Jan Dyer

In 1976, several thousand members of the American Legion were celebrating the bicentennial in Philadelphia, and many were staying at the Bellevue-Stratford Hotel. Within a week of the convention, more than 182 attendees, mostly men, had been hospitalized with tiredness, chest pains, congestion, and fever, and 29 had died.

Finally, a year later the deadly bacterium infecting them was identified. Although also responsible for earlier outbreaks, Legionella pneumophila had been breeding in the hotel’s cooling towers. An important overlooked clue was that even people simply walking by the hotel got sick.

Although that outbreak led to changes in how water management and climate control systems are monitored, the bacterium still takes about 5,000 lives a year. According to the CDC, between 2000 and 2014, reported cases of legionellosis, which comprises both Legionnaire disease and a milder form, Pontiac fever, jumped 286%.

The data come from 27 field investigations of outbreaks, involving 415 cases. Of those, health care-associated outbreaks accounted for 57%. Although 44% of the cases were travel related, the health care-related outbreaks resulted in more deaths.

The CDC-investigated outbreak sources all had at least 1 deficiency, and half had deficiencies in more than 2 categories. Most cases were linked to process failures, such as contaminated potable water and human error.

The infection is fatal for about 1 in 10 people. Those at highest risk are people aged ≥ 50 years, smokers, and those with chronic lung disease, weakened immune systems, or other underlying medical conditions.

The CDC says the federal government is improving health care for veterans by requiring plans for prevention of Legionnaires disease at VHA hospitals and long-term care facilities. Health care providers can test (using a urinary antigen test and a culture from a lower respiratory specimen) for Legionnaires disease in people with serious pneumonia, especially those in intensive care or who recently stayed in a health care facility or hotel, or on a cruise ship.

Widespread use of effective water management programs, the CDC advises, in addition to early diagnosis, might reduce the number and size of Legionnaires disease outbreaks.

In 1976, several thousand members of the American Legion were celebrating the bicentennial in Philadelphia, and many were staying at the Bellevue-Stratford Hotel. Within a week of the convention, more than 182 attendees, mostly men, had been hospitalized with tiredness, chest pains, congestion, and fever, and 29 had died.

Finally, a year later the deadly bacterium infecting them was identified. Although also responsible for earlier outbreaks, Legionella pneumophila had been breeding in the hotel’s cooling towers. An important overlooked clue was that even people simply walking by the hotel got sick.

Although that outbreak led to changes in how water management and climate control systems are monitored, the bacterium still takes about 5,000 lives a year. According to the CDC, between 2000 and 2014, reported cases of legionellosis, which comprises both Legionnaire disease and a milder form, Pontiac fever, jumped 286%.

The data come from 27 field investigations of outbreaks, involving 415 cases. Of those, health care-associated outbreaks accounted for 57%. Although 44% of the cases were travel related, the health care-related outbreaks resulted in more deaths.

The CDC-investigated outbreak sources all had at least 1 deficiency, and half had deficiencies in more than 2 categories. Most cases were linked to process failures, such as contaminated potable water and human error.

The infection is fatal for about 1 in 10 people. Those at highest risk are people aged ≥ 50 years, smokers, and those with chronic lung disease, weakened immune systems, or other underlying medical conditions.

The CDC says the federal government is improving health care for veterans by requiring plans for prevention of Legionnaires disease at VHA hospitals and long-term care facilities. Health care providers can test (using a urinary antigen test and a culture from a lower respiratory specimen) for Legionnaires disease in people with serious pneumonia, especially those in intensive care or who recently stayed in a health care facility or hotel, or on a cruise ship.

Widespread use of effective water management programs, the CDC advises, in addition to early diagnosis, might reduce the number and size of Legionnaires disease outbreaks.

In 1976, several thousand members of the American Legion were celebrating the bicentennial in Philadelphia, and many were staying at the Bellevue-Stratford Hotel. Within a week of the convention, more than 182 attendees, mostly men, had been hospitalized with tiredness, chest pains, congestion, and fever, and 29 had died.

Finally, a year later the deadly bacterium infecting them was identified. Although also responsible for earlier outbreaks, Legionella pneumophila had been breeding in the hotel’s cooling towers. An important overlooked clue was that even people simply walking by the hotel got sick.

Although that outbreak led to changes in how water management and climate control systems are monitored, the bacterium still takes about 5,000 lives a year. According to the CDC, between 2000 and 2014, reported cases of legionellosis, which comprises both Legionnaire disease and a milder form, Pontiac fever, jumped 286%.

The data come from 27 field investigations of outbreaks, involving 415 cases. Of those, health care-associated outbreaks accounted for 57%. Although 44% of the cases were travel related, the health care-related outbreaks resulted in more deaths.

The CDC-investigated outbreak sources all had at least 1 deficiency, and half had deficiencies in more than 2 categories. Most cases were linked to process failures, such as contaminated potable water and human error.

The infection is fatal for about 1 in 10 people. Those at highest risk are people aged ≥ 50 years, smokers, and those with chronic lung disease, weakened immune systems, or other underlying medical conditions.

The CDC says the federal government is improving health care for veterans by requiring plans for prevention of Legionnaires disease at VHA hospitals and long-term care facilities. Health care providers can test (using a urinary antigen test and a culture from a lower respiratory specimen) for Legionnaires disease in people with serious pneumonia, especially those in intensive care or who recently stayed in a health care facility or hotel, or on a cruise ship.

Widespread use of effective water management programs, the CDC advises, in addition to early diagnosis, might reduce the number and size of Legionnaires disease outbreaks.

The IHS and Centers for Medicare & Medicaid Services (CMS) are partnering to “strengthen the quality of care delivered in IHS-operated hospitals.” IHS hospitals will receive assistance from a CMS-supported Hospital Engagement Network (HEN) whose purpose is to help health care facilities deliver better care and spend more efficiently. The effort includes IHS hospitals in the Great Plains Area.

The HENs focus on reducing preventable patient harm, such as hospital-acquired infections and avoidable readmissions. They help identify proven solutions and then share them among hospitals. The HENs also track and monitor hospital progress in meeting quality improvement goals. The IHS will be able to access technical assistance and support, for example, from quality improvement experts.

This is not the first time the 2 organizations have joined forces. The new partnership actually dates from 2013, when some parts of IHS participated in a “first-round” HEN. “Quality improvement is a continuous effort at IHS hospitals—as it is at all health care facilities,” says Mary Smith, IHS principal deputy director. “Working with a Hospital Engagement Network brings more resources and underscores our commitment to focus on delivering efficient and high-quality care for our patients.”

The IHS and Centers for Medicare & Medicaid Services (CMS) are partnering to “strengthen the quality of care delivered in IHS-operated hospitals.” IHS hospitals will receive assistance from a CMS-supported Hospital Engagement Network (HEN) whose purpose is to help health care facilities deliver better care and spend more efficiently. The effort includes IHS hospitals in the Great Plains Area.

The HENs focus on reducing preventable patient harm, such as hospital-acquired infections and avoidable readmissions. They help identify proven solutions and then share them among hospitals. The HENs also track and monitor hospital progress in meeting quality improvement goals. The IHS will be able to access technical assistance and support, for example, from quality improvement experts.

This is not the first time the 2 organizations have joined forces. The new partnership actually dates from 2013, when some parts of IHS participated in a “first-round” HEN. “Quality improvement is a continuous effort at IHS hospitals—as it is at all health care facilities,” says Mary Smith, IHS principal deputy director. “Working with a Hospital Engagement Network brings more resources and underscores our commitment to focus on delivering efficient and high-quality care for our patients.”

The IHS and Centers for Medicare & Medicaid Services (CMS) are partnering to “strengthen the quality of care delivered in IHS-operated hospitals.” IHS hospitals will receive assistance from a CMS-supported Hospital Engagement Network (HEN) whose purpose is to help health care facilities deliver better care and spend more efficiently. The effort includes IHS hospitals in the Great Plains Area.

The HENs focus on reducing preventable patient harm, such as hospital-acquired infections and avoidable readmissions. They help identify proven solutions and then share them among hospitals. The HENs also track and monitor hospital progress in meeting quality improvement goals. The IHS will be able to access technical assistance and support, for example, from quality improvement experts.

This is not the first time the 2 organizations have joined forces. The new partnership actually dates from 2013, when some parts of IHS participated in a “first-round” HEN. “Quality improvement is a continuous effort at IHS hospitals—as it is at all health care facilities,” says Mary Smith, IHS principal deputy director. “Working with a Hospital Engagement Network brings more resources and underscores our commitment to focus on delivering efficient and high-quality care for our patients.”

Standard and intensive blood pressure treatments are equally effective in emergency treatment of acute intracerebral hemorrhage, according to a study funded by the National Institute of Neurological Disorders and Stroke. That is, reducing systolic blood pressure rapidly to 140-179 mm Hg worked as well as reducing to 110-139 mm Hg.

“For decades, doctors wondered whether intensive blood pressure management was more effective than standard treatment for controlling intracerebral hemorrhage,” said principal investigator Adnan Qureshi, MD, professor of neurology, neurosurgery and radiology at the Zeenat Qureshi Stroke Research Center, University of Minnesota in Minneapolis. “Our results may help patients and their doctors make better treatment decisions.”

In the 110-site international study, 1,000 patients were treated within 4.5 hours of a stroke. Half were assigned to intensive treatment and half to standard treatment. Brain scans taken 24 hours after treatment showed no difference in the rates of hemorrhage growth between the 2 groups. Because the researchers found no differences, the study was stopped after enrolling 1,000 patients rather than 1,280.

Moreover, after 90 days, the rate of death or severe disability was about 38% in both groups—a number much lower than the expected 60%. Patients in the intensive treatment group had a slightly higher rate of serious adverse events in the 90 days after the stroke but at lower levels than expected. The researchers say that may be because more than half of enrolled patients had experienced mild strokes and had a better chance of good results.

Their findings suggest that intensive reduction in the systolic blood pressure level does not provide “an incremental clinical benefit,” the researchers say. Dr. Qureshi noted, “Rapidly lowering blood pressure to normal levels may further damage the brain. The levels we used are tolerable for emergencies. Normal levels can be safely obtained gradually.”

Standard and intensive blood pressure treatments are equally effective in emergency treatment of acute intracerebral hemorrhage, according to a study funded by the National Institute of Neurological Disorders and Stroke. That is, reducing systolic blood pressure rapidly to 140-179 mm Hg worked as well as reducing to 110-139 mm Hg.

“For decades, doctors wondered whether intensive blood pressure management was more effective than standard treatment for controlling intracerebral hemorrhage,” said principal investigator Adnan Qureshi, MD, professor of neurology, neurosurgery and radiology at the Zeenat Qureshi Stroke Research Center, University of Minnesota in Minneapolis. “Our results may help patients and their doctors make better treatment decisions.”

In the 110-site international study, 1,000 patients were treated within 4.5 hours of a stroke. Half were assigned to intensive treatment and half to standard treatment. Brain scans taken 24 hours after treatment showed no difference in the rates of hemorrhage growth between the 2 groups. Because the researchers found no differences, the study was stopped after enrolling 1,000 patients rather than 1,280.

Moreover, after 90 days, the rate of death or severe disability was about 38% in both groups—a number much lower than the expected 60%. Patients in the intensive treatment group had a slightly higher rate of serious adverse events in the 90 days after the stroke but at lower levels than expected. The researchers say that may be because more than half of enrolled patients had experienced mild strokes and had a better chance of good results.

Their findings suggest that intensive reduction in the systolic blood pressure level does not provide “an incremental clinical benefit,” the researchers say. Dr. Qureshi noted, “Rapidly lowering blood pressure to normal levels may further damage the brain. The levels we used are tolerable for emergencies. Normal levels can be safely obtained gradually.”

Standard and intensive blood pressure treatments are equally effective in emergency treatment of acute intracerebral hemorrhage, according to a study funded by the National Institute of Neurological Disorders and Stroke. That is, reducing systolic blood pressure rapidly to 140-179 mm Hg worked as well as reducing to 110-139 mm Hg.

“For decades, doctors wondered whether intensive blood pressure management was more effective than standard treatment for controlling intracerebral hemorrhage,” said principal investigator Adnan Qureshi, MD, professor of neurology, neurosurgery and radiology at the Zeenat Qureshi Stroke Research Center, University of Minnesota in Minneapolis. “Our results may help patients and their doctors make better treatment decisions.”

In the 110-site international study, 1,000 patients were treated within 4.5 hours of a stroke. Half were assigned to intensive treatment and half to standard treatment. Brain scans taken 24 hours after treatment showed no difference in the rates of hemorrhage growth between the 2 groups. Because the researchers found no differences, the study was stopped after enrolling 1,000 patients rather than 1,280.

Moreover, after 90 days, the rate of death or severe disability was about 38% in both groups—a number much lower than the expected 60%. Patients in the intensive treatment group had a slightly higher rate of serious adverse events in the 90 days after the stroke but at lower levels than expected. The researchers say that may be because more than half of enrolled patients had experienced mild strokes and had a better chance of good results.

Their findings suggest that intensive reduction in the systolic blood pressure level does not provide “an incremental clinical benefit,” the researchers say. Dr. Qureshi noted, “Rapidly lowering blood pressure to normal levels may further damage the brain. The levels we used are tolerable for emergencies. Normal levels can be safely obtained gradually.”

Intensive control of blood sugar levels can cut the risk of diabetic retinopathy in half, according to a follow-up study of the landmark ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial.

The finding from the ACCORD Follow-on eye study (ACCORDION) “sends a powerful message to people with type 2 diabetes mellitus (T2DM) who worry about losing vision,” said Emily Chew, MD, deputy director of the National Eye Institute Division of Epidemiology and Clinical Applications and lead author of the study report.

The ACCORDION trial is an assessment of diabetic retinopathy progression in 1,310 people who participated in ACCORD. That study tested 3 treatment strategies to reduce the risk of cardiovascular disease in people with longstanding T2DM: maintaining near-normal blood sugar levels (intensive control), improving blood lipid levels, and lowering blood pressure.

Because of an increase in death among participants in the intensive glycemic control group, ACCORD was aborted at 3.5 years. (The increased mortality, which was due to a range of causes, was seen in both intensive and standard groups.) From the data they had, the researchers found tight control reduced glycemia to an average HbA_1C of 6.4% compared with 7.7% among those in the standard control group. It did not cut the risk of cardiovascular disease, but it had cut retinopathy progression by about one- third when the study was abruptly ended.

The follow-up study reassessed diabetic retinopathy 4 years after the intensive control portion of ACCORD had ended, 8 years after enrollment. Average HbA_1C was nearly the same. Diabetic retinopathy, however, had advanced in only 5.8% of participants in the intensive group, compared with 12.7% of the standard treatment group.

The continuing beneficial effects—an approximately 50% reduction in risk of further retinopathy progression—are attributed to “metabolic memory,” a phenomenon also known as the “legacy effect.” Similar effects have been seen in 2 other large, long studies: the 10-year-long Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Project.

Intensive control of blood sugar levels can cut the risk of diabetic retinopathy in half, according to a follow-up study of the landmark ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial.

The finding from the ACCORD Follow-on eye study (ACCORDION) “sends a powerful message to people with type 2 diabetes mellitus (T2DM) who worry about losing vision,” said Emily Chew, MD, deputy director of the National Eye Institute Division of Epidemiology and Clinical Applications and lead author of the study report.

The ACCORDION trial is an assessment of diabetic retinopathy progression in 1,310 people who participated in ACCORD. That study tested 3 treatment strategies to reduce the risk of cardiovascular disease in people with longstanding T2DM: maintaining near-normal blood sugar levels (intensive control), improving blood lipid levels, and lowering blood pressure.

Because of an increase in death among participants in the intensive glycemic control group, ACCORD was aborted at 3.5 years. (The increased mortality, which was due to a range of causes, was seen in both intensive and standard groups.) From the data they had, the researchers found tight control reduced glycemia to an average HbA_1C of 6.4% compared with 7.7% among those in the standard control group. It did not cut the risk of cardiovascular disease, but it had cut retinopathy progression by about one- third when the study was abruptly ended.

The follow-up study reassessed diabetic retinopathy 4 years after the intensive control portion of ACCORD had ended, 8 years after enrollment. Average HbA_1C was nearly the same. Diabetic retinopathy, however, had advanced in only 5.8% of participants in the intensive group, compared with 12.7% of the standard treatment group.

The continuing beneficial effects—an approximately 50% reduction in risk of further retinopathy progression—are attributed to “metabolic memory,” a phenomenon also known as the “legacy effect.” Similar effects have been seen in 2 other large, long studies: the 10-year-long Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Project.

Intensive control of blood sugar levels can cut the risk of diabetic retinopathy in half, according to a follow-up study of the landmark ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial.

The finding from the ACCORD Follow-on eye study (ACCORDION) “sends a powerful message to people with type 2 diabetes mellitus (T2DM) who worry about losing vision,” said Emily Chew, MD, deputy director of the National Eye Institute Division of Epidemiology and Clinical Applications and lead author of the study report.

The ACCORDION trial is an assessment of diabetic retinopathy progression in 1,310 people who participated in ACCORD. That study tested 3 treatment strategies to reduce the risk of cardiovascular disease in people with longstanding T2DM: maintaining near-normal blood sugar levels (intensive control), improving blood lipid levels, and lowering blood pressure.

Because of an increase in death among participants in the intensive glycemic control group, ACCORD was aborted at 3.5 years. (The increased mortality, which was due to a range of causes, was seen in both intensive and standard groups.) From the data they had, the researchers found tight control reduced glycemia to an average HbA_1C of 6.4% compared with 7.7% among those in the standard control group. It did not cut the risk of cardiovascular disease, but it had cut retinopathy progression by about one- third when the study was abruptly ended.

The follow-up study reassessed diabetic retinopathy 4 years after the intensive control portion of ACCORD had ended, 8 years after enrollment. Average HbA_1C was nearly the same. Diabetic retinopathy, however, had advanced in only 5.8% of participants in the intensive group, compared with 12.7% of the standard treatment group.

The continuing beneficial effects—an approximately 50% reduction in risk of further retinopathy progression—are attributed to “metabolic memory,” a phenomenon also known as the “legacy effect.” Similar effects have been seen in 2 other large, long studies: the 10-year-long Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Project.

TRICARE recently announced it will cover transcranial magnetic stimulation (TMS) as a treatment for major depressive disorder. Transcranial magnetic stimulation is used when other depression treatments have not been effective. Only half the patients treated for major depressive disorder with medication and talk therapy show lasting results.

Transcranial magnetic stimulation is noninvasive, and treatments are typically outpatient, not requiring anesthesia. An electromagnetic coil placed against the scalp delivers a magnetic pulse through the skull, inducing a low-level current. The patient receives multiple pulses over several seconds. The electrical pulses stimulate nerve cells in the region of the brain that controls mood and depression. Each treatment session lasts about 40 minutes.

The new benefit is effective now. It is not part of a pilot or demonstration program but is part of the basic TRICARE benefit.

TRICARE recently announced it will cover transcranial magnetic stimulation (TMS) as a treatment for major depressive disorder. Transcranial magnetic stimulation is used when other depression treatments have not been effective. Only half the patients treated for major depressive disorder with medication and talk therapy show lasting results.

Transcranial magnetic stimulation is noninvasive, and treatments are typically outpatient, not requiring anesthesia. An electromagnetic coil placed against the scalp delivers a magnetic pulse through the skull, inducing a low-level current. The patient receives multiple pulses over several seconds. The electrical pulses stimulate nerve cells in the region of the brain that controls mood and depression. Each treatment session lasts about 40 minutes.

The new benefit is effective now. It is not part of a pilot or demonstration program but is part of the basic TRICARE benefit.

TRICARE recently announced it will cover transcranial magnetic stimulation (TMS) as a treatment for major depressive disorder. Transcranial magnetic stimulation is used when other depression treatments have not been effective. Only half the patients treated for major depressive disorder with medication and talk therapy show lasting results.

Transcranial magnetic stimulation is noninvasive, and treatments are typically outpatient, not requiring anesthesia. An electromagnetic coil placed against the scalp delivers a magnetic pulse through the skull, inducing a low-level current. The patient receives multiple pulses over several seconds. The electrical pulses stimulate nerve cells in the region of the brain that controls mood and depression. Each treatment session lasts about 40 minutes.

The new benefit is effective now. It is not part of a pilot or demonstration program but is part of the basic TRICARE benefit.

It is a brilliant, practical, and lifesaving option for kidney transplant candidates who have a living donor who is not compatible: Someone who is compatible donates while the candidate’s “first choice” donor gives a kidney to someone else on the list.

“Kidney-paired donation,” as it is called, has been bringing hope to thousands of hard-to-match patients. Now, veterans will be eligible to participate. Walter Reed National Military Medical Center is piloting a program to pioneer kidney-paired donation chains via the military share program. Family members of active-duty military service members can donate to patients listed for transplant at the Walter Reed campus. Those kidneys also will be available to veterans and their dependents as well as civilian patients.

Walter Reed surgeons perform an average of 25 transplants per year on patients from across the country.

Because a kidney-paired program can also extend through 3, 4, and higher numbers of participants, it extends the possibilities. Experts at Johns Hopkins University,  which has an exchange program, estimate that 45% of donor/recipient pairs could find a perfectly matched donor by entering the national paired kidney exchange program.

It is a brilliant, practical, and lifesaving option for kidney transplant candidates who have a living donor who is not compatible: Someone who is compatible donates while the candidate’s “first choice” donor gives a kidney to someone else on the list.

“Kidney-paired donation,” as it is called, has been bringing hope to thousands of hard-to-match patients. Now, veterans will be eligible to participate. Walter Reed National Military Medical Center is piloting a program to pioneer kidney-paired donation chains via the military share program. Family members of active-duty military service members can donate to patients listed for transplant at the Walter Reed campus. Those kidneys also will be available to veterans and their dependents as well as civilian patients.

Walter Reed surgeons perform an average of 25 transplants per year on patients from across the country.

Because a kidney-paired program can also extend through 3, 4, and higher numbers of participants, it extends the possibilities. Experts at Johns Hopkins University,  which has an exchange program, estimate that 45% of donor/recipient pairs could find a perfectly matched donor by entering the national paired kidney exchange program.

It is a brilliant, practical, and lifesaving option for kidney transplant candidates who have a living donor who is not compatible: Someone who is compatible donates while the candidate’s “first choice” donor gives a kidney to someone else on the list.

“Kidney-paired donation,” as it is called, has been bringing hope to thousands of hard-to-match patients. Now, veterans will be eligible to participate. Walter Reed National Military Medical Center is piloting a program to pioneer kidney-paired donation chains via the military share program. Family members of active-duty military service members can donate to patients listed for transplant at the Walter Reed campus. Those kidneys also will be available to veterans and their dependents as well as civilian patients.

Walter Reed surgeons perform an average of 25 transplants per year on patients from across the country.

Because a kidney-paired program can also extend through 3, 4, and higher numbers of participants, it extends the possibilities. Experts at Johns Hopkins University,  which has an exchange program, estimate that 45% of donor/recipient pairs could find a perfectly matched donor by entering the national paired kidney exchange program.

Births among all American teenagers have dropped > 40% during the past decade, according to a CDC analysis reported in MMWR. Births among Hispanic and black teens have dropped by almost half since 2006.

But despite those dramatic drops—51% among Hispanic teens and 44% among blacks—their birth rates remain twice as high than among whites. In some states, birth rates among Hispanic and black teens are more than 3 times as high as those of whites. For example, in Nebraska, the birth rate for white teens (16%) approximated the national rate; rates for black and Hispanic teens (43% and 54%, respectively) far exceeded the national rate, the MMWR report notes. Counties with higher teen birth rates were clustered in southern and southwestern states and in areas with higher unemployment and lower income and education.

“These data underscore that the solution to our nation’s teen pregnancy problem is not going to be a one-size-fits-all—teen birth rates vary greatly across state lines and even within states,” said Lisa Romero, DrPH, a health scientist in the CDC’s Division of Reproductive Health and lead author of the analysis.

The HHS’s Office of Adolescent Health partnered with the CDC from 2010 to 2015 to fund community-wide initiatives in 9 communities with some of the highest teen birth rates in the U.S., focusing on black and Hispanic teens. Projects included offering evening and weekend hours for health care and low-cost services to increase access. Preliminary data suggest that each community increased the number of teens who received reproductive health services and contraceptive methods.

Researchers attribute some of the drop in births to prevention interventions that address socioeconomic conditions such as unemployment and lower education levels. State and community leaders, their report advises, can use local data to better understand teen pregnancy in their communities and direct programs and resources to areas with the greatest need.

Births among all American teenagers have dropped > 40% during the past decade, according to a CDC analysis reported in MMWR. Births among Hispanic and black teens have dropped by almost half since 2006.

But despite those dramatic drops—51% among Hispanic teens and 44% among blacks—their birth rates remain twice as high than among whites. In some states, birth rates among Hispanic and black teens are more than 3 times as high as those of whites. For example, in Nebraska, the birth rate for white teens (16%) approximated the national rate; rates for black and Hispanic teens (43% and 54%, respectively) far exceeded the national rate, the MMWR report notes. Counties with higher teen birth rates were clustered in southern and southwestern states and in areas with higher unemployment and lower income and education.

“These data underscore that the solution to our nation’s teen pregnancy problem is not going to be a one-size-fits-all—teen birth rates vary greatly across state lines and even within states,” said Lisa Romero, DrPH, a health scientist in the CDC’s Division of Reproductive Health and lead author of the analysis.

The HHS’s Office of Adolescent Health partnered with the CDC from 2010 to 2015 to fund community-wide initiatives in 9 communities with some of the highest teen birth rates in the U.S., focusing on black and Hispanic teens. Projects included offering evening and weekend hours for health care and low-cost services to increase access. Preliminary data suggest that each community increased the number of teens who received reproductive health services and contraceptive methods.

Researchers attribute some of the drop in births to prevention interventions that address socioeconomic conditions such as unemployment and lower education levels. State and community leaders, their report advises, can use local data to better understand teen pregnancy in their communities and direct programs and resources to areas with the greatest need.

Births among all American teenagers have dropped > 40% during the past decade, according to a CDC analysis reported in MMWR. Births among Hispanic and black teens have dropped by almost half since 2006.

But despite those dramatic drops—51% among Hispanic teens and 44% among blacks—their birth rates remain twice as high than among whites. In some states, birth rates among Hispanic and black teens are more than 3 times as high as those of whites. For example, in Nebraska, the birth rate for white teens (16%) approximated the national rate; rates for black and Hispanic teens (43% and 54%, respectively) far exceeded the national rate, the MMWR report notes. Counties with higher teen birth rates were clustered in southern and southwestern states and in areas with higher unemployment and lower income and education.

“These data underscore that the solution to our nation’s teen pregnancy problem is not going to be a one-size-fits-all—teen birth rates vary greatly across state lines and even within states,” said Lisa Romero, DrPH, a health scientist in the CDC’s Division of Reproductive Health and lead author of the analysis.

The HHS’s Office of Adolescent Health partnered with the CDC from 2010 to 2015 to fund community-wide initiatives in 9 communities with some of the highest teen birth rates in the U.S., focusing on black and Hispanic teens. Projects included offering evening and weekend hours for health care and low-cost services to increase access. Preliminary data suggest that each community increased the number of teens who received reproductive health services and contraceptive methods.

Researchers attribute some of the drop in births to prevention interventions that address socioeconomic conditions such as unemployment and lower education levels. State and community leaders, their report advises, can use local data to better understand teen pregnancy in their communities and direct programs and resources to areas with the greatest need.

Culture-independent diagnostic tests (CIDTs) are a boon, helping to identify infections from foodborne illness faster. Without a bacterial culture, CIDTs cut the time needed to diagnose to mere hours.

The CIDTs are making it easier to find cases that were not previously diagnosed, according to an MMWR report on findings from the CDC’s Foodborne Diseases Active Surveillance Network (FoodNet). In 2015, the percentage of foodborne infections diagnosed only by CIDT was “markedly higher”—about double, compared with the percentage in 2012-2014, the report says. For instance, the incidence of Cryptosporidium was significantly higher in 2015 than the average for the previous 3 years.

But without a bacterial culture, public health officials can’t get all the detailed information they need to track outbreaks and trends. The CDC is working with partners to develop advanced testing methods that, without culture, will still give the needed data for diagnosis as well as the preventive clues. In the short term, the CDC advises clinical laboratories to work with public health laboratories to make sure a culture is done whenever a CIDT indicates that someone with diarrheal illness has a bacterial infection.

Culture-independent diagnostic tests (CIDTs) are a boon, helping to identify infections from foodborne illness faster. Without a bacterial culture, CIDTs cut the time needed to diagnose to mere hours.

The CIDTs are making it easier to find cases that were not previously diagnosed, according to an MMWR report on findings from the CDC’s Foodborne Diseases Active Surveillance Network (FoodNet). In 2015, the percentage of foodborne infections diagnosed only by CIDT was “markedly higher”—about double, compared with the percentage in 2012-2014, the report says. For instance, the incidence of Cryptosporidium was significantly higher in 2015 than the average for the previous 3 years.

But without a bacterial culture, public health officials can’t get all the detailed information they need to track outbreaks and trends. The CDC is working with partners to develop advanced testing methods that, without culture, will still give the needed data for diagnosis as well as the preventive clues. In the short term, the CDC advises clinical laboratories to work with public health laboratories to make sure a culture is done whenever a CIDT indicates that someone with diarrheal illness has a bacterial infection.

Culture-independent diagnostic tests (CIDTs) are a boon, helping to identify infections from foodborne illness faster. Without a bacterial culture, CIDTs cut the time needed to diagnose to mere hours.

The CIDTs are making it easier to find cases that were not previously diagnosed, according to an MMWR report on findings from the CDC’s Foodborne Diseases Active Surveillance Network (FoodNet). In 2015, the percentage of foodborne infections diagnosed only by CIDT was “markedly higher”—about double, compared with the percentage in 2012-2014, the report says. For instance, the incidence of Cryptosporidium was significantly higher in 2015 than the average for the previous 3 years.

But without a bacterial culture, public health officials can’t get all the detailed information they need to track outbreaks and trends. The CDC is working with partners to develop advanced testing methods that, without culture, will still give the needed data for diagnosis as well as the preventive clues. In the short term, the CDC advises clinical laboratories to work with public health laboratories to make sure a culture is done whenever a CIDT indicates that someone with diarrheal illness has a bacterial infection.

In 1992, the World Health Organization recommended vaccinating all newborns and children aged < 12 months, along with adolescents, for hepatitis B virus (HBV). Russia was one of the countries that took that recommendation to heart, beginning a mass immunization program in 1997. The progtam started with newborns, added adolescents in 2001, and included adults nationwide in 2006. Children aged < 12 months are now vaccinated in 3 doses: the first within 24 hours of birth with additional boosters at 1 and 6 months.

Related: Can Hepatitis B and C Be Eliminated?

To gauge its success, researchers from Chumakov Institute of Poliomyelitis and Viral Encephalitides, Moscow, and The Ministry of Health of the Russian Federation collected sera samples from volunteers in 6 geographically distant and epidemiologically different regions of Russia. They used a mathematical model developed by the CDC to estimate the effects of vaccination and birth dose coverage on the incidence of HBV. Hepatitis B virus DNA was detected in 63 sera samples.

Between 1993 and 1996, infection rates had risen from 22.4 per 100,000 people to 40 per 100,000. Following the initiation of the mass HBV vaccination program, the researchers say the number of acute HBV cases dropped by more than 33-fold, to 1.3 per 100,000 in 2014.

Still, they note, the incidence of chronic hepatitis—down only to 11.3 per 100,000 in 2014, from 14.2 per 100,000 in 2008—remains a source of concern, indicating “a persistent, substantial reservoir of the infection.”

Related: Hepatitis B: Screening, Awareness, and the Need to Treat

Based on the reported data on vaccination of newborns, the number of expected acute  and chronic HBV cases in the study generation (children born in 2008) can be reduced as much as 19-fold, the researchers say. They estimate that vaccination prevents 91% to 95% of cases of HBV that would otherwise occur. Timely vaccination also can reduce the estimated number of HBV-associated deaths by nearly 19-fold, they say.

Despite the substantial reduction in the incidence of acute HBV, though, the epidemic in Russia remains serious, the researchers say. However, they add, the low prevalence of HBV immune escape mutants 10 years after the mass vaccination began bodes well for the program’s future effectiveness.

Related: Accelerated Hepatitis A and B Immunization in a Substance Abuse Treatment Program

Source:
Klushkina VV, Kyuregyan KK, Kozhanova TV, et al. PLoS ONE. 2016;11(6):e0157161.
doi:10.1371/journal.pone.0157161.

In 1992, the World Health Organization recommended vaccinating all newborns and children aged < 12 months, along with adolescents, for hepatitis B virus (HBV). Russia was one of the countries that took that recommendation to heart, beginning a mass immunization program in 1997. The progtam started with newborns, added adolescents in 2001, and included adults nationwide in 2006. Children aged < 12 months are now vaccinated in 3 doses: the first within 24 hours of birth with additional boosters at 1 and 6 months.

Related: Can Hepatitis B and C Be Eliminated?

To gauge its success, researchers from Chumakov Institute of Poliomyelitis and Viral Encephalitides, Moscow, and The Ministry of Health of the Russian Federation collected sera samples from volunteers in 6 geographically distant and epidemiologically different regions of Russia. They used a mathematical model developed by the CDC to estimate the effects of vaccination and birth dose coverage on the incidence of HBV. Hepatitis B virus DNA was detected in 63 sera samples.

Between 1993 and 1996, infection rates had risen from 22.4 per 100,000 people to 40 per 100,000. Following the initiation of the mass HBV vaccination program, the researchers say the number of acute HBV cases dropped by more than 33-fold, to 1.3 per 100,000 in 2014.

Still, they note, the incidence of chronic hepatitis—down only to 11.3 per 100,000 in 2014, from 14.2 per 100,000 in 2008—remains a source of concern, indicating “a persistent, substantial reservoir of the infection.”

Related: Hepatitis B: Screening, Awareness, and the Need to Treat

Based on the reported data on vaccination of newborns, the number of expected acute  and chronic HBV cases in the study generation (children born in 2008) can be reduced as much as 19-fold, the researchers say. They estimate that vaccination prevents 91% to 95% of cases of HBV that would otherwise occur. Timely vaccination also can reduce the estimated number of HBV-associated deaths by nearly 19-fold, they say.

Despite the substantial reduction in the incidence of acute HBV, though, the epidemic in Russia remains serious, the researchers say. However, they add, the low prevalence of HBV immune escape mutants 10 years after the mass vaccination began bodes well for the program’s future effectiveness.

Related: Accelerated Hepatitis A and B Immunization in a Substance Abuse Treatment Program

Source:
Klushkina VV, Kyuregyan KK, Kozhanova TV, et al. PLoS ONE. 2016;11(6):e0157161.
doi:10.1371/journal.pone.0157161.

In 1992, the World Health Organization recommended vaccinating all newborns and children aged < 12 months, along with adolescents, for hepatitis B virus (HBV). Russia was one of the countries that took that recommendation to heart, beginning a mass immunization program in 1997. The progtam started with newborns, added adolescents in 2001, and included adults nationwide in 2006. Children aged < 12 months are now vaccinated in 3 doses: the first within 24 hours of birth with additional boosters at 1 and 6 months.

Related: Can Hepatitis B and C Be Eliminated?

To gauge its success, researchers from Chumakov Institute of Poliomyelitis and Viral Encephalitides, Moscow, and The Ministry of Health of the Russian Federation collected sera samples from volunteers in 6 geographically distant and epidemiologically different regions of Russia. They used a mathematical model developed by the CDC to estimate the effects of vaccination and birth dose coverage on the incidence of HBV. Hepatitis B virus DNA was detected in 63 sera samples.

Between 1993 and 1996, infection rates had risen from 22.4 per 100,000 people to 40 per 100,000. Following the initiation of the mass HBV vaccination program, the researchers say the number of acute HBV cases dropped by more than 33-fold, to 1.3 per 100,000 in 2014.

Still, they note, the incidence of chronic hepatitis—down only to 11.3 per 100,000 in 2014, from 14.2 per 100,000 in 2008—remains a source of concern, indicating “a persistent, substantial reservoir of the infection.”

Related: Hepatitis B: Screening, Awareness, and the Need to Treat

Based on the reported data on vaccination of newborns, the number of expected acute  and chronic HBV cases in the study generation (children born in 2008) can be reduced as much as 19-fold, the researchers say. They estimate that vaccination prevents 91% to 95% of cases of HBV that would otherwise occur. Timely vaccination also can reduce the estimated number of HBV-associated deaths by nearly 19-fold, they say.

Despite the substantial reduction in the incidence of acute HBV, though, the epidemic in Russia remains serious, the researchers say. However, they add, the low prevalence of HBV immune escape mutants 10 years after the mass vaccination began bodes well for the program’s future effectiveness.

Related: Accelerated Hepatitis A and B Immunization in a Substance Abuse Treatment Program

Source:
Klushkina VV, Kyuregyan KK, Kozhanova TV, et al. PLoS ONE. 2016;11(6):e0157161.
doi:10.1371/journal.pone.0157161.

The 2015 National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of halving inappropriate outpatient antibiotic use by 2020. The CDC researchers analyzed the 2010-2011 National Ambulatory Medical Survey and the National Hospital Ambulatory Medical Care Survey to figure out whether we’re getting closer to the goal.

About 1 in 3 antibiotic prescriptions is unneeded, according to the CDC study. Those 47 million excess prescriptions each year put patients at risk for allergy reactions or sometimes deadly diarrhea. Many of the unnecessary antibiotics are prescribed for respiratory conditions caused by viruses.

To help shift momentum in the right direction, the researchers suggest that outpatient health care providers (HCPs) can evaluate their prescribing habits and implement antibiotic stewardship activities, such as watchful waiting or delayed prescribing. Health systems can provide communications training, clinical decision support, and patient and HCP education. Patients also can talk with their HCPs about when antibiotics are needed and when they aren’t.

For more information on antibiotic stewardship, visit www.cedc.gov/getsmart.

The 2015 National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of halving inappropriate outpatient antibiotic use by 2020. The CDC researchers analyzed the 2010-2011 National Ambulatory Medical Survey and the National Hospital Ambulatory Medical Care Survey to figure out whether we’re getting closer to the goal.

About 1 in 3 antibiotic prescriptions is unneeded, according to the CDC study. Those 47 million excess prescriptions each year put patients at risk for allergy reactions or sometimes deadly diarrhea. Many of the unnecessary antibiotics are prescribed for respiratory conditions caused by viruses.

To help shift momentum in the right direction, the researchers suggest that outpatient health care providers (HCPs) can evaluate their prescribing habits and implement antibiotic stewardship activities, such as watchful waiting or delayed prescribing. Health systems can provide communications training, clinical decision support, and patient and HCP education. Patients also can talk with their HCPs about when antibiotics are needed and when they aren’t.

For more information on antibiotic stewardship, visit www.cedc.gov/getsmart.

The 2015 National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of halving inappropriate outpatient antibiotic use by 2020. The CDC researchers analyzed the 2010-2011 National Ambulatory Medical Survey and the National Hospital Ambulatory Medical Care Survey to figure out whether we’re getting closer to the goal.

About 1 in 3 antibiotic prescriptions is unneeded, according to the CDC study. Those 47 million excess prescriptions each year put patients at risk for allergy reactions or sometimes deadly diarrhea. Many of the unnecessary antibiotics are prescribed for respiratory conditions caused by viruses.

To help shift momentum in the right direction, the researchers suggest that outpatient health care providers (HCPs) can evaluate their prescribing habits and implement antibiotic stewardship activities, such as watchful waiting or delayed prescribing. Health systems can provide communications training, clinical decision support, and patient and HCP education. Patients also can talk with their HCPs about when antibiotics are needed and when they aren’t.

For more information on antibiotic stewardship, visit www.cedc.gov/getsmart.