Archive for the ‘Guidelines’ Category

Earlier this month the US Preventive Services Task Force (USPSTF), an independent panel of respected experts in primary care and prevention, caused an uproar when they presented evidence that routine mammogram screening for breast cancer should not begin until the age of 50. The group based their recommendation on evidence showing that the “additional benefit gained by starting screening at age 40 years rather than at age 50 years is small, and that moderate harms from screening remain at any age”.  Essentially, the number of women we need to screen in order to extend one woman’s life is far higher for the group between the ages of 40 to 49 than for the group aged 50 to 59. However, current US Health and Human Services secretary, Kathleen Sebelius, issued a statement yesterday stating that there will not be any changes to government policy on mammography: screening mammograms should continue to start at the age of 40. [via Medical News Today]

Additional USPSTF recommendations include:

• Regular biennial screening mammography for women aged 50 to 74.
• No teaching of breast self-examination (BSE).
• There is not enough evidence to assess whether clinical breast examination (CBE) does more harm than good, beyond screening mammography in women 40 years or older.
• Current evidence is not enough to assess whether digital mammography or magnetic resonance imaging (MRI) would be better or worse than film mammography.

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The Drug and Therapeutics Bulletin, a monthly review of pharmacotherapeutics in medicine published by the British Medical Journal, is recommending that physicians take a second look before prescribing daily low-dose aspirin to patients. A recent review of European data questions whether there is any benefit at all for those without a history of cardiovascular disease to be taking a daily aspirin, especially since long-term low-dose aspirin therapy almost doubles the likelihood of gastrointestinal bleeding (a potentially serious side effect). The journal authors support continued use of aspirin in those with known cardiovascular disease, such as diabetes, high blood pressure and heart attacks. But, in light of current evidence, is not recommending daily low-dose aspirin for prevention of cardiovascular disease. [via Drug and Therapeutics Bulletin]

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This is going to be a busy flu season, especially considering that there will be two different flu vaccines available – one for the seasonal flu and the other for H1N1 (swine) flu. There are different recommendations for both vaccines, but only the seasonal flu vaccine is currently available. The Centers for Disease Control and Prevention recommends any adult who wants to reduce their risk of becoming ill with influenza to get the vaccine. However, if you are on the fence about the decision here is an up-to-date list from the CDC of high risk groups that should not think twice about getting the vaccine:

• persons aged 50 years and older;
• women who will be pregnant during the influenza season;
• persons who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematological or metabolic disorders (including diabetes mellitus);
• persons who have immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus;
• residents of nursing homes and other long-term care facilities;
• health-care personnel;
• household contacts and caregivers of children aged <5 years and adults aged 50 years and older, with particular emphasis on vaccinating contacts of children aged <6 months; and
• household contacts and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza.

*If you have concerns about thimerosal or other vaccine preservatives, this year’s flu vaccine only comes in two flavors – latex-containing and latex-free. Neither contains thimerosal.

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As the start of another school year is upon us, parents are asking what to do should their children come down with symptoms of influenza. The World Health Organization just released updated guidelines with regards to children and the H1N1 (swine) flu. The current recommendation is prompt treatment for children who show severe or deteriorating illness, and those at risk of more severe or complicated disease. This includes all children under 5 years of age because this age group is at an increased risk of severe H1N1 infection. Children who are otherwise healthy and older than the age of 5 do not need to be given antiviral medication unless their illness persists or worsen. Most patients, including children, who are infected with the pandemic H1N1 virus will experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. The two antivirals currently used are oseltamivir and zanamivir. They can help to reduce disease severity and reduce the need for hospitalization. [via WHO]

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A recent study presented at the 56th annual meeting of the American College of Sports Medicine (ACSM) suggests that the mood enhancing effects of exercise can last longer than an hour, as previously thought. Compared with a control group that did not exercise, the survey group of healthy men and women who exercised reported enhanced moods up to 12 hours post-exercise. volunteers performed exercise at 60% of aerobic capacity, which indicates that moderate-intensity exercise is enough to boost mood. Because these effects appear to fade after 12 hours, the researchers are recommending daily exercise. Current ACSM guidelines recommend at least 150 minutes of moderate-intensity exercise each week, which can be achieved in 30 minute segments five days a week.

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Hand washing is one of the best and most effective ways of controlling the spread of diseases – if done correctly. As we accumulate germs on our hands, we can infect ourselves with these germs by touching our eyes, mouth or nose which act as entryways into our body. Dirty hands can spread germs to others if you touch them directly, or if you touch a surface that they also touch. The best way to clean your hands is to use soap and clean running water. Alcohol-based hand sanitizers are also great at germ-killing. Antibacterial soaps are NOT recommended because they are no more effective than regular soap. Furthermore, they may induce the development of bacteria that are resistant to antibiotics. For proper hand-washing follow these simple rules:

1.  Use warm running water to wet your hands first, then apply a liquid or bar soap.
2.  Rub your hands together vigorously for at least 15 to 20 seconds, making sure that all surfaces are exposed to the soap, including your wrists, between the fingers, back of the hands and under the fingernails.
3.  Rinse well and dry with a clean or disposable towel.
4.  Turn off the faucet with a disposable towel to prevent contaminating your hands.

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According to the US Centers for Disease Control and Prevention (CDC), as of April 26 there are 20 documented cases of swine influenza in the US. Swine influenza is a respiratory disease of pigs that can sometimes infect humans, who can then transmit it to other humans. The current strain of virus that is circulating among humans is the H1N1 strain. The latest laboratory testing shows that this strain is susceptible to the prescription antiviral drugs oseltamivir and zanamivir. The CDC has released guidelines on the use of these drugs, as well as how to take care of someone who is sick with the flu, available here. Also, see an interactive map of the locations of the outbreak.

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The Evenflo company of Miamisburg, Ohio is recalling 640,000 high chairs due to safety concerns. The company has already received 320 reports of seatbacks detaching or reclining, unexpectedly causing injury. As well, there were reports of screws coming loose causing children to choke. A model number can be found on a white label on the seatback. Click here to view all the recalled model numbers. All consumers should stop using the recalled chairs and contact Evenflo to receive a free repair kit.

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Researchers from the US Centers for Disease Control and Prevention (CDC) have found that 15 brands of infant powdered formula contain perchlorate, a compound used in rocket fuel, which is also known to contaminate drinking water in many states. The concerned brands were not listed, however, the two most contaminated brands accounted for 87% of the US powdered formula market in 2000. Perchlorate was once used to treat patients with hyperthyroidism because of its ability to reduce thyroid hormone production. Perchlorate pollution is largely a legacy of Cold War rocket and missile testing.

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The British Medical Journal today published a revealing study on the risks of smoking during pregnancy. Women smokers who do not quit prior to 15 weeks of pregnancy are 3 times as likely to give birth prematurely. And if you are a long time smoker and think that quitting now won’t make a difference, think again. Women who stopped smoking during pregnancy, compared to nonsmokers, have the same rate of preterm birth. This goes to show that it’s never too late to quit.

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