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New From the GAO

October 20, 2014 Comments off

New GAO Reports
Source: Government Accountability Office

1. Food Safety: USDA Needs to Strengthen Its Approach to Protecting Human Health from Pathogens in Poultry Products. GAO-14-744, September 30.
http://www.gao.gov/products/GAO-14-744
Highlights – http://www.gao.gov/assets/670/666230.pdf
Podcast – http://www.gao.gov/multimedia/podcasts/666518

2. Changing Crude Oil Markets: Allowing Exports Could Reduce Consumer Fuel Prices, and the Size of the Strategic Reserves Should Be Reexamined. GAO-14-807, September 30.
http://www.gao.gov/products/GAO-14-807
Highlights – http://www.gao.gov/assets/670/666275.pdf

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CRS — Ebola: Basics About the Disease (October 3, 2014)

October 17, 2014 Comments off

Ebola: Basics About the Disease (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

In March 2014, global health officials recognized an outbreak of Ebola virus disease (EVD) in Guinea, West Africa. In retrospect, officials determined that the outbreak began in December 2013, and spread to the adjacent countries of Liberia and Sierra Leone. In September 2014, the U.S. Centers for Disease Control and Prevention (CDC) confirmed the first EVD case diagnosed in the United States,1 heightening concerns among some who fear the disease could spread in American communities.2 This report discusses EVD in general, including symptoms, modes of transmission, incubation period, and treatments; presents projections of the future course of the outbreak; and lists additional CRS products, including products focused on the situation in West Africa. Unless otherwise cited, information in this report is drawn from Ebola information pages of CDC3 and the World Health Organization (WHO).

The Ebola Outbreak: Select Legal Issues, CRS Legal Sidebar (October 6, 2014)

October 17, 2014 Comments off

The Ebola Outbreak: Select Legal Issues, CRS Legal Sidebar (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

On August 8th, the World Health Organization declared the outbreak of the Ebola Virus Disease in West Africa a Public Health Emergency of International Concern. The recent arrival in the United States of several health care workers who contracted the disease, combined with the first diagnosis of a case in the U.S. at a hospital in Dallas, has sparked discussion about the appropriate government response. Aside from the various policy considerations at issue, the outbreak has generated several legal questions about the federal government’s authority to restrict specific passengers’ travel and/or contain the outbreak of an infectious disease. These questions include, inter alia, whether the federal government may: (1) restrict which countries U.S. nationals may travel to in the event of a public health crisis; (2) bar the entry into the United States of people who may have been infected by a disease; and (3) impose isolation or quarantine measures in order to control infectious diseases.

CRS — Federal and State Quarantine and Isolation Authority (October 9, 2014)

October 17, 2014 Comments off

Federal and State Quarantine and Isolation Authority (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

In the wake of increasing fears about the spread of highly contagious diseases, federal, state, and local governments have become increasingly aware of the need for a comprehensive public health response to such events. An effective response could include the quarantine of persons exposed to infectious biological agents that are naturally occurring or released during a terrorist attack, the isolation of infected persons, and the quarantine of certain cities or neighborhoods.

The public health authority of the states derives from the police powers granted by their constitutions and reserved to them by the Tenth Amendment to the U.S. Constitution. The authority of the federal government to prescribe quarantine and other health measures is based on the Commerce Clause, which gives Congress exclusive authority to regulate interstate and foreign commerce. Thus, state and local governments have the primary authority to control the spread of dangerous diseases within their jurisdictions, and the federal government has authority to quarantine and impose other health measures to prevent the spread of diseases from foreign countries and between states. In addition, the federal government may assist state efforts to prevent the spread of communicable diseases if requested by a state or if state efforts are inadequate to halt the spread of disease.

This report provides an overview of federal and state public health laws as they relate to the quarantine and isolation of individuals and a discussion of constitutional issues that may be raised should individual liberties be restricted in a quarantine or isolation situation.

Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study

October 16, 2014 Comments off

Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study
Source: BMC Medicine

Background
Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors are individually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of this study was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factors – healthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore the association of this index with CRC incidence using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Methods
In the EPIC cohort, a total of 347,237 men and women, 25- to 70-years old, provided dietary and lifestyle information at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC cases were identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazards regression models and population attributable risks (PARs) have been calculated.

Results
After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors, the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70 to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors; P-trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; P for trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend <0.0001) for rectal cancer, respectively (P-difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) were attributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index.

Conclusions
Combined lifestyle factors are associated with a lower incidence of CRC in European populations characterized by western lifestyles. Prevention strategies considering complex targeting of multiple lifestyle factors may provide practical means for improved CRC prevention.

Announcement: Now Available Online: Final 2013–14 Influenza Vaccination Coverage Estimates for Selected Local Areas, States, and the United States

October 14, 2014 Comments off

Announcement: Now Available Online: Final 2013–14 Influenza Vaccination Coverage Estimates for Selected Local Areas, States, and the United States
Source: Morbidity and Mortality Weekly Report (CDC)

Final 2013–14 influenza season vaccination coverage estimates are now available online at FluVaxView (http://www.cdc.gov/flu/fluvaxview). The online information includes estimates of the cumulative percentage of persons vaccinated by the end of each month, from July 2013 through May 2014, for select local areas, each state, each U.S. Department of Health and Human Services region, and the United States overall.
Analyses were conducted using National Immunization Survey influenza vaccination data for children aged 6 months–17 years and Behavioral Risk Factor Surveillance System data for adults aged ≥18 years. Estimates are provided by age group and race/ethnicity. These estimates are presented in an interactive report (http://www.cdc.gov/flu/fluvaxview/interactive.htm) and complemented by an online summary report (http://www.cdc.gov/flu/fluvaxview/coverage-1314estimates.htm).

Opioids for chronic noncancer pain: A position paper of the American Academy of Neurology

October 10, 2014 Comments off

Opioids for chronic noncancer pain: A position paper of the American Academy of Neurology
Source: Neurology

The Patient Safety Subcommittee requested a review of the science and policy issues regarding the rapidly emerging public health epidemic of prescription opioid-related morbidity and mortality in the United States. Over 100,000 persons have died, directly or indirectly, from prescribed opioids in the United States since policies changed in the late 1990s. In the highest-risk group (age 35–54 years), these deaths have exceeded mortality from both firearms and motor vehicle accidents. Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction. The objectives of the article are to review the following: (1) the key initiating causes of the epidemic; (2) the evidence for safety and effectiveness of opioids for chronic pain; (3) federal and state policy responses; and (4) recommendations for neurologists in practice to increase use of best practices/universal precautions most likely to improve effective and safe use of opioids and to reduce the likelihood of severe adverse and overdose events.

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