME,) (21). Note there is a precedent in New York State for requiring vaccination of health workers for MMR, although this is only in hospitals.
New York State Specific Data
Nursing home resident vaccination rates in New York State are above the national average from 2000-2007 the NYS average was 84% vaccination coverage where as the 2006-2007 season boasted a high of 87% (unpublished data presented at the 2008 APHA conference).
Employees of long term care facilities in New York State are on par with the national average with median vaccination coverage of 42.3% in 2006-2007. Employee vaccination is highest in Adult Day Health facilities and lowest in Adult Care facilities. Results also vary by region with the Metropolitan and New York City regions significantly below the state average. Efforts by New York State to visit nursing homes, a single type of long term care facility, have increased voluntary uptake of vaccine but not significantly (unpublished data presented at the 2008 APHA conference).
In conclusion, health care worker influenza vaccination is low, and well below levels that would protect patients, especially those in long term care facilities who are more vulnerable. Increasing vaccine coverage among long term care residents is recommended as a priority. In considering mandating vaccination of long term care staff, there is precedent of requiring vaccination in other states, as well as in hospital workers here in New York State against Measles and Rubella. Further, studies demonstrate reduced absenteeism from work among those health workers who receive vaccination, and vaccination of health workers is associated with reduced deaths among nursing home patients. Several professional organizations have also recommended requiring vaccination.
However, there are certainly many other issues to consider, including, but not limited too the true disease burden, vaccine efficacy, vaccine safety, costs for vaccine, moral and ethical considerations, sociocultural aspects and legal issues. These aspects are currently being researched by some of my colleagues, and their findings will soon be added once permission is received.
References
1. US Department of Health and Human Services. Healthy people 2010 2nd ed. With understanding and improving health and objectives for improving health (2 vols.). Washington, DC: US Department of Health and Human Services; 2000.
2. US Department of Health and Human Services. Healthy people 2000: national health promotion and disease prevention objectives---full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service; 1991.
3. Centers for Disease Control and Prevention. Improving influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among adults aged <65 years at high risk: a report on recommendations of the Task Force on Community Preventive Services. MMWR 2005;54(No. RR-5).
4. Ndiaye SM, Hopkins DP, Shefer AM, et. al. Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults: a systematic review. Am J Prev Med 2005;28:248--79.
5. Centers for Disease Control and Prevention. Prevention and Control of Influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. MMWR 2008;57:1-60 (RR07).
6. Stefanacci RG. Creating artificial barriers to vaccination. J Am Med Dir Assoc 2005;6:357--8.
7. Centers for Medicare and Medicaid Services. 2006--2007 Influenza (flu) season resources for health care professionals. Available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0667.pdf.
8. Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs. Condition of participation: immunization standard for long term care facilities. Final rule. Federal Register 2005:70:194; 58834--52.
9. National Foundation for Infectious Diseases. Call to action: influenza immunization among health-care workers, 2003. Bethesda, MD: National Foundation for Infectious Diseases; 2003. Available at http://www.nfid.org/publications/calltoaction.pdf.
10. Poland GA, Tosh P, Jacobson RM. Requiring influenza vaccination for health care workers: seven truths we must accept. Vaccine 2005; 23:2251--5.
11. CDC. Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR 2006;55(No.RR-2).
12. Elder AG, O'Donnell B, McCruden EA, et al. Incidence and recall of influenza in a cohort of Glasgow health-care workers during the 1993--4 epidemic: results of serum testing and questionnaire. BMJ 1996;313:1241--2.
13. Carman WF, Elder AG, Wallace LA, et al. Effects of influenza vaccination of health-care personnel on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000;355:93--7.
14. Hayward AC, Harling R, Wetten S, et. al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ 2006;333:1241.
15. Thomas RE, Jefferson TO, Demicheli V, et. al.. Influenza vaccination for health-care workers who work with elderly people in institutions: a systematic review. Lancet Infect Dis 2006;6:273—9.
16. Ofstead CL, Tucker SJ, Beebe TJ, et. al. Influenza vaccination among registered nurses: Information receipt, knowledge, and decision-making at an institution with a multifaceted educational program. Infect Control Hosp Epidemiol 2008;29:99--106.
17. Centers for Disease Control and Prevention. Interventions to increase influenza vaccination of health-care personnel---California and Minnesota. MMWR 2005;54:196--9.
18. Joint Commission on the Accreditation of Health Care Organizations. Approved: New Infection Control Requirement for Offering Influenza Vaccination to Staff and Licensed Independent Practitioners. Joint Commission Perspectives 2006:26:10—11
19. Infectious Diseases Society of America. Pandemic and seasonal influenza: principles for U.S. action. Arlington, VA: Infectious Diseases Society of America; 2007. Available at http://www.idsociety.org/Content/NavigationMenu/News_Room1/Pandemic_and_Seasonal_Influenza/IDSA_flufinalAPPROVED1.24.07.pdf.
20. Stewart A, Cox M, Rosenbaum S. The epidemiology of U.S. immunization law: immunization requirements for staff and residents of long-term care facilities under state laws/regulations. Washington, DC: George Washington University; 2005. Available at http://www.gwumc.edu/sphhs/healthpolicy/immunization/EUSIL-LTC-report.pdf.
21. Lindley MC, Horlick GA, Shefer AM, et al. Assessing state immunization requirements for healthcare workers and patients. Am J Prev Med 2007;32:459--65.
22. Centers for Disease Control and Prevention. CDC State immunization laws for healthcare workers and patients. Available at http://www2a.cdc.gov/nip/stateVaccApp/StateVaccsApp/default.asp.
Vaccination Coverage Levels
Mandating health care workers and staff in New York State Long Term Care Facilities has the potential to disrupt supply, and so annual monitoring of supply is recommended, which is also supported by ACIP.
One of the national health objectives for 2010 includes achieving an influenza vaccination coverage level of 90% for persons aged >65 years and among nursing home residents (1,2); new strategies to improve coverage are recommended as necessary to achieve these objectives (3,4) to prevent illness.
ACIP is currently recommending increasing vaccination coverage among persons who have high-risk conditions and are aged <65>
Estimated vaccination coverage levels in 2007 among persons aged >65 years was 72.1%, with a rate higher among non-Hispanic whites (74.2%) versus non-Hispanic blacks (62.3%) (5). Overall, vaccination against influenza in the general population has increased.
Vaccination of long term care residents and health workers/staff
ACIP recommends vaccination be provided to all residents of long term care facilities noting that signed consent is not required (6), which will prevent illness.
Since 2005, the Centers for Medicare and Medicaid Services (CMS) has required nursing homes participating in the Medicare and Medicaid programs to offer all residents influenza and pneumococcal vaccines. According to the requirements, each resident is to be vaccinated unless contraindicated medically, the resident or a legal representative refuses vaccination, or the vaccine is not available because of shortage. This information reported as part of the CMS Minimum Data Set, which tracks nursing home health data (7,8).
Although annual vaccination is recommended for health care workers and is a high priority for reducing morbidity associated with influenza in health-care settings and for expanding influenza vaccine use, national survey data shows vaccination coverage of only 41.8% among health care providers during the 2005--06 season (9-11).
Vaccination of health care workers has been associated with reduced work absenteeism (12) and with fewer deaths among nursing home patients (13, 14) and elderly hospitalized patients (15). Beliefs frequently cited by those who decline vaccination include doubts about the risk for influenza, the need for vaccination, concerns about effectiveness and side effects, and dislike of injections (16)
Studies show that organized campaigns can attain higher rates of vaccination among health care workers with moderate effort and by using strategies to increase vaccine acceptance (9, 11, 17).These efforts are supported by various national accrediting and professional organizations and in certain states by statute. The Joint Commission on Accreditation of Health-Care Organizations has an infection-control standard requiring accredited organizations to offer influenza vaccinations to staff, including volunteers and licensed independent practitioners with patient contact. This became an accreditation requirement January 1, 2007 (18). In addition, the Infectious Diseases Society of America recommends mandatory vaccination for health care workers and staff, with a provision for exemption based on religious or medical reasons (19).
Fifteen states have regulations regarding vaccination of health care workers in long-term care facilities (20), six states require that health-care facilities offer influenza vaccination to staff, and three states require that health workers either receive influenza vaccination or indicate a religious, medical, or philosophical reason for not being vaccinated, (AL, CA, NH) (21, 22). Other states have mandated health workers be vaccinated against varicella (ME, OK, RI), MMR (AK, IL, ME, MD, MA, NM, NY, OK, RI, WI), and HepB (AK, ME,) (21). Note there is a precedent in New York State for requiring vaccination of health workers for MMR, although this is only in hospitals.
New York State Specific Data
Nursing home resident vaccination rates in New York State are above the national average from 2000-2007 the NYS average was 84% vaccination coverage where as the 2006-2007 season boasted a high of 87% (unpublished data presented at the 2008 APHA conference).
Employees of long term care facilities in New York State are on par with the national average with median vaccination coverage of 42.3% in 2006-2007. Employee vaccination is highest in Adult Day Health facilities and lowest in Adult Care facilities. Results also vary by region with the Metropolitan and New York City regions significantly below the state average. Efforts by New York State to visit nursing homes, a single type of long term care facility, have increased voluntary uptake of vaccine but not significantly (unpublished data presented at the 2008 APHA conference).
In conclusion, health care worker influenza vaccination is low, and well below levels that would protect patients, especially those in long term care facilities who are more vulnerable. Increasing vaccine coverage among long term care residents is recommended as a priority. In considering mandating vaccination of long term care staff, there is precedent of requiring vaccination in other states, as well as in hospital workers here in New York State against Measles and Rubella. Further, studies demonstrate reduced absenteeism from work among those health workers who receive vaccination, and vaccination of health workers is associated with reduced deaths among nursing home patients. Several professional organizations have also recommended requiring vaccination.
However, there are certainly many other issues to consider, including, but not limited too the true disease burden, vaccine efficacy, vaccine safety, costs for vaccine, moral and ethical considerations, sociocultural aspects and legal issues. These aspects are currently being researched by some of my colleagues, and their findings will soon be added once permission is received.
References
1. US Department of Health and Human Services. Healthy people 2010 2nd ed. With understanding and improving health and objectives for improving health (2 vols.). Washington, DC: US Department of Health and Human Services; 2000.
2. US Department of Health and Human Services. Healthy people 2000: national health promotion and disease prevention objectives---full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service; 1991.
3. Centers for Disease Control and Prevention. Improving influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among adults aged <65 years at high risk: a report on recommendations of the Task Force on Community Preventive Services. MMWR 2005;54(No. RR-5).
4. Ndiaye SM, Hopkins DP, Shefer AM, et. al. Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults: a systematic review. Am J Prev Med 2005;28:248--79.
5. Centers for Disease Control and Prevention. Prevention and Control of Influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. MMWR 2008;57:1-60 (RR07).
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7. Centers for Medicare and Medicaid Services. 2006--2007 Influenza (flu) season resources for health care professionals. Available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0667.pdf.
8. Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs. Condition of participation: immunization standard for long term care facilities. Final rule. Federal Register 2005:70:194; 58834--52.
9. National Foundation for Infectious Diseases. Call to action: influenza immunization among health-care workers, 2003. Bethesda, MD: National Foundation for Infectious Diseases; 2003. Available at http://www.nfid.org/publications/calltoaction.pdf.
10. Poland GA, Tosh P, Jacobson RM. Requiring influenza vaccination for health care workers: seven truths we must accept. Vaccine 2005; 23:2251--5.
11. CDC. Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR 2006;55(No.RR-2).
12. Elder AG, O'Donnell B, McCruden EA, et al. Incidence and recall of influenza in a cohort of Glasgow health-care workers during the 1993--4 epidemic: results of serum testing and questionnaire. BMJ 1996;313:1241--2.
13. Carman WF, Elder AG, Wallace LA, et al. Effects of influenza vaccination of health-care personnel on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000;355:93--7.
14. Hayward AC, Harling R, Wetten S, et. al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ 2006;333:1241.
15. Thomas RE, Jefferson TO, Demicheli V, et. al.. Influenza vaccination for health-care workers who work with elderly people in institutions: a systematic review. Lancet Infect Dis 2006;6:273—9.
16. Ofstead CL, Tucker SJ, Beebe TJ, et. al. Influenza vaccination among registered nurses: Information receipt, knowledge, and decision-making at an institution with a multifaceted educational program. Infect Control Hosp Epidemiol 2008;29:99--106.
17. Centers for Disease Control and Prevention. Interventions to increase influenza vaccination of health-care personnel---California and Minnesota. MMWR 2005;54:196--9.
18. Joint Commission on the Accreditation of Health Care Organizations. Approved: New Infection Control Requirement for Offering Influenza Vaccination to Staff and Licensed Independent Practitioners. Joint Commission Perspectives 2006:26:10—11
19. Infectious Diseases Society of America. Pandemic and seasonal influenza: principles for U.S. action. Arlington, VA: Infectious Diseases Society of America; 2007. Available at http://www.idsociety.org/Content/NavigationMenu/News_Room1/Pandemic_and_Seasonal_Influenza/IDSA_flufinalAPPROVED1.24.07.pdf.
20. Stewart A, Cox M, Rosenbaum S. The epidemiology of U.S. immunization law: immunization requirements for staff and residents of long-term care facilities under state laws/regulations. Washington, DC: George Washington University; 2005. Available at http://www.gwumc.edu/sphhs/healthpolicy/immunization/EUSIL-LTC-report.pdf.
21. Lindley MC, Horlick GA, Shefer AM, et al. Assessing state immunization requirements for healthcare workers and patients. Am J Prev Med 2007;32:459--65.
22. Centers for Disease Control and Prevention. CDC State immunization laws for healthcare workers and patients. Available at http://www2a.cdc.gov/nip/stateVaccApp/StateVaccsApp/default.asp.
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