CDC
17 Apr CDC Discusses Best Practices and Resources For Childhood ADHD
MedicalResearch.com Interview with:
Susanna N. Visser, DrPH
Epidemiologist at the National Center on Birth Defects and Developmental Disabilities
CDC
Medical Research: What is the background for this study? What are the main findings?
Dr. Visser: Attention-Deficit/Hyperactivity Disorder, or ADHD is one of the most common chronic conditions of childhood. It often persists into adulthood. When children diagnosed with ADHD receive proper treatment, they have the best chance of thriving at home, doing well at school, and making and keeping friends.
In 2011, the American Academy of Pediatrics (AAP) updated their guidelines for ADHD treatment. The new guidelines give this advice to healthcare providers, psychologists, educators, and parents of children with ADHD:
- For preschoolers ages 4-5 with ADHD, use behavioral therapy before medication.
- For older children and teens with ADHD, use behavioral therapy along with medication.
- Less than 1 in 3 children with ADHD received both medication treatment and behavioral therapy, the preferred treatment approach for children ages 6 and older.
- Only half of preschoolers (4-5 years of age) with ADHD received behavioral therapy, which is now the recommended first-line treatment for this group.
- About half of preschoolers with ADHD were taking medication for ADHD, and about 1 in 4 were treated only with medication.
19 Mar Young Children May Acquire A Taste For Salt From Common Foods In Infancy
MedicalResearch.com Interview with:
Joyce Maalouf MS MPH
Nutrition Epidemiologist
CDC, Atlanta
Medical Research: What is the background for this study? What are the main findings?
Response: Although significant research shows U.S. children are eating too much sodium, data on the top dietary sources contributing to that intake is limited – particularly among babies and toddlers. This study identifies the primary sources of dietary sodium consumed by children from birth to 24-months-old, as well as differences in intake and food source broken down by demographic characteristics including age, gender and race/ethnicity.
Overall, our research revealed that after the age of six months, more than 70 percent of sodium intake comes from foods other than breast milk and infant formula. Commercial baby foods, soups and pasta mixed dishes are top sodium contributors for U.S. infants 6 to 11.9 months, while soups, cheese, pasta mixed dishes and frankfurters and sausages are key contributors among toddlers aged 12 up to 24 months. Top sodium sources varied by race/ethnicity within age groups, suggesting that for sodium reduction to be effective, it needs to occur across a wide variety of foods.
In addition, we found that non-Hispanic black toddlers ate more sodium than non-Hispanic white and Mexican-American children. Average sodium intake increased almost 9-fold from children under six months to those between one and two-years-old, while average energy intake only doubled. This suggests that, during the first two years of life, U.S. children increasingly consume sodium-rich foods.
To determine these findings, we examined eight years of data encompassing more than 2,900 participants between birth and two-years-old. The information was pulled from the nationwide NHANES What We Eat in America survey between 2003 and 2010.
17 Mar New TB Screening Of Immigrants To US Has Resulted in Better Detection and Treatment Opportunities
MedicalResearch.com Interview with: Dr.Yecai Liu Division of Global Migration and Quarantine Centers for Disease Control and Prevention, Atlanta, Georgia Medical Research: What is the background for this study? What are the main findings? Response: Since the early 1900s, immigrants and refugees applying for a visa to come to the United States undergo a medical examination that includes tuberculosis (TB) screening. In 2007, CDC began implementing the new screening guidelines, which require people suspected of having TB to receive a much more sensitive sputum culture test to confirm TB to ensure that those individuals who do have TB receive treatment before they arrive in the United States. These requirements have now been completely rolled out to all countries with U.S.-bound immigrants and refugees. From 2007 through 2012, half of the 3.2 million arrivals of immigrants and refugees to the United States were screened for TB by the new screening guidelines. Out of more than 4,000 TB cases diagnosed by the new screening guidelines during this period, nearly 2,200 were smear-negative and culture positive. These cases would likely have been missed under the previous screening requirements. The results of this study showed that the updated overseas screening guidelines led to a roughly one-third decrease in the annual number of TB cases among foreign-born persons within their first year in the United States.16 Mar Sodium Content In Commercial Foods Remains High and Variable
MedicalResearch.com Interview with: Jaspreet Ahuja, Nutritionist
USDA, Agricultural Research Service
Nutrient Data Laboratory
Beltsville, MD 20705
MedicalResearch: What is the background for this study? What are the main findings?
Response: Most sodium in the U.S. diet comes from commercially processed and restaurant foods. Sodium reduction in these foods is key to several recent public health efforts. In this paper, we provide an overview of a program led by Nutrient Data Laboratory, USDA, in partnership with CDC and FDA to monitor sodium contents in commercially processed and restaurant foods in United States.
We track about 125 highly consumed, sodium-contributing foods, termed “Sentinel Foods” annually using information from food manufacturers and periodically by nationwide sampling and laboratory analyses. In addition, we monitor over 1,100 other commercially processed and restaurant food items, termed “Priority-2 Foods,” biennially using information from food manufacturers. These foods serve as indicators for assessing changes in the sodium content of commercially processed and restaurant foods in the U.S. In addition to sodium, we are monitoring related nutrients (potassium, total dietary fiber, total and saturated fat, total sugar) because their levels may change when manufacturers and restaurants reformulate their products to reduce their sodium content.
We sampled all Sentinel Foods nationwide and reviewed all Priority-2 Foods in 2010–2013 to determine baseline sodium concentrations. The results of sodium reduction efforts, based on re-sampling of the Sentinel Foods or re-review of P2Fs, will become available in 2015 on our website. The updated data are also released in USDA food composition databases, National Nutrient Database for Standard Reference and Food and Nutrient Database for Dietary Studies.
13 Mar Majority of Women Experience Stressful Life Events In Year Before Giving Birth
MedicalResearch.com Interview with: Elizabeth Burns, MPH Rollins School of Public Health Emory University MedicalResearch: What is the background for this study? What are the main findings? Response: Epidemiologic studies suggest that prenatal stress is associated with preterm birth, low birth weight and peripartum anxiety and depressive symptoms. The most recent population-based study on the prevalence of stress among pregnant women, which used data from 1990-1995, reported that 64% of women experience stressful life events (SLEs) in the year before their infant’s birth. More recent estimates of prevalence and trends of prenatal stressful life events are useful for clinicians in order to understand the risk profile of their patients. The Pregnancy Risk Assessment Monitoring System (PRAMS) collects self-reported information on maternal experiences and behaviors before, during, and after pregnancy among women who delivered a live infant. PRAMS includes 13 questions about maternal SLEs experienced in the year preceding the birth of the child. Based on previous research, SLEs were grouped into four dichotomous constructs: 1) emotional stressors (family member was ill and hospitalized or someone very close died); 2) financial stressors (moved to a new address, lost job, partner lost job, or unable to pay bills); 3) partner-associated stressors (separated/divorced, argued more than usual with partner/husband, or husband/partner said he did not want pregnancy); and 4) traumatic stressors (homeless, involved in a physical fight, partner or self-went to jail, or someone very close had a problem with drinking or drugs). The prevalence of self-reported stressful life events decreased modestly but significantly during 2000–2010. Despite this, 70.2% of women reported ≥1 SLEs in 2010. Prevalence of stressful life events vary by state and maternal demographic characteristics and are especially prevalent among younger women, women with ≤12 years of education (75.6%), unmarried women (79.6%), and women that were covered by Medicaid for prenatal care or delivery of their child (78.7%).11 Mar Nearly All Babies Born With Neonatal Abstinence Syndrome Were Exposed To Opioids
MedicalResearch.com Interview with:
Dr. Jennifer Lind PharmD, MPH
Division of Birth Defects and Developmental Disabilities,
CDC
Medical Research: What is the background for this study?
Dr. Lind: CDC and Florida investigators published a new report describing the characteristics of infants with neonatal abstinence syndrome (NAS) and their mothers. NAS is a group of signs exhibited by newborns exposed to addictive drugs taken by a mother during pregnancy. Infants with neonatal abstinence syndrome have prolonged hospital stays, experience serious medical complications, and are very costly to treat.
Medical Research: What are the main findings?
Dr. Lind: In this investigation, 242 infants with neonatal abstinence syndrome were identified in three Florida hospitals during a 2-year period (2010–2011). Nearly all of the infants with NAS were exposed to opioid painkillers during pregnancy (99.6%) and experienced serious medical complications, with more than 97% being admitted to an intensive care unit, where the average length of stay was 26 days. Despite a high prevalence of positive urine toxicology tests during the birth hospitalization, only a small proportion of mothers had documentation of referrals for drug counseling or rehabilitation.
07 Mar More Medical Advice May Help Patients Reduce Salt Intake
MedicalResearch.com Interview with:
Dr. Sandra L. Jackson, Ph.D., M.P.H
Epidemic intelligence service fellow
Centers for Disease Control and Prevention, Chamblee, GA
Medical Research: What is the background for this study? What are the main findings?
Dr. Jackson: With more than 90 percent of U.S. adults exceeding recommended sodium intake levels, healthcare providers can play a key role in counseling patients on the importance of limiting salt in the diet.
To assess the impact of medical advice on an individual’s efforts to reduce sodium intake, CDC researchers examined self-reported telephone survey information from nearly 174,000 U.S. adults. Overall, more than half of the respondents reported watching or reducing their sodium intake in 2013 – but less than one quarter (23 percent) said they received advice from a doctor or healthcare professional about sodium reduction. Of those that received the medical advice, 82 percent reported taking action to limit their sodium intake. In comparison, only 44 percent of respondents who reported not receiving medical advice said they took steps to reduce sodium.
The substantial proportion of patients who are not receiving medical advice (77%), according to these findings, reveals a missed opportunity to reduce sodium intake, particularly among groups that have a higher risk of developing cardiovascular disease. This includes African Americans, and those with high blood pressure, diabetes or chronic kidney disease.
05 Mar Troubling Increase In HIV Infections In MSM
MedicalResearch.com Interview with: Lorena Espinoza Center for Disease Control MedicalResearch: What is the background for this study? What are the main findings? Response: Men who have sex with men remain the risk group most severely affected by HIV in the United States, accounting for approximately two-thirds of new infections each year. Understanding trends in...
05 Mar Black MSM More Likely To Be HIV Positive
MedicalResearch.com Interview with: Cyprian Wejnert Center For Disease Control MedicalResearch: What is the background for this study? What are the main findings? Cyprian Wejnert: Men who have sex with men (MSM) remain the risk group most severely affected by HIV in the United States, accounting for approximately two-thirds of new infections each year. Understanding racial and age disparities among MSM is critical to tailor effective prevention efforts. Our study examined data from CDC’s National HIV Behavioral Surveillance system (NHBS) from 20 U.S. cities. We assessed changes in HIV prevalence, awareness of infection, and risk behavior among MSM, by age and race, from 2008 to 2011, finding that: o Among black Men who have sex with men, 30 percent were HIV-infected overall, and 1 in 5 black MSM aged 18-24 were infected with HIV. Compared to 14 percent and 4 percent among white MSM. o In all age groups younger than 40 years, black Men who have sex with men were significantly more likely to be HIV-positive compared to all other racial/ethnic groups. o Disparities in HIV prevalence between black and white MSM were greatest among the youngest MSM, and increased between 2008 and 2011. o Black MSM were less likely to be aware of their infection than their white counterparts (54 vs. 86 percent). o Black Men who have sex with men did not report higher levels of condomless sex overall or condomless sex with partners of discordant or unknown HIV status.05 Mar African American Women Less Likely To Achieve HIV Viral Suppression
MedicalResearch.com Interview with: Dr. Ndidi Nwangwu-Ike Center Disease Control MedicalResearch: What is the background for this study? What are the main findings? Response: CDC data has shown encouraging signs of a decrease in new HIV infections among black women in recent years. However, African American women continue to be far more affected by HIV than women of any other race or ethnicity, with a rate of new infection 20 times that of white women and nearly five times that of Hispanic women. Ensuring people with HIV are diagnosed and remain in care is key to controlling HIV in the nation. When used consistently, antiretroviral medication can keep HIV controlled at very low levels in the body (known as viral suppression), allowing people with HIV to live longer, healthier lives and reducing the likelihood they will transmit HIV to others. Our study finds that viral suppression among women diagnosed with HIV is low, with young women and black women the least likely to achieve viral suppression. Specifically, we found that: o Of women newly diagnosed with HIV in 2012, 83 percent were linked to care within three months of diagnosis. o Retention in care varied by age and race/ethnicity; overall, just over half of women (52 percent) diagnosed and living with HIV in 2011 received ongoing HIV care. o Overall, only 44 percent of women diagnosed and living with HIV in 2011 had a suppressed viral load.03 Mar Long-acting Reversible Contraception Use Fluctuated Over 30 Years
MedicalResearch.com Interview with: Amy Branum M.S.P.H., Ph.D and Jo Jones Ph.D Center for Health Statistics Division of Vital Statistics, Reproductive Statistics Branch Medical Research: What is the background for this study? Response: This data brief was based on multiple years of the National Survey of Family Growth (NSFG). The NSFG, first conducted in 1973, is administered by NCHS in response to a legal mandate that says that NCHS “shall collect statistics on …family formation, growth, and dissolution.” (PHS Act, Sec 306). Up through the 2002 NSFG, the survey was conducted periodically; with the 2006-2010 data collection, the NSFG is a continuous survey with interviews conducted over multiple years. We felt it was important to examine long-term trends in Long-acting Reversible Contraception use due to fluctuations over time in IUD and implant acceptability and availability as contraception methods, especially in light of recent efforts to promote LARC use to prevent unintended pregnancies and for birth spacing. Medical Research: What are the main findings? Response: We found that Long-acting Reversible Contraception use declined between 1982 and 1988, remained stable through 2002 and then increased almost five-fold between 2002 and 2011-2013 (from 1.5% to 7.2). Long-acting Reversible Contraception use has, and continues to be, generally highest among women aged 25-34 but has increased the most among women 15-24 since 2002. Hispanic women used Long-acting Reversible Contraception at higher rates in 1982 compared to non-Hispanic white and non-Hispanic black women but patterns of use diverged after 1995 so that by 2011-2013, patterns of use were more similar by race and Hispanic origin. Women who have at least one previous live birth have used, and continue to use, LARCs at a higher rate compared to women with no previous births.28 Feb One Case Of Hepatitis C Transmitted From Shared Kidney Perfusion Machine
MedicalResearch.com Interview with: Gwen Borlaug, CIC, MPH Coordinator, HAI Prevention Program Wisconsin Division of Public Health Madison, WI 53702 MedicalResearch: What is the background for this study? What are the main findings? Response: Healthcare-associated transmission of blood borne pathogens such as hepatitis C and B viruses is previously documented. A single incident of HCV transmission likely occurred...
28 Feb HIV Diagnosis and Care Critical To Preventing Spread Of Virus To Others
MedicalResearch.com Interview With Jacek Skarbinski, MD Medical officer Centers for Disease Control and Prevention MedicalResearch: What is the background for this study? What are the main findings? Dr. Skarbinski: Previous research has indicated that HIV diagnosis and viral suppression are important prevention tools that can help reduce continued transmission. However, this analysis is the first...
27 Feb Respiratory Viral Infections Leading to Pediatric Pneumonia
MedicalResearch.com Interview with:
Seema Jain, MD
Medical Epidemiologist
Epidemiology and Prevention Branch, Influenza Division
Centers for Disease Control and Prevention
Atlanta, GA 30329
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Jain: Pneumonia is the leading cause of hospitalization among children in the United States with medical costs estimated at almost $1 billion in 2009. The Centers for Disease Control and Prevention’s Etiology of Pneumonia in the Community (EPIC) study was a multi-center, active population-based surveillance study that aimed to estimate the incidence and etiology of community-acquired pneumonia requiring hospitalization in U.S. children. Children in the study were enrolled from January 2010 to June 2012 in three U.S. children’s hospitals in Memphis, Nashville, and Salt Lake City. Study staff tested children using a range of laboratory tests for viral and bacterial respiratory pathogen detection.
During the study period, the EPIC study team enrolled 2,638 children, of which 2,358 (89 percent) had radiographically-confirmed pneumonia. The median age of children in the study was 2 years old. Intensive care was required for 497 (21 percent) of the children, and three children died. Among 2,222 children with radiographic pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 1802 (81%). One or more viruses were detected in 1,472 (66%) of these children. Bacteria were detected in 175 (8%), and bacterial and viral co-detection occurred in 155 (7%). The study estimated that annual pneumonia incidence was 15.7/10,000 children during the study period. The highest incidence was among children younger than 2 years old (62.2/10,000). Respiratory syncytial virus (RSV) was the most common pathogen detected (28%), and it was associated with the highest incidence among children younger than 2 years old with pneumonia. Human rhinovirus was detected in 22 percent of cases, but it was also identified in 17 percent of asymptomatic controls who were enrolled, by convenience sample, at the same site during the same time period; thus, making it challenging to interpret the meaning of human rhinovirus detection in children hospitalized with pneumonia. Other detected pathogens were human metapneumovirus (13%), adenovirus (11%), Mycoplasma pneumoniae (8%), parainfluenza viruses (7%), influenza (7%), coronaviruses (5%), Streptococcus pneumoniae (4%), Staphylococcus aureus (1%), and Streptococcus pyogenes (<1%). The low prevalence of bacterial detections likely reflects both the effectiveness of bacterial conjugate vaccines and suboptimal sensitivity of bacterial diagnostic tests.
26 Feb C. difficile Most Common Health Care Associated Infection
MedicalResearch.com Interview with:
Fernanda C. Lessa, M.D., M.P.H.
Centers for Disease Control and Prevention
Atlanta, GA
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Lessa: The epidemiology of Clostridium difficile has gone through dramatic changes over the last decade. C. difficile has become the most common cause of healthcare-associated infections in US hospitals and it has been also increasingly reported outside of healthcare settings. As the epidemiology of this pathogen changes, it is important to understand the magnitude and scope of this infection in the United States to help guide priorities for prevention.
Main findings:
1) C. difficile was responsible for almost half million infections and associated with 29,000 deaths in 2011 in the United States
2) Among the patients who developed C. difficile, 83,000 had recurrent infections
3) C. difficile incidence was higher among females, whites, and persons 65 years of age or older
4) Approximately 345,400 infections occurred outside of the hospital indicating that C. difficile prevention should go beyond hospital settings.
21 Feb Pharmacy Shopping and Overlapping Prescriptions Linked To Opioid Overdose
MedicalResearch.com Interview with:
Dr. Zhou Yang
Office of the Associate Director for Policy
Centers for Disease Control and Prevention, Atlanta, GA
Medical Research: What is the background for this study?
Response: Prescription drug misuse and abuse, largely those involving opioid painkillers, have been characterized as an epidemic. According to a CDC report, drug-related overdose has surpassed traffic crashes to become the leading cause of injury death in the U.S. in 2009. Medicaid programs in most states implement Patient Review and Restriction (PRR) programs, also called ‘lock-in’ program. The PRR programs use a set of behavioral indicators to identify patients at higher risk of opioid drug misuse and abuse, and ‘locks’ them in to a designated provider, pharmacy, or both. Pharmacy shopping is one of the key indicators employed by the PRR program. However, definition of pharmacy shopper varies widely across states. In addition, the PRR programs have not paid attention to the indicators of prescribing overlapped drugs, which we see as a missed opportunity to help the PRR program to better target users at high risk of overdose.
Medical Research: What are the main findings?
Response: Among a number of currently used definitions of pharmacy shopping, we found that the definition of ‘four or more pharmacies visited within any 90-day period’ is the most effective one. We also found that having overlapping opioid prescriptions is associated with an elevated risk of overdose. In fact, patients who exhibited both pharmacy shopping and having overlapping prescription had more than twice the risk of overdose than those who only exhibited pharmacy shopping.
14 Feb Sodium Reduction Not Linked To Higher Fasting Glucose Concentrations
MedicalResearch.com Interview with: Sheena M. Patel, MPH, ORISE, Fellow Division for Heart Disease and Stroke Prevention CDC MedicalResearch: What is the background for this study? What are the main findings? Dr. Patel: Although significant evidence reveals reduced sodium intake lowers blood pressure, some studies report that sodium reduction could have a negative impact on insulin...
14 Feb Binge Drinking Linked To Risky Sexual Behavior in MSM
MedicalResearch.com Interview with: Kristen Hess ORISE Fellow Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention Atlanta, GA MedicalResearch: What is the background for this study? Response: Men who have sex with men (MSM) of all races continue to be the risk group most severely affected by HIV in the United States. CDC’s most recent HIV incidence data show that the number of new infections among MSM increased 12 percent between 2008 and 2010, with an even steeper increase among the youngest MSM. These data clearly show the urgent need to better understand the factors that affect their risk and to develop effective prevention interventions. One specific factor is excessive alcohol use, which is responsible for 88,000 deaths in this nation each year, and cost the U.S. about $224 billion in 2006. Binge drinking (consuming ≥5 drinks for men on an occasion; ≥4 drinks for women) is the most common form of excessive alcohol consumption. The association between excessive alcohol consumption, including binge drinking, and risky sexual behaviors among MSM has had mixed results in the literature with some studies finding an association and others not. One limitation of previous work is that the definition of excessive alcohol consumption varies between studies, so results are not easily compared between studies and populations. Our study examines the relationship between binge drinking and sexual risk behaviors among MSM who are current drinkers and who were either HIV-negative or unaware of their HIV status. MedicalResearch: What are the main findings? Response: We assessed the prevalence of binge drinking, using a standard definition, among a sample of MSM recruited from 20 cities across the U.S. We also examined the association between binge drinking and several risky sexual behaviors. The findings show that 6 in 10 MSM reported binge drinking. Those who binge drank, in comparison to non-binge drinkers, were more likely to engage in risky sexual behaviors such as sex with an HIV-positive or unknown status partner and exchange sex for money or drugs at last sex, as well as more likely to have concurrent partners and more condomless sex partners in the past year. We also found that the likelihood of risky sexual behaviors went up with increased frequency of binge drinking. In fact, MSM who reported 10 or more binge-drinking episodes in the past month were more likely to report risky behaviors. This is a critical point, especially given that, among those who binged, 22 percent reported 10 or more binge drinking episodes in the past month.10 Feb Measles Mumps Rubella Vaccine in Adults: CDC Reports Excellent Safety Record
MedicalResearch.com Interview with: Tom Shimabukuro, MD, MPH, MBA Captain, U.S. Public Health Service Deputy Director Immunization Safety Office Centers for Disease Control and Prevention (CDC) Medical Research: What is the background for this study? What are the main findings? Response: CDC conducted a study looking at reports of adverse events (possible side effects) following measles, mumps, and rubella (MMR) vaccination in adults. Researchers reviewed the Vaccine Adverse Event Reporting System (VAERS) database for U.S. reports of adults aged 19 years and older who received MMR vaccine from January 1, 2003 to July 31, 2013. During this period, VAERS received 3,175 U.S. reports after MMR vaccine in adults. The most common signs and symptoms for all reports were fever (19%), rash (17%), pain (13%), and joint pain (13%). The study included adults only, a population for which there is limited safety data for this vaccine. This study further supports the MMR vaccine’s safety. Researchers did not find any new or unexpected safety concerns.07 Feb Many Women Exceeding Gestational Weight Gain Recommendations
MedicalResearch.com Interview with:
Jonetta L. Johnson, PhD, MPH
Epidemiologist
Division of Reproductive Health, CDC.
Medical Research: What is the background for this study?
Dr. Johnson: Achieving adequate gestational weight gain (GWG) is important for optimal health of the infant and mother. Women who gain below or above Institute of Medicine (IOM) recommendations are more likely to experience maternal complications and negative infant birth outcomes. Realizing the importance of gestational weight gain to maternal and infant health, the IOM established recommendations for gestational weight gain based on a woman’s prepregnancy body mass index (BMI) in 1990 and updated them in 2009. Trends in GWG are particularly of interest since prepregnancy BMI has increased over time in the U.S and little data was available on how gestational weight gain has changed over time.
Medical Research: What are the main findings?
Dr. Johnson: Our findings show that from 2000-2009, the majority of women did not gain weight within IOM GWG recommendations and that women were more likely to gain outside recommendations in more recent years. In fact, from 2000–2009, there was a gradual decrease (1.0 percentage point every 2 years) in women gaining within IOM gestational weight gain recommendations and a gradual increase (0.8 percentage points every 2 years) in women gaining above IOM recommendations while the percentage of women gaining weight below IOM recommendations remained relatively constant. Although there were slight differences in mean gestational weight gain by BMI group, gestational weight gain was about 31 pounds on average. The decreasing percentage of women gaining within IOM recommendations during our study period may be influenced by increases in prepregnancy BMI during the same time period because women in higher BMI groups are recommended to gain less weight during pregnancy compared to women in lower BMI groups. Thus, even with no change in gestational weight gain over time, an increase in the proportion of women who are obese could result in a decrease in the proportion of women gaining within gestational weight gain recommendations.
06 Feb Pregnant Flight Attendants May Have Increased Risk of Miscarriage
MedicalResearch.com Interview with: Barbara Grajewski, Ph.D., M.S., Epidemiologist Elizabeth Whelan, Ph.D., Branch Chief Christina Lawson, Ph.D., Epidemiologist Division of Surveillance, Hazard Evaluations and Field Studies National Institute for Occupational Safety and Health Centers for Disease Control and Prevention Medical Research: What is the background for this study? Response: The study, published January 5 online ahead of print in the journal Epidemiology, looked at potential workplace reproductive hazards for flight attendants. While in flight, flight attendants are exposed to cosmic radiation from space and, periodically, can be exposed to radiation from solar particle events. Flight attendants can also experience circadian disruption (disruption to the body’s internal time clock) from traveling across time zones and from working during hours when they would normally be asleep. For this study, we analyzed 840 pregnancies among 673 female flight attendants and examined company records of 2 million single flights flown by these women. From these data, we estimated a marker of circadian disruption—working during normal sleeping hours—and exposure to cosmic and solar particle event radiation for each flight. This gives us a much more specific estimate of the exposures these workers face on the job every day. We also assessed the physical demands of the job, such as standing and walking for more than 8 hours a day and bending at the waist more than 25 times a day. Cosmic radiation and circadian disruption among flight attendants are linked very closely on many flights and are very difficult to look at separately when trying to understand what causes miscarriage. This is the first study that has attempted to separate these two exposures to determine which is potentially linked to miscarriage. This study is also an improvement over other studies in its assessment of cosmic radiation for each individual flight flown and from documentation of solar particle events. Earlier studies have looked at how many years a flight attendant has worked or other ways to estimate exposures that are not as specific.06 Feb Black Mortality from HIV Declines But Still Higher Than Whites, Hispanics
MedicalResearch.com Interview with: Azfar-e-Alam Siddiqi, MD, PhD Associate Chief of Science (Acting) HIV Incidence and Case Surveillance Branch Division of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention Medical Research: What is the background for this study? What are the main findings? Dr. Sidiqqi: African Americans remain the population most affected by HIV in the United States -- accounting for almost half (44 percent) of all new infections and more than a third (41 percent) of people living with HIV, despite representing just 12 percent of the U.S. population. We also know that far too many African Americans living with HIV do not get the medical care and treatment they need to stay healthy and protect themselves and others. In fact, less than half (40 percent) of African Americans living with HIV are engaged in care and only one-quarter (28 percent) have the virus under control through treatment. To better understand mortality among African Americans with HIV, our team analyzed data from the National HIV Surveillance System for 2008 through 2012. Because immune suppression caused by HIV infection can result in fatal co-illnesses, our analysis estimated deaths due to all causes, rather than limiting their analysis to deaths resulting directly from HIV infection. This method allowed us to capture the fullest picture of mortality among African Americans with HIV. According to our new analysis, from 2008-2012, the death rate per 1,000 blacks living with HIV decreased 28 percent, more than the overall decline (22 percent) observed among all persons living with HIV and more than declines observed among other races/ethnicities (13 percent for whites and 25 percent for Hispanics). Despite substantial declines in mortality, the death rate per 1,000 blacks living with HIV in 2012 was 13 percent higher than the rate for whites and 47 percent higher than the rate for Hispanics.05 Feb Cost-Effectiveness of CDC Recommended HIV Prevention Strategies
MedicalResearch.com Interview with: Ya-lin (Aileen) Huang, PhD. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention Atlanta, GA, 30329 Medical Research: What is the background for this study? What are the main findings? Dr. Huang: With an estimated 50,000 new HIV infections each year in this country, and no vaccine or cure available yet, prevention is critical. Maximizing the impact of all available prevention strategies could significantly reduce new infections in this country. The purpose of this study is to provide evidence for the cost effectiveness of the interventions recommended under the funding announcement and to highlight where more cost-effectiveness studies may be needed. We limited our scope to the four interventions required under the health department funding announcement, including HIV testing, prevention with HIV-positives and their partners, condom distribution and efforts to align policies with optimal HIV prevention, care and treatment. Our review provides an updated summary of the published evidence of cost-effectiveness of four key HIV prevention interventions recommended by CDC: HIV testing, prevention with HIV-positives and their partners, condom distribution and policy initiatives. Models suggest that more than 350,000 HIV infections have been avoided because of the nation’s HIV prevention efforts. In addition to lives saved, HIV prevention has also generated substantial economic benefits. For every HIV infection that is prevented, an estimated $402,000 (http://www.ncbi.nlm.nih.gov/pubmed/23615000) is saved in the cost of providing lifetime HIV treatment. It is estimated that HIV prevention efforts have averted more than $125 billion in medical costs since the beginning of the epidemic.04 Feb Fall Prevention Programs Can Reduce Injuries and Costs
MedicalResearch.com Interview with:
Dr. Judy Stevens PhD
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
Medical Research: What is the background for this study? What are the main findings?
Dr. Stevens: Falls among people aged 65 and older are a serious, costly, and growing public health problem. As our population ages, falls will continue to increase unless we implement effective prevention strategies that are also cost-effective.
This study found that three evidence-based fall prevention programs, the Otago Exercise Program, Tai Chi: Moving for Better Balance, and Stepping On, were not only practical and effective but also provided a positive return on investment (ROI) or net benefit. An ROI of 150% means for each $1 spent on implementing the program, you can expect a net benefit of $1.50.
The analysis found that the cost of implementing each of these fall prevention programs was considerably less than the potential medical costs needed to care for someone injured from a fall. These research findings can help community organizations and policymakers identify and use programs that can both save lives and reduce costs.
04 Feb Pneumococcal Vaccines Prove Highly Effective In Preventing Severe Illness
MedicalResearch.com Interview with:
Dr Matthew R Moore, MD
National Center for Immunization and Respiratory Diseases,
Centers for Disease Control and Prevention, Atlanta, GA, USA
MedicalResearch: What is the background for this study?
Dr. Moore: Since introduction, pneumococcal conjugate vaccines have resulted in dramatic decreases in the number of cases of invasive pneumococcal disease in both children and adults. The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into the routine infant immunization program in the United States in 2000. It was recommended for infants using a 4-dose schedule: 2, 4, 6, and 12 through 15 months of age. Studies showed that PCV7 was highly effective in preventing invasive pneumococcal disease. In 2010, the 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 using the same 4-dose schedule. PCV13 is similar to PCV7, but includes protection against six additional serotypes of Streptococcus pneumoniae. There are more than 90 serotypes of pneumococcal bacteria.
Streptococcus pneumoniae, or pneumococcus, is a major cause of illness and death globally. Pneumococcus can cause many types of illness that ranging from mild to life-threatening, including pneumonia, ear and sinus infections, meningitis, and bacteremia. Some of these infections are considered invasive because they invade parts of the body that are normally free from bacteria. Invasive pneumococcal disease, including meningitis and bacteremia, is often severe and can be deadly.
MedicalResearch: What are the main findings?
Dr. Moore: Invasive pneumococcal disease decreased substantially in the first 3 years after PCV13 was introduced into the U.S. infant immunization schedule. By June 2013, more than 30,000 cases of invasive pneumococcal disease and 3,000 deaths are estimated to have been prevented in the United States due to PCV13. Children under the age of five, which is the age group that actually received the vaccine, experienced the greatest and quickest benefit from PCV13. For example, the overall number of cases of invasive pneumococcal disease decreased by 64% in this age group between 2010 and 2013. Significant decreases were seen as early as six months after the immunization recommendation was made.
Adults, who were not targeted for vaccination, also experienced health benefits from PCV13 introduction. For example, the overall number of cases of invasive pneumococcal disease decreased by 32% for adults aged 18 to 49 years, while adults 65 and older experienced a more modest 12% decrease. These reductions are further evidence that both PCV7 and PCV13 reduce the spread of pneumococcus, which is why vaccinating children leads to disease reductions in adults.
For both children and adults, the greatest reductions were seen in the number of cases of invasive pneumococcal disease that were caused by serotypes that are covered by PCV13 but not PCV7 (serotypes 19A and 7F specifically).
04 Feb Household Members Protected Against Some Rotavirus Infections When Infants Vaccinated
Posted at 14:22h
in Author Interviews, CDC, Gastrointestinal Disease, Infections, Pediatrics, Vaccine Studies
MedicalResearch.com Interview with:
Margaret M. Cortese MD
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Medical Research: What is the background for this study? What are the main findings?
Dr. Cortese: The introduction of rotavirus vaccine in the United States resulted in a dramatic reduction in hospitalizations and emergency department care for rotavirus disease among young children, as well as provided indirect protection to unvaccinated peers.
However, what our study looked at was whether or not older children and adults may experience indirect protection from having children in the house who are vaccinated for rotavirus.
We used 2008-2012 Marketscan claims data to compare gastroenteritis rates among households whose child had received rotavirus vaccine with households whose child did not receive vaccine.
We found statistically significantly lower rates of hospitalization from rotavirus gastroenteritis or unspecified-gastroenteritis in vaccinated households among all persons 20-29 years and females 20-29 years during the 2008-2009 rotavirus season as well as males 30-39 years in the 2009-2010 season. Lower emergency department gastroenteritis rates occurred in vaccinated households among females 20-29 years during the 2009-2010 season and individuals 5-19 years during the 2010-2011 season.
30 Jan Study Addresses Strategies US Adults Use to Save On Prescription Drug Costs
MedicalResearch.com Interview with: Robin A. Cohen, Ph.D Medical Research: What is the background for this study? Dr. Cohen: Estimates are based on data collected from the 2013 National Health Interview Survey (NHIS). The NHIS is a survey conducted by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics. NHIS collects information about health and health care of the civilian noninstitutionalized population of the United States. In 2013, questions about strategies used to reduce prescription drug cost were asked of more than 34,000 adults aged 18 and over. Medical Research: What are the main findings? Dr. Cohen: To save money, almost 8% of U.S. adults (7.8%) did not take their medication as prescribed, 15.1% asked a doctor for a lower-cost medication, 1.6% bought prescription drugs from another country, and 4.2% used alternative therapies. Adults aged 18–64 (8.5%) were nearly twice as likely as adults aged 65 and over (4.4%) to have not taken their medication as prescribed to save money. Among adults aged 18–64, uninsured adults (14.0%) were more likely than those with Medicaid (10.4%) or private coverage (6.1%) to have not taken their medication as prescribed to save money. The poorest adults—those with incomes below 139% of the federal poverty level—were the most likely to not take medication as prescribed to save money. Among adults aged 65 and over, those living with incomes in the 139-400% FPL range were more likely than adults living in lower or higher income thresholds to have asked their provider for a lower cost prescription to save money.25 Jan Opioids Commonly Taken By Women of Childbearing Age
MedicalResearch.com Interview with:
Dr. Jennifer Lind PharmD, MPH
Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, CDC
Medical Research: What is the background for this study?
Dr. Lind: CDC researchers published a new study estimating the proportion of women aged 15-44 years who filled a prescription for opioid pain medications. Opioids are prescribed by healthcare providers to treat moderate to severe pain. They are also found in some prescription cough medications. Opioids include medications like codeine, oxycodone, hydrocodone, or morphine. For this study, researchers used data from two large insurance claims datasets—one on Medicaid and one on private insurance—and looked at data from 2008-2012.
Medical Research: What are the main findings?
Dr. Lind: Opioid medications are widely used among women of reproductive age in the United States, regardless of insurance type. On average, more than a third (39 percent) of women aged 15-44 years enrolled in Medicaid, and more than one fourth (28 percent) of those with private insurance filled a prescription for an opioid pain medication each year during 2008-2012. Taking these medications early in pregnancy, often before women know they are pregnant, can increase the risk for some birth defects (such as spina bifida) and other poor pregnancy outcomes (such as preterm birth or low birth weight).