Jonathan Gardner

The clinical and cost effectiveness agency for England and Wales has affirmed its decision to allow the three drugs donepezil, galantamine, and rivastigmine to be prescribed only to those Alzheimer's patients with moderate disease.

In affirming its May final guidance on the three drugs, the National Institute for Health and Clinical Excellence on Oct. 11 rejected appeals from 10 organizations and companies. The NICE decision, which will be sent to the National Health Service in November, will limit the use of all three drugs for newly diagnosed Alzheimer's patients.

NICE's final decision was based on cost effectiveness. The drugs cost £890.60 to £1,248.30 per year but do not avert enough costs to justify that expenditure–for example, delaying by less than 2 months the need for full-time care, according to analyses prepared for the NICE committee drafting the guidance.

“Alzheimer's is a cruel and devastating illness, and we realize that today's announcement will be disappointing to people with Alzheimer's and those who treat and care for them,” NICE Chief Executive Andrew Dillon said in a written statement. “But … based on all the evidence, including data presented by the drug companies themselves, our experts have concluded that these drugs do not make enough of a difference for us to recommend their use for treating all stages of Alzheimer's disease.

The Alzheimer's Society criticized the decision. “This blatant cost cutting will rob people of priceless time early in the disease, and later clinicians will have no choice but to use dangerous sedatives that increase the risk of heart disease and stroke,” Neil Hunt, chief executive of the Alzheimer's Society, said in a written statement.

The clinical and cost effectiveness agency for England and Wales has affirmed its decision to allow the three drugs donepezil, galantamine, and rivastigmine to be prescribed only to those Alzheimer's patients with moderate disease.

In affirming its May final guidance on the three drugs, the National Institute for Health and Clinical Excellence on Oct. 11 rejected appeals from 10 organizations and companies. The NICE decision, which will be sent to the National Health Service in November, will limit the use of all three drugs for newly diagnosed Alzheimer's patients.

NICE's final decision was based on cost effectiveness. The drugs cost £890.60 to £1,248.30 per year but do not avert enough costs to justify that expenditure–for example, delaying by less than 2 months the need for full-time care, according to analyses prepared for the NICE committee drafting the guidance.

“Alzheimer's is a cruel and devastating illness, and we realize that today's announcement will be disappointing to people with Alzheimer's and those who treat and care for them,” NICE Chief Executive Andrew Dillon said in a written statement. “But … based on all the evidence, including data presented by the drug companies themselves, our experts have concluded that these drugs do not make enough of a difference for us to recommend their use for treating all stages of Alzheimer's disease.

The Alzheimer's Society criticized the decision. “This blatant cost cutting will rob people of priceless time early in the disease, and later clinicians will have no choice but to use dangerous sedatives that increase the risk of heart disease and stroke,” Neil Hunt, chief executive of the Alzheimer's Society, said in a written statement.

The clinical and cost effectiveness agency for England and Wales has affirmed its decision to allow the three drugs donepezil, galantamine, and rivastigmine to be prescribed only to those Alzheimer's patients with moderate disease.

In affirming its May final guidance on the three drugs, the National Institute for Health and Clinical Excellence on Oct. 11 rejected appeals from 10 organizations and companies. The NICE decision, which will be sent to the National Health Service in November, will limit the use of all three drugs for newly diagnosed Alzheimer's patients.

NICE's final decision was based on cost effectiveness. The drugs cost £890.60 to £1,248.30 per year but do not avert enough costs to justify that expenditure–for example, delaying by less than 2 months the need for full-time care, according to analyses prepared for the NICE committee drafting the guidance.

“Alzheimer's is a cruel and devastating illness, and we realize that today's announcement will be disappointing to people with Alzheimer's and those who treat and care for them,” NICE Chief Executive Andrew Dillon said in a written statement. “But … based on all the evidence, including data presented by the drug companies themselves, our experts have concluded that these drugs do not make enough of a difference for us to recommend their use for treating all stages of Alzheimer's disease.

The Alzheimer's Society criticized the decision. “This blatant cost cutting will rob people of priceless time early in the disease, and later clinicians will have no choice but to use dangerous sedatives that increase the risk of heart disease and stroke,” Neil Hunt, chief executive of the Alzheimer's Society, said in a written statement.

A short course of traditional acupuncture can relieve nonspecific lower-back pain better than usual care at a small increased cost to payers, a new study has found.

The study (BMJ 2006 [Epub doi:10.1136/bmj.38878.907361.7C]) randomized 160 adults from York, England, into acupuncture and 81 into usual care of physical therapy, manipulation, pain relief drugs, and exercise, following up at 12 and 24 months to test back pain. Researchers selected a larger group for acupuncture to test differences in pain relief among patients treated by different acupuncturists.

Patients who underwent up to 10 acupuncture treatments over 3 months saw their mean score on the 100-point SF-36 bodily pain index–in which 100 equals no pain–increase from 30.8 at baseline to 64 at 12 months and 67.8 at 24 months. By comparison, those in the usual-care group rose from 30.4 at baseline to 58.3 at 12 months and 59.5 at 24 months. The difference at 12 months did not achieve statistical significance, but the difference at 24 months did, researchers said. Their conclusion: “Weak evidence was found of an effect of acupuncture care on nonspecific low back pain at 12 months, but stronger evidence of a small benefit at 24 months.”

Although the researchers said they had chosen a sample size to determine at least a 10-point difference in pain relief, they wrote: “A difference of at least 5 points in the mean score of the SF-36 bodily pain dimension is, however, considered to represent a clinically worthwhile benefit and a difference of between 5 and 9 points can be viewed as a moderate effect.”

An accompanying economic analysis (BMJ 2006 [Epub doi: 10.1136/bmj.38932.806134.7C]) found that acupuncture cost the National Health Service £459.70 per patient, £114.50 more than usual care.

Acupuncture resulted in a gain of 1.453 quality-adjusted life years–a measurement of a patient's quality of life year in which 1 year in perfect health equals 1.0–while usual care resulted in a gain of 1.426 quality-adjusted life years.

The researchers said the incremental cost of per quality-adjusted life year of acupuncture over usual care was £4,241 at 24 months, below the £20,000 cost-effectiveness standard set by the National Institute for Health and Clinical Effectiveness.

A short course of traditional acupuncture can relieve nonspecific lower-back pain better than usual care at a small increased cost to payers, a new study has found.

The study (BMJ 2006 [Epub doi:10.1136/bmj.38878.907361.7C]) randomized 160 adults from York, England, into acupuncture and 81 into usual care of physical therapy, manipulation, pain relief drugs, and exercise, following up at 12 and 24 months to test back pain. Researchers selected a larger group for acupuncture to test differences in pain relief among patients treated by different acupuncturists.

Patients who underwent up to 10 acupuncture treatments over 3 months saw their mean score on the 100-point SF-36 bodily pain index–in which 100 equals no pain–increase from 30.8 at baseline to 64 at 12 months and 67.8 at 24 months. By comparison, those in the usual-care group rose from 30.4 at baseline to 58.3 at 12 months and 59.5 at 24 months. The difference at 12 months did not achieve statistical significance, but the difference at 24 months did, researchers said. Their conclusion: “Weak evidence was found of an effect of acupuncture care on nonspecific low back pain at 12 months, but stronger evidence of a small benefit at 24 months.”

Although the researchers said they had chosen a sample size to determine at least a 10-point difference in pain relief, they wrote: “A difference of at least 5 points in the mean score of the SF-36 bodily pain dimension is, however, considered to represent a clinically worthwhile benefit and a difference of between 5 and 9 points can be viewed as a moderate effect.”

An accompanying economic analysis (BMJ 2006 [Epub doi: 10.1136/bmj.38932.806134.7C]) found that acupuncture cost the National Health Service £459.70 per patient, £114.50 more than usual care.

Acupuncture resulted in a gain of 1.453 quality-adjusted life years–a measurement of a patient's quality of life year in which 1 year in perfect health equals 1.0–while usual care resulted in a gain of 1.426 quality-adjusted life years.

The researchers said the incremental cost of per quality-adjusted life year of acupuncture over usual care was £4,241 at 24 months, below the £20,000 cost-effectiveness standard set by the National Institute for Health and Clinical Effectiveness.

A short course of traditional acupuncture can relieve nonspecific lower-back pain better than usual care at a small increased cost to payers, a new study has found.

The study (BMJ 2006 [Epub doi:10.1136/bmj.38878.907361.7C]) randomized 160 adults from York, England, into acupuncture and 81 into usual care of physical therapy, manipulation, pain relief drugs, and exercise, following up at 12 and 24 months to test back pain. Researchers selected a larger group for acupuncture to test differences in pain relief among patients treated by different acupuncturists.

Patients who underwent up to 10 acupuncture treatments over 3 months saw their mean score on the 100-point SF-36 bodily pain index–in which 100 equals no pain–increase from 30.8 at baseline to 64 at 12 months and 67.8 at 24 months. By comparison, those in the usual-care group rose from 30.4 at baseline to 58.3 at 12 months and 59.5 at 24 months. The difference at 12 months did not achieve statistical significance, but the difference at 24 months did, researchers said. Their conclusion: “Weak evidence was found of an effect of acupuncture care on nonspecific low back pain at 12 months, but stronger evidence of a small benefit at 24 months.”

Although the researchers said they had chosen a sample size to determine at least a 10-point difference in pain relief, they wrote: “A difference of at least 5 points in the mean score of the SF-36 bodily pain dimension is, however, considered to represent a clinically worthwhile benefit and a difference of between 5 and 9 points can be viewed as a moderate effect.”

An accompanying economic analysis (BMJ 2006 [Epub doi: 10.1136/bmj.38932.806134.7C]) found that acupuncture cost the National Health Service £459.70 per patient, £114.50 more than usual care.

Acupuncture resulted in a gain of 1.453 quality-adjusted life years–a measurement of a patient's quality of life year in which 1 year in perfect health equals 1.0–while usual care resulted in a gain of 1.426 quality-adjusted life years.

The researchers said the incremental cost of per quality-adjusted life year of acupuncture over usual care was £4,241 at 24 months, below the £20,000 cost-effectiveness standard set by the National Institute for Health and Clinical Effectiveness.

Occupational therapy improves the daily functioning of patients with mild to moderate dementia, results of a randomized, controlled trial show.

“We believe that, in the long term, occupational therapy will result in less dependence on social and health care resources and less need for institutionalization,” reported Maud J.L. Graff, of the Research Group for Allied Health Care at University Medical Center Nijmegen, the Netherlands, and her associates (BMJ 2006 Nov. 17 [Epub doi:10.1136/bmj.39001.688843.BE]).

In the study, dementia patients were randomized to an occupational therapy treatment group (68) or to a control group (67). Study participants had to be aged 65 years or older, diagnosed with mild or moderate dementia, and cared for once a week or more by a primary caregiver.

At 6 weeks, those in the intervention group had statistically significant improvements over the controls on three tests. Patients in the therapy group had a mean score that was 1 point higher on the 8-point motor and process skills test and 10.9 points higher on the 44-point performance interview. Caregivers in the therapy group had a mean score 16.2 points higher on the 135-point competence questionnaire.

One limitation of the study was that it was not double blinded.

Occupational therapy improves the daily functioning of patients with mild to moderate dementia, results of a randomized, controlled trial show.

“We believe that, in the long term, occupational therapy will result in less dependence on social and health care resources and less need for institutionalization,” reported Maud J.L. Graff, of the Research Group for Allied Health Care at University Medical Center Nijmegen, the Netherlands, and her associates (BMJ 2006 Nov. 17 [Epub doi:10.1136/bmj.39001.688843.BE]).

In the study, dementia patients were randomized to an occupational therapy treatment group (68) or to a control group (67). Study participants had to be aged 65 years or older, diagnosed with mild or moderate dementia, and cared for once a week or more by a primary caregiver.

At 6 weeks, those in the intervention group had statistically significant improvements over the controls on three tests. Patients in the therapy group had a mean score that was 1 point higher on the 8-point motor and process skills test and 10.9 points higher on the 44-point performance interview. Caregivers in the therapy group had a mean score 16.2 points higher on the 135-point competence questionnaire.

One limitation of the study was that it was not double blinded.

Occupational therapy improves the daily functioning of patients with mild to moderate dementia, results of a randomized, controlled trial show.

“We believe that, in the long term, occupational therapy will result in less dependence on social and health care resources and less need for institutionalization,” reported Maud J.L. Graff, of the Research Group for Allied Health Care at University Medical Center Nijmegen, the Netherlands, and her associates (BMJ 2006 Nov. 17 [Epub doi:10.1136/bmj.39001.688843.BE]).

In the study, dementia patients were randomized to an occupational therapy treatment group (68) or to a control group (67). Study participants had to be aged 65 years or older, diagnosed with mild or moderate dementia, and cared for once a week or more by a primary caregiver.

At 6 weeks, those in the intervention group had statistically significant improvements over the controls on three tests. Patients in the therapy group had a mean score that was 1 point higher on the 8-point motor and process skills test and 10.9 points higher on the 44-point performance interview. Caregivers in the therapy group had a mean score 16.2 points higher on the 135-point competence questionnaire.

One limitation of the study was that it was not double blinded.

Nearly half of British rheumatologists report that they are unable to prescribe approved drugs for rheumatoid arthritis patients because of financial caps and other constraints placed by their local National Health Service trusts, according to a recent survey.

Rheumatologists reported barriers to prescribing infliximab and etanercept for rheumatoid arthritis patients meeting the guidelines set forth by the National Institute for Health and Clinical Effectiveness (NICE). NHS trusts in England and Wales are required to provide any drug or treatment meeting NICE's clinical and cost-effectiveness standards (Rheumatology 2006 Oct. 11 [Epub doi:10.1093/rheumatology/kel333]).

The survey's authors, Dr. Lesley Kay and Dr. Ian Griffiths, of the musculoskeletal unit at Freeman Hospital in Newcastle-Upon-Tyne, England, sent questionnaires to all 509 consultant rheumatologists who were members of the British Society for Rheumatology. A total of 136 responses on behalf of 252 consultant rheumatologists were received.

Despite NICE's guidelines, 56 of the returned questionnaires, or 42%, representing 115, or 46% of the rheumatologists covered, reported some type of limit on anti-tumor necrosis factor-α therapies such as infliximab or etanercept, the authors wrote.

Of those reporting limits, 40 said they were in the form of caps on funding or the number of rheumatoid arthritis patients allowed the treatment, 12 reported limits on staffing to meet patient needs, and 4 reported lack of other facilities. Forty-eight respondents also reported a waiting list for such therapies, according to researchers.

Ninety respondents said they are able to prescribe anti-tumor necrosis factor agents for ankylosing spondylitis or psoriatic arthritis in at least some circumstances, leaving 33% of consultant rheumatologists unable to prescribe the therapies for those patients, the researchers wrote.

“The fact that different funding organizations set different restrictions has led to variation of access for equally affected patients to effective treatment, depending on where they live,” the authors said. “Long waiting times for patients to receive these drugs once a decision to prescribe has been made are not uncommon, which will add further to their deterioration and compromise their likely outcome.”

The organization representing NHS trusts would not comment directly on the survey, but did defend the decisions of its members. “[Primary care trusts] receive a fixed allocation of money to deliver all the services for their local community and have to take difficult decisions on competing priorities,” Nigel Edwards, director of policy at the NHS Confederation, said in a written statement.

“For example, this year many PCTs have been faced with decisions about spending money on expensive drugs and cutting waiting lists.

“The decisions that PCTs take are informed by professional executive committees made up of doctors and nurses, as well as managers,” Mr. Edwards said. “These committees decide what the local priorities are, and, as every community is different, it is not surprising that they often reach different decisions.

“Many primary care trusts also have active ways of engaging their communities in the decisions they make, and naturally, communities will have different views and priorities themselves.”

Nearly half of British rheumatologists report that they are unable to prescribe approved drugs for rheumatoid arthritis patients because of financial caps and other constraints placed by their local National Health Service trusts, according to a recent survey.

Rheumatologists reported barriers to prescribing infliximab and etanercept for rheumatoid arthritis patients meeting the guidelines set forth by the National Institute for Health and Clinical Effectiveness (NICE). NHS trusts in England and Wales are required to provide any drug or treatment meeting NICE's clinical and cost-effectiveness standards (Rheumatology 2006 Oct. 11 [Epub doi:10.1093/rheumatology/kel333]).

The survey's authors, Dr. Lesley Kay and Dr. Ian Griffiths, of the musculoskeletal unit at Freeman Hospital in Newcastle-Upon-Tyne, England, sent questionnaires to all 509 consultant rheumatologists who were members of the British Society for Rheumatology. A total of 136 responses on behalf of 252 consultant rheumatologists were received.

Despite NICE's guidelines, 56 of the returned questionnaires, or 42%, representing 115, or 46% of the rheumatologists covered, reported some type of limit on anti-tumor necrosis factor-α therapies such as infliximab or etanercept, the authors wrote.

Of those reporting limits, 40 said they were in the form of caps on funding or the number of rheumatoid arthritis patients allowed the treatment, 12 reported limits on staffing to meet patient needs, and 4 reported lack of other facilities. Forty-eight respondents also reported a waiting list for such therapies, according to researchers.

Ninety respondents said they are able to prescribe anti-tumor necrosis factor agents for ankylosing spondylitis or psoriatic arthritis in at least some circumstances, leaving 33% of consultant rheumatologists unable to prescribe the therapies for those patients, the researchers wrote.

“The fact that different funding organizations set different restrictions has led to variation of access for equally affected patients to effective treatment, depending on where they live,” the authors said. “Long waiting times for patients to receive these drugs once a decision to prescribe has been made are not uncommon, which will add further to their deterioration and compromise their likely outcome.”

The organization representing NHS trusts would not comment directly on the survey, but did defend the decisions of its members. “[Primary care trusts] receive a fixed allocation of money to deliver all the services for their local community and have to take difficult decisions on competing priorities,” Nigel Edwards, director of policy at the NHS Confederation, said in a written statement.

“For example, this year many PCTs have been faced with decisions about spending money on expensive drugs and cutting waiting lists.

“The decisions that PCTs take are informed by professional executive committees made up of doctors and nurses, as well as managers,” Mr. Edwards said. “These committees decide what the local priorities are, and, as every community is different, it is not surprising that they often reach different decisions.

“Many primary care trusts also have active ways of engaging their communities in the decisions they make, and naturally, communities will have different views and priorities themselves.”

Nearly half of British rheumatologists report that they are unable to prescribe approved drugs for rheumatoid arthritis patients because of financial caps and other constraints placed by their local National Health Service trusts, according to a recent survey.

Rheumatologists reported barriers to prescribing infliximab and etanercept for rheumatoid arthritis patients meeting the guidelines set forth by the National Institute for Health and Clinical Effectiveness (NICE). NHS trusts in England and Wales are required to provide any drug or treatment meeting NICE's clinical and cost-effectiveness standards (Rheumatology 2006 Oct. 11 [Epub doi:10.1093/rheumatology/kel333]).

The survey's authors, Dr. Lesley Kay and Dr. Ian Griffiths, of the musculoskeletal unit at Freeman Hospital in Newcastle-Upon-Tyne, England, sent questionnaires to all 509 consultant rheumatologists who were members of the British Society for Rheumatology. A total of 136 responses on behalf of 252 consultant rheumatologists were received.

Despite NICE's guidelines, 56 of the returned questionnaires, or 42%, representing 115, or 46% of the rheumatologists covered, reported some type of limit on anti-tumor necrosis factor-α therapies such as infliximab or etanercept, the authors wrote.

Of those reporting limits, 40 said they were in the form of caps on funding or the number of rheumatoid arthritis patients allowed the treatment, 12 reported limits on staffing to meet patient needs, and 4 reported lack of other facilities. Forty-eight respondents also reported a waiting list for such therapies, according to researchers.

Ninety respondents said they are able to prescribe anti-tumor necrosis factor agents for ankylosing spondylitis or psoriatic arthritis in at least some circumstances, leaving 33% of consultant rheumatologists unable to prescribe the therapies for those patients, the researchers wrote.

“The fact that different funding organizations set different restrictions has led to variation of access for equally affected patients to effective treatment, depending on where they live,” the authors said. “Long waiting times for patients to receive these drugs once a decision to prescribe has been made are not uncommon, which will add further to their deterioration and compromise their likely outcome.”

The organization representing NHS trusts would not comment directly on the survey, but did defend the decisions of its members. “[Primary care trusts] receive a fixed allocation of money to deliver all the services for their local community and have to take difficult decisions on competing priorities,” Nigel Edwards, director of policy at the NHS Confederation, said in a written statement.

“For example, this year many PCTs have been faced with decisions about spending money on expensive drugs and cutting waiting lists.

“The decisions that PCTs take are informed by professional executive committees made up of doctors and nurses, as well as managers,” Mr. Edwards said. “These committees decide what the local priorities are, and, as every community is different, it is not surprising that they often reach different decisions.

“Many primary care trusts also have active ways of engaging their communities in the decisions they make, and naturally, communities will have different views and priorities themselves.”

Shortened nightly sleep may help explain the rise in childhood obesity because sleep deprivation can disrupt levels of key hormones that regulate appetite and suppress physical activity, an endocrinology researcher reports.

Encouraging longer nightly sleep among children and adolescents should be considered as a component in any antiobesity campaign, according to Dr. Shahrad Taheri of the University of Bristol, England (Arch. Dis. Child. 2006 Oct. 19 [epub doi:10.1136/adc.2005.093013]).

Parents should encourage earlier bedtimes and longer sleep by taking such measures as enforcing strict bedtimes and wake times; providing a quiet, dark, and relaxing bedroom environment; avoiding large meals near bedtime; and removing computers, electronic games, and mobile phones from bedrooms, he said.

Even sleep deprivation early in life may contribute. In the 1990s, the Avon Longitudinal Study of Parents and Children in the United Kingdom linked short sleep duration at 30 months with obesity at age 7, according to Dr. Taheri.

Although most of the data linking disrupted sleep patterns with obesity are cross-sectional and do not prove that the former causes the latter, sleep deprivation can contribute to physiologic changes that could lead to obesity.

For example, sleep deprivation can reduce levels of the hormone leptin, which signals an energy deficit, and increase levels of ghrelin, which may signal hunger, Dr. Taheri wrote. Fatigue stemming from sleep deprivation also can discourage physical activity, increasing the body's caloric surplus. And longer waking hours can increase opportunities to eat, also increasing the caloric surplus.

Despite this possible link, Dr. Taheri said it might be difficult to prove unequivocally a causal relationship between short sleep duration and obesity.

Shortened nightly sleep may help explain the rise in childhood obesity because sleep deprivation can disrupt levels of key hormones that regulate appetite and suppress physical activity, an endocrinology researcher reports.

Encouraging longer nightly sleep among children and adolescents should be considered as a component in any antiobesity campaign, according to Dr. Shahrad Taheri of the University of Bristol, England (Arch. Dis. Child. 2006 Oct. 19 [epub doi:10.1136/adc.2005.093013]).

Parents should encourage earlier bedtimes and longer sleep by taking such measures as enforcing strict bedtimes and wake times; providing a quiet, dark, and relaxing bedroom environment; avoiding large meals near bedtime; and removing computers, electronic games, and mobile phones from bedrooms, he said.

Even sleep deprivation early in life may contribute. In the 1990s, the Avon Longitudinal Study of Parents and Children in the United Kingdom linked short sleep duration at 30 months with obesity at age 7, according to Dr. Taheri.

Although most of the data linking disrupted sleep patterns with obesity are cross-sectional and do not prove that the former causes the latter, sleep deprivation can contribute to physiologic changes that could lead to obesity.

For example, sleep deprivation can reduce levels of the hormone leptin, which signals an energy deficit, and increase levels of ghrelin, which may signal hunger, Dr. Taheri wrote. Fatigue stemming from sleep deprivation also can discourage physical activity, increasing the body's caloric surplus. And longer waking hours can increase opportunities to eat, also increasing the caloric surplus.

Despite this possible link, Dr. Taheri said it might be difficult to prove unequivocally a causal relationship between short sleep duration and obesity.

Shortened nightly sleep may help explain the rise in childhood obesity because sleep deprivation can disrupt levels of key hormones that regulate appetite and suppress physical activity, an endocrinology researcher reports.

Encouraging longer nightly sleep among children and adolescents should be considered as a component in any antiobesity campaign, according to Dr. Shahrad Taheri of the University of Bristol, England (Arch. Dis. Child. 2006 Oct. 19 [epub doi:10.1136/adc.2005.093013]).

Parents should encourage earlier bedtimes and longer sleep by taking such measures as enforcing strict bedtimes and wake times; providing a quiet, dark, and relaxing bedroom environment; avoiding large meals near bedtime; and removing computers, electronic games, and mobile phones from bedrooms, he said.

Even sleep deprivation early in life may contribute. In the 1990s, the Avon Longitudinal Study of Parents and Children in the United Kingdom linked short sleep duration at 30 months with obesity at age 7, according to Dr. Taheri.

Although most of the data linking disrupted sleep patterns with obesity are cross-sectional and do not prove that the former causes the latter, sleep deprivation can contribute to physiologic changes that could lead to obesity.

For example, sleep deprivation can reduce levels of the hormone leptin, which signals an energy deficit, and increase levels of ghrelin, which may signal hunger, Dr. Taheri wrote. Fatigue stemming from sleep deprivation also can discourage physical activity, increasing the body's caloric surplus. And longer waking hours can increase opportunities to eat, also increasing the caloric surplus.

Despite this possible link, Dr. Taheri said it might be difficult to prove unequivocally a causal relationship between short sleep duration and obesity.

Treating children of Asian origin with a 2-year course of vitamin D supplementation might reduce the increased rate of rickets, hypocalcemia, and related conditions that are seen in these children.

This conclusion is based on a British analysis of the costs associated with treating children with complications of vitamin D deficiency. The Burnley National Health Service Trust, which serves a population of 242,000 in northwest England, including many of Asian descent, spent an average of £2,500 ($4,675) per case. By supplementing Asian children with vitamin D for the first 2 years of their lives, the expected cost of prevention of vitamin D deficiency is £2,400 ($4,488) per avoided case, investigators said (Arch. Dis. Child. 2006;doi:10.1136/adc.2006.098467).

Vitamin D supplementation has been on the decline in the United Kingdom. In 1995, 12% of babies received supplementation. In 2000, it was given to 4%, wrote Christos S. Zipitis of Burnley General Hospital Lancashire, England, and associates.

The Burnley Health Care NHS Trust identified all patients presenting to the pediatric department between January 1994 and May 2005 whose records included the words “rickets,” “hypocalcemic tetany,” and “hypocalcemic convulsions.” They identified vitamin D deficiency based on bowlegs, tetany, convulsions resulting from hypocalcemia, radiologic evidence, or biochemistry.

There were 14 cases of vitamin D deficiency, 13 of them in children of Asian descent. Eight were initially seen for other conditions, such as eczema or lower respiratory tract infections. The total treatment cost for the 14 was £35,075.12 ($65,590.47), or £2,505.37 ($4,685.04) per patient. The prevalence of vitamin D deficiencies in the entire Burnley NHS population is one case for every 923 children, so preventing a single case of rickets would cost £19,013.80 ($35,554.31) if children got multivitamin drops for 2 years.

But at a prevalence of one case of vitamin D deficiency for every 117 Asian children, the cost to prevent one case of rickets would be £2,410.20 ($4,507.07), almost 100 pounds ($187) less than treating a case of vitamin D deficiency. “We therefore suggest that supplementation with vitamin D of all babies of Asian origin for the first 2 years of life might be the economic answer to a growing problem,” they wrote.

Treating children of Asian origin with a 2-year course of vitamin D supplementation might reduce the increased rate of rickets, hypocalcemia, and related conditions that are seen in these children.

This conclusion is based on a British analysis of the costs associated with treating children with complications of vitamin D deficiency. The Burnley National Health Service Trust, which serves a population of 242,000 in northwest England, including many of Asian descent, spent an average of £2,500 ($4,675) per case. By supplementing Asian children with vitamin D for the first 2 years of their lives, the expected cost of prevention of vitamin D deficiency is £2,400 ($4,488) per avoided case, investigators said (Arch. Dis. Child. 2006;doi:10.1136/adc.2006.098467).

Vitamin D supplementation has been on the decline in the United Kingdom. In 1995, 12% of babies received supplementation. In 2000, it was given to 4%, wrote Christos S. Zipitis of Burnley General Hospital Lancashire, England, and associates.

The Burnley Health Care NHS Trust identified all patients presenting to the pediatric department between January 1994 and May 2005 whose records included the words “rickets,” “hypocalcemic tetany,” and “hypocalcemic convulsions.” They identified vitamin D deficiency based on bowlegs, tetany, convulsions resulting from hypocalcemia, radiologic evidence, or biochemistry.

There were 14 cases of vitamin D deficiency, 13 of them in children of Asian descent. Eight were initially seen for other conditions, such as eczema or lower respiratory tract infections. The total treatment cost for the 14 was £35,075.12 ($65,590.47), or £2,505.37 ($4,685.04) per patient. The prevalence of vitamin D deficiencies in the entire Burnley NHS population is one case for every 923 children, so preventing a single case of rickets would cost £19,013.80 ($35,554.31) if children got multivitamin drops for 2 years.

But at a prevalence of one case of vitamin D deficiency for every 117 Asian children, the cost to prevent one case of rickets would be £2,410.20 ($4,507.07), almost 100 pounds ($187) less than treating a case of vitamin D deficiency. “We therefore suggest that supplementation with vitamin D of all babies of Asian origin for the first 2 years of life might be the economic answer to a growing problem,” they wrote.

Treating children of Asian origin with a 2-year course of vitamin D supplementation might reduce the increased rate of rickets, hypocalcemia, and related conditions that are seen in these children.

This conclusion is based on a British analysis of the costs associated with treating children with complications of vitamin D deficiency. The Burnley National Health Service Trust, which serves a population of 242,000 in northwest England, including many of Asian descent, spent an average of £2,500 ($4,675) per case. By supplementing Asian children with vitamin D for the first 2 years of their lives, the expected cost of prevention of vitamin D deficiency is £2,400 ($4,488) per avoided case, investigators said (Arch. Dis. Child. 2006;doi:10.1136/adc.2006.098467).

Vitamin D supplementation has been on the decline in the United Kingdom. In 1995, 12% of babies received supplementation. In 2000, it was given to 4%, wrote Christos S. Zipitis of Burnley General Hospital Lancashire, England, and associates.

The Burnley Health Care NHS Trust identified all patients presenting to the pediatric department between January 1994 and May 2005 whose records included the words “rickets,” “hypocalcemic tetany,” and “hypocalcemic convulsions.” They identified vitamin D deficiency based on bowlegs, tetany, convulsions resulting from hypocalcemia, radiologic evidence, or biochemistry.

There were 14 cases of vitamin D deficiency, 13 of them in children of Asian descent. Eight were initially seen for other conditions, such as eczema or lower respiratory tract infections. The total treatment cost for the 14 was £35,075.12 ($65,590.47), or £2,505.37 ($4,685.04) per patient. The prevalence of vitamin D deficiencies in the entire Burnley NHS population is one case for every 923 children, so preventing a single case of rickets would cost £19,013.80 ($35,554.31) if children got multivitamin drops for 2 years.

But at a prevalence of one case of vitamin D deficiency for every 117 Asian children, the cost to prevent one case of rickets would be £2,410.20 ($4,507.07), almost 100 pounds ($187) less than treating a case of vitamin D deficiency. “We therefore suggest that supplementation with vitamin D of all babies of Asian origin for the first 2 years of life might be the economic answer to a growing problem,” they wrote.

A 2-week course of ibuprofen after total hip replacement or revision surgery can reduce ectopic bone growth, but does not reduce pain or improve mobility significantly several months after surgery and can lead to serious postoperative bleeding, a randomized study has found.

Routine prophylaxis with nonsteroidal anti-inflammatory drugs after hip surgery is believed to reduce the occurrence of ectopic bone growth, which occurs in one-third of all hip-replacement patients. Physicians believe ectopic bone growth is a determinant in the risk of long-term pain or disability. The researchers in this study examined whether postsurgical ibuprofen led to reduced pain and improved mobility 6-12 months after surgery.

Marlene Fransen of the University of Sydney, Australia, and her associates compared outcomes for 898 patients (mean age 66) in Australia and New Zealand undergoing the surgery at 20 hospitals between February 2002 and May 2004. Half were randomized to receive ibuprofen (two doses of 200 mg taken three times daily), the other half to placebo. Treatment began within 24 hours of surgery and lasted for 14 days (BMJ 2006;333:519-23).

Of the patients who received follow-up examinations 6-12 months after surgery, the 391 patients in the ibuprofen group had significantly reduced risk of developing ectopic bone of any grade (risk ratio 0.7) and severe ectopic bone (0.4), compared with the 407 patients in the placebo group.

Compared with patients on placebo, those on ibuprofen showed no statistically significant improvements in pain and physical function, such as physical activity, ability to get out of the house, walking speed, time taken to stand up from sitting in a chair, and use of analgesics.

The risks of bleeding were higher with ibuprofen. During the hospital admission, patients in the ibuprofen group were twice as likely (risk ratio 2.1) to experience a bleeding complication.

“Our results provide no evidence of clinical benefit 6 to 12 months postoperatively and raise concerns about the safety of ibuprofen for the prevention of ectopic bone formation after hip arthroplasty,” the authors wrote.

In an accompanying editorial, Fraser Birrell, consultant and senior lecturer in rheumatology, Northumbria Healthcare National Health Service Trust and School of Clinical Medical Sciences, University of Newcastle upon Tyne (England), and Stefan Lohmander, senior lecturer Department of Orthopaedics, University Hospital in Lund, Sweden, wrote that while it has been shown that use of ibuprofen and other NSAIDs reduce ectopic bone growth, the study demonstrates the risk of this practice (BMJ 2006;333:506-7).

A 2-week course of ibuprofen after total hip replacement or revision surgery can reduce ectopic bone growth, but does not reduce pain or improve mobility significantly several months after surgery and can lead to serious postoperative bleeding, a randomized study has found.

Routine prophylaxis with nonsteroidal anti-inflammatory drugs after hip surgery is believed to reduce the occurrence of ectopic bone growth, which occurs in one-third of all hip-replacement patients. Physicians believe ectopic bone growth is a determinant in the risk of long-term pain or disability. The researchers in this study examined whether postsurgical ibuprofen led to reduced pain and improved mobility 6-12 months after surgery.

Marlene Fransen of the University of Sydney, Australia, and her associates compared outcomes for 898 patients (mean age 66) in Australia and New Zealand undergoing the surgery at 20 hospitals between February 2002 and May 2004. Half were randomized to receive ibuprofen (two doses of 200 mg taken three times daily), the other half to placebo. Treatment began within 24 hours of surgery and lasted for 14 days (BMJ 2006;333:519-23).

Of the patients who received follow-up examinations 6-12 months after surgery, the 391 patients in the ibuprofen group had significantly reduced risk of developing ectopic bone of any grade (risk ratio 0.7) and severe ectopic bone (0.4), compared with the 407 patients in the placebo group.

Compared with patients on placebo, those on ibuprofen showed no statistically significant improvements in pain and physical function, such as physical activity, ability to get out of the house, walking speed, time taken to stand up from sitting in a chair, and use of analgesics.

The risks of bleeding were higher with ibuprofen. During the hospital admission, patients in the ibuprofen group were twice as likely (risk ratio 2.1) to experience a bleeding complication.

“Our results provide no evidence of clinical benefit 6 to 12 months postoperatively and raise concerns about the safety of ibuprofen for the prevention of ectopic bone formation after hip arthroplasty,” the authors wrote.

In an accompanying editorial, Fraser Birrell, consultant and senior lecturer in rheumatology, Northumbria Healthcare National Health Service Trust and School of Clinical Medical Sciences, University of Newcastle upon Tyne (England), and Stefan Lohmander, senior lecturer Department of Orthopaedics, University Hospital in Lund, Sweden, wrote that while it has been shown that use of ibuprofen and other NSAIDs reduce ectopic bone growth, the study demonstrates the risk of this practice (BMJ 2006;333:506-7).

A 2-week course of ibuprofen after total hip replacement or revision surgery can reduce ectopic bone growth, but does not reduce pain or improve mobility significantly several months after surgery and can lead to serious postoperative bleeding, a randomized study has found.

Routine prophylaxis with nonsteroidal anti-inflammatory drugs after hip surgery is believed to reduce the occurrence of ectopic bone growth, which occurs in one-third of all hip-replacement patients. Physicians believe ectopic bone growth is a determinant in the risk of long-term pain or disability. The researchers in this study examined whether postsurgical ibuprofen led to reduced pain and improved mobility 6-12 months after surgery.

Marlene Fransen of the University of Sydney, Australia, and her associates compared outcomes for 898 patients (mean age 66) in Australia and New Zealand undergoing the surgery at 20 hospitals between February 2002 and May 2004. Half were randomized to receive ibuprofen (two doses of 200 mg taken three times daily), the other half to placebo. Treatment began within 24 hours of surgery and lasted for 14 days (BMJ 2006;333:519-23).

Of the patients who received follow-up examinations 6-12 months after surgery, the 391 patients in the ibuprofen group had significantly reduced risk of developing ectopic bone of any grade (risk ratio 0.7) and severe ectopic bone (0.4), compared with the 407 patients in the placebo group.

Compared with patients on placebo, those on ibuprofen showed no statistically significant improvements in pain and physical function, such as physical activity, ability to get out of the house, walking speed, time taken to stand up from sitting in a chair, and use of analgesics.

The risks of bleeding were higher with ibuprofen. During the hospital admission, patients in the ibuprofen group were twice as likely (risk ratio 2.1) to experience a bleeding complication.

“Our results provide no evidence of clinical benefit 6 to 12 months postoperatively and raise concerns about the safety of ibuprofen for the prevention of ectopic bone formation after hip arthroplasty,” the authors wrote.

In an accompanying editorial, Fraser Birrell, consultant and senior lecturer in rheumatology, Northumbria Healthcare National Health Service Trust and School of Clinical Medical Sciences, University of Newcastle upon Tyne (England), and Stefan Lohmander, senior lecturer Department of Orthopaedics, University Hospital in Lund, Sweden, wrote that while it has been shown that use of ibuprofen and other NSAIDs reduce ectopic bone growth, the study demonstrates the risk of this practice (BMJ 2006;333:506-7).

HIV/AIDS health workers need to accelerate efforts to prevent HIV patients from contracting tuberculosis and treat those who do, top public health officials said.

Speaking at the 16th International AIDS Conference in Toronto, leaders of the World Health Organization and International AIDS Society said a quarter of a million people with HIV die from tuberculosis every year, even though many of those deaths are preventable.

People with HIV are more vulnerable to tuberculosis than those without HIV, even if under treatment using antiretroviral therapy. More than one-third of all people infected with HIV also are infected with tuberculosis bacillus, Dr. Helene Gayle, the International AIDS Society president, said in a written statement. HIV infections number about 38.6 million worldwide.

“TB prevention, diagnostic, and treatment services must become core functions of all HIV services,” Dr. Kevin De Cock, WHO's HIV director, said in the statement. “TB can be treated and cured, so most of these deaths are absolutely preventable. HIV policy makers, health ministers, and health workers all have a vital role in making sure that deaths from TB are reduced.”

The officials touted a study in Rio de Janeiro, Brazil, that is seeking to reduce the prevalence of tuberculosis in 15,000 patients who are seeking treatment at 29 HIV clinics. Although antiretroviral treatment can reduce the risk of contracting tuberculosis, the study aims to find out whether a comprehensive policy of screening and treatment latent tuberculosis can reduce tuberculosis incidence by an expected 60%, which would prevent 1,670 cases of tuberculosis per 100,000.

HIV/AIDS health workers need to accelerate efforts to prevent HIV patients from contracting tuberculosis and treat those who do, top public health officials said.

Speaking at the 16th International AIDS Conference in Toronto, leaders of the World Health Organization and International AIDS Society said a quarter of a million people with HIV die from tuberculosis every year, even though many of those deaths are preventable.

People with HIV are more vulnerable to tuberculosis than those without HIV, even if under treatment using antiretroviral therapy. More than one-third of all people infected with HIV also are infected with tuberculosis bacillus, Dr. Helene Gayle, the International AIDS Society president, said in a written statement. HIV infections number about 38.6 million worldwide.

“TB prevention, diagnostic, and treatment services must become core functions of all HIV services,” Dr. Kevin De Cock, WHO's HIV director, said in the statement. “TB can be treated and cured, so most of these deaths are absolutely preventable. HIV policy makers, health ministers, and health workers all have a vital role in making sure that deaths from TB are reduced.”

The officials touted a study in Rio de Janeiro, Brazil, that is seeking to reduce the prevalence of tuberculosis in 15,000 patients who are seeking treatment at 29 HIV clinics. Although antiretroviral treatment can reduce the risk of contracting tuberculosis, the study aims to find out whether a comprehensive policy of screening and treatment latent tuberculosis can reduce tuberculosis incidence by an expected 60%, which would prevent 1,670 cases of tuberculosis per 100,000.

HIV/AIDS health workers need to accelerate efforts to prevent HIV patients from contracting tuberculosis and treat those who do, top public health officials said.

Speaking at the 16th International AIDS Conference in Toronto, leaders of the World Health Organization and International AIDS Society said a quarter of a million people with HIV die from tuberculosis every year, even though many of those deaths are preventable.

People with HIV are more vulnerable to tuberculosis than those without HIV, even if under treatment using antiretroviral therapy. More than one-third of all people infected with HIV also are infected with tuberculosis bacillus, Dr. Helene Gayle, the International AIDS Society president, said in a written statement. HIV infections number about 38.6 million worldwide.

“TB prevention, diagnostic, and treatment services must become core functions of all HIV services,” Dr. Kevin De Cock, WHO's HIV director, said in the statement. “TB can be treated and cured, so most of these deaths are absolutely preventable. HIV policy makers, health ministers, and health workers all have a vital role in making sure that deaths from TB are reduced.”

The officials touted a study in Rio de Janeiro, Brazil, that is seeking to reduce the prevalence of tuberculosis in 15,000 patients who are seeking treatment at 29 HIV clinics. Although antiretroviral treatment can reduce the risk of contracting tuberculosis, the study aims to find out whether a comprehensive policy of screening and treatment latent tuberculosis can reduce tuberculosis incidence by an expected 60%, which would prevent 1,670 cases of tuberculosis per 100,000.

HIV/AIDS health workers need to accelerate efforts to prevent HIV patients from contracting tuberculosis and treat those who do, top public health officials said.

Speaking at the 16th International AIDS Conference in Toronto, leaders of the World Health Organization and International AIDS Society said a quarter of a million people with HIV die from tuberculosis every year, even though many of those deaths are preventable.

People with HIV are more vulnerable to tuberculosis than those without HIV, even if under treatment using antiretroviral therapy. More than one-third of all people infected with HIV also are infected with tuberculosis bacillus, Dr. Helene Gayle, the International AIDS Society president, said in a written statement. HIV infections number about 38.6 million worldwide.

“TB prevention, diagnostic, and treatment services must become core functions of all HIV services,” Dr. Kevin De Cock, WHO's HIV director, said in the statement. “TB can be treated and cured, so most of these deaths are absolutely preventable. HIV policy makers, health ministers, and health workers all have a vital role in making sure that deaths from TB are reduced.”

The officials touted a study in Rio de Janeiro that is seeking to reduce the prevalence of tuberculosis in 15,000 patients seeking treatment at 29 HIV clinics. While antiretroviral treatment can reduce the risk of contracting tuberculosis, the study aims to find out whether a comprehensive policy of screening and treatment latent tuberculosis can reduce tuberculosis incidence by an expected 60%, which would prevent 1,670 cases of tuberculosis per 100,000.

HIV/AIDS health workers need to accelerate efforts to prevent HIV patients from contracting tuberculosis and treat those who do, top public health officials said.

Speaking at the 16th International AIDS Conference in Toronto, leaders of the World Health Organization and International AIDS Society said a quarter of a million people with HIV die from tuberculosis every year, even though many of those deaths are preventable.

People with HIV are more vulnerable to tuberculosis than those without HIV, even if under treatment using antiretroviral therapy. More than one-third of all people infected with HIV also are infected with tuberculosis bacillus, Dr. Helene Gayle, the International AIDS Society president, said in a written statement. HIV infections number about 38.6 million worldwide.

“TB prevention, diagnostic, and treatment services must become core functions of all HIV services,” Dr. Kevin De Cock, WHO's HIV director, said in the statement. “TB can be treated and cured, so most of these deaths are absolutely preventable. HIV policy makers, health ministers, and health workers all have a vital role in making sure that deaths from TB are reduced.”

The officials touted a study in Rio de Janeiro that is seeking to reduce the prevalence of tuberculosis in 15,000 patients seeking treatment at 29 HIV clinics. While antiretroviral treatment can reduce the risk of contracting tuberculosis, the study aims to find out whether a comprehensive policy of screening and treatment latent tuberculosis can reduce tuberculosis incidence by an expected 60%, which would prevent 1,670 cases of tuberculosis per 100,000.

HIV/AIDS health workers need to accelerate efforts to prevent HIV patients from contracting tuberculosis and treat those who do, top public health officials said.

Speaking at the 16th International AIDS Conference in Toronto, leaders of the World Health Organization and International AIDS Society said a quarter of a million people with HIV die from tuberculosis every year, even though many of those deaths are preventable.

People with HIV are more vulnerable to tuberculosis than those without HIV, even if under treatment using antiretroviral therapy. More than one-third of all people infected with HIV also are infected with tuberculosis bacillus, Dr. Helene Gayle, the International AIDS Society president, said in a written statement. HIV infections number about 38.6 million worldwide.

“TB prevention, diagnostic, and treatment services must become core functions of all HIV services,” Dr. Kevin De Cock, WHO's HIV director, said in the statement. “TB can be treated and cured, so most of these deaths are absolutely preventable. HIV policy makers, health ministers, and health workers all have a vital role in making sure that deaths from TB are reduced.”

The officials touted a study in Rio de Janeiro that is seeking to reduce the prevalence of tuberculosis in 15,000 patients seeking treatment at 29 HIV clinics. While antiretroviral treatment can reduce the risk of contracting tuberculosis, the study aims to find out whether a comprehensive policy of screening and treatment latent tuberculosis can reduce tuberculosis incidence by an expected 60%, which would prevent 1,670 cases of tuberculosis per 100,000.

International public health officials have announced actions necessary to combat deadly new strains of tuberculosis that are resistant to most drugs on the market.

Officials from the South African Medical Research Council, the World Health Organization, and the Centers for Disease Control and Prevention called for rapid surveys of the prevalence of extensive drug-resistant TB in high-risk countries, increased laboratory capacity to carry out vital culture and drug resistance testing, improved clinical capacity, infection control precautions, and research support for new drug and diagnostic tests.

Of particular concern are countries with a high prevalence of HIV/AIDS, which public health officials warned has the potential to turn extensive drug-resistant TB into “an uncontrollable epidemic.” They called for universal access to antiretroviral drugs in joint TB/HIV projects.

Extensive or extreme drug-resistant TB describes strains that are resistant to the two most potent anti-TB drugs, isoniazid and rifampin, and at least three of six classes of second-line drugs.

International public health leaders gathered recently in Johannesburg in an emergency session with public health authorities from 11 southern African countries to discuss how to combat extensive drug-resistant TB.

“It is an area where the global community will need to be helpful to the countries that don't have resources, but locally, there needs to be ownership of the issue,” Ken Castro, director of the CDC's division of tuberculosis elimination, said in a press conference that was held in Johannesburg to discuss the threat of extensive drug-resistant TB.

New drugs and vaccines are in the works, officials said. Dr. Castro said that four agents look promising as drugs, but must still be proved through clinical trials.

Use of vaccines, including the BCG vaccine, is a possible approach, Dr. Castro said, although he added, “we will not be able to rely on vaccines to address the problem confronting us.”

Infection control in health care facilities is a priority, he said. To keep extensive drug-resistant TB from spreading to other patients, health care facilities need to promptly identify patients suffering from it, separate them from the rest of the patients, and make use of respiratory devices.

International public health officials have announced actions necessary to combat deadly new strains of tuberculosis that are resistant to most drugs on the market.

Officials from the South African Medical Research Council, the World Health Organization, and the Centers for Disease Control and Prevention called for rapid surveys of the prevalence of extensive drug-resistant TB in high-risk countries, increased laboratory capacity to carry out vital culture and drug resistance testing, improved clinical capacity, infection control precautions, and research support for new drug and diagnostic tests.

Of particular concern are countries with a high prevalence of HIV/AIDS, which public health officials warned has the potential to turn extensive drug-resistant TB into “an uncontrollable epidemic.” They called for universal access to antiretroviral drugs in joint TB/HIV projects.

Extensive or extreme drug-resistant TB describes strains that are resistant to the two most potent anti-TB drugs, isoniazid and rifampin, and at least three of six classes of second-line drugs.

International public health leaders gathered recently in Johannesburg in an emergency session with public health authorities from 11 southern African countries to discuss how to combat extensive drug-resistant TB.

“It is an area where the global community will need to be helpful to the countries that don't have resources, but locally, there needs to be ownership of the issue,” Ken Castro, director of the CDC's division of tuberculosis elimination, said in a press conference that was held in Johannesburg to discuss the threat of extensive drug-resistant TB.

New drugs and vaccines are in the works, officials said. Dr. Castro said that four agents look promising as drugs, but must still be proved through clinical trials.

Use of vaccines, including the BCG vaccine, is a possible approach, Dr. Castro said, although he added, “we will not be able to rely on vaccines to address the problem confronting us.”

Infection control in health care facilities is a priority, he said. To keep extensive drug-resistant TB from spreading to other patients, health care facilities need to promptly identify patients suffering from it, separate them from the rest of the patients, and make use of respiratory devices.

International public health officials have announced actions necessary to combat deadly new strains of tuberculosis that are resistant to most drugs on the market.

Officials from the South African Medical Research Council, the World Health Organization, and the Centers for Disease Control and Prevention called for rapid surveys of the prevalence of extensive drug-resistant TB in high-risk countries, increased laboratory capacity to carry out vital culture and drug resistance testing, improved clinical capacity, infection control precautions, and research support for new drug and diagnostic tests.

Of particular concern are countries with a high prevalence of HIV/AIDS, which public health officials warned has the potential to turn extensive drug-resistant TB into “an uncontrollable epidemic.” They called for universal access to antiretroviral drugs in joint TB/HIV projects.

Extensive or extreme drug-resistant TB describes strains that are resistant to the two most potent anti-TB drugs, isoniazid and rifampin, and at least three of six classes of second-line drugs.

International public health leaders gathered recently in Johannesburg in an emergency session with public health authorities from 11 southern African countries to discuss how to combat extensive drug-resistant TB.

“It is an area where the global community will need to be helpful to the countries that don't have resources, but locally, there needs to be ownership of the issue,” Ken Castro, director of the CDC's division of tuberculosis elimination, said in a press conference that was held in Johannesburg to discuss the threat of extensive drug-resistant TB.

New drugs and vaccines are in the works, officials said. Dr. Castro said that four agents look promising as drugs, but must still be proved through clinical trials.

Use of vaccines, including the BCG vaccine, is a possible approach, Dr. Castro said, although he added, “we will not be able to rely on vaccines to address the problem confronting us.”

Infection control in health care facilities is a priority, he said. To keep extensive drug-resistant TB from spreading to other patients, health care facilities need to promptly identify patients suffering from it, separate them from the rest of the patients, and make use of respiratory devices.