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    <recommendedItem id="20100101_19_3230"
                     title="Hospital-Acquired Infections Trend Downward"
                     score="0.015"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/InfectionControl/tb/21985?impressionId=1283457953605"
                     
      &lt;p&gt;Although healthcare-associated infections (HAIs) remain a large and at least partly avoidable problem in hospitals, it appears to be less of one than it was a few years ago, according to the Agency for Healthcare Research and Quality.&lt;/p&gt;
&lt;p&gt;After peaking in 2004 and 2005 at 2.30 per 1,000 hospital stays, HAI rates among adults declined to 2.03 per 1,000 stays in 2007, according to the most recent data from the Healthcare Cost and Utilization Project, summarized in an AHRQ statistical brief.&lt;/p&gt;
&lt;p&gt;The 2007 figure was identical to the rate seen in 2000 when the project first began collecting data, according to AHRQ researchers led by Claudia Steiner, MD, MPH.&lt;/p&gt;
&lt;p&gt;HAIs were recorded in just 0.2% of hospital stays in 2007.&lt;/p&gt;
&lt;p&gt;All patient subgroups, stratified by age, geographic region, and type of payer, shared in the decline, the researchers also found.&lt;/p&gt;
&lt;p&gt;The findings were seemingly at odds with &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/19568&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/19568&quot; target=&quot;_blank&quot;&gt;another AHRQ report&lt;/a&gt; issued earlier in the year. The agency&apos;s 2009 National Healthcare Quality Report, released in April, struck a pessimistic note by highlighting increases in the 2007 data for certain types of infections  --  postoperative sepsis and urinary tract infections  --  from 2006.&lt;/p&gt;
&lt;p&gt;But the new report indicates that, overall, 2007 was better than the previous year for HAIs, with the rate per 1,000 hospital stays down from 2.19 in 2006.&lt;/p&gt;
&lt;p&gt;No explanation for the downward trend was offered by Steiner and colleagues, but other investigators who have identified declining hospital infection rates have suggested that improved adherence to treatment guidelines and better management of risk factors for HAIs are responsible.&lt;/p&gt;
&lt;p&gt;The new report identified several hospital characteristics that were significantly (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) associated with increased rates of HAIs: &lt;ul&gt; &lt;li&gt;Hospital size of 500 beds or more&lt;/li&gt; &lt;li&gt;Location in metropolitan area&lt;/li&gt; &lt;li&gt;Teaching hospital&lt;/li&gt; &lt;li&gt;Private for-profit status&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The report also indicated that stays marked by HAIs were distributed almost equally between male and female patients, in contrast with the nearly 2:1 ratio of women to men among hospital patients overall.&lt;/p&gt;
&lt;p&gt;The Healthcare Cost and Utilization Project collects data on all inpatients treated at a rotating nationwide sample of about 1,000 short-term, non-federal hospitals.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_3175"
                     title="Car Crash Injury Costs Yield Sticker Shock"
                     score="0.013"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/tb/21904?impressionId=1283457953605"
                     
      &lt;p&gt;Medical expenses and costs of lost productivity related to motor vehicle crashes topped $99 billion dollars in a single year, according to CDC investigators.&lt;/p&gt;
&lt;p&gt;Most of the costs  --  $70 billion  --  were attributed to accidents involving cars and light trucks. Motorcyclists cost $12 billion, pedestrians $10 billion, and bicyclists $5 billion, according to the study published online in &lt;em&gt;Traffic Injury Prevention&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Accidents that involved a fatality were the most costly, at about $58 billion. Nonfatal accidents that resulted in hospitalization absorbed another $28 billion of the total sum. People who were treated in an emergency department and released still accumulated $14 billion in costs.&lt;/p&gt;
&lt;p&gt;Study investigators based their totals on &lt;em&gt;&lt;/em&gt;costs associated with medical care, treatment, rehabilitation, and productive life-years lost from premature death or long-term disability.&lt;/p&gt;
&lt;p&gt;They analyzed data for 2005 from the National Vital Statistics System, the Fatality Analysis Reporting System, the Healthcare Cost and Utilization Project-National Inpatient Sample, and the National Electronic Injury Surveillance System-All Injury Program.&lt;/p&gt;
&lt;p&gt;Teens and young adults between 15 and 24  --  who make up about 14% of the population  --  accounted for a disproportionate share of the injuries and costs (28% of injuries and 31% of cost  --  approximately $25 billion).&lt;/p&gt;
&lt;p&gt;Motor vehicle crashes also took a heavier toll on men than women  --  70% of deaths and 52% of injuries occurred in men. Their injuries and deaths accounted for 74% of total costs ($74 billion).&lt;/p&gt;
&lt;p&gt;In a prepared statement announcing release of the study, the CDC recommended a number of measures to decrease cost and injury rates, including: &lt;ul&gt; &lt;li&gt;Use of graduated driver licensing policies for teen drivers&lt;/li&gt; &lt;li&gt;Education on proper use of child safety seats, as well as distribution of seats properly sized and installed&lt;/li&gt; &lt;li&gt;Increased ticketing for seat belt violations&lt;/li&gt; &lt;li&gt;Greater promotion of seat belt safety (such as &quot;Click It or Ticket&quot; ads)&lt;/li&gt; &lt;li&gt;Emphasis on use of helmets for motor- and bicyclists&lt;/li&gt; &lt;li&gt;More sobriety checkpoints&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_3169"
                     title="Declines in Teen Smoking Rates Stalled (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/tb/21899?impressionId=1283457953605"
                     
      The declines in tobacco use among young people seen earlier in the decade appear to have leveled off in the last three years, suggesting that greater preventive efforts are needed, CDC researchers reported.&lt;br&gt;
&lt;br&gt;In 2009, 8.2% of middle school students and 23.9% of high school students reported any tobacco use, and 5.2% and 17.2%, respectively, said they currently smoke cigarettes, according to a report in the Aug. 27 issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;These numbers come from the school-based National Youth Tobacco Survey, which has been conducted about every two years since 2000.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;The questionnaire asks not only about any tobacco use and cigarette smoking, but also about the use of smokeless tobacco, cigars, pipes, bidis, which are small cigarettes wrapped in a leaf, and kreteks, or clove cigarettes.&lt;/p&gt;
&lt;p&gt;The 2009 survey included a nationally representative sample of 22,679 students from 205 schools.&lt;/p&gt;
&lt;p&gt;The current numbers are down significantly from percentages seen in 2000, when 15.1% of middle school students and 34.5% of high school students reported using some form of tobacco.&lt;/p&gt;
&lt;p&gt;Current cigarette smoking is down significantly, too, from 11% in 2000 among middle schoolers and 28% among high school kids.&lt;/p&gt;
&lt;p&gt;But most of the declines came in the first half of the decade.&lt;/p&gt;
&lt;p&gt;Between 2006 and 2009 significant declines (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) were seen in only a few categories: &lt;ul&gt; &lt;li&gt;Female middle school students, current cigarette smoking, 6.4% to 4.7%&lt;/li&gt; &lt;li&gt;Non-Hispanic white middle school students, current cigarette smoking, 6.5% to 4.3%&lt;/li&gt; &lt;li&gt;Female high school students, current tobacco use, 21.3% to 18.2%&lt;/li&gt; &lt;li&gt;Female high school students, current cigarette smoking, 18.4% to 14.8%&lt;/li&gt; &lt;li&gt;Non-Hispanic white high school students, current bidis use, 2.6% to 1.7%&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;And there was no decline in the percentage of kids who said they didn&apos;t smoke but might try.&lt;/p&gt;
&lt;p&gt;That willingness to try smoking reflects the ineffectiveness of tobacco control efforts and might help explain the slowing in the decline of youth tobacco use, according to an editorial note accompanying the report.&lt;/p&gt;
&lt;p&gt;&quot;The findings from this report suggest further efforts are needed to counter tobacco industry influences on youths,&quot; the editors noted.&lt;/p&gt;
&lt;p&gt;Among measures that could be implemented, they suggested, are tax increases, further restrictions on access and advertising, and prohibition of tobacco sponsorship of athletic and social events.&lt;/p&gt;
&lt;p&gt;Funding for tobacco control programs also must be increased. &quot;The more states spend on sustained comprehensive tobacco control programs, the greater the reductions in youth and adult smoking rates,&quot; the editors argued.&lt;/p&gt;
&lt;p&gt;Finally, greater efforts will be needed to implement changes in social norms to help reduce the susceptibility of young people.&lt;/p&gt;
&lt;p&gt;The report was subject to certain limitations, in that the data collection began only in 2000 so previous trends could not be measured, data were self-reported, and teens who drop out of school were not included.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors are employees of the CDC.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3168"
                     title="Lab Tests Confirm Source of Salmonella in Eggs"
                     score="0.012"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/tb/21897?impressionId=1283457953605"
                     
      &lt;p&gt;Test results from environmental samples at Wright County Egg  --  one of two related companies believed to have supplied &lt;em&gt;Salmonella&lt;/em&gt;-contaminated eggs now under nationwide recall  --  showed strains of the bacteria with the same DNA fingerprint seen in clinical isolates, FDA officials said.&lt;/p&gt;
&lt;p&gt;Chicken feed at facilities supplying Iowa-based Wright County Egg and Hillandale Farms also tested positive for &lt;em&gt;Salmonella enteritidis&lt;/em&gt; with the same genomic fingerprint, officials told reporters during a telephone briefing.&lt;/p&gt;
&lt;p&gt;&quot;Feed and feed ingredients perhaps were the sources, but maybe not the only sources,&quot; said Sherri McGarry of the FDA&apos;s food safety division.&lt;/p&gt;
&lt;p&gt;She noted that investigators had taken many more samples for which test results were not yet available.&lt;/p&gt;
&lt;p&gt;Jeff Farrar, DVM, PhD, MPH, associate commissioner of food safety at FDA, said the investigation still hadn&apos;t determined how &lt;em&gt;Salmonella&lt;/em&gt; bacteria got into the chicken feed, though rodent feces are the usual source in such situations.&lt;/p&gt;
&lt;p&gt;Farrar defended the government&apos;s response to the contamination, which has been criticized as too slow.&lt;/p&gt;
&lt;p&gt;&quot;We have to strike a balance between being timely and being accurate,&quot; he said, noting that the FDA requested that Wright County Egg and Hillandale Farms initiate the recall before lab results had confirmed that the companies&apos; eggs were the source of the outbreak.&lt;/p&gt;
&lt;p&gt;Christopher Braden, MD, of the CDC&apos;s foodborne diseases unit, said 2,403 &lt;em&gt;Salmonella enteritidis&lt;/em&gt; illnesses confirmed with the same DNA fingerprint had been reported from May 1 to Aug. 25.&lt;/p&gt;
&lt;p&gt;He emphasized that many of these probably were not related to the contaminated eggs, while other case reports would not have yet made their way to the CDC.&lt;/p&gt;
&lt;p&gt;Braden said 933 case reports of &lt;em&gt;Salmonella &lt;/em&gt;would have been expected during the same period, on the basis of averages seen in previous years.&lt;/p&gt;
&lt;p&gt;Since the CDC&apos;s last summary issued last week, no new clusters of illnesses and no reports of deaths associated with the outbreak had been received, Braden added.&lt;/p&gt;
&lt;p&gt;He also reported what he called &quot;good news&quot;  --  that no clusters of illnesses in nursing homes had been seen yet, which is important because the elderly are particularly vulnerable to &lt;em&gt;Salmonella&lt;/em&gt; illness.&lt;/p&gt;
&lt;p&gt;Moreover, he added, disease clusters traced to restaurants and other gatherings seen to date have all been small.&lt;/p&gt;
&lt;p&gt;Nevertheless, Braden said, the current outbreak was the largest ever reported for &lt;em&gt;Salmonella&lt;/em&gt;. The previous record for a &lt;em&gt;Salmonella &lt;/em&gt;outbreak occurred in 1994 from ice cream containing contaminated eggs  --  but that outbreak had fewer than 800 cases.&lt;/p&gt;
&lt;p&gt;More than half a billion eggs sold under 35 brands are now included in the recall.&lt;/p&gt;
&lt;p&gt;Farrar repeated a theme struck earlier in the week by FDA Commissioner Margaret Hamburg, MD  --  that enhanced powers for the FDA to regulate food production could have been helpful in containing the current outbreak.&lt;/p&gt;
&lt;p&gt;Legislation passed by the House of Representatives last year to strengthen the FDA&apos;s authority has languished in the Senate, though movement is now expected when senators return from their August holiday.&lt;/p&gt;
&lt;p&gt;Farrar said several aspects of the legislation &quot;could have sped up the investigation.&quot;&lt;/p&gt;
&lt;p&gt;Specifically, he said, the bill would let the FDA implement rules to allow retail foods to be traced quickly to their sources and would require that food producers open their records to FDA inspectors. It would also allow the FDA to order recalls.&lt;/p&gt;
&lt;p&gt;Currently, the agency can only request that companies voluntarily provide records and initiate recalls. Farrar said the egg companies had cooperated in the current investigation.&lt;/p&gt;
&lt;p&gt;Nevertheless, he asserted that the outbreak probe could have moved even faster if the FDA could have put muscle behind its requests.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_3157"
                     title="Death Risk Widens for Blacks With Colorectal Cancer (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/tb/21885?impressionId=1283457953605"
                     
      The risk of death from colorectal cancer is greater for blacks than whites and the differences have been widening for four decades, researchers said.&lt;br&gt;
&lt;br&gt;The widening disparities have occurred in both sexes and in all stages of the disease, despite improvements in detection and treatment, according to Samir Soneji, PhD, and colleagues at the University of Pennsylvania.&lt;br&gt;
&lt;br&gt;The disparities  --  largely driven by consistent improvements among whites  --  are most likely the result of differences in access to care or the quality of care, the researchers wrote online in the&lt;em&gt; American Journal of Public Health&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;Colorectal cancer is one of the few cancers that has had advances in detection, treatment, and survival over the second half of the twentieth century,&quot; Soneji said in a statement. &quot;But despite these advancements, we observed ever-widening racial gaps in overall and stage-specific survival.&quot;&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Earlier this year, &lt;a href=&quot;http://www.medpagetoday.com/HematologyOncology/ColonCancer/19436&quot; mce_href=&quot;http://www.medpagetoday.com/HematologyOncology/ColonCancer/19436&quot; target=&quot;_blank&quot;&gt;another research team also concluded&lt;/a&gt; that healthcare use might be responsible for the observed differences by race.&lt;/p&gt;
&lt;p&gt;The current findings come from a retrospective analysis of data from the National Center for Health Statistics and the Surveillance, Epidemiology, and End Results (SEER) database between 1960 and 2005, Soneji and colleagues reported.&lt;/p&gt;
&lt;p&gt;One surprising finding was that death rates from colorectal cancer were once higher among whites, Soneji said, at about 250 deaths per million person-years for women and 275 per million for men in 1960.&lt;/p&gt;
&lt;p&gt;But since then, death rates for whites have been dropping, while they dropped more slowly among black women and actually increased among black men, the researchers found. Specifically: &lt;ul&gt; &lt;li&gt;Among white women, mortality steadily declined from 241 deaths per million person-years in 1960 to 111 deaths per million person-years in 2005  --  equivalent to a 54% relative reduction.&lt;/li&gt; &lt;li&gt;Among black women, the relative decline was 14%  --  from 203 deaths per million person-years in 1960 to 174 in 2005.&lt;/li&gt; &lt;li&gt;For white men, mortality fell from 273 deaths per million person-years in 1960 to 166 in 2005, a 39% relative decline. &lt;/li&gt; &lt;li&gt;In contrast, death rates for black men increased 28% over the same time period, to 258 deaths per million person-years in 2005 from 201 in 1960.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The researchers also found that blacks had worse rates of stage-specific survival and life expectancy than whites.&lt;/p&gt;
&lt;p&gt;For example, they reported, the life expectancy of a 60-year-old white man with localized colorectal cancer in the 1970s was 1.01 year longer than that of a black man the same age with the same disease stage. In the first decade of this century, they found, the gap was 2.7 years.&lt;/p&gt;
&lt;p&gt;Overall, when the researchers controlled for age, sex, and stage at diagnosis, the hazard of death in the 1970s was 1.11 times greater for blacks than for whites. The disparity &quot;increased consistently&quot; over the next 30 years, reaching 1.22 times greater in the1980s, 1.26 times greater in the 1990s, and 1.33 times greater in the 2000s.&lt;/p&gt;
&lt;p&gt;The researchers said it&apos;s possible that variability and biases in death certificate data may distort the results. As well, they noted, the SEER registry does not capture the entire U.S., which may mean that some trends were missed.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study had support from Robert Wood Johnson Foundation Health &amp;amp; Society Scholars and Robert Wood Johnson Clinical Scholars.&lt;/p&gt;&lt;p&gt;The researchers did not report conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>
