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July 7, 2016
HHS announces new actions to combat opioid epidemic
U.S. Health and Human Services (HHS) Secretary Sylvia M. Burwell announced several new actions the department is taking to combat the nation’s
opioid epidemic.
The actions include expanding access to buprenorphine, a medication to treat opioid use disorder, a proposal to eliminate any potential financial
incentive for doctors to prescribe opioids based on patient experience survey questions, and a requirement for Indian Health Service prescribers and
pharmacists to check state Prescription Drug Monitoring Program (PDMP) databases before prescribing or dispensing opioids for pain.
In addition, the department is launching more than a dozen new scientific studies on opioid misuse and pain treatment and soliciting feedback to
improve and expand prescriber education and training programs.
The actions announced build on the HHS Opioid Initiative, which was launched in March 2015 and is focused on three key priorities: 1) improving
opioid prescribing practices; 2) expanding access to medication-assisted treatment (MAT) for opioid use disorder; and 3) increasing the use of
naloxone to reverse opioid overdoses. They also build on the National Pain Strategy, the federal government’s first coordinated plan to reduce the
burden of chronic pain in the U.S.
Visit HHS for the release.
Motor vehicle crash fatalities in the U.S. could drop by half with proven strategies
About 90 people die each day from motor vehicle crashes in the United States, resulting in the highest death rate among 19 high-income comparison
countries. Our nation has made progress in road safety, reducing crash deaths by 31 percent from 2000 to 2013. But other high-income countries
reduced crash deaths even further—by an average of 56 percent during the same period, according to the latest Vital Signs report by the Centers for
Disease Control and Prevention (CDC).
Lower death rates in comparison countries, as well as the high prevalence of risk factors in the U.S., suggest that we can make more progress in
saving lives. Compared with other high-income countries, the U.S. had the:
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most motor vehicle crash deaths per 100,000 population and per 10,000 registered vehicles;
second highest percentage of deaths involving alcohol (31 percent);
third lowest front seat belt use (87 percent).
If the U.S. had the same motor vehicle crash death rate as Belgium—the country with the second highest death rate after the U.S.—about 12,000
fewer lives would have been lost and an estimated $140 million in direct medical costs would have been averted in 2013. And if the U.S. had the
same rate as Sweden—the country with the lowest crash death rate—about 24,000 fewer lives would have been lost and an estimated $281 million
in direct medical costs would have been averted in 2013.
Visit PR Newswire for the release.
Could E.Coli be used to fight disease? Bacteria could transport next-generation vaccines, experts reveal
A superbug normally associated with severe food poisoning could be harnessed by scientists to prevent pneumonia, meningitis and even cancer.
Researchers show E.coli bacteria could deliver tomorrow's vaccines with expert precision and at very little cost.
Ingesting some strains of E.coli can cause crippling stomach pains, chronic diarrhea and even death, but the majority are safe and beneficial to the
digestive system.
But using one of the safe varieties, scientists have developed an E.coli-based transport capsule to target specific immune cells.
In a study published in Science Advances, researchers tested the capsules on mice. The harmless E.coli sits at the core of the capsule, encased by
a chain-link-style synthetic polymer. The negative-charged bacteria is a catalyst for the positive-charged polymer, creating a capsule shape. Inside
the capsule, the researchers then inserted a protein-based vaccine designed to fight pneumococcal disease. That capsule was fed to mice.
Visit the Daily Mail for the report.
Unintended consequence: Blood banks could feel the squeeze from Zika advisories
As public health officials hustle to implement strategies like these to undermine the threat of the Zika virus, one such tactic could exacerbate a
different health concern: maintaining the nation’s supply of donated blood.
The FDA is encouraging blood banks, which already often struggle to meet demand, to turn away potential donors who might be at risk. Specifically,
people who have traveled to a country where the disease is being spread, or had sex with someone else who did, should not donate for four weeks.
The protocol is being followed by clinics across the country.
To date, there are more than 800 confirmed cases of the virus reported in the continental United States, almost all of which were connected to
travelling abroad. But, though none of those cases was caused by local mosquitoes, experts warn it’s only a matter of time.
Even in locations where Zika isn’t likely to pose as great a threat, blood banks are worried that the impact of the FDA’s advisory — because of the
sheer number of people traveling to areas where the virus is active and growing case count — could undercut their supplies.
Experts say the advisory makes sense. There is no widely available, government-approved blood test to screen donations, though one is being used
on an experimental basis for blood collected in Puerto Rico and Houston.
Unsafe blood has spread a number of dangerous viruses, such as HIV. And the consequences of getting Zika — especially for women in the early
stages of pregnancy — can be severe, including birth defects for children or miscarriage. But that caution can still have consequences. Many banks
report they are already feeling the squeeze.
“We’ve absolutely seen a reduction,” said Jayne Giroux, director of community development at SunCoast Blood Bank in Florida. Along with Texas,
Florida is expected to be among the hardest hit by the virus. The limitation matters, especially since blood banks typically face difficulties in
maintaining adequate reserves, Giroux said. And not just in Florida. “It’s a concern everywhere.”
The American Red Cross, which is responsible for about 40 percent of the health system’s donated blood, estimates that, so far, only one-tenth of
one percent of its donors were turned away because of Zika exposure. But, a spokeswoman noted, that doesn’t account for people who otherwise
would have donated but never came. United Blood Services, which operates banks in 17 states, estimates its donations are down by 3 percent this
year — there are several potential causes, and Zika is likely among them, said Barbara Kain, a spokeswoman.
The donor drop-off is probably greater in Southern states, where people more frequently travel to affected areas like Mexico, parts of the Caribbean
and South America, said Louis Katz, chief medical officer of America’s Blood Centers, another national blood bank network.
Though Zika has had an impact, he emphasized that it’s only one among many challenges blood banks are grappling with. Banks are trying to stock
up in anticipation of any shortages, Giroux said. Blood plasma can be collected and frozen for years, but other components have shorter shelf lives.
There’s another option: Federal officials hope to expand the blood testing technology that’s being used for Puerto Rico and Texas, so banks can
collect blood from donors, screen it and then discard whatever comes up positive for Zika. The FDA has given two tests the go-ahead to be used in
clinical trials, which means blood centers can become testing sites and use the technology.
One test was developed by Roche. The other, which gained that conditional FDA approval in June, is manufactured by Hologic. If the Zika threat
grows, more blood banks will try to get in on using those, said Steven Kleinman, chief medical advisor at the American Association of Blood Banks.
The Department of Health and Human Services has awarded about $50 million in grants to two companies that are trying to improve “pathogen
reduction technology,” which takes infected blood and removes the virus, making it safe for use. That would mitigate some blood shortage concerns
around transfusions, noted Gary Disbrow, acting director of the division of chemical, biological, radiological and nuclear countermeasures at HHS’
Biomedical Advanced Research and Development Authority.
Such technology already exists for treating viruses such as Zika in platelets and plasma. Researchers are working to improve it and develop a similar
“cleanser” for red blood cells, the most commonly transfused part of blood. But, experts noted, that could take years.
The uncertainty, meanwhile, comes in a field where planning is already difficult, Giroux said, and where not having enough supplies on hand can
have major consequences.
Visit Kaiser Health for the story.
'Super bacteria' discovered in Rio's waters as Olympics near
A group of Brazilian scientists has detected a drug-resistant bacteria growing off some of Rio de Janeiro's most stunning beaches, in research being
published a month before the city hosts the 2016 Olympic Games.
According to lead researcher Renata Picao, the "super bacteria" entered the city's waterways when sewage coming from local hospitals got
channeled into the bay. "We have been looking for 'super bacteria' in coastal waters during a one-year period in five beaches," Picao told CNN
during a visit to her lab.
Picao said there is no reason to believe the levels have changed because raw sewage continues to flow into many waterways. She said the next
step is to test the impact these bacteria can have when humans come in contact with them in coastal waters.
The news comes as Rio prepares to host hundreds of thousands of athletes and tourists during next month's Summer Olympics. Among the beaches
flagged were Flamengo and Botafogo, which border the bay where Olympic sailors are scheduled to compete.
"Fifty-one percent of the city's sewage is now treated," production director Edes de Oliveira told CNN. "Seven years ago it was only 11%." A new
sewage plant that opened in May in the western part of the city will serve about 430,000 residents.
When Rio made its bid to host the Summer Games back in 2009, it promised to clean up the polluted waterways and connect 80% of homes to the
sewage system.
Despite health concerns and it being only a month until the Rio 2016 Summer Olympic Games, neither Picao nor international Olympic authorities
recommend moving the sailing venue. Picao said, "We are making this alert because if athletes get infected there is a chance this bacteria is
multiresistant and the physicians should know about this."
The Rio Games are scheduled to begin on August 5, but with a month to go safety and financial issues continue to plague the international event.
Visit CNN for the story.
Here's what's causing the toxic algae blooms infesting Florida's coastlines and waterways
As an "unprecedented" amount of toxic algae blooms continues to infest miles of southern Florida's coastline and waterways, many residents have
been left wondering how the problem started in the first place.
Officials believe the root of the algal blooms, which have been described as "vile"-smelling and "guacamole-thick," can be traced to Lake
Okeechobee -- the nation's second largest freshwater lake and the largest lake in Florida.
In recent decades, Lake Okeechobee has been loaded with excessive amounts of nitrogen and phosphorus from a variety of sources, including
fertilization runoff from farms and urbanization, according to John Campbell, spokesman for the U.S. Army Corp of Engineers Jacksonville District.
Such nutrients, along with other environmental factors (such as warmer temperatures), promote the growth of blue-green algae, also known as
cyanobacteria.
More than two weeks ago, the U.S. Army Corps of Engineers Jacksonville District discharged a high volume of the lake's nutrient-polluted water into
local canals to prevent flooding, Campbell told ABC News today. The nutrients from the released water likely contributed to the putrid algal blooms
that have since been seen proliferating in canals, rivers and estuaries in four counties across southern Florida.
However, since a number of the algae-infested canals and rivers flow into estuaries and inlets that empty into the ocean, several beaches in Martin
County have also begun experiencing blue-algae blooms, according to Deborah Drum, manager of the ecosystem restoration and management
division for Martin County.
Drum told ABC News that authorities have not yet been able to confirm if the algal blooms on the county's beaches are caused by something other
than the release of nutrient-polluted water from Lake Okeechobee. However, she noted that "a recent sample of water from a beach showed that the
algae there was the same species as the algae found in Lake Okeechobee and in affected estuaries."
Meanwhile, residents said they're still frustrated and concerned about the possible health problems the algae poses, and a number of them have
also been spotted wearing masks in an attempt to avoid inhaling the smell released by the algae. Some people have also blamed the algae for
headaches, respiratory issues and even rashes.
Health risks associated with blue-green algae occur when "people or animals are exposed to toxins that are sometimes produced by certain kinds of
these organisms," according to the Florida Department of Health. "Exposure can happen through unintentionally swallowing lake or river water,
breathing water spray or coming into direct contact with the blooms. At high levels, these can affect the gastrointestinal tract, liver, nervous system,
and skin."
Visit ABC News for the article.
Few young doctors are training to care for U.S. elderly
At Edgewood Summit retirement community in Charleston, WV, 93-year-old Mary Mullens is waxing eloquent about her geriatrician, Dr. Todd
Goldberg.
West Virginia has the third oldest population in the nation, right behind Maine and Florida. But Goldberg is one of only 36 geriatricians in the state.
That includes geriatricians — physicians who specialize in the treatment of adults age 65 and older — as well as nurses, physical therapists, and
psychologists who know how to care for this population.
The deficit of properly trained physicians is expected to get worse. By 2030, one in five Americans will be eligible for Medicare, the government
health insurance for those 65 and older.
Goldberg also teaches at the Charleston division of West Virginia University, and runs one of the state's four geriatric fellowship programs for
medical residents. Geriatric fellowships are required for any physician wanting to enter the field.
For the past three years, no physicians have entered the fellowship program at WVU-Charleston. In fact, no students have enrolled in any of the four
geriatric fellowship programs in West Virginia in the past three years.
The United States has 130 geriatric fellowship programs, with 383 positions. In 2016, only 192 of them were filled. With that kind of competition,
Goldberg laments, why would a resident apply to a West Virginia School, when they could get into a program like Yale or Harvard?
Adding to the problem, the average medical student graduates with $183,000 in debt, and every year of added education pushes that debt higher.
Visit NPR for the report.
To improve global health, experts call for a standard list of essential diagnostic tests
A team of experts has put together a list of the key diagnostic tests that every country should have available, with high quality standards, in order to
make the best use of the World Health Organization's list of essential medicines. Many developing countries will need help with establishing highquality labs to use them, but in the end it may be cost effective.
In a western doctor's office or hospital, patients don't think twice about giving a blood or urine sample that can tell if they have a disease or infection,
or show if their medicines are working. The samples get rushed to a testing lab with modern equipment that's held to high quality standards.
But in developing nations, many of those tests aren't available. Or if they are, doctors may not put much faith in them because of the state of their
country's testing labs.
And some of those tests, which can detect emerging viruses like Zika or Ebola, could make the difference in outbreaks that can quickly affect the rest
of the world.
Now, a team of experts has put together a list of the key tests that every country should have available, with high quality standards, in hopes of
changing this situation.
Writing in the New England Journal of Medicine, they put forth a list of tests that syncs with another, much more established list: the Model List of
Essential Medicines, or EML, published by the World Health Organization.
A parallel Model List of Essential Diagnostics, which the new paper proposes, could make the most of that spending. When performed correctly,
these tests can help health teams figure out which of the EML medications a patient needs and at what dose, track their response to treatment, and
monitor for medication toxicity.
The researchers from Johns Hopkins University, scoured expert databases on diagnostic testing to determine which tests are needed to support the
use of each medicine on the EML. The resulting list includes 147 essential laboratory tests in 57 categories. A single diagnostic test can guide the
use of many different EML drugs.
The paper includes a table of 19 test categories that can guide the use of 10 or more EML medicines including:
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Accurate counts of different types of blood cells in a sample, which can directly affect the use of 136 different items on the EML list.
Accurate blood tests assessing liver toxicity, which can support the use of 104 EML drugs.
Accurate blood tests for kidney function, which should be used in conjunction with more than 80 items on the EML
Standardized use of microscope-based diagnostic tests, which can guide the best use of 85 essential medicines, most of them aimed at
treating and preventing infectious disease.
Urinalysis, when performed well, can monitor the use of 64 EML drugs.
Tests that look for DNA signatures from an infectious microbe, or isolate and grow that microbe from a sample taken from a patient. These
tests can make a difference in outbreaks and the use of 62 EMLs.
In fact, a recent literature review by the WHO identified multiple studies reporting that between 2 and as many as 10 percent of diagnosed HIV
patients in the developing world may not have ever been infected by HIV. Rather, these misdiagnoses were based on inappropriate use of diagnostic
testing -- leading people to believe they have the virus that causes AIDS when in fact they don't.
Visit Science Daily for the report.