Heidi Splete

Chicago — Children with Crohn's disease who received growth hormone in addition to corticosteroids showed significant improvements in symptoms after 12 weeks, based on data from 20 children aged 7-18 years with active Crohn's disease.

Previous studies have shown that growth hormone may reduce symptoms in adults with Crohn's disease and may improve growth in children, but the effect of growth hormone on intestinal inflammation in children with Crohn's is not well known, said Dr. Lee Denson of Cincinnati Children's Hospital Medical Center.

To assess the impact of growth hormone on symptoms in children with Crohn's, Dr. Denson and colleagues randomized 10 children with active disease to receive corticosteroids alone, or to receive 0.075 mg/kg per day of growth hormone (somatropin) in addition to corticosteroids.

After 12 weeks, 65% of the children who received growth hormone showed clinical remission of their Crohn's, compared with 20% of the children who did not receive growth hormone, a statistically significant difference. Growth hormone is not currently approved by the Food and Drug Administration to treat Crohn's disease, Dr. Denson reported at the annual Digestive Disease Week.

Endoscopic disease activity (measured using the Crohn's Disease Endoscopic Index of Severity) was lower in the growth hormone group. The difference between the groups was not significant. But 70% of the children in the growth hormone group achieved inactive mucosal disease at 12 weeks, compared with 50% of the children who didn't take growth hormone.

Microarray analyses of colon biopsies showed increases in some cellular components involved in neurophysiological function, cell signaling, and solute transport in children who took growth hormone that were not seen in biopsies from children who didn't take growth hormone, but the implications of these differences aren't fully understood.

In addition, 61% of the children who received growth hormone maintained their clinical response through 64 weeks, and differences in their predicted adult height after 48 weeks compared with baseline indicated catch-up growth.

“In the longer phase of the study, we found that most children who received growth hormone had a catch-up [in growth] and got back to where they would have been without the illness,” said Dr. Denson said. The growth hormone was well tolerated, and the results indicate the need for a larger multicenter study to assess the overall benefit of using growth hormone to treat Crohn's disease symptoms in children.

Dr. Denson has received grant and research support from Abbott Laboratories and Genentech Inc. This study was sponsored in part by Genentech.

Chicago — Children with Crohn's disease who received growth hormone in addition to corticosteroids showed significant improvements in symptoms after 12 weeks, based on data from 20 children aged 7-18 years with active Crohn's disease.

Previous studies have shown that growth hormone may reduce symptoms in adults with Crohn's disease and may improve growth in children, but the effect of growth hormone on intestinal inflammation in children with Crohn's is not well known, said Dr. Lee Denson of Cincinnati Children's Hospital Medical Center.

To assess the impact of growth hormone on symptoms in children with Crohn's, Dr. Denson and colleagues randomized 10 children with active disease to receive corticosteroids alone, or to receive 0.075 mg/kg per day of growth hormone (somatropin) in addition to corticosteroids.

After 12 weeks, 65% of the children who received growth hormone showed clinical remission of their Crohn's, compared with 20% of the children who did not receive growth hormone, a statistically significant difference. Growth hormone is not currently approved by the Food and Drug Administration to treat Crohn's disease, Dr. Denson reported at the annual Digestive Disease Week.

Endoscopic disease activity (measured using the Crohn's Disease Endoscopic Index of Severity) was lower in the growth hormone group. The difference between the groups was not significant. But 70% of the children in the growth hormone group achieved inactive mucosal disease at 12 weeks, compared with 50% of the children who didn't take growth hormone.

Microarray analyses of colon biopsies showed increases in some cellular components involved in neurophysiological function, cell signaling, and solute transport in children who took growth hormone that were not seen in biopsies from children who didn't take growth hormone, but the implications of these differences aren't fully understood.

In addition, 61% of the children who received growth hormone maintained their clinical response through 64 weeks, and differences in their predicted adult height after 48 weeks compared with baseline indicated catch-up growth.

“In the longer phase of the study, we found that most children who received growth hormone had a catch-up [in growth] and got back to where they would have been without the illness,” said Dr. Denson said. The growth hormone was well tolerated, and the results indicate the need for a larger multicenter study to assess the overall benefit of using growth hormone to treat Crohn's disease symptoms in children.

Dr. Denson has received grant and research support from Abbott Laboratories and Genentech Inc. This study was sponsored in part by Genentech.

Chicago — Children with Crohn's disease who received growth hormone in addition to corticosteroids showed significant improvements in symptoms after 12 weeks, based on data from 20 children aged 7-18 years with active Crohn's disease.

Previous studies have shown that growth hormone may reduce symptoms in adults with Crohn's disease and may improve growth in children, but the effect of growth hormone on intestinal inflammation in children with Crohn's is not well known, said Dr. Lee Denson of Cincinnati Children's Hospital Medical Center.

To assess the impact of growth hormone on symptoms in children with Crohn's, Dr. Denson and colleagues randomized 10 children with active disease to receive corticosteroids alone, or to receive 0.075 mg/kg per day of growth hormone (somatropin) in addition to corticosteroids.

After 12 weeks, 65% of the children who received growth hormone showed clinical remission of their Crohn's, compared with 20% of the children who did not receive growth hormone, a statistically significant difference. Growth hormone is not currently approved by the Food and Drug Administration to treat Crohn's disease, Dr. Denson reported at the annual Digestive Disease Week.

Endoscopic disease activity (measured using the Crohn's Disease Endoscopic Index of Severity) was lower in the growth hormone group. The difference between the groups was not significant. But 70% of the children in the growth hormone group achieved inactive mucosal disease at 12 weeks, compared with 50% of the children who didn't take growth hormone.

Microarray analyses of colon biopsies showed increases in some cellular components involved in neurophysiological function, cell signaling, and solute transport in children who took growth hormone that were not seen in biopsies from children who didn't take growth hormone, but the implications of these differences aren't fully understood.

In addition, 61% of the children who received growth hormone maintained their clinical response through 64 weeks, and differences in their predicted adult height after 48 weeks compared with baseline indicated catch-up growth.

“In the longer phase of the study, we found that most children who received growth hormone had a catch-up [in growth] and got back to where they would have been without the illness,” said Dr. Denson said. The growth hormone was well tolerated, and the results indicate the need for a larger multicenter study to assess the overall benefit of using growth hormone to treat Crohn's disease symptoms in children.

Dr. Denson has received grant and research support from Abbott Laboratories and Genentech Inc. This study was sponsored in part by Genentech.

WASHINGTON — The health cost of obesity in the United States jumped over the past decade, from $74 billion in 1998 to approximately $147 billion today, based on data from a study conducted by the Centers for Disease Control and Prevention and the Research Triangle Institute.

“Obesity affects every body system,” Dr. Thomas R. Frieden, director of the CDC, said during opening remarks at the agency's inaugural Weight of the Nation conference on obesity.

Obesity accounted for 6.5% of overall annual medical costs in the United States in 1998, but that proportion increased to 9.1% by 2006, said the study's lead author, Eric Finkelstein, Ph.D., of the independent Research Triangle Institute.

The annual cost of medical care per adult in the United States is 41% less for a normal-weight individual than for an obese individual. Prescription drugs are among the top contributors to the costs of obesity, Dr. Finkelstein said. In 2006, across all insurance payers, the average annual prescription drug cost for a normal-weight individual was $707, compared with $1,275 for an obese individual.

WASHINGTON — The health cost of obesity in the United States jumped over the past decade, from $74 billion in 1998 to approximately $147 billion today, based on data from a study conducted by the Centers for Disease Control and Prevention and the Research Triangle Institute.

“Obesity affects every body system,” Dr. Thomas R. Frieden, director of the CDC, said during opening remarks at the agency's inaugural Weight of the Nation conference on obesity.

Obesity accounted for 6.5% of overall annual medical costs in the United States in 1998, but that proportion increased to 9.1% by 2006, said the study's lead author, Eric Finkelstein, Ph.D., of the independent Research Triangle Institute.

The annual cost of medical care per adult in the United States is 41% less for a normal-weight individual than for an obese individual. Prescription drugs are among the top contributors to the costs of obesity, Dr. Finkelstein said. In 2006, across all insurance payers, the average annual prescription drug cost for a normal-weight individual was $707, compared with $1,275 for an obese individual.

WASHINGTON — The health cost of obesity in the United States jumped over the past decade, from $74 billion in 1998 to approximately $147 billion today, based on data from a study conducted by the Centers for Disease Control and Prevention and the Research Triangle Institute.

“Obesity affects every body system,” Dr. Thomas R. Frieden, director of the CDC, said during opening remarks at the agency's inaugural Weight of the Nation conference on obesity.

Obesity accounted for 6.5% of overall annual medical costs in the United States in 1998, but that proportion increased to 9.1% by 2006, said the study's lead author, Eric Finkelstein, Ph.D., of the independent Research Triangle Institute.

The annual cost of medical care per adult in the United States is 41% less for a normal-weight individual than for an obese individual. Prescription drugs are among the top contributors to the costs of obesity, Dr. Finkelstein said. In 2006, across all insurance payers, the average annual prescription drug cost for a normal-weight individual was $707, compared with $1,275 for an obese individual.

The majority (88%) of postpartum women reported current use of at least one form of contraception, based on an analysis of data from more than 43,000 women.

Reducing the percentage of births within a year of a previous birth among women in the United States is one of the Center's for Disease Control and Prevention's Healthy People 2010 goals. Use of effective contraceptive methods after a recent pregnancy can help prevent unintended pregnancies, ensure adequate birth spacing, and reduce adverse maternal and infant outcomes, according to Maura Whiteman, Ph.D., and colleagues at the CDC.

The researchers reviewed data from the CDC's Pregnancy Risk Assessment Monitoring System from 2004 to 2006 from New York City and 12 states. The postpartum period was defined as 2–9 months after giving birth. The report is the first population-based study to examine differences in postpartum contraceptive use based on maternal characteristics (MMWR 2009;58:821–6).

Overall, 62% of of 43,887 postpartum women reported using highly effective contraceptive methods (such as sterilization, IUD, pill, patch, or ring).

Another 20% reported using moderately effective methods (such as condoms) and 6% reported using less effective methods (such as the rhythm method, sponge, or diaphragm), while 12% reported no postpartum contraception, they reported.

Women who were least likely to use at least one method of contraception included those who had no prenatal care, women aged 35 years and older, women who said they wanted to get pregnant sooner, and women who identified themselves as Asian/Pacific Islander.

Highly effective postpartum contraception use by age ranged from a low of 53% among women aged 35 and older to a high of 73% among women younger than 20 years.

When the data were broken down by race, highly effective postpartum contraception use ranged from a low of 35% among Asian/Pacific Islanders to a high of 71% among black women and American Indian/Alaska Native women.

In addition, women with Medicaid coverage prior to pregnancy were more likely to use highly effective contraception postpartum than women without Medicaid, while women with no prenatal care were less likely to use highly effective contraception postpartum than those who had any prenatal care.

The study was limited by several factors, including the use of self- reports, a lack of data from all parts of the United States, and a lack of data on several additional contraceptive methods such as spermicides, emergency contraception, and lactational amenorrhea.

But the results can help clinicians identify women who need more information about postpartum contraception, the researchers noted.

“Health care providers should consider encouraging postpartum women to use highly effective contraceptive methods to increase the proportion of pregnancies that are intended and promote healthy birth spacing,” they said.

The majority (88%) of postpartum women reported current use of at least one form of contraception, based on an analysis of data from more than 43,000 women.

Reducing the percentage of births within a year of a previous birth among women in the United States is one of the Center's for Disease Control and Prevention's Healthy People 2010 goals. Use of effective contraceptive methods after a recent pregnancy can help prevent unintended pregnancies, ensure adequate birth spacing, and reduce adverse maternal and infant outcomes, according to Maura Whiteman, Ph.D., and colleagues at the CDC.

The researchers reviewed data from the CDC's Pregnancy Risk Assessment Monitoring System from 2004 to 2006 from New York City and 12 states. The postpartum period was defined as 2–9 months after giving birth. The report is the first population-based study to examine differences in postpartum contraceptive use based on maternal characteristics (MMWR 2009;58:821–6).

Overall, 62% of of 43,887 postpartum women reported using highly effective contraceptive methods (such as sterilization, IUD, pill, patch, or ring).

Another 20% reported using moderately effective methods (such as condoms) and 6% reported using less effective methods (such as the rhythm method, sponge, or diaphragm), while 12% reported no postpartum contraception, they reported.

Women who were least likely to use at least one method of contraception included those who had no prenatal care, women aged 35 years and older, women who said they wanted to get pregnant sooner, and women who identified themselves as Asian/Pacific Islander.

Highly effective postpartum contraception use by age ranged from a low of 53% among women aged 35 and older to a high of 73% among women younger than 20 years.

When the data were broken down by race, highly effective postpartum contraception use ranged from a low of 35% among Asian/Pacific Islanders to a high of 71% among black women and American Indian/Alaska Native women.

In addition, women with Medicaid coverage prior to pregnancy were more likely to use highly effective contraception postpartum than women without Medicaid, while women with no prenatal care were less likely to use highly effective contraception postpartum than those who had any prenatal care.

The study was limited by several factors, including the use of self- reports, a lack of data from all parts of the United States, and a lack of data on several additional contraceptive methods such as spermicides, emergency contraception, and lactational amenorrhea.

But the results can help clinicians identify women who need more information about postpartum contraception, the researchers noted.

“Health care providers should consider encouraging postpartum women to use highly effective contraceptive methods to increase the proportion of pregnancies that are intended and promote healthy birth spacing,” they said.

The majority (88%) of postpartum women reported current use of at least one form of contraception, based on an analysis of data from more than 43,000 women.

Reducing the percentage of births within a year of a previous birth among women in the United States is one of the Center's for Disease Control and Prevention's Healthy People 2010 goals. Use of effective contraceptive methods after a recent pregnancy can help prevent unintended pregnancies, ensure adequate birth spacing, and reduce adverse maternal and infant outcomes, according to Maura Whiteman, Ph.D., and colleagues at the CDC.

The researchers reviewed data from the CDC's Pregnancy Risk Assessment Monitoring System from 2004 to 2006 from New York City and 12 states. The postpartum period was defined as 2–9 months after giving birth. The report is the first population-based study to examine differences in postpartum contraceptive use based on maternal characteristics (MMWR 2009;58:821–6).

Overall, 62% of of 43,887 postpartum women reported using highly effective contraceptive methods (such as sterilization, IUD, pill, patch, or ring).

Another 20% reported using moderately effective methods (such as condoms) and 6% reported using less effective methods (such as the rhythm method, sponge, or diaphragm), while 12% reported no postpartum contraception, they reported.

Women who were least likely to use at least one method of contraception included those who had no prenatal care, women aged 35 years and older, women who said they wanted to get pregnant sooner, and women who identified themselves as Asian/Pacific Islander.

Highly effective postpartum contraception use by age ranged from a low of 53% among women aged 35 and older to a high of 73% among women younger than 20 years.

When the data were broken down by race, highly effective postpartum contraception use ranged from a low of 35% among Asian/Pacific Islanders to a high of 71% among black women and American Indian/Alaska Native women.

In addition, women with Medicaid coverage prior to pregnancy were more likely to use highly effective contraception postpartum than women without Medicaid, while women with no prenatal care were less likely to use highly effective contraception postpartum than those who had any prenatal care.

The study was limited by several factors, including the use of self- reports, a lack of data from all parts of the United States, and a lack of data on several additional contraceptive methods such as spermicides, emergency contraception, and lactational amenorrhea.

But the results can help clinicians identify women who need more information about postpartum contraception, the researchers noted.

“Health care providers should consider encouraging postpartum women to use highly effective contraceptive methods to increase the proportion of pregnancies that are intended and promote healthy birth spacing,” they said.

WASHINGTON — Adding epinephrine to epidural bupivacaine and fentanyl significantly reduced the breakthrough pain of women in labor, based on supplemental pain relief data from a randomized study of 107 women with uncomplicated singleton pregnancies.

Previous studies have shown that epinephrine enhances the analgesic effects of local anesthesia during labor, but the effect of epinephrine added during the epidural infusion has not been well studied, noted Dr. Philip E. Hess of Harvard Medical School, Boston.

In this study, Dr. Hess and his colleagues enrolled women in active labor who were at least 7 cm dilated. The average age of the women was 32 years. All the patients received a standard epidural with bupivacaine and fentanyl, and then were randomized to receive or not to receive 1.66 mcg/mL epinephrine (1:600,000) as part of the epidural solution. The results were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

“The primary outcome was the need for the treatment of breakthrough pain,” Dr. Hess said during an oral review of posters. Overall, the mean number of boluses of supplemental pain medication was significantly lower in the epinephrine group compared with the control group (1.16 vs. 0.74), and the bolus rate was significantly lower in the epinephrine group compared with the controls.

But there were no significant differences in the duration of labor or in the occurrence of side effects (including hypotension, nausea, and vomiting) between the two groups. Pain scores were recorded every 15 minutes during labor using the visual analog scale. The results suggest that adding epidural epinephrine at the beginning of labor significantly reduced the need for extra anesthesia to manage breakthrough pain, noted Dr. Hess, who said he had no conflicts to disclose.

WASHINGTON — Adding epinephrine to epidural bupivacaine and fentanyl significantly reduced the breakthrough pain of women in labor, based on supplemental pain relief data from a randomized study of 107 women with uncomplicated singleton pregnancies.

Previous studies have shown that epinephrine enhances the analgesic effects of local anesthesia during labor, but the effect of epinephrine added during the epidural infusion has not been well studied, noted Dr. Philip E. Hess of Harvard Medical School, Boston.

In this study, Dr. Hess and his colleagues enrolled women in active labor who were at least 7 cm dilated. The average age of the women was 32 years. All the patients received a standard epidural with bupivacaine and fentanyl, and then were randomized to receive or not to receive 1.66 mcg/mL epinephrine (1:600,000) as part of the epidural solution. The results were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

“The primary outcome was the need for the treatment of breakthrough pain,” Dr. Hess said during an oral review of posters. Overall, the mean number of boluses of supplemental pain medication was significantly lower in the epinephrine group compared with the control group (1.16 vs. 0.74), and the bolus rate was significantly lower in the epinephrine group compared with the controls.

But there were no significant differences in the duration of labor or in the occurrence of side effects (including hypotension, nausea, and vomiting) between the two groups. Pain scores were recorded every 15 minutes during labor using the visual analog scale. The results suggest that adding epidural epinephrine at the beginning of labor significantly reduced the need for extra anesthesia to manage breakthrough pain, noted Dr. Hess, who said he had no conflicts to disclose.

WASHINGTON — Adding epinephrine to epidural bupivacaine and fentanyl significantly reduced the breakthrough pain of women in labor, based on supplemental pain relief data from a randomized study of 107 women with uncomplicated singleton pregnancies.

Previous studies have shown that epinephrine enhances the analgesic effects of local anesthesia during labor, but the effect of epinephrine added during the epidural infusion has not been well studied, noted Dr. Philip E. Hess of Harvard Medical School, Boston.

In this study, Dr. Hess and his colleagues enrolled women in active labor who were at least 7 cm dilated. The average age of the women was 32 years. All the patients received a standard epidural with bupivacaine and fentanyl, and then were randomized to receive or not to receive 1.66 mcg/mL epinephrine (1:600,000) as part of the epidural solution. The results were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

“The primary outcome was the need for the treatment of breakthrough pain,” Dr. Hess said during an oral review of posters. Overall, the mean number of boluses of supplemental pain medication was significantly lower in the epinephrine group compared with the control group (1.16 vs. 0.74), and the bolus rate was significantly lower in the epinephrine group compared with the controls.

But there were no significant differences in the duration of labor or in the occurrence of side effects (including hypotension, nausea, and vomiting) between the two groups. Pain scores were recorded every 15 minutes during labor using the visual analog scale. The results suggest that adding epidural epinephrine at the beginning of labor significantly reduced the need for extra anesthesia to manage breakthrough pain, noted Dr. Hess, who said he had no conflicts to disclose.

WASHINGTON — Curbing the obesity epidemic in America requires community intervention, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at the CDC's Weight of the Nation conference.

“The only way on a societal basis to reduce the prevalence of obesity is through community action, not through individual clinical interventions,” Dr. Frieden said in a press conference.

“We got to this stage in the [obesity] epidemic because of a change in our environment,” he said. “Only a change in our environment again will allow us to get back to a healthier place.”

To help communities respond to the obesity epidemic, the CDC launched Common Community Measures for Obesity Prevention. As part of this project, the CDC convened a panel of experts in a variety of areas including nutrition, urban planning, and physical activity, as well as obesity prevention (MMWR 2009:58 [RR-7]:1-26).

“We can't wait for the best possible evidence, we have to act on the best available evidence,” said Dr. William Dietz, director of the CDC's Division of Nutrition, Physical Activity, and Obesity. Dr. Dietz presented the CDC's recommendations at a press conference.

The panel agreed on 24 strategies, which fall into six categories:

▸ To promote the availability of affordable healthy foods and beverages (example: adding grocery stores in underserved areas).

▸ To support healthy food and beverage choices (example: limiting ads for unhealthy food and beverages).

▸ To encourage breast-feeding (example: encouraging workplaces to support breastfeeding moms).

▸ To encourage physical activity or limit sedentary activity in children and adolescents (example: requiring physical education in schools).

▸ To create safe communities that support physical activity (example: enhancing infrastructure to support walking and biking).

▸ To encourage communities to organize for change (example: participating in coalitions and partnerships to address obesity).

The panel chose strategies that are likely to have a broad reach and a long-term, meaningful impact on health, according to the full report. And the panel deemed the strategies reasonable for a community to implement.

“I think there is a responsibility to physicians and the medical profession generally to be active in their communities promoting prevention,” said Dr. Frieden. It is often physicians who encourage community actions and influence policy makers, he emphasized.

It is often physicians who encourage community actions and influence policy makers.

Source DR. FRIEDEN

WASHINGTON — Curbing the obesity epidemic in America requires community intervention, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at the CDC's Weight of the Nation conference.

“The only way on a societal basis to reduce the prevalence of obesity is through community action, not through individual clinical interventions,” Dr. Frieden said in a press conference.

“We got to this stage in the [obesity] epidemic because of a change in our environment,” he said. “Only a change in our environment again will allow us to get back to a healthier place.”

To help communities respond to the obesity epidemic, the CDC launched Common Community Measures for Obesity Prevention. As part of this project, the CDC convened a panel of experts in a variety of areas including nutrition, urban planning, and physical activity, as well as obesity prevention (MMWR 2009:58 [RR-7]:1-26).

“We can't wait for the best possible evidence, we have to act on the best available evidence,” said Dr. William Dietz, director of the CDC's Division of Nutrition, Physical Activity, and Obesity. Dr. Dietz presented the CDC's recommendations at a press conference.

The panel agreed on 24 strategies, which fall into six categories:

▸ To promote the availability of affordable healthy foods and beverages (example: adding grocery stores in underserved areas).

▸ To support healthy food and beverage choices (example: limiting ads for unhealthy food and beverages).

▸ To encourage breast-feeding (example: encouraging workplaces to support breastfeeding moms).

▸ To encourage physical activity or limit sedentary activity in children and adolescents (example: requiring physical education in schools).

▸ To create safe communities that support physical activity (example: enhancing infrastructure to support walking and biking).

▸ To encourage communities to organize for change (example: participating in coalitions and partnerships to address obesity).

The panel chose strategies that are likely to have a broad reach and a long-term, meaningful impact on health, according to the full report. And the panel deemed the strategies reasonable for a community to implement.

“I think there is a responsibility to physicians and the medical profession generally to be active in their communities promoting prevention,” said Dr. Frieden. It is often physicians who encourage community actions and influence policy makers, he emphasized.

It is often physicians who encourage community actions and influence policy makers.

Source DR. FRIEDEN

WASHINGTON — Curbing the obesity epidemic in America requires community intervention, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at the CDC's Weight of the Nation conference.

“The only way on a societal basis to reduce the prevalence of obesity is through community action, not through individual clinical interventions,” Dr. Frieden said in a press conference.

“We got to this stage in the [obesity] epidemic because of a change in our environment,” he said. “Only a change in our environment again will allow us to get back to a healthier place.”

To help communities respond to the obesity epidemic, the CDC launched Common Community Measures for Obesity Prevention. As part of this project, the CDC convened a panel of experts in a variety of areas including nutrition, urban planning, and physical activity, as well as obesity prevention (MMWR 2009:58 [RR-7]:1-26).

“We can't wait for the best possible evidence, we have to act on the best available evidence,” said Dr. William Dietz, director of the CDC's Division of Nutrition, Physical Activity, and Obesity. Dr. Dietz presented the CDC's recommendations at a press conference.

The panel agreed on 24 strategies, which fall into six categories:

▸ To promote the availability of affordable healthy foods and beverages (example: adding grocery stores in underserved areas).

▸ To support healthy food and beverage choices (example: limiting ads for unhealthy food and beverages).

▸ To encourage breast-feeding (example: encouraging workplaces to support breastfeeding moms).

▸ To encourage physical activity or limit sedentary activity in children and adolescents (example: requiring physical education in schools).

▸ To create safe communities that support physical activity (example: enhancing infrastructure to support walking and biking).

▸ To encourage communities to organize for change (example: participating in coalitions and partnerships to address obesity).

The panel chose strategies that are likely to have a broad reach and a long-term, meaningful impact on health, according to the full report. And the panel deemed the strategies reasonable for a community to implement.

“I think there is a responsibility to physicians and the medical profession generally to be active in their communities promoting prevention,” said Dr. Frieden. It is often physicians who encourage community actions and influence policy makers, he emphasized.

It is often physicians who encourage community actions and influence policy makers.

Source DR. FRIEDEN

The majority (88%) of postpartum women reported current use of at least one form of contraception, based on an analysis of data from more than 43,000 women.

Reducing the percentage of births within a year of a previous birth among women in the United States is one of the Center's for Disease Control and Prevention's Healthy People 2010 goals. Use of effective contraceptive methods after a recent pregnancy can help prevent unintended pregnancies, ensure adequate birth spacing, and reduce adverse maternal and infant outcomes, according to Maura Whiteman, Ph.D., and colleagues at the CDC.

The researchers reviewed data from the CDC's Pregnancy Risk Assessment Monitoring System from 2004-2006 from New York City and 12 states. The postpartum period was defined as 2-9 months after giving birth.

The report is the first population-based study designed to examine differences in postpartum contraceptive use based on maternal characteristics (MMWR 2009;58:821-6).

Overall, 62% of of 43,887 postpartum women reported using highly effective contraceptive methods (such as sterilization, IUD, pill, patch, or ring). Another 20% reported using moderately effective methods (such as condoms) and 6% reported using less effective methods (such as the rhythm method, sponge, or diaphragm), while 12% reported no postpartum contraception.

Women who were least likely to use at least one method of contraception included those who had no prenatal care, women aged 35 years and older, women who said they wanted to get pregnant sooner, and women who identified themselves as Asian/Pacific Islander.

Highly effective postpartum contraception use by age ranged from a low of 53% among women aged 35 and older to a high of 73% among women younger than 20 years.

When the data were broken down by race, the use of highly effective postpartum contraception ranged from a low of 35% among Asian/Pacific Islanders to a high of 71% among black women and American Indian/Alaska Native women, Dr. Whiteman and associates reported.

In addition, women who had Medicaid coverage prior to pregnancy were more likely to use highly effective contraception postpartum than women who did not have Medicaid, while women with no prenatal care were less likely to use highly effective contraception postpartum than those who had any prenatal care.

The study was limited by several factors, including the use of self reports, a lack of data from all parts of the United States, and a lack of data on several additional contraceptive methods such as spermicides, emergency contraception, and lactational amenorrhea.

But the results can help clinicians identify women who need more information about postpartum contraception, the researchers noted.

“Health care providers should consider encouraging postpartum women to use highly effective contraceptive methods to increase the proportion of pregnancies that are intended and promote healthy birth spacing,” they said.

The majority (88%) of postpartum women reported current use of at least one form of contraception, based on an analysis of data from more than 43,000 women.

Reducing the percentage of births within a year of a previous birth among women in the United States is one of the Center's for Disease Control and Prevention's Healthy People 2010 goals. Use of effective contraceptive methods after a recent pregnancy can help prevent unintended pregnancies, ensure adequate birth spacing, and reduce adverse maternal and infant outcomes, according to Maura Whiteman, Ph.D., and colleagues at the CDC.

The researchers reviewed data from the CDC's Pregnancy Risk Assessment Monitoring System from 2004-2006 from New York City and 12 states. The postpartum period was defined as 2-9 months after giving birth.

The report is the first population-based study designed to examine differences in postpartum contraceptive use based on maternal characteristics (MMWR 2009;58:821-6).

Overall, 62% of of 43,887 postpartum women reported using highly effective contraceptive methods (such as sterilization, IUD, pill, patch, or ring). Another 20% reported using moderately effective methods (such as condoms) and 6% reported using less effective methods (such as the rhythm method, sponge, or diaphragm), while 12% reported no postpartum contraception.

Women who were least likely to use at least one method of contraception included those who had no prenatal care, women aged 35 years and older, women who said they wanted to get pregnant sooner, and women who identified themselves as Asian/Pacific Islander.

Highly effective postpartum contraception use by age ranged from a low of 53% among women aged 35 and older to a high of 73% among women younger than 20 years.

When the data were broken down by race, the use of highly effective postpartum contraception ranged from a low of 35% among Asian/Pacific Islanders to a high of 71% among black women and American Indian/Alaska Native women, Dr. Whiteman and associates reported.

In addition, women who had Medicaid coverage prior to pregnancy were more likely to use highly effective contraception postpartum than women who did not have Medicaid, while women with no prenatal care were less likely to use highly effective contraception postpartum than those who had any prenatal care.

The study was limited by several factors, including the use of self reports, a lack of data from all parts of the United States, and a lack of data on several additional contraceptive methods such as spermicides, emergency contraception, and lactational amenorrhea.

But the results can help clinicians identify women who need more information about postpartum contraception, the researchers noted.

“Health care providers should consider encouraging postpartum women to use highly effective contraceptive methods to increase the proportion of pregnancies that are intended and promote healthy birth spacing,” they said.

The majority (88%) of postpartum women reported current use of at least one form of contraception, based on an analysis of data from more than 43,000 women.

Reducing the percentage of births within a year of a previous birth among women in the United States is one of the Center's for Disease Control and Prevention's Healthy People 2010 goals. Use of effective contraceptive methods after a recent pregnancy can help prevent unintended pregnancies, ensure adequate birth spacing, and reduce adverse maternal and infant outcomes, according to Maura Whiteman, Ph.D., and colleagues at the CDC.

The researchers reviewed data from the CDC's Pregnancy Risk Assessment Monitoring System from 2004-2006 from New York City and 12 states. The postpartum period was defined as 2-9 months after giving birth.

The report is the first population-based study designed to examine differences in postpartum contraceptive use based on maternal characteristics (MMWR 2009;58:821-6).

Overall, 62% of of 43,887 postpartum women reported using highly effective contraceptive methods (such as sterilization, IUD, pill, patch, or ring). Another 20% reported using moderately effective methods (such as condoms) and 6% reported using less effective methods (such as the rhythm method, sponge, or diaphragm), while 12% reported no postpartum contraception.

Women who were least likely to use at least one method of contraception included those who had no prenatal care, women aged 35 years and older, women who said they wanted to get pregnant sooner, and women who identified themselves as Asian/Pacific Islander.

Highly effective postpartum contraception use by age ranged from a low of 53% among women aged 35 and older to a high of 73% among women younger than 20 years.

When the data were broken down by race, the use of highly effective postpartum contraception ranged from a low of 35% among Asian/Pacific Islanders to a high of 71% among black women and American Indian/Alaska Native women, Dr. Whiteman and associates reported.

In addition, women who had Medicaid coverage prior to pregnancy were more likely to use highly effective contraception postpartum than women who did not have Medicaid, while women with no prenatal care were less likely to use highly effective contraception postpartum than those who had any prenatal care.

The study was limited by several factors, including the use of self reports, a lack of data from all parts of the United States, and a lack of data on several additional contraceptive methods such as spermicides, emergency contraception, and lactational amenorrhea.

But the results can help clinicians identify women who need more information about postpartum contraception, the researchers noted.

“Health care providers should consider encouraging postpartum women to use highly effective contraceptive methods to increase the proportion of pregnancies that are intended and promote healthy birth spacing,” they said.

The Centers for Disease Control and Prevention has posted on its Web site guidance on novel influenza A(H1N1) vaccination of interest to clinicians, as well as to state and local governments.

The CDC's vaccination planning Q&A page addresses issues including vaccine administration and cost. When administering the vaccine, physicians and other health care planners should assume that two doses will be needed. This will not be confirmed “until the late summer- early fall, once clinical trials are completed,” the site says.

Among other points from the Q&A:

▸ Dosage. Physicians should assume 21-28 days between the first and second vaccinations, but at this time there will be no federal requirement to recall individuals for a second dose if necessary. The first and second doses may not be the same product, although ideally they will be.

▸ Formula. An adjuvanted H1N1 vaccine is unlikely, but the exact formulation of the vaccine will vary by provider, and the CDC will provide more information about adjuvants, storage requirements, and mixing procedures once data from the vaccine's clinical trials are available.

▸ Logistics. Clinical trials are ongoing, but the CDC expects that the H1N1 vaccine may be given at the same visit as the seasonal flu vaccine.

▸ Priorities. The CDC's Advisory Committee on Immunization Practices has recommended that initial H1N1 vaccinations be prioritized for five target groups: emergency medical personnel, pregnant women, children and adults aged 6 months to 24 years, caregivers and cohabitants of children younger than 6 months, and adults aged 25-64 years who are immunocompromised or who have chronic health conditions that may increase their flu risk.

▸ Pneumococcal vaccine. Although there is potential for increased risk of pneumococcal disease associated with influenza, the CDC has no new recommendations for administering the pneumococcal vaccine to groups other than those for whom it is currently recommended. But this could change as summer flu epidemiologic data become available.

In response to a CDC query regarding cost, America's Health Insurance Plans (AHIP) said in a statement: “Public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings, e.g., doctor's offices, ambulatory clinics, health care facilities, and in nontraditional settings, where contracts with insurers have been established.” AHIP is an organization representing more than 1,000 health insurance companies in the United States.

The CDC's guidance for other issues related to the cost of H1N1 vaccination covers these points:

▸ The uninsured. Private providers will be able to charge uninsured patients up to the allowable Medicare charge for their region for the vaccination, as long as the provider has signed an H1N1 influenza vaccine Provider Agreement.

▸ Public health clinics. Public health clinics will receive “implementation funds to support H1N1 vaccination clinics,” according to the Web site. “Public health departments can bill… for an H1N1 vaccine administration fee, but cannot turn anyone away due to inability to pay.”

For the CDC's complete Q&A on H1N1 vaccination planning, visit www.cdc.gov/h1n1flu/vaccination/statelocal/qa.htm

The Centers for Disease Control and Prevention has posted on its Web site guidance on novel influenza A(H1N1) vaccination of interest to clinicians, as well as to state and local governments.

The CDC's vaccination planning Q&A page addresses issues including vaccine administration and cost. When administering the vaccine, physicians and other health care planners should assume that two doses will be needed. This will not be confirmed “until the late summer- early fall, once clinical trials are completed,” the site says.

Among other points from the Q&A:

▸ Dosage. Physicians should assume 21-28 days between the first and second vaccinations, but at this time there will be no federal requirement to recall individuals for a second dose if necessary. The first and second doses may not be the same product, although ideally they will be.

▸ Formula. An adjuvanted H1N1 vaccine is unlikely, but the exact formulation of the vaccine will vary by provider, and the CDC will provide more information about adjuvants, storage requirements, and mixing procedures once data from the vaccine's clinical trials are available.

▸ Logistics. Clinical trials are ongoing, but the CDC expects that the H1N1 vaccine may be given at the same visit as the seasonal flu vaccine.

▸ Priorities. The CDC's Advisory Committee on Immunization Practices has recommended that initial H1N1 vaccinations be prioritized for five target groups: emergency medical personnel, pregnant women, children and adults aged 6 months to 24 years, caregivers and cohabitants of children younger than 6 months, and adults aged 25-64 years who are immunocompromised or who have chronic health conditions that may increase their flu risk.

▸ Pneumococcal vaccine. Although there is potential for increased risk of pneumococcal disease associated with influenza, the CDC has no new recommendations for administering the pneumococcal vaccine to groups other than those for whom it is currently recommended. But this could change as summer flu epidemiologic data become available.

In response to a CDC query regarding cost, America's Health Insurance Plans (AHIP) said in a statement: “Public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings, e.g., doctor's offices, ambulatory clinics, health care facilities, and in nontraditional settings, where contracts with insurers have been established.” AHIP is an organization representing more than 1,000 health insurance companies in the United States.

The CDC's guidance for other issues related to the cost of H1N1 vaccination covers these points:

▸ The uninsured. Private providers will be able to charge uninsured patients up to the allowable Medicare charge for their region for the vaccination, as long as the provider has signed an H1N1 influenza vaccine Provider Agreement.

▸ Public health clinics. Public health clinics will receive “implementation funds to support H1N1 vaccination clinics,” according to the Web site. “Public health departments can bill… for an H1N1 vaccine administration fee, but cannot turn anyone away due to inability to pay.”

For the CDC's complete Q&A on H1N1 vaccination planning, visit www.cdc.gov/h1n1flu/vaccination/statelocal/qa.htm

The Centers for Disease Control and Prevention has posted on its Web site guidance on novel influenza A(H1N1) vaccination of interest to clinicians, as well as to state and local governments.

The CDC's vaccination planning Q&A page addresses issues including vaccine administration and cost. When administering the vaccine, physicians and other health care planners should assume that two doses will be needed. This will not be confirmed “until the late summer- early fall, once clinical trials are completed,” the site says.

Among other points from the Q&A:

▸ Dosage. Physicians should assume 21-28 days between the first and second vaccinations, but at this time there will be no federal requirement to recall individuals for a second dose if necessary. The first and second doses may not be the same product, although ideally they will be.

▸ Formula. An adjuvanted H1N1 vaccine is unlikely, but the exact formulation of the vaccine will vary by provider, and the CDC will provide more information about adjuvants, storage requirements, and mixing procedures once data from the vaccine's clinical trials are available.

▸ Logistics. Clinical trials are ongoing, but the CDC expects that the H1N1 vaccine may be given at the same visit as the seasonal flu vaccine.

▸ Priorities. The CDC's Advisory Committee on Immunization Practices has recommended that initial H1N1 vaccinations be prioritized for five target groups: emergency medical personnel, pregnant women, children and adults aged 6 months to 24 years, caregivers and cohabitants of children younger than 6 months, and adults aged 25-64 years who are immunocompromised or who have chronic health conditions that may increase their flu risk.

▸ Pneumococcal vaccine. Although there is potential for increased risk of pneumococcal disease associated with influenza, the CDC has no new recommendations for administering the pneumococcal vaccine to groups other than those for whom it is currently recommended. But this could change as summer flu epidemiologic data become available.

In response to a CDC query regarding cost, America's Health Insurance Plans (AHIP) said in a statement: “Public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings, e.g., doctor's offices, ambulatory clinics, health care facilities, and in nontraditional settings, where contracts with insurers have been established.” AHIP is an organization representing more than 1,000 health insurance companies in the United States.

The CDC's guidance for other issues related to the cost of H1N1 vaccination covers these points:

▸ The uninsured. Private providers will be able to charge uninsured patients up to the allowable Medicare charge for their region for the vaccination, as long as the provider has signed an H1N1 influenza vaccine Provider Agreement.

▸ Public health clinics. Public health clinics will receive “implementation funds to support H1N1 vaccination clinics,” according to the Web site. “Public health departments can bill… for an H1N1 vaccine administration fee, but cannot turn anyone away due to inability to pay.”

For the CDC's complete Q&A on H1N1 vaccination planning, visit www.cdc.gov/h1n1flu/vaccination/statelocal/qa.htm

For the CDC's Q&A on H1N1 vaccination planning, visit www.cdc.gov/h1n1flu/vaccination/statelocal/qa.htm

The Centers for Disease Control and Prevention offers novel influenza A(H1N1) vaccination planning guidance of interest to clinicians, as well as to state and local governments, on its Web site.

The CDC's vaccination planning Q&A page addresses issues including vaccine administration and cost.

When administering the vaccine, physicians and other health care planners should assume that two doses will be needed. This will not be confirmed "until the late summer- early fall, once clinical trials are completed," the site says. Among other points from the Q&A:

▸Dosage: Physicians should assume 21–28 days between the first and second vaccinations, but at this time there will be no federal requirement to recall individuals for a second dose if necessary. The first and second doses may not be the same product, although ideally they will.

▸Formula: An adjuvanted H1N1 vaccine is unlikely, but the exact formulation of the vaccine will vary by provider, and the CDC will provide more information about adjuvants, storage requirements, and mixing procedures once data from the vaccine's clinical trials are available.

▸Logistics: Clinical trials are ongoing, but the CDC expects that the H1N1 vaccine may be given at the same visit as the seasonal flu vaccine.

▸Pneumococcal vaccine: While there is potential for increased risk of pneumococcal disease associated with influenza, the CDC has no new recommendations for administering the pneumococcal vaccine to groups other than those for whom it is currently recommended. But this could change as summer flu epidemiologic data become available.

In response to a CDC query regarding cost, America's Health Insurance Plans (AHIP) said, "Public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings e.g., doctor's offices, ambulatory clinics, health care facilities, and in nontraditional settings, where contracts with insurers have been established." AHIP is an organization representing more than 1,000 health insurance companies in the United States.

The CDC's guidance for other issues related to the cost of H1N1 vaccination includes:

▸The uninsured: Private providers will be able to charge uninsured patients up to the allowable Medicare charge for their region.

▸Public health clinics: Public health clinics will receive "implementation funds to support H1N1 vaccination clinics," according to the Web site. "Public health departments can bill … for an H1N1 vaccine administration fee, but cannot turn anyone away due to inability to pay."

For the CDC's Q&A on H1N1 vaccination planning, visit www.cdc.gov/h1n1flu/vaccination/statelocal/qa.htm

The Centers for Disease Control and Prevention offers novel influenza A(H1N1) vaccination planning guidance of interest to clinicians, as well as to state and local governments, on its Web site.

The CDC's vaccination planning Q&A page addresses issues including vaccine administration and cost.

When administering the vaccine, physicians and other health care planners should assume that two doses will be needed. This will not be confirmed "until the late summer- early fall, once clinical trials are completed," the site says. Among other points from the Q&A:

▸Dosage: Physicians should assume 21–28 days between the first and second vaccinations, but at this time there will be no federal requirement to recall individuals for a second dose if necessary. The first and second doses may not be the same product, although ideally they will.

▸Formula: An adjuvanted H1N1 vaccine is unlikely, but the exact formulation of the vaccine will vary by provider, and the CDC will provide more information about adjuvants, storage requirements, and mixing procedures once data from the vaccine's clinical trials are available.

▸Logistics: Clinical trials are ongoing, but the CDC expects that the H1N1 vaccine may be given at the same visit as the seasonal flu vaccine.

▸Pneumococcal vaccine: While there is potential for increased risk of pneumococcal disease associated with influenza, the CDC has no new recommendations for administering the pneumococcal vaccine to groups other than those for whom it is currently recommended. But this could change as summer flu epidemiologic data become available.

In response to a CDC query regarding cost, America's Health Insurance Plans (AHIP) said, "Public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings e.g., doctor's offices, ambulatory clinics, health care facilities, and in nontraditional settings, where contracts with insurers have been established." AHIP is an organization representing more than 1,000 health insurance companies in the United States.

The CDC's guidance for other issues related to the cost of H1N1 vaccination includes:

▸The uninsured: Private providers will be able to charge uninsured patients up to the allowable Medicare charge for their region.

▸Public health clinics: Public health clinics will receive "implementation funds to support H1N1 vaccination clinics," according to the Web site. "Public health departments can bill … for an H1N1 vaccine administration fee, but cannot turn anyone away due to inability to pay."

For the CDC's Q&A on H1N1 vaccination planning, visit www.cdc.gov/h1n1flu/vaccination/statelocal/qa.htm

The Centers for Disease Control and Prevention offers novel influenza A(H1N1) vaccination planning guidance of interest to clinicians, as well as to state and local governments, on its Web site.

The CDC's vaccination planning Q&A page addresses issues including vaccine administration and cost.

When administering the vaccine, physicians and other health care planners should assume that two doses will be needed. This will not be confirmed "until the late summer- early fall, once clinical trials are completed," the site says. Among other points from the Q&A:

▸Dosage: Physicians should assume 21–28 days between the first and second vaccinations, but at this time there will be no federal requirement to recall individuals for a second dose if necessary. The first and second doses may not be the same product, although ideally they will.

▸Formula: An adjuvanted H1N1 vaccine is unlikely, but the exact formulation of the vaccine will vary by provider, and the CDC will provide more information about adjuvants, storage requirements, and mixing procedures once data from the vaccine's clinical trials are available.

▸Logistics: Clinical trials are ongoing, but the CDC expects that the H1N1 vaccine may be given at the same visit as the seasonal flu vaccine.

▸Pneumococcal vaccine: While there is potential for increased risk of pneumococcal disease associated with influenza, the CDC has no new recommendations for administering the pneumococcal vaccine to groups other than those for whom it is currently recommended. But this could change as summer flu epidemiologic data become available.

In response to a CDC query regarding cost, America's Health Insurance Plans (AHIP) said, "Public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings e.g., doctor's offices, ambulatory clinics, health care facilities, and in nontraditional settings, where contracts with insurers have been established." AHIP is an organization representing more than 1,000 health insurance companies in the United States.

The CDC's guidance for other issues related to the cost of H1N1 vaccination includes:

▸The uninsured: Private providers will be able to charge uninsured patients up to the allowable Medicare charge for their region.

▸Public health clinics: Public health clinics will receive "implementation funds to support H1N1 vaccination clinics," according to the Web site. "Public health departments can bill … for an H1N1 vaccine administration fee, but cannot turn anyone away due to inability to pay."

WASHINGTON — Surgical mask or N95 respirator? The question of whether the Centers for Disease Control and Prevention should advise the use of respirators as standard protective gear by health care workers at risk for exposure to the novel influenza A(H1N1) virus was featured at a workshop sponsored by the Institute of Medicine.

The workshop served as "an open, on-the-record, information-gathering session" for the Institute of Medicine's Committee on Personal Protective Equipment [PPE] for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A, said Dr. Kenneth Shine, chair of the committee. The committee is charged with sending a draft report to the CDC with recommendations for updated guidance on H1N1-related PPE for health care workers.

Regardless of any changes in recommendations, PPE is only one layer in a health care worker's protection against the virus, said Dr. Toby L. Merlin, deputy director of the CDC's influenza coordination unit.

"We believe emphatically that PPE is one element in a hierarchy of controls," Dr. Merlin explained. Other measures to control the spread of the novel H1N1 virus currently recommended by the CDC include wearing gloves and gowns when in contact with infected persons, practicing proper hand hygiene, covering coughs and sneezes, and isolating individuals who appear ill.

"There's no such thing as a risk-free environment," said Dr. Rosemary Sokas of the Occupational Safety and Health Administration. But Dr. Sokas emphasized that employers are responsible for providing workers with the highest level of protection possible. At the workshop, the committee heard results of several studies about the use of PPE in preventing flu transmission.

In one study, Dr. Raina MacIntyre of the University of New South Wales, Australia, and her colleagues conducted a randomized, controlled trial of more than 1,000 health care workers in 24 hospitals in Beijing.

The study compared infection rates in individuals who wore surgical masks, N95 respirators that were fit tested, N95 respirators that were not fit tested, and controls. The respirators—regardless of whether they were fit tested—were more effective than either surgical masks or controls.

There was no significant difference in effectiveness between the fit-tested and non-fit-tested N95 respirators. The complete study results will be presented at the upcoming Interscience Conference on Antimicrobial Agents and Chemotherapy meeting this month, Dr. MacIntyre said.

Despite such findings supporting the use of N95 respirators to mitigate the spread of the H1N1 virus, requiring their use might not go over well with clinicians in the trenches, said Dr. Alexander Isakov, an emergency medicine physician from Emory University in Atlanta. Dr. Isakov also serves as director of Emory's Section on Prehospital and Disaster Medicine, and as director of the Emory Office of Critical Event Preparedness and Response.

In an emergency setting, it is not always immediately clear what is required for each patient, Dr. Isakov said. Emergency departments that are already busy and may not be able to give infected patients adequate time if personnel are burdened with PPE requirements that may not be supported by sufficient evidence, he emphasized.

"The level of PPE required of emergency health care workers does have implications on their ability to do their jobs," Dr. Isakov said. PPE recommendations must be appropriate to the mission of the health care worker, he stressed. "Adding additional burdens on the health care provider for an extra modicum of safety that can't be measured might not actually benefit the health care worker or the patients they are trying to serve," he said.

For example, if doctors take longer to manage patients because they must don full protective gear before entering each room, it could slow down operations and cause more backlogs and crowding, he explained.

The committee also heard from representatives of workers' organizations, including the Service Employees Union and the American Federation of State, County, and Municipal Employees, who expressed support for keeping the current recommendation that health care workers use N95 respirators when managing patients with H1N1.

'The level of PPE required of emergency health care workers does have implications on their ability to do their jobs.'

Source DR. ISAKOV

WASHINGTON — Surgical mask or N95 respirator? The question of whether the Centers for Disease Control and Prevention should advise the use of respirators as standard protective gear by health care workers at risk for exposure to the novel influenza A(H1N1) virus was featured at a workshop sponsored by the Institute of Medicine.

The workshop served as "an open, on-the-record, information-gathering session" for the Institute of Medicine's Committee on Personal Protective Equipment [PPE] for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A, said Dr. Kenneth Shine, chair of the committee. The committee is charged with sending a draft report to the CDC with recommendations for updated guidance on H1N1-related PPE for health care workers.

Regardless of any changes in recommendations, PPE is only one layer in a health care worker's protection against the virus, said Dr. Toby L. Merlin, deputy director of the CDC's influenza coordination unit.

"We believe emphatically that PPE is one element in a hierarchy of controls," Dr. Merlin explained. Other measures to control the spread of the novel H1N1 virus currently recommended by the CDC include wearing gloves and gowns when in contact with infected persons, practicing proper hand hygiene, covering coughs and sneezes, and isolating individuals who appear ill.

"There's no such thing as a risk-free environment," said Dr. Rosemary Sokas of the Occupational Safety and Health Administration. But Dr. Sokas emphasized that employers are responsible for providing workers with the highest level of protection possible. At the workshop, the committee heard results of several studies about the use of PPE in preventing flu transmission.

In one study, Dr. Raina MacIntyre of the University of New South Wales, Australia, and her colleagues conducted a randomized, controlled trial of more than 1,000 health care workers in 24 hospitals in Beijing.

The study compared infection rates in individuals who wore surgical masks, N95 respirators that were fit tested, N95 respirators that were not fit tested, and controls. The respirators—regardless of whether they were fit tested—were more effective than either surgical masks or controls.

There was no significant difference in effectiveness between the fit-tested and non-fit-tested N95 respirators. The complete study results will be presented at the upcoming Interscience Conference on Antimicrobial Agents and Chemotherapy meeting this month, Dr. MacIntyre said.

Despite such findings supporting the use of N95 respirators to mitigate the spread of the H1N1 virus, requiring their use might not go over well with clinicians in the trenches, said Dr. Alexander Isakov, an emergency medicine physician from Emory University in Atlanta. Dr. Isakov also serves as director of Emory's Section on Prehospital and Disaster Medicine, and as director of the Emory Office of Critical Event Preparedness and Response.

In an emergency setting, it is not always immediately clear what is required for each patient, Dr. Isakov said. Emergency departments that are already busy and may not be able to give infected patients adequate time if personnel are burdened with PPE requirements that may not be supported by sufficient evidence, he emphasized.

"The level of PPE required of emergency health care workers does have implications on their ability to do their jobs," Dr. Isakov said. PPE recommendations must be appropriate to the mission of the health care worker, he stressed. "Adding additional burdens on the health care provider for an extra modicum of safety that can't be measured might not actually benefit the health care worker or the patients they are trying to serve," he said.

For example, if doctors take longer to manage patients because they must don full protective gear before entering each room, it could slow down operations and cause more backlogs and crowding, he explained.

The committee also heard from representatives of workers' organizations, including the Service Employees Union and the American Federation of State, County, and Municipal Employees, who expressed support for keeping the current recommendation that health care workers use N95 respirators when managing patients with H1N1.

'The level of PPE required of emergency health care workers does have implications on their ability to do their jobs.'

Source DR. ISAKOV

WASHINGTON — Surgical mask or N95 respirator? The question of whether the Centers for Disease Control and Prevention should advise the use of respirators as standard protective gear by health care workers at risk for exposure to the novel influenza A(H1N1) virus was featured at a workshop sponsored by the Institute of Medicine.

The workshop served as "an open, on-the-record, information-gathering session" for the Institute of Medicine's Committee on Personal Protective Equipment [PPE] for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A, said Dr. Kenneth Shine, chair of the committee. The committee is charged with sending a draft report to the CDC with recommendations for updated guidance on H1N1-related PPE for health care workers.

Regardless of any changes in recommendations, PPE is only one layer in a health care worker's protection against the virus, said Dr. Toby L. Merlin, deputy director of the CDC's influenza coordination unit.

"We believe emphatically that PPE is one element in a hierarchy of controls," Dr. Merlin explained. Other measures to control the spread of the novel H1N1 virus currently recommended by the CDC include wearing gloves and gowns when in contact with infected persons, practicing proper hand hygiene, covering coughs and sneezes, and isolating individuals who appear ill.

"There's no such thing as a risk-free environment," said Dr. Rosemary Sokas of the Occupational Safety and Health Administration. But Dr. Sokas emphasized that employers are responsible for providing workers with the highest level of protection possible. At the workshop, the committee heard results of several studies about the use of PPE in preventing flu transmission.

In one study, Dr. Raina MacIntyre of the University of New South Wales, Australia, and her colleagues conducted a randomized, controlled trial of more than 1,000 health care workers in 24 hospitals in Beijing.

The study compared infection rates in individuals who wore surgical masks, N95 respirators that were fit tested, N95 respirators that were not fit tested, and controls. The respirators—regardless of whether they were fit tested—were more effective than either surgical masks or controls.

There was no significant difference in effectiveness between the fit-tested and non-fit-tested N95 respirators. The complete study results will be presented at the upcoming Interscience Conference on Antimicrobial Agents and Chemotherapy meeting this month, Dr. MacIntyre said.

Despite such findings supporting the use of N95 respirators to mitigate the spread of the H1N1 virus, requiring their use might not go over well with clinicians in the trenches, said Dr. Alexander Isakov, an emergency medicine physician from Emory University in Atlanta. Dr. Isakov also serves as director of Emory's Section on Prehospital and Disaster Medicine, and as director of the Emory Office of Critical Event Preparedness and Response.

In an emergency setting, it is not always immediately clear what is required for each patient, Dr. Isakov said. Emergency departments that are already busy and may not be able to give infected patients adequate time if personnel are burdened with PPE requirements that may not be supported by sufficient evidence, he emphasized.

"The level of PPE required of emergency health care workers does have implications on their ability to do their jobs," Dr. Isakov said. PPE recommendations must be appropriate to the mission of the health care worker, he stressed. "Adding additional burdens on the health care provider for an extra modicum of safety that can't be measured might not actually benefit the health care worker or the patients they are trying to serve," he said.

For example, if doctors take longer to manage patients because they must don full protective gear before entering each room, it could slow down operations and cause more backlogs and crowding, he explained.

The committee also heard from representatives of workers' organizations, including the Service Employees Union and the American Federation of State, County, and Municipal Employees, who expressed support for keeping the current recommendation that health care workers use N95 respirators when managing patients with H1N1.

'The level of PPE required of emergency health care workers does have implications on their ability to do their jobs.'

Source DR. ISAKOV

WASHINGTON — Curbing the obesity epidemic requires community intervention, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at the CDC's Weight of the Nation conference.

“The only way on a societal basis to reduce the prevalence of obesity is through community action, not through individual clinical interventions,” Dr. Frieden said in a press conference.

“We got to this stage in the [obesity] epidemic because of a change in our environment,” he said. “Only a change in our environment again will allow us to get back to a healthier place.”

To help communities respond to the obesity epidemic, the CDC launched Common Community Measures for Obesity Prevention. As part of this project, the CDC convened a panel of experts in a variety of areas including nutrition, urban planning, and physical activity, as well as obesity prevention. The complete recommendations, along with supporting evidence and suggestions for implementation, were published in the Morbidity and Mortality Weekly Report (2009:58 [RR-7]:1-26).

“We can't wait for the best possible evidence; we have to act on the best available evidence,” explained Dr. William Dietz, director of the CDC's Division of Nutrition, Physical Activity, and Obesity. Dr. Dietz presented the CDC's recommendations at a press conference.

The panel agreed on 24 strategies, which fall into six categories:

▸ To promote availability of affordable healthy foods and beverages (e.g., adding grocery stores in underserved areas).

▸ To support healthy food and beverage choices (e.g., limiting ads for unhealthy food and beverages).

▸ To encourage breast-feeding (e.g., encouraging workplaces to support breastfeeding mothers).

▸ To encourage physical activity or limit sedentary activity in children and adolescents (e.g., requiring physical education in schools).

▸ To create safe communities that support physical activity (e.g., enhancing infrastructure to support walking and biking).

▸ To encourage communities to organize for change (e.g., participating in coalitions and partnerships to address obesity).

The panel chose strategies that are likely to have a broad reach and a long-term, meaningful impact on health, according to the full report. And the panel deemed the strategies reasonable for a community to implement.

“Of course there are important things that physicians can do in their own practices, in terms of measuring [body mass index], counseling patients, and taking action to encourage weight loss and maintenance of weight loss,” Dr. Frieden said.

But physicians' roles shouldn't begin and end in the office setting, he added.

“I think there is a responsibility to physicians and the medical profession generally to be active in their communities promoting prevention,” said Dr. Frieden. It is often physicians who encourage community actions and influence policy makers, he emphasized.

It is often physicians who encourage community actions and influence policy makers.

Source DR. FRIEDEN

WASHINGTON — Curbing the obesity epidemic requires community intervention, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at the CDC's Weight of the Nation conference.

“The only way on a societal basis to reduce the prevalence of obesity is through community action, not through individual clinical interventions,” Dr. Frieden said in a press conference.

“We got to this stage in the [obesity] epidemic because of a change in our environment,” he said. “Only a change in our environment again will allow us to get back to a healthier place.”

To help communities respond to the obesity epidemic, the CDC launched Common Community Measures for Obesity Prevention. As part of this project, the CDC convened a panel of experts in a variety of areas including nutrition, urban planning, and physical activity, as well as obesity prevention. The complete recommendations, along with supporting evidence and suggestions for implementation, were published in the Morbidity and Mortality Weekly Report (2009:58 [RR-7]:1-26).

“We can't wait for the best possible evidence; we have to act on the best available evidence,” explained Dr. William Dietz, director of the CDC's Division of Nutrition, Physical Activity, and Obesity. Dr. Dietz presented the CDC's recommendations at a press conference.

The panel agreed on 24 strategies, which fall into six categories:

▸ To promote availability of affordable healthy foods and beverages (e.g., adding grocery stores in underserved areas).

▸ To support healthy food and beverage choices (e.g., limiting ads for unhealthy food and beverages).

▸ To encourage breast-feeding (e.g., encouraging workplaces to support breastfeeding mothers).

▸ To encourage physical activity or limit sedentary activity in children and adolescents (e.g., requiring physical education in schools).

▸ To create safe communities that support physical activity (e.g., enhancing infrastructure to support walking and biking).

▸ To encourage communities to organize for change (e.g., participating in coalitions and partnerships to address obesity).

The panel chose strategies that are likely to have a broad reach and a long-term, meaningful impact on health, according to the full report. And the panel deemed the strategies reasonable for a community to implement.

“Of course there are important things that physicians can do in their own practices, in terms of measuring [body mass index], counseling patients, and taking action to encourage weight loss and maintenance of weight loss,” Dr. Frieden said.

But physicians' roles shouldn't begin and end in the office setting, he added.

“I think there is a responsibility to physicians and the medical profession generally to be active in their communities promoting prevention,” said Dr. Frieden. It is often physicians who encourage community actions and influence policy makers, he emphasized.

It is often physicians who encourage community actions and influence policy makers.

Source DR. FRIEDEN

WASHINGTON — Curbing the obesity epidemic requires community intervention, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at the CDC's Weight of the Nation conference.

“The only way on a societal basis to reduce the prevalence of obesity is through community action, not through individual clinical interventions,” Dr. Frieden said in a press conference.

“We got to this stage in the [obesity] epidemic because of a change in our environment,” he said. “Only a change in our environment again will allow us to get back to a healthier place.”

To help communities respond to the obesity epidemic, the CDC launched Common Community Measures for Obesity Prevention. As part of this project, the CDC convened a panel of experts in a variety of areas including nutrition, urban planning, and physical activity, as well as obesity prevention. The complete recommendations, along with supporting evidence and suggestions for implementation, were published in the Morbidity and Mortality Weekly Report (2009:58 [RR-7]:1-26).

“We can't wait for the best possible evidence; we have to act on the best available evidence,” explained Dr. William Dietz, director of the CDC's Division of Nutrition, Physical Activity, and Obesity. Dr. Dietz presented the CDC's recommendations at a press conference.

The panel agreed on 24 strategies, which fall into six categories:

▸ To promote availability of affordable healthy foods and beverages (e.g., adding grocery stores in underserved areas).

▸ To support healthy food and beverage choices (e.g., limiting ads for unhealthy food and beverages).

▸ To encourage breast-feeding (e.g., encouraging workplaces to support breastfeeding mothers).

▸ To encourage physical activity or limit sedentary activity in children and adolescents (e.g., requiring physical education in schools).

▸ To create safe communities that support physical activity (e.g., enhancing infrastructure to support walking and biking).

▸ To encourage communities to organize for change (e.g., participating in coalitions and partnerships to address obesity).

The panel chose strategies that are likely to have a broad reach and a long-term, meaningful impact on health, according to the full report. And the panel deemed the strategies reasonable for a community to implement.

“Of course there are important things that physicians can do in their own practices, in terms of measuring [body mass index], counseling patients, and taking action to encourage weight loss and maintenance of weight loss,” Dr. Frieden said.

But physicians' roles shouldn't begin and end in the office setting, he added.

“I think there is a responsibility to physicians and the medical profession generally to be active in their communities promoting prevention,” said Dr. Frieden. It is often physicians who encourage community actions and influence policy makers, he emphasized.

It is often physicians who encourage community actions and influence policy makers.

Source DR. FRIEDEN