martes, 1 de octubre de 2013

NIOSH eNews - October, 2013

NIOSH eNews - October, 2013


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NIOSH eNews

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The Monthly Newsletter of the National Institute for Occupational Safety and Health
Volume 11 Number 6 October 2013

From the Director’s Desk

John Howard, M.D., Director, NIOSH
I am pleased to announce that NIOSH and its partners met in Denver on Sept. 26–27 at the Western States Occupational Network (WestON) Sixth Annual Meeting. This was a valuable opportunity, with representation from NIOSH and its partners in the Western United States, to assess our mutual progress in the work that we are performing together in that economically important region and to identify priorities and strategies for continued teamwork ahead.
The issues and challenges addressed at WestON reflect our larger purpose to better understand critical needs and opportunities in occupational safety and health in the Western United States, to have a physical presence in that region, and to develop a network of local partners with whom we can conduct research and move the products of research into practice. The need for this level of service became apparent to us early in the last decade, as economists predicted that a rising demand for domestic energy would spur new economic growth, industry expansion, and job creation in the West.

NIOSH Offers Flood Resources for Responders

As responders aid communities affected by the flooding in Colorado, NIOSH offers informational resources for minimizing risks of work-related injury or illness from recovery activities, including disaster site management, generator safety, flood clean-up, and other issues.

New Factsheets Provide Tips for Young Drivers

A new set of factsheets is now available from NIOSH to help young drivers stay safe on the job. One of the factsheets is for employers and another one is for parents and young workers. Both provide recommendations on how to prevent motor vehicle crashes on the job. http://www.cdc.gov/niosh/updates/upd-09-04-13.html

Workplace Safety and Health on Pinterest!

Follow NIOSH on our Pinterest board to see the newest products including videos, apps, and factsheets on workplace safety and health issues. http://www.pinterest.com/cdcgov/workplace-safety-and-health/

NIOSH Releases Data and Statistics Gateway

The NIOSH Data and Statistics Gateway is a NIOSH scientific data repository where NIOSH-generated public-use research datasets valuable for the public, industry, and the scientific community are available for download. The Gateway also provides convenient access to surveillance, statistics, and other collections of NIOSH data focused on occupational safety and health. http://www.cdc.gov/niosh/data/

PTSD Treatment for Flight 93 Responders

In September, Laurie Breyer of NIOSH and manager of communications & outreach for the World Trade Center Health Program gave an interview with a Pittsburgh NPR affiliate on coverage offered by the program. She explains in the interview that responders can receive coverage for PTSD, anxiety, depression, and substance abuse. Coverage even extends to airway diseases, digestive disorders, and more than 50 forms of cancer. Hear the full interview at http://wesa.fm/post/ptsd-treatment-flight-93-responders.

Shell Partners with UT School of Public Health on Occupational and Environmental Health Faculty Chair

Shell Oil Company is partnering with The University of Texas School of Public Health, a part of The University of Texas Health Science Center at Houston (UTHealth), in supporting a permanent endowed faculty chair in occupational and environmental health. This partnership honors the legacy of Marcus M. Key, M.D., and his contributions to the field of occupational health. Key was a longtime faculty member at the UT School of Public Health and the founding director of NIOSH and, for 3 years, Assistant Surgeon General of the United States. http://www.newswise.com/articles/shell-partners-with-ut-school-of-public-health-on-occupational-and-environmental-health-faculty-chair

NIOSH Participates in U.S. News Sleep Chat

NIOSH scientists participated in a Twitter chat event organized by U.S. News Health & Wellness on September 4. Twelve NIOSH experts along with others from the Centers for Disease Control and Prevention, the National Institutes of Health, and the University of Pennsylvania answered questions about sleep and health (including shift work and long working hours). #SleepHealth was a top trending hashtag during that day. The chat can be found by going to twitter.com and searching #SleepHealth.

NYT Highlights Advancements in Respirators since 9/11

The Science Page of the New York Times ran a prominent article on September 11 about advancements in respirators since the World Trade Center attack of Sept. 11, 2001, and highlighted the NIOSH National Personal Protective Technology Laboratory leadership with partners in those advancements. The article and a related video can be found at http://www.nytimes.com/2013/09/10/science/improving-respirator-masks-to-put-fresh-air-in-reach.html.

Patient Outcomes Improved by Pay-For-Performance - National Institutes of Health (NIH)

Patient Outcomes Improved by Pay-For-Performance - National Institutes of Health (NIH)

Patient Outcomes Improved by Pay-For-Performance

Pay incentives for clinician performance can improve cardiovascular care in small primary care clinics that use electronic health records, a new study reports.
A woman and her doctor at a computer.
Management of chronic diseases, such as diabetes and heart disease, is important in improving patient health and reducing health care costs. One new health care model is pay-for-performance (P4P), which provides financial incentives to clinicians for achieving better health outcomes. In the traditional “fee for service” model, doctors are paid a set amount regardless of patient outcomes.
A team led by Drs. Naomi S. Bardach and R. Adams Dudley from the University of California, San Francisco, in conjunction with researchers from the New York City Department of Health and Mental Hygiene, examined the effects of P4P in small primary care clinics (1-10 clinicians). The 84 participating clinics were located in New York City and used electronic health records software as part of a city program.
Participating clinics were grouped by size and location and randomized to incentive or control (usual care). There were an average of about 4,500 patients in the intervention group clinics and 3,000 in control group clinics. At least 10% of the patients were on Medicaid or were uninsured.
The study was funded in part by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Center for Research Resources (NCRR), and National Center for Advancing Translational Sciences (NCATS). The findings were published on September 11, 2013, in the Journal of the American Medical Association.
There were 4 key quality goals. All are known to reduce long-term cardiovascular risk: aspirin or antithrombotic medication prescription, blood pressure control, cholesterol control, and smoking cessation interventions. For the P4P clinics, a financial incentive was paid to physicians when a patient met a quality goal. Incentives were tiered; higher payments were given when patients who were sicker, or who had Medicaid or were uninsured, met goals. Maximum payments were $200 per patient and $100,000 per clinic. The effects were assessed from April 2009 through March 2010.
Performance improved in both groups of clinics over the course of the study. Clinics with the incentive plan demonstrated significantly greater improvements than control clinics in rates of appropriate antithrombotic prescription (12% vs. 6.1%) and rates of smoking cessation interventions (12.4% vs. 7.7%).
The incentivized clinics also showed improvements in blood pressure control in patients with hypertension (9.7% vs. 4.3%) and in patients with hypertension plus diabetes or vascular disease (9.5% vs. 1.7%). Incentivized clinics performed better on most measures for Medicaid and uninsured patients, but these effects weren’t great enough to prove they weren’t due to chance.
“Pay-for-performance programs shift the focus from basic care delivery to high-quality care delivery, so they are designed to incentivize people to improve care,” Bardach says. “The numbers are meaningful because the rates of blood pressure control were low to begin with, so an improvement of even 5% of patients is relatively quite large. This is a high-risk population for heart attack and stroke, so getting their blood pressure under control will make a difference.”
The researchers note that since the goal of the P4P program is to improve long-term outcomes, it will be important to assess the impact over a longer time period.
—by Carol Torgan, Ph.D.

Related Links:

Reference: Effect of pay-for-performance incentives on quality of care in small practices with electronic health records: a randomized trial. JAMA. 2013 Sep 11;310(10):1051-9. doi: 10.1001/jama.2013.277353. PMID: 24026600.
Funding: NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Center for Research Resources (NCRR), National Center for Advancing Translational Sciences (NCATS); the Robin Hood Foundation; and the Agency for Healthcare Research and Quality.

Dra. Marisa Aizenberg: El Instituto Nacional del Cáncer creó una red nacional de cáncer familiar y hereditario

Dra. Marisa Aizenberg: El Instituto Nacional del Cáncer creó una red nacional de cáncer familiar y hereditario

Posted: 30 Sep 2013 05:35 AM PDT
El objetivo de la red es fortalecer la capacitación y unificar pautas para la detección y el manejo de este tipo de cáncer, que genera al menos diez mil nuevos casos por año.

El Instituto Nacional del Cáncer, organismo dependiente del Ministerio de Salud de la Nación, creó una red de atención y referencia integrada por profesionales dedicados al asesoramiento genético en oncología de la Argentina con el fin de fortalecer la capacitación y unificar pautas para la detección y manejo del cáncer familiar y hereditario, que genera al menos diez mil nuevos casos por año en nuestro país.

La red –una experiencia novedosa para nuestro país y la región dado que sólo en Brasil existía una de este tipo- que funcionará bajo la órbita del Plan Nacional de Tumores Familiares y Hereditarios del INC, quedó conformada en un taller del que participaron cuarenta representantes regionales de distintas instituciones del país vinculados a la temática.

"La meta principal del Plan de Tumores Hereditarios es mejorar la prevención, la detección y el manejo de las familias que están afectadas por cáncer familiar", señaló María Viniegra, coordinadora técnica del INC, al dar inicio al encuentro y expresó que la red servirá "para que todos trabajemos mejor, no solamente para los pacientes y para la población sino también para que dejemos de trabajar en soledad".

Por su parte, Lina Nuñez, coordinadora del Plan indicó que "la concepción actual del cáncer como enfermedad multifactorial nos enfrenta a la susceptibilidad genética de cada individuo, como un componente indispensable a ser evaluado en la atención de todo paciente oncológico", por lo que "identificar a estos individuos con predisposición genética y a sus familias es la base para plantear estrategias de prevención diferenciales y un abordaje sistemático efectivo en el control de la enfermedad".

En esa línea, "la red permitirá compartir los casos clínicos que estamos viendo y nos va a permitir generar un flujo de pacientes desde los lugares donde hay menos recursos a los lugares donde hay más recursos para tratar de dar una mayor cobertura y poder hacer un aprovechamiento más adecuado de los recursos con que disponemos", evaluó Norma Rossi, médica genetista del Hospital de Niños de Córdoba e integrante de la Red.

Durante el encuentro de trabajo, se presentaron, además, los resultados del primer Censo Nacional de Recursos Humanos y Moleculares en Cáncer Hereditario y un Manual para la Práctica Clínica en Asesoramiento Genético en Oncología, se revisaron áreas de incumbencia de la red, se definieron conceptos básicos en relación a la atención de pacientes de alto riesgo y se delinearon líneas de acción para el próximo año, entre ellas, el fortalecimiento de la red y la capacitación de sus integrantes. También se definieron temas para redacción de guías consensuadas de manejo y soporte multidisciplinario a centros de asesoramiento que no cuenten con atención polivalente, así como la redacción de guías de detección de tumores hereditarios pediátricos.

El cáncer hereditario

Entre el 5 y 10 por ciento de todos los cánceres son hereditarios. Esto quiere decir que se producen por mutaciones genéticas heredadas que se transmiten de padres a hijos y de generación en generación. Cada hijo de un individuo que posee una mutación tiene 50 por ciento de probabilidades de heredar la mutación y 50 por ciento de no heredarla. Pero no siempre las personas que heredan estas alteraciones desarrollarán cáncer, aunque su riego es más elevado.

"Cuando consideramos tumores de alta prevalencia como el cáncer de mama o el colorrectal y analizamos la proporción de casos nuevos que tienen componente hereditario, entre 6.000 y 8.000 casos por año entre ambos, vemos claramente el impacto que estos tumores tienen sobre el sistema de salud y la importancia indudable de un correcto abordaje de los grupos de mayor riesgo, que nos permita mejorar su detección y prevenir su aparición", destacó Nuñez, de allí la necesidad de la inclusión de esta temática en las políticas de control a nivel poblacional y de conformar redes de atención y referencia.

"De esta manera es posible aunar esfuerzos, optimizar recursos y conocer en detalle la epidemiología local, hasta ahora desconocida", aseveró la especialista.

Censo de Recursos Humanos y Moleculares en Cáncer Hereditario

En tanto, durante el 2012, el Plan Nacional de Tumores Familiares y Hereditariosrealizó un Censo de Recursos Humanos y Moleculares en Cáncer Hereditario, el cual es de libre acceso para todo aquel profesional que desee conocer los recursos con los que cuenta en su provincia. El censo está concebido como un recurso de relevo activo, que permitirá incorporar instituciones en forma progresiva y constante. En la publicación -que está disponible online en el sitio web del INC- se relevaron las unidades de asesoramiento genético en oncología (AGO) y los laboratorios que realizan determinaciones moleculares en cáncer hereditario.

Según explicó, la coordinadora del Plan, "el asesoramiento genético es un proceso en el cual los individuos y familias que presentan riesgo elevado de desarrollar cáncer son asesorados en aspectos médicos, psico-sociales y éticos. El estudio molecular es una herramienta más a utilizar, a la cual no siempre es necesario recurrir".

Los datos del censo indican que la presencia de consultorios de AGO en nuestro país se da en forma desigual, concentrándose el 61 por ciento de las prestaciones en las provincias de Buenos Aires y Santa Fe mientras que quince provincias no poseen consultorios de AGO. Esta distribución no se da en relación con la concentración demográfica de cada región, ni tampoco posee una jerarquía regional adecuada que abarque la extensión total del país.

La disponibilidad de estudios moleculares de Cáncer Hereditario en el país es abundante, variada y heterogénea, lo que permite que puedan ser abordadas una gran cantidad de patologías, aún aquellas muy poco frecuentes. En ese orden, el Plan Nacional tiene como objetivo colaborar en la formulación de políticas que permitan el acceso a este tipo de estudios para todo aquel que lo necesite.

Los tumores Hereditarios y Familiares constituyen un claro desafío en la atención oncológica actual, ya que involucran a una población expuesta a mayor riesgo de aparición de cáncer, que para ser abordada correctamente, debe enfrentarse a la complejidad de las técnicas moleculares actualmente disponibles y requiere de un manejo preventivo multidisciplinario que abarque diversos aspectos del individuo, tanto orgánicos como emocionales, sociales y culturales.

Fuente: Ministerio de Salud de la Nación

U.S. Preventive Services Task Force Update

U.S. Preventive Services Task Force Update

U.S. Preventive Services Task Force Update



The U.S. Preventive Services Task Force posted today a draft evidence report and draft recommendation statement on primary care behavioral interventions to reduce illicit drug and nonmedical pharmaceutical use in children and adolescents. Both are available for review and public comment from October 1, 2013 through October 28, 2013.  To review the draft evidence report and draft recommendation statement and submit comments, go to http://www.uspreventiveservicestaskforce.org/tfcomment.htm    

EHC Program Update: Notification of Limited Web Site Services -- October 1-4, 2013

EHC Program Update: Notification of Limited Web Site Services -- October 1-4, 2013
Effective Health Care Program - Helping You Make Better Treatment Choices

The Effective Health Care Program Web site will be transitioning to a new hosting environment starting October 1, 2013. The transition should be complete by October 4, 2013.
During this transition period the Web site will not be able to accept submissions of:
  • Comments on draft reports
  • Suggestions for research
  • Scientific information packets
  • Key contacts for scientific information requests
We will notify you when the transition is complete and when these submissions can again be accepted. 
The Effective Health Care Program
http://effectivehealthcare.ahrq.gov/

Primary Care Research Highlighted in JABFM

Primary Care Research Highlighted in JABFM

AHRQ Prevention and Chronic Care Program logo

JABFM Focuses on PBRNs Accelerating Primary Care

The Agency for Healthcare Research and Quality is pleased to announce the release of the Practice-Based Research Networks (PBRN’s) special issue with the Journal of the American Board of Family Medicine (JABFM). AHRQ supports the Practice-Based Research Networks, whose purpose is to answer primary care-based health care questions and translate research findings into practice. The current issue of JABFM focuses on how practice-based research networks are answering pressing patient and provider questions regarding disease prevention, clinician satisfaction, contemporary practice challenges, and strategies for integrating research in primary care. Select to access the supplement: http://www.jabfm.org/content/26/5.toc.

The issue comes in time for Primary Care Week, celebrated October 7-11, 2013. Primary care includes health promotion, disease prevention, and diagnosis and treatment of health concerns. The Practice Based Research Networks facilitate research on best practices in primary care. Interested practices and health systems are encouraged to request a subscription to the PBRN list serve by contacting, PBRN@abtassoc.com. Practiced Based Research Networks are encouraged to register with AHRQ or visit the PBRN website for more information.


Learn more about how to improve primary care. Visit AHRQ’s Prevention & Chronic Care Program at:  http://www.ahrq.gov/professionals/prevention-chronic-care/index.html

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