sábado, 31 de diciembre de 2011

ProMED-mail | ProMED-mail: TOSFERINA, BROTE: INFORMACIÓN NO CONFIRMADA - CUBA (HOLGUÍN)

ProMED-mail ProMED-mail

TOSFERINA, BROTE: INFORMACIÓN NO CONFIRMADA - CUBA (HOLGUÍN)

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Un comunicado de ProMED-mail
http://www.promedmail.org/
ProMED-mail es un programa de la
Sociedad Internacional de Enfermedades Infecciosas
http://www.isid.org/


Fecha: 29 de diciembre, 2011
Fuente: Martí, EEUU
http://www.martinoticias.com/noticias/Brote-de-tos-ferina-en-Antilla-Holguin--136392218.html
 [Editado por J. Torres]

Casi un centenar de personas en un pueblo del oriente cubano se han contagiado con un brote de tos ferina, según confirman a Radio Martí fuentes locales.

Desde el municipio de Antilla, en la provincia de Holguín, Miguel Santana Brefe, quien padece la enfermedad, asegura que hay 83 casos en el pueblo, incluyendo varios niños y que es muy difícil encontrar lo
medicamentos para tratar la enfermedad.

Por otra parte, Cristian Toranzo Fundichely , denuncia que no hay medicamentos para tratar la enfermedad,  “ni siquiera en las farmacias en dólares”, declaró.

Comunicado por: Jaime R. Torres torresjaime@cantv.net
-- ProMED-ESP

ProMED-mail | ProMED-mail: RICKETTSIOSIS, BROTE EXTENSO: ALERTA - MÉXICO (MICHOACÁN)

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RICKETTSIOSIS, BROTE EXTENSO: ALERTA - MÉXICO (MICHOACÁN)

Un comunicado de ProMED-mail
http://www.promedmail.org/
ProMED-mail es un programa de la
Sociedad Internacional de Enfermedades Infecciosas

http://www.isid.org/


Fecha: 30 de diciembre, 2011
Fuente: Terra, Noticias, México
http://noticias.terra.com.mx/mexico/estados/alertan-por-brote-epidemico-en-michoacan,a4465d7993094310VgnVCM4000009bf154d0RCRD.html
 [Editado por J. Torres]

Autoridades de Salud alertaron sobre un brote epidémico de rickettsiosis en Michoacán, una infección que puede causar la muerte y que se transmite mediante garrapatas, pulgas y piojos.

Guadalupe Hernández Alcalá, Secretario de Salud en el Estado, reveló que en las últimas tres semanas se registraron 25 casos confirmados y 99 sospechosos.

En conferencia de prensa, el funcionario informó que todos los portadores fueron ubicados en colonias y comunidades del Municipio de Lázaro Cárdenas, en los límites de Michoacán y Guerrero.

"La rickettsia es una enfermedad que es transmitida por la garrapata, por las pulgas y por los piojos. El periodo de incubación, es decir, desde que pica el animalito hasta la aparición de los síntomas es de 20 a 40 días, casi mes y medio", explicó.

"Inicia como una lesión cutánea, como un edema en cualquier parte del cuerpo, luego empieza una inflamación de ganglios. Posteriormente hay fiebre alta, dolor de cabeza, confusión mental, hay digamos fotofobia porque la luz molesta muchísimo; hay dolor de articulaciones, de músculos y conjuntivitis".

Hernández Alcalá dijo que la tasa de mortalidad en pacientes de la rickettsiosis es de hasta el 35 por ciento, una tasa alta en este tipo de padecimientos.

De acuerdo al funcionario, por muchos años no se había registrado una incidencia tan alta de casos en Michoacán.

Comentó que el último brote detectado se dio en 2009, pero con sólo nueve casos en el Municipio de La Piedad.

Destacó que ya se hicieron exploraciones en 77 escuelas cercanas a las zonas de contagio y se inició el tratamiento médico de los 25 pacientes confirmados.

Agregó que también se iniciaron acciones de promoción de higiene, incluidos esquemas de fumigación en casas y calles, para contener la propagación de la enfermedad.

La alerta emitida este viernes forma parte de las acciones contempladas por el plan de reacción de las autoridades michoacanas ante la aparición de la epidemia, la cual, aseguró, está controlada de momento.

Comunicado por: Jaime R. Torres torresjaime@cantv.net
-- ProMED-ESP

.................................jt
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ProMED-mail | ProMED-mail: LEISHMANIASIS VISCERAL, MUERTE, CASOS - ARGENTINA (MISIONES)

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LEISHMANIASIS VISCERAL, MUERTE, CASOS - ARGENTINA (MISIONES)
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Un comunicado de ProMED-mail
http://www.promedmail.org/
ProMED-mail es un programa de la
Sociedad Internacional de Enfermedades Infecciosas
http://www.isid.org/


Fecha: 30 de diciembre, 2011
Fuente: Misiones On Line, Argentina
http://www.misionesonline.net/noticias/30/12/2011/salud-publica-precisa-sobre-casos-de-leishmaniasis
 [Editado por J. Torres]

La dirección de Epidemiología del Ministerio de Salud Pública de Misiones a través de un informe epidemiológico comunicó que ayer se produjo el deceso de la paciente de 14 años, oriunda de Eldorado, que había sido diagnosticada por Leishmaniasis visceral y estaba internada en un sanatorio privado de Posadas. El caso fue detectado en la semana epidemiológica 51 (del 18 al 24 de diciembre) junto al de la niña de Garupá, que hoy recibirá el alta médico.

Ante esta situación la cartera sanitaria recuerda que la tenencia responsable de los perros y los cuidados domiciliarios para evitar la propagación del _Lutzomyia longipalpis_ (caracha-í), mosquito que transmite la leishmaniasis, son fundamentales para frenar el avance de la enfermedad en Misiones. Por ello dichas medidas deben aplicarse todos los días, de esta manera no sólo logramos disminuir el riesgo de contagio, sino que además evitamos la proliferación del vector.

Por otra parte, en el informe se indica que la actual semana epidemiológica Nº 52 (25 al 31 de diciembre) se registró un nuevo caso de Leishmaniasis visceral en un paciente de 51 años, sexo masculino, quien presenta una patología oncológica de base. El paciente está con tratamiento específico de la enfermedad y está evolucionando favorablemente. Se encuentra internado en el Hospital Escuela de Agudos "Dr. Ramón Madariaga".

 En cuanto al caso de la paciente de Eldorado, en el parte se indica que la joven inicio el tratamiento específico para leishmaniasis el día 23 de diciembre, presentado una respuesta inicial satisfactoria, pero su estado general de salud (agrandamiento de órganos (hígado y bazo) y signos de adelgazamiento muy marcado), la llevó a un empeoramiento rápido, provocando su deceso el día 29 de diciembre en un sanatorio privado de la capital provincial.

En el caso de la niña de 10 años de Garupá, informa que hoy será dada de alta, habiéndose realizado las acciones de control medio ambiental con la participación de personal del municipio. La pequeña continuará
con el tratamiento en forma ambulatoria.
Comunicado por: Jaime R. Torres torresjaime@cantv.net
-- ProMED-ESP

.................................jt

Research Activities, January 2012: Agency News and Notes: More seniors getting pneumonia shots, but some lag behind

Research Activities, January 2012: Agency News and Notes: More seniors getting pneumonia shots, but some lag behind


More seniors getting pneumonia shots, but some lag behind
The overall proportion of Americans age 65 and older who have ever been vaccinated against pneumonia, a leading killer of seniors, increased from 53 to 60 percent between 2000 and 2008, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ). Specifically, AHRQ found that in 2008:
•Almost two thirds (65 percent) of high-income seniors reported ever being vaccinated against pneumonia compared with less than half (46 percent) of poor seniors.
•Only 52 percent of seniors who live in a large inner-city area, where residents tend to be low-income and minority, reported ever being vaccinated against pneumonia compared with 64 percent of seniors who live in medium-size cities.
•Just 37 percent of Hispanic seniors reported ever being vaccinated against pneumonia compared with 65 percent of white seniors. The proportion of Asian and black seniors who have ever been vaccinated against pneumonia fell in between—46 and 45 percent, respectively.
This AHRQ News and Numbers is based on information in Chapter 2 of the 2010 National Healthcare Quality Report. (http://www.ahrq.gov/qual/nhqr10/Chap2c.htm). The report examines Americans' access to and quality of health care.

For additional information or to speak to an AHRQ data expert, please contact Linwood Norman at linwood.norman@ahrq.hhs.gov or call (301) 427-1248.

Research Activities, January 2012: Announcements: AHRQ releases first primary care workforce facts and stats series

Research Activities, January 2012: Announcements: AHRQ releases first primary care workforce facts and stats series

AHRQ releases first primary care workforce facts and stats series

To further inform policy discussions around the U.S. primary care workforce, AHRQ's Center for Primary Care, Prevention, and Clinical Partnerships has released the first two in a series of fact sheets to provide health care policy and decisionmakers with information on:
  • The primary care workforce currently in place in the United States.
  • Its capacity to care for the current U.S. population.
  • Needed growth in this workforce to accommodate population changes and expanded health insurance coverage.
The two fact sheets available now are:
  • The Number of Practicing Primary Care Physicians in the U.S., which reports that, of the 624,434 physicians who spend the majority of their time in direct patient care, slightly less than one-third are in primary care.
  • The Number of Nurse Practitioners and Physician Assistants Practicing Primary Care in the U.S., which estimates that, in 2010, approximately 56,000 nurse practitioners and 30,000 physician assistants were practicing primary care.
AHRQ commissioned the Robert Graham Center, a non-partisan primary care policy and analysis organization, to conduct a comprehensive primary care workforce analysis that includes secondary analyses of several workforce, population, and health outcome data sources. During the coming months, AHRQ will release additional Primary Care Workforce Fact Sheets examining topics such as:
  • The distribution of the U.S. primary care workforce.
  • Patient panel sizes in primary care.
  • Primary care workforce needs due to changes in population growth, demographics, and other factors.
You can view the U.S. Primary Care Workforce Facts and Stats Series at http://www.ahrq.gov/research/pcworkforce.htm.

Research Activities, January 2012: Announcements: New health information technology funding opportunity on advancing health services through system modeling research

Research Activities, January 2012: Announcements: New health information technology funding opportunity on advancing health services through system modeling research

New health information technology funding opportunity on advancing health services through system modeling research

The Agency for Healthcare Research and Quality (AHRQ), in collaboration with the National Science Foundation (NSF), will accept and review investigator-initiated proposals that address systems modeling in health services research. The NSF's Service Enterprise Systems Program in the Civil, Mechanical, and Manufacturing Innovation Division of the Engineering Directorate will be the lead program on this interdisciplinary topic. Through this partnership, AHRQ and NSF look to foster new collaborations among health services researchers and industrial and systems engineers with a specific emphasis on the supportive role of health information technology. Proposals are due by February 15, 2012.

For more information or to submit a proposal, go to http://nsf.gov/funding/pgm_summ.jsp?pims_id=504720.

Research Activities, January 2012: Announcements: Two EHC program report series identify research needs and provide guidance on identifying gaps in clinical evidence

Research Activities, January 2012: Announcements: Two EHC program report series identify research needs and provide guidance on identifying gaps in clinical evidence


Two EHC program report series identify research needs and provide guidance on identifying gaps in clinical evidence

Needs for Future Research

A growing series of reports from the Effective Health Care (EHC) Program of the Agency for Healthcare Research and Quality (AHRQ) identifies gaps in clinical evidence so that researchers and funders of research can improve the body of knowledge available to health care decisionmakers. The series, Future Research Needs, currently includes eight reports that identify research needs in areas such as management of gestational diabetes, treating prostate cancer, and treating common hip fracture. Forty reports are expected over the next several years. These reports are produced by AHRQ-supported Evidence-based Practice Centers, which conduct systematic reviews of existing research on the effectiveness, comparative effectiveness, and comparative harms of different health care interventions. Gaps in evidence identified in these projects are highlighted in the Future Research Needs series. The reports are designed to help researchers and funders of research identify research projects that will expand the body of patient-centered outcomes research available to help health care decisionmakers make evidence-based decisions.
Download and read the Future Research Needs reports at http://www.effectivehealthcare.ahrq.gov/futureresearch.cfm.

Methods for Future Research

Another EHC Program series of reports titled, Future Research Needs—Methods Research, is also available from AHRQ. These reports provide guidance on methodological approaches to identifying gaps in clinical evidence. They are intended to support the ongoing effort to evaluate and improve the knowledge base in priority clinical areas. The series complements the Future Research Needs series.
You can download and read the methods research series at http://www.effectivehealthcare.ahrq.gov/futureresearchneedsmethods.cfm.
Research Activities, January 2012: Announcements: Two EHC program report series identify research needs and provide guidance on identifying gaps in clinical evidence

Research Activities, January 2012: Agency News and Notes: New AHRQ campaign encourages Hispanics to work with their doctors to make the best treatment decisions

Research Activities, January 2012: Agency News and Notes: New AHRQ campaign encourages Hispanics to work with their doctors to make the best treatment decisions

New AHRQ campaign encourages Hispanics to work with their doctors to make the best treatment decisions
The Agency for Healthcare Research and Quality (AHRQ) is partnering with Hispanic-serving organizations to promote the Agency's Spanish-language resources and to encourage consumers to become more active partners in their health care. AHRQ's easy-to-read resources help consumers understand the benefits and risks of treatment options and encourage shared decisionmaking between patients and their health care teams. To date, 10 organizations have signed a pledge of commitment to promote AHRQ's Spanish-language, evidence-based resources, including the National Hispanic Medical Association, Latino Student Medical Association, National Association of Hispanic Elderly, District of Columbia Office on Latino Affairs, National Latina Health Network, Telemundo, and the National Center for Farmworkers Health.

To assist in this effort, AHRQ recently launched the "Toma las riendas" ("Take the reins") campaign, a nationwide effort to encourage Hispanics to take control of their health and explore treatment options. The campaign launched November 13 at the Telemundo-sponsored Feria de la Familia (Family Fair) event at the D.C. Armory in Washington, D.C.

The Toma las riendas campaign addresses the need for high-quality health information in Spanish. It promotes a wide variety of resources produced by AHRQ's Effective Health Care Program.  These tools, which include consumer-friendly publications that summarize treatment options for common health conditions, help Hispanics work with their health care teams to select the best possible treatment option.  The tools do not tell patients and doctors what to do, but offer factual, unbiased information to help answer questions such as: What are the benefits and risks of different medical treatments? How strong is the science behind each option? Which treatment is most likely to work best for me?

"The Toma las riendas campaign comes at a terrific time for spreading the word about AHRQ's evidence-based Spanish-language resources," said AHRQ Director Carolyn M. Clancy, M.D. "AHRQ's Effective Health Care Program now has more than 20 free, Spanish-language publications that provide information about common health conditions, including diabetes, heart disease and depression."

Hispanics, who account for 15 percent of the U.S. population, are often more likely than whites to experience poor health outcomes. For example, Hispanics have significantly higher rates of hospital admissions for short-term complications due to diabetes, according to AHRQ's 2010 National Healthcare Disparities Report. Hispanics are also less likely to take prescription medications to control asthma.  For many Hispanics, seeking treatment means using a new language to navigate a complex health care system.  AHRQ's Spanish-language publications provide opportunities for Hispanics to easily compare treatments for many common conditions.

"If you don't get the best possible information about all your treatment options, you might not make an informed decision on which treatment is most appropriate for you," said AHRQ Scientific Review Officer Ileana Ponce-González, M.D., and Toma las riendas campaign spokesperson.

To encourage use of the materials and engage Hispanics in the discussion, AHRQ has also launched a Facebook Page, http://www.facebook.com/AHRQehc.espanol .

AHRQ's Spanish-language Effective Health Care Program patient guides are available online at http://effectivehealthcare.ahrq.gov/index.cfm/informacion-en-espanol. To order printed copies, E-mail the AHRQ Publications Clearinghouse at ahrqpubs@ahrq.gov or call 1-800-358-9295.

For other AHRQ Spanish-language consumer tools, go to http://www.ahrq.gov/consumer/espanoix.htm  .

Research Activities, January 2012: Agency News and Notes: Cost of hospitalization highest among the non-elderly

Research Activities, January 2012: Agency News and Notes: Cost of hospitalization highest among the non-elderly


Cost of hospitalization highest among the non-elderly
The average cost of a hospital stay grew more quickly for patients age 64 and younger than it did for the elderly between 1997 and 2009, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ). 

 According to data from the Federal agency, the cost of a stay in a community hospital during this period increased by 4 percent per year for patients 64 and younger, and by 3 percent per year for those 65 and older. AHRQ also found that:
•A total of $208 billion was spent for hospital stays for patients age 64 and younger in 2009, compared with $154 billion for older patients.
•Between 1997 and 2009, the average hospital stay remained constant at 4 days for patients age 64 and younger, yet the average stay among older patients decreased from 6 days to 5 days.
•Among all patients, septicemia, back problems, and osteoarthritis were the three conditions that had the greatest increase in hospital costs.

This AHRQ News and Numbers summary is based on data from Statistical Brief #123: Components of Growth in Inpatient Hospital Costs, 1997-2009 (http://www.hcup-us.ahrq.gov/reports/statbriefs/sb123.jsp).
The report uses data from the Nationwide Inpatient Sample. For information about this AHRQ database, go to http://www.ahrq.gov/data/hcup/datahcup.htm.

For additional information, or to speak with an AHRQ data expert, please contact Linwood Norman at linwood.norman@ahrq.hhs.gov or call (301) 427-1248.

Research Activities, January 2012: Agency News and Notes: New study finds e-prescribing is safe and efficient, but barriers remain

Research Activities, January 2012: Agency News and Notes: New study finds e-prescribing is safe and efficient, but barriers remain

New study finds e-prescribing is safe and efficient, but barriers remain

Physician practices and pharmacies generally view electronic prescribing as an important tool to improve patient safety and save time, but both groups face barriers to realizing the technology's full benefit, according to a study funded by the Agency for Healthcare Research and Quality (AHRQ).  The study was published online November 18 in the Journal of the American Medical Informatics Association.

Electronic prescribing, or e-prescribing, has multiple potential benefits, including helping to reduce the risk of medication errors caused by illegible or incomplete handwritten prescriptions. The study focused on a key aspect of e-prescribing: the electronic exchange of prescription data between physician practices and pharmacies, which can save time and money by streamlining the way in which new prescriptions and renewals are processed.

Physician practices and pharmacies generally were positive about the electronic transmission of new prescriptions, the study found. However, prescription renewals, connectivity between physician offices and mail-order pharmacies, and manual entry of certain prescription information by pharmacists—particularly drug name, dosage form, quantity, and patient instructions—continue to pose problems.

"Physicians and pharmacies have come a long way in their use of e-prescribing, and that's a very positive trend for safer patient care and improved efficiency," said AHRQ Director Carolyn M. Clancy, M.D. "This study identifies issues that need attention to improve e-prescribing for physicians, pharmacies, and patients."
Researchers at the Center for Studying Health System Change, Washington, D.C., conducted 114 interviews with representatives of 24 physician practices, 48 community pharmacies, and three mail-order pharmacies using e-prescribing. Community pharmacies were divided between local and national companies. Physician practices and pharmacies used e-prescribing features for electronic renewals much less often than for new prescriptions. More than a quarter of the community pharmacies reported that they did not send electronic renewal requests to physicians. Similarly, one-third of physician practices had e-prescribing systems that were not set up to receive electronic renewals or only received them infrequently. Physician practices reported that some pharmacies that sent renewal requests electronically also sent requests via fax or phone, even after the physician had responded electronically. At the same time, pharmacies reported that physicians often approved electronic requests by phone or fax or mistakenly denied the request and sent a new prescription.

The study noted that resolving e-prescribing challenges will become more pressing as increasing numbers of physicians adopt the technology in response to Federal incentives.  Physicians can qualify for Medicare and Medicaid electronic health record incentive payments by generating and transmitting more than 40 percent of all prescriptions to pharmacies electronically, excluding prescriptions for controlled substances, as part of the HITECH Act of 2009.

Other key study findings include:
  • About three-quarters of physician practices reported problems sending new prescriptions and renewals electronically to mail-order pharmacies. Many practices were unsure which mail-order pharmacies accepted e-prescriptions and believed that, even when a mail-order company did accept them, the process was unreliable.
  • Pharmacies noted the need to sometimes manually edit certain prescription information, such as drug name, dosage, and quantity. One common cause reported by both physicians and pharmacists was that physicians must select medications with more specificity when e-prescribing and make decisions about such factors as packaging and drug form. Such decisions had typically been made by pharmacists for handwritten prescriptions.
  • Nearly half of pharmacies reported that patient instructions typically had to be rewritten for patients to understand them.
The study, "Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies," concludes that a broad group of public and private stakeholders will need to work together to address these issues. Stakeholders include the Federal government, e-prescribing standard-setting organizations, vendors, and others.

Research Activities, January 2012: Disparities/Minority Health: Many Texas residents cross Mexican border to obtain health care services

Research Activities, January 2012: Disparities/Minority Health: Many Texas residents cross Mexican border to obtain health care services

Many Texas residents cross Mexican border to obtain health care services

The U.S.-Mexico border stretches from San Diego, CA all the way to Brownsville, TX. Many residents living on the U.S. side of the border are poor and uninsured, and have difficulties accessing health care services. A new study reveals that many U.S.-border residents in Texas cross the border into Mexico for health care services.

Overall, 63.4 percent of those surveyed said they used one of the four types of health care services in Mexico: medications, visits to doctors, visits to dentists, and hospital admissions. Nearly half of respondents (49.3 percent) admitted to crossing the border to purchase medications in Mexico, 41 percent visited a doctor, and 37.3 percent visited a dentist. Inpatient care in Mexico had the lowest utilization rate among respondents at 6.7 percent. Factors associated with using health care services in Mexico included having no health insurance, being dissatisfied with the quality of care in the United States, and having poor self-reported health status.

The findings were based on responses to the Cross-Border Utilization of Health Care Survey. This was a telephone survey conducted in 2008 of residents living in 32 Texas counties within 62 miles of the Mexican border. Responses came from 1,405 adults who were mostly of Mexican origin. Participants were asked about seeking out health care services in Mexico. Nearly half of those participating had no health insurance coverage. The study was supported in part by the Agency for Healthcare Research and Quality (HS17003).
See "Cross-border utilization of health care: Evidence from a population-based study in south Texas," by Dejun Su, Ph.D., Chad Richardson, Ph.D., Ming Wen, Ph.D., and José A. Pagán, Ph.D., in the June 2011 HSR: Health Services Research 46(3), pp. 859-876.

Research Activities, January 2012: Disparities/Minority Health: Communications between patients with HIV and their providers differ along racial and substance use lines

Research Activities, January 2012: Disparities/Minority Health: Communications between patients with HIV and their providers differ along racial and substance use lines


Communications between patients with HIV and their providers differ along racial and substance use lines

Two new studies reveal that communications between patients with HIV and their providers differ along racial and substance-use lines. This is important, given that significant racial disparities exist in HIV care in the United States and that more than half of Americans infected with HIV report a history of substance use.
The first study found that providers were more verbally dominant in conversations with black than white patients. The second study revealed that, while it appears there is healthy patient-provider communication with illicit drug users, patients with unhealthy alcohol use are less satisfied with their provider encounters. Both studies, supported by the Agency for Healthcare Research and Quality (Contract No. 190-01-0012 and grant HS13903) are briefly summarized here.


Beach, M.C., Saha, S., Korthuis P.T., and others (2011). "Patient-provider communication differs for black compared to white HIV-infected patients." AIDS Behavior 15, pp. 805-811.

This study found providers to be more verbally dominant with their black patients than their white patients. In other words, providers expressed more complete thoughts (utterances) than the patient did and blacks provided less information to their providers than whites during clinic visits. However, there was no association between visit length and the patient's race.

The researchers audio recorded patient care visits at four HIV outpatient care sites in Baltimore, Detroit, New York, and Portland. A total of 45 providers, including physicians, nurse practitioners, and physician assistants, agreed to participate in the study. The final sample of patients included 246 blacks and 100 whites. Recordings were analyzed using a coding system that categorizes utterances into question-asking, counseling, and socio-emotional communication. Overall, the patients who participated in the study were satisfied with the care they received at these clinics. The amount and quality of patient and provider socio-emotional communication was similar for blacks and whites. However, because blacks spoke less during their clinic visits, the researchers recommend that providers make an extra effort to engage and involve blacks with HIV more during the medical encounter.


Korthius, P.T., Saha, S., Chander, G., and others (2011). "Substance use and the quality of patient-provider communication in HIV clinics." AIDS Behavior 15, pp. 832-841.

This study found that providers spent less time talking with patients who reported either current or past unhealthy alcohol use. In addition, they used fewer patient-engagement and activating statements and fewer counseling statements on lifestyle or psychosocial behaviors to patients reporting current unhealthy drinking patterns compared with patients who were not problem drinkers. In turn, these patients made fewer engaging, activating, and positive statements to their providers. Patients without a history of unhealthy drinking had clinic visits that averaged around 4 minutes longer and received more patient-engagement and activating statements during their visit with providers. With illicit drug users, providers were more likely to make negative statements and ask more questions during encounters compared with patients without a history of illicit drug use. These drug users also made more negative statements. However, more counseling and lifestyle statements were exchanged during these medical visits than with visits with problem drinkers. Problem drinkers rated the quality of provider-patient communication lower than patients without unhealthy alcohol use. On the other hand, there was no difference in the ratings of provider-patient communication between illicit drug users and non-users of illicit drugs.

The study used the same 45 providers who participated in the first study. Among the patient participants, 39 were current unhealthy alcohol users, 198 past users, and 170 who never had unhealthy alcohol use. The study also included 113 current illicit drug users, 203 former users, and 97 who never used these drugs. As in the other study, clinic encounters were audiotaped and analyzed using the same method. According to the researchers, the communication patterns between providers and unhealthy drinkers with HIV infection suggest a higher risk for poor HIV-related outcomes. Even as patients' levels of depression increased, they were still less likely to receive psychosocial or counseling statements from their providers. The researchers suggest that more resources, time, and interventions need to be in place so that care can be improved for patients with unhealthy alcohol use and HIV.

Research Activities, January 2012: Women's Health: Lower educational level increases the likelihood of preclinical changes in mobility in older women

Research Activities, January 2012: Women's Health: Lower educational level increases the likelihood of preclinical changes in mobility in older women


Lower educational level increases the likelihood of preclinical changes in mobility in older women

If you have less than 9 years of schooling, you are more likely than someone with 12 or more years of education to report changing the way or how often you do at least one of four mobility tasks: walking 0.5 miles, climbing up steps, doing heavy housework, and getting in/out of a bed or chair, even though you don't report difficulty with the task, according to a new study. Such a change, made before difficulty with the task arises, is termed preclinical mobility disability (PCD), and has previously been identified as an independent predictor of functional decline in the elderly.

The study authors suggest that PCD is a marker for early attempts to preserve function by compensating for impairments at an early stage, when intervention may be beneficial. Using a longitudinal study of initially high-functioning older women, the researchers found that 66 of 174 women who had high mobility function at their baseline examination developed PCD during the study. Those women with less than 9 years of education were 3.1 times more likely to develop PCD during followup than did those with over 12 years of education—even after adjusting for age, race, income, number of diseases, and other factors. The number of chronic diseases a woman reported was the single other factor significantly associated with increased risk of PCD, which boosted PCD risk by 30 percent.

The researchers recruited 436 women, ages 70–79 years, from neighboring ZIP codes in Baltimore City and Baltimore County, MD. They interviewed the women at baseline and during six followup exams (all spaced 18 months apart, except for an average of 3 years between the third and fourth followup). The researchers suggest that future studies should evaluate the ability of interventions to aid women with lower education in accessing resources to prevent functional loss. The study was funded in part by the Agency for Healthcare Research and Quality (HS17956).

More details are in "Education predicts incidence of preclinical mobility disability in initially high-functioning older women: The Women's Health and Aging Study II," by Patricia C. Gregory, M.D., Sarah L. Szanton, Ph.D., M.S.N., Qian-Li Xue, and others in the May 2011 Journal of Gerontology: Medical Sciences 66A(5); pp. 577–581.

Research Activities, January 2012: Women's Health: Breast cancer is associated with higher health care use and costs for women covered by fee-for-service Medicaid

Research Activities, January 2012: Women's Health: Breast cancer is associated with higher health care use and costs for women covered by fee-for-service Medicaid


Breast cancer is associated with higher health care use and costs for women covered by fee-for-service Medicaid

In addition to being the most frequently diagnosed cancer among women in the United States, breast cancer accounts for up to 20 percent of the total costs of cancer overall. Women covered by Medicaid have unique challenges when it comes to this disease. For example, Medicaid recipients are more likely to be diagnosed at an advanced stage. They also have much lower screening rates compared to the general population. A new study found a high prevalence of breast cancer in Medicaid patients as well as significantly higher health care use and costs.

The study was based on administrative claims data for fee-for-service recipients enrolled in West Virginia Medicaid. A total of 876 Medicaid recipients, 21 to 64 years of age and who had breast cancer-related treatment, were identified during 2005. Nearly half were between the ages of 50 and 59. Prevalence rates for breast cancer were highest for women 60 to 64 years of age, white women, and women residing in rural counties. These three groups also had the highest rates of office visits. Older and rural groups also had the highest rates of emergency room (ER) visits and cancer-related hospitalizations. Nearly three-fourths (73 percent) of the women had at least one claim for treatment. The vast majority of treatment services (98 percent) were delivered in the office setting. Hormone therapy was the most common form of treatment, with more than half (55.1 percent) of women receiving it.

Women with breast cancer were compared to a matched control group of female Medicaid recipients without breast cancer. Health care costs for all causes were significantly higher for the women with breast cancer ($16,345) compared with the women without breast cancer ($13,027). These additional costs were driven by expenses for office and ER visits as well as for prescription medications. The West Virginia Medicaid fee-for-service program paid approximately $4.9 million for breast cancer-related treatment and services in 2005. The study was supported in part by the Agency for Healthcare Research and Quality (HS18546).

See "Prevalence, healthcare utilization, and costs of breast cancer in a state Medicaid fee-for-service program," by Rahul Khanna, M.B.A., Ph.D., S. Suresh Madhavan, M.B.A., Ph.D., Abhijeet Bhanegaonkar, M.P.H., and Scott C. Remick, M.D., in the Journal of Women's Health 20(5), pp. 739-747, 2011.

Research Activities, January 2012: Child/Adolescent Health: Pediatric cardiology centers vary in treatment of infants with single-ventricle congenital heart disease

Research Activities, January 2012: Child/Adolescent Health: Pediatric cardiology centers vary in treatment of infants with single-ventricle congenital heart disease

Pediatric cardiology centers vary in treatment of infants with single-ventricle congenital heart disease

Pediatric cardiology centers vary greatly in their initial treatment of infants and newborns with single-ventricle congenital heart defects (CHD) such as hypoplastic left heart syndrome (HLHS), according to three studies supported in part by the Agency for Healthcare Research and Quality (HS16957). This variability makes the initial treatment of these congenital heart problems, in which the infant is missing the left ventricle, a clear target for quality improvement efforts, note the researchers from the Joint Council on Congenital Heart Disease's National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC).

Repair of HLHS involves a series of surgeries that are typically performed over the child's first 4 years of life, with stage-I surgery typically occurring within days after birth. Additional corrective surgeries are performed at later ages (typically between 4–6 months and 18 months to 3 years, respectively). Since the infant is missing the left ventricle, which normally pumps oxygen-rich blood to the body, the goal of the initial Norwood procedure is to reroute blood flow from the right ventricle to serve this function.

To conduct the studies, the researchers drew on data for the first 100 infants enrolled in the NPC-QIC registry through 21 participating centers. Most of the infants (75 percent) had received a prenatal diagnosis of their heart disease. The three studies are briefly described here.


Brown, D.A., Connor, J.A., Pigula, F.A., and others. "Variation in preoperative and intraoperative first-stage palliation of single-ventricle heart disease: A report from the Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement Cooperative." (2011, March/April). Congenital Heart Disease 6(2), pp. 108–115.

This study found substantial variation across surgical centers in the successful initial palliation of infants with single-ventricle heart disease, particularly with regard to choice of palliation strategy and intraoperative techniques such as use of regional perfusion and depth of hypothermia. Infants with a prenatal diagnosis of CHD were significantly less likely to have preoperative problems than those diagnosed after birth (45 percent versus 84 percent). The median age of stage-I repair was 5 days, but ranged from 2–78 days.

The majority of infants (55 percent) were treated with a stage-I right ventricle to pulmonary artery (RV-PA) conduit, with 28 percent receiving a stage-I Norwood shunt. There was great variation in the surgical approach taken by the 11 centers contributing at least 4 patients to the database. Several of the centers used only the RV-PA conduit procedure, while another center performed mostly hybrid stage-I procedures (and accounted for 89 percent of such procedures in the registry).

Excluding the patients who underwent hybrid stage-I repairs, the median time for a patient to be on total cardiopulmonary bypass during surgery was 137 minutes, with most participating centers' medians staying in the 100 to 200 minute range. The intraoperative procedures with the greatest degree of center-specific variation were circulatory arrest (used in 77 percent of the patients for a median of 10 minutes; range = 0–79 minutes) and hypothermia (median lowest temperature in the operating room of 18°C, and under 20°C for most of the participating centers). Immediately after surgery, three patients required use of extracorporeal membrane oxygenation support, but most only required postoperative mechanical ventilation (a median of 9 days on ventilation in the intensive care unit). Reoperations were done on 19 patients, in 6 cases to manage recurrent bleeding.


Baker-Smith, C.M., Neish, S.R., Klitzner, T.S., and others (2011, March/April). "Variation in postoperative care following stage I palliation for single-ventricle patients: A report from the Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement Cooperative." Congenital Heart Disease 6(2), pp. 116–127.

This study examined variations in treatment while the infant was still in the hospital after stage-I surgery for HLHS. Infants stayed a median of 11 days in the intensive care unit (ICU) following stage-I surgery, with a range between 3 and 68 days. The 47 infants with the aortic atresia variety of HLHS stayed in the ICU longer than 24 infants with the aortic hypoplasia variety (10 vs. 8 median days). The length of postoperative stay in the ICU also varied depending on the type of surgery performed, from a median of 18 days for the 16 patients who underwent the modified Blalock-Taussig shunt (mBTS), to a median of 11 days for the 44 patients undergoing the RV-PA shunt, to a median of 9 days for the 10 patients undergoing hybrid repair.
However, ICU stays varied by center, as did use of inotropic agents (that affect the strength of cardiac contraction), need for reoperation or cardiac catheterization, and postoperative complications.
Neurologic injury was the most common complication (15 events occurred in 13 patients); 20 postoperative infections occurred in 15 patients; and 22 instances of arrhythmia occurred in 19 patients. Complications occurred least frequently for infants who underwent the hybrid procedure (2 patients, or 20 percent) and were most common for those who underwent the RV-PA shunt (27 patients, or 49 percent). Some patients experienced more than one complication.


Schidlow, D.N., Anderson, J.B., Klitzner, T.S., and others. "Variation in interstage outpatient care after the Norwood Procedure: A report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative." (2011, March/April). Congenital Heart Disease 6(2); pp. 98–107.

This study examined the care and outcomes of infants after discharge from the hospital following stage-I repair of HLHS. Of the 100 infants in the group, 62 received outpatient care from the center that performed their surgery, 25 infants were cared for at another center, and 13 infants received care from more than one center. Communication with the patients' outpatient physicians (a written medication list, nutrition plan, and red-flag checklist) was quite variable and incomplete for the majority of these practitioners. Nearly half of the outpatient primary cardiologists (45 percent) received all three elements of the communications compared with only 26 percent of the primary care physicians (PCPs). None of the elements of communications were received by 10 outpatient cardiologists and 19 PCPs.

Nutrition management was quite variable, with 49 infants fed orally, 38 receiving a combination of oral and nasogastric/nasojejunal feeding, and 6 receiving a combination of oral and gastronomy tube feeding. One infant was fed by gastronomy tube exclusively. Caloric density ranged from 20 to 30 kcal/oz of nonfortified formula or breast milk, with more than half the infants using fortified formula initially (24 kcal/oz at time of hospital discharge).

The use, type, location, and frequency of monitoring strategies varied widely. Nineteen of the infants had no monitoring done between visits to the cardiology center. Surveillance strategies were used in 81 infants; the majority were monitored in the home. Of these infants, 77 had both weight and blood-oxygen levels measured regularly, and 4 had only oxygen levels monitored.
Research Activities, January 2012: Child/Adolescent Health: Pediatric cardiology centers vary in treatment of infants with single-ventricle congenital heart disease

Research Activities, January 2012: Child/Adolescent Health: Clostridium difficile infection rate has risen among hospitalized children since late 1990s

Research Activities, January 2012: Child/Adolescent Health: Clostridium difficile infection rate has risen among hospitalized children since late 1990s

Clostridium difficile infection rate has risen among hospitalized children since late 1990s

The number of cases of Clostridium difficile infection (CDI) among hospitalized children in the United States more than doubled over a 10-year period, according to a new study. A bacterium that can colonize the gastrointestinal tract, C. difficile can cause symptoms ranging from nothing to severe diarrhea, inflammation of the colon, bowel perforation, and even death. The researchers found that the incidence of CDI in hospitalized children increased from 3,565 cases in 1997 to 7,779 cases in 2006.

Children with CDI had a 20 percent greater risk of death and a 36 percent higher risk of requiring surgery to remove part of or the entire colon. In addition, children diagnosed with CDI were four times more likely to have an extended hospital stay and twice as likely to have higher hospital costs than hospitalized children not infected by C. difficile.

The researchers found no trend in the severity of CDI over time, despite the disease's increased incidence. However, patients with inflammatory bowel disease were 11.4 times as likely to have CDI compared with childlren without this condition. Solid-organ transplants, HIV infection, and transplantation of blood-forming stem cells—all requiring or resulting in immune suppression—increased the odds of CDI 3.3- to 4.5-fold in adjusted multivariable analysis.

The researchers used data from the AHRQ-funded Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP-KID) for 1997, 2000, 2003, and 2006. HCUP-KID is a stratified random sample of 5.8 million inpatient discharges for children from 22 to 38 States (depending on the year). For 2006, it represented an estimated 89 percent of all pediatric hospital discharges in the United States. The study was funded in part by the Agency for Healthcare Research and Quality (HS016957).

More details are in "Clostridium difficile infection in hospitalized children in the United States," by Cade M. Nylund, M.D., Anthony Goudie, Ph.D., Jose M. Garza, M.D., and others in the May 2011 Archives of Pediatrics and Adolescent Medicine 165(5), pp. 451-457.

Research Activities, January 2012: Child/Adolescent Health: A large proportion of hospitalized children receive numerous medications during their hospitalization


Research Activities, January 2012: Child/Adolescent Health: A large proportion of hospitalized children receive numerous medications during their hospitalization


A large proportion of hospitalized children receive numerous medications during their hospitalization

A large proportion of hospitalized babies and children are given five or more drugs and therapeutic agents during each day they are in the hospital, reveals a new study. Children with less common conditions were more likely to be exposed to more drugs. A dozen drugs and therapeutic agents were taken over the course of the hospitalization for the typical child admitted to a children's hospital (median stay of 5 days) and two drugs and therapeutic agents for the typical child admitted to a general hospital (median stay of 2 days). However, these differences between hospital types were nullified when patient clinical characteristics were taken into account.

Children younger than 1 year at children's hospitals, who were at the 90th percentile of the number of the distinct drugs received, received 11 drugs on the first day of hospitalization, while children 1 year and older received 13 drugs; in general hospitals, the numbers were 8 and 12 drugs, respectively. By hospital day 7, those in children's hospitals who were younger than 1 year and at the 90th percentile of drug exposure had received 29 drugs and those 1 year or older had received 35 drugs; in general hospitals, the numbers were 22 and 28 drugs, respectively.

Cumulative numbers of distinct agents varied substantially among hospitals for three common conditions (asthma, appendectomy, and seizure), even after accounting for differences in length of stay for the condition. This suggests that actions can be taken to reduce the degree to which a child is exposed to multiple medications for common ailments while maintaining—or even improving—patient outcomes, note Chris Feudtner, M.D., Ph.D., M.P.H., of Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, and colleagues.

Their findings were based on 2006 data from the Pediatric Health Information System (40 children's hospitals) and the Perspective Data Warehouse (423 academic and community hospitals nationwide). The study was funded in part by the Agency for Healthcare Research and Quality (HS17991) to the University of Pennsylvania School of Medicine's Center for Education and Research on Therapeutics (CERT). For more information on the CERTs program, visit http://www.certs.hhs.gov/.

More details are in "Prevalence of polypharmacy exposure among hospitalized children in the United States" by Chris Feudtner, M.D., Ph.D., M.P.H., Dingwei Dai, Ph.D., Kari R. Hexem, M.P.H., and others in the September 2011 Archives of Pediatric and Adolescent Medicine (E-pub ahead of print).
Research Activities, January 2012: Child/Adolescent Health: A large proportion of hospitalized children receive numerous medications during their hospitalization

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