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Notes from the Field: Occupationally Acquired HIV Infection Among Health Care Workers — United States, 1985–2013

January 12, 2015 Comments off

Notes from the Field: Occupationally Acquired HIV Infection Among Health Care Workers — United States, 1985–2013
Source: Morbidity and Mortality Weekly Report (CDC)

During 1985–2013, 58 confirmed and 150 possible cases of occupationally acquired HIV infection among HCWs were reported to CDC; since 1999, only one confirmed case (a laboratory technician sustaining a needle puncture while working with a live HIV culture in 2008) has been reported (1; Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, unpublished data, 2014) (Figure). Among the 58 confirmed cases, the routes of exposure resulting in infection were: percutaneous puncture or cut (49 cases), mucocutaneous exposure (five), both percutaneous and mucocutaneous exposure (two), and unknown (two). A total of 49 HCWs were exposed to HIV-infected blood, four to concentrated virus in a laboratory, one to visibly bloody fluid, and four to unspecified body fluids. Occupations of the HCWs with confirmed or possible HIV infection have varied widely (Table).

Association Between 7 Years of Intensive Treatment of Type 1 Diabetes and Long-term Mortality

January 10, 2015 Comments off

Association Between 7 Years of Intensive Treatment of Type 1 Diabetes and Long-term Mortality
Source: Journal of the American Medical Association

Importance
Whether mortality in type 1 diabetes mellitus is affected following intensive glycemic therapy has not been established.

Objective
To determine whether mortality differed between the original intensive and conventional treatment groups in the long-term follow-up of the Diabetes Control and Complications Trial (DCCT) cohort.

Design, Setting, and Participants
After the DCCT (1983-1993) ended, participants were followed up in a multisite (27 US and Canadian academic clinical centers) observational study (Epidemiology of Diabetes Control and Complications [EDIC]) until December 31, 2012. Participants were 1441 healthy volunteers with diabetes mellitus who, at baseline, were 13 to 39 years of age with 1 to 15 years of diabetes duration and no or early microvascular complications, and without hypertension, preexisting cardiovascular disease, or other potentially life-threatening disease.

Interventions and Exposures
During the clinical trial, participants were randomly assigned to receive intensive therapy (n = 711) aimed at achieving glycemia as close to the nondiabetic range as safely possible, or conventional therapy (n = 730) with the goal of avoiding symptomatic hypoglycemia and hyperglycemia. At the end of the DCCT, after a mean of 6.5 years, intensive therapy was taught and recommended to all participants and diabetes care was returned to personal physicians.

Main Outcomes and Measures
Total and cause-specific mortality was assessed through annual contact with family and friends and through records over 27 years’ mean follow-up.

Results
Vital status was ascertained for 1429 (99.2%) participants. There were 107 deaths, 64 in the conventional and 43 in the intensive group. The absolute risk difference was −109 per 100 000 patient-years (95% CI, −218 to −1), with lower all-cause mortality risk in the intensive therapy group (hazard ratio [HR] = 0.67 [95% CI, 0.46-0.99]; P = .045). Primary causes of death were cardiovascular disease (24 deaths; 22.4%), cancer (21 deaths; 19.6%), acute diabetes complications (19 deaths; 17.8%), and accidents or suicide (18 deaths; 16.8%). Higher levels of glycated hemoglobin (HbA1c) were associated with all-cause mortality (HR = 1.56 [95% CI, 1.35-1.81 per 10% relative increase in HbA1c]; P < .001), as well as the development of albuminuria (HR = 2.20 [95% CI, 1.46-3.31]; P < .001).

Conclusions and Relevance
After a mean of 27 years’ follow-up of patients with type 1 diabetes, 6.5 years of initial intensive diabetes therapy was associated with a modestly lower all-cause mortality rate when compared with conventional therapy.

Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer

January 9, 2015 Comments off

Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer (PDF)
Source: Cancer
BACKGROUND
The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updates on cancer incidence and death rates and trends in these outcomes for the United States. This year’s report includes the prevalence of comorbidity at the time of first cancer diagnosis among patients with lung, colorectal, breast, or prostate cancer and survival among cancer patients based on comorbidity level.

METHODS
Data on cancer incidence were obtained from the NCI, the CDC, and the NAACCR; and data on mortality were obtained from the CDC. Long-term (1975/1992-2010) and short-term (2001-2010) trends in age-adjusted incidence and death rates for all cancers combined and for the leading cancers among men and women were examined by joinpoint analysis. Through linkage with Medicare claims, the prevalence of comorbidity among cancer patients who were diagnosed between 1992 through 2005 residing in 11 Surveillance, Epidemiology, and End Results (SEER) areas were estimated and compared with the prevalence in a 5% random sample of cancer-free Medicare beneficiaries. Among cancer patients, survival and the probabilities of dying of their cancer and of other causes by comorbidity level, age, and stage were calculated.

RESULTS
Death rates continued to decline for all cancers combined for men and women of all major racial and ethnic groups and for most major cancer sites; rates for both sexes combined decreased by 1.5% per year from 2001 through 2010. Overall incidence rates decreased in men and stabilized in women. The prevalence of comorbidity was similar among cancer-free Medicare beneficiaries (31.8%), breast cancer patients (32.2%), and prostate cancer patients (30.5%); highest among lung cancer patients (52.9%); and intermediate among colorectal cancer patients (40.7%). Among all cancer patients and especially for patients diagnosed with local and regional disease, age and comorbidity level were important influences on the probability of dying of other causes and, consequently, on overall survival. For patients diagnosed with distant disease, the probability of dying of cancer was much higher than the probability of dying of other causes, and age and comorbidity had a smaller effect on overall survival.

CONCLUSIONS
Cancer death rates in the United States continue to decline. Estimates of survival that include the probability of dying of cancer and other causes stratified by comorbidity level, age, and stage can provide important information to facilitate treatment decisions. Cancer 2014;120:1290–1314. © 2013 American Cancer Society.

Categories: cancer, Cancer

Outbreaks: Protecting Americans from Infectious Diseases

January 5, 2015 Comments off

Outbreaks: Protecting Americans from Infectious Diseases
Source: Trust for America’s Health

The Outbreaks: Protecting Americans from Infectious Diseases report finds that the Ebola outbreak exposes serious underlying gaps in the nation’s ability to manage severe infectious disease threats.

Half of states and Washington, D.C. scored five or lower out of 10 key indicators related to preventing, detecting, diagnosing and responding to outbreaks. Maryland, Massachusetts, Tennessee, Vermont and Virginia tied for the top score – achieving eight out of 10 indicators. Arkansas has the lowest score at two out of 10.

Feed the Future: 2014 Year in Review

January 5, 2015 Comments off

Feed the Future: 2014 Year in Review
Source: U.S. Agency for International Development and other agencies

For generations, the United States has been a leader in providing development assistance across the globe to alleviate suffering and build shared progress and prosperity. But global food price spikes and resulting instability in 2007 and 2008 were a wake-up call: More needed to be done to break the vicious cycle of hunger and poverty.

The answer: Unlock the potential of agriculture as the key to reducing hunger, extreme poverty and malnutrition through a movement that became Feed the Future.

In 2014, the U.S. Government and its partners have continued to build on Feed the Future’s early success to drive real change on a large scale. Read on for highlights on how we’re sustaining progress toward the goal of ending hunger in our lifetimes.

Caffeine improves reaction time, vigilance and logical reasoning during extended periods with restricted opportunities for sleep

December 31, 2014 Comments off

Caffeine improves reaction time, vigilance and logical reasoning during extended periods with restricted opportunities for sleep
Source: Psychopharmacology

Rationale
Various occupational groups are required to maintain optimal physical and cognitive function during overnight periods of wakefulness, often with less than optimal sleep. Strategies are required to help mitigate the impairments in cognitive function to help sustain workplace safety and productivity.

Objectives
To test the effectiveness of repeated 200 mg doses of caffeine on cognitive function and live-fire marksmanship with soldiers during three successive nights of sustained wakefulness followed by 4-h afternoon sleep periods.

Methods
Twenty Special Forces personnel (28.6 ± 4.7 years, 177.6 ± 7.5 cm and 81.2 ± 8.0 kg) were randomly assigned to receive four 200-mg doses of caffeine (n = 10) or placebo (n = 10) during the late evening and early morning hours during three successive days. An afternoon 4-h sleep period followed. The psychomotor (PVT) and field (FVT) vigilance, logical reasoning (LRT) tests and a vigilance monitor assessed cognitive function throughout the study. Live-fire marksmanship requiring friend–foe discrimination was assessed.

Results
Caffeine maintained speed on the PVT (p < 0.02), improved detection of events during FVT (p < 0.001), increased number of correct responses to stimuli as assessed by the vigilance monitor (p < 0.001) and increased response speed during the LRT (p < 0.001) throughout the three overnight testing periods. Live-fire marksmanship was not altered by caffeine.

Conclusions
A total daily dose of 800 mg caffeine during successive overnight periods of wakefulness is an effective strategy to maintain cognitive function when optimal sleep periods during the day are not available.

Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness

December 24, 2014 Comments off

Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness
Source: Proceedings of the National Academy of Sciences

In the past 50 y, there has been a decline in average sleep duration and quality, with adverse consequences on general health. A representative survey of 1,508 American adults recently revealed that 90% of Americans used some type of electronics at least a few nights per week within 1 h before bedtime. Mounting evidence from countries around the world shows the negative impact of such technology use on sleep. This negative impact on sleep may be due to the short-wavelength–enriched light emitted by these electronic devices, given that artificial-light exposure has been shown experimentally to produce alerting effects, suppress melatonin, and phase-shift the biological clock. A few reports have shown that these devices suppress melatonin levels, but little is known about the effects on circadian phase or the following sleep episode, exposing a substantial gap in our knowledge of how this increasingly popular technology affects sleep. Here we compare the biological effects of reading an electronic book on a light-emitting device (LE-eBook) with reading a printed book in the hours before bedtime. Participants reading an LE-eBook took longer to fall asleep and had reduced evening sleepiness, reduced melatonin secretion, later timing of their circadian clock, and reduced next-morning alertness than when reading a printed book. These results demonstrate that evening exposure to an LE-eBook phase-delays the circadian clock, acutely suppresses melatonin, and has important implications for understanding the impact of such technologies on sleep, performance, health, and safety.

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