Infectious Disease
Sierra Leone researchers are calling for improved health surveillance and communication around Ebola crisis. Researchers working in Sierra Leone have suggested priority actions they say are needed to tackle the ongoing Ebola crisis in West Africa. In a letter to the British medical journal The Lancet published last month, scientists affiliated with institutions in the U.S. and Sierra Leone call forcefully for improvements in access to diagnostic technologies and healthcare resources.
At present, there is little incentive for patients to seek professional diagnosis of suspected Ebola, say the authors, with most people with febrile illnesses in Sierra Leone treated at home; the extent of the outbreak therefore is very difficult to determine. Also, disease surveillance systems in the region are inadequate, despite research suggesting that mobile phones and smartphones can be effectively deployed to collect data.
The authors highlight a shortage of medical personnel and access to healthcare facilities for people in the region. Also, “the relatively few physicians, nurses, and healthcare providers attending to these underserved populations often have poor access to basic personal protective equipment….There is an urgent need to provide reliable and constant access to personal protective equipment in healthcare centers across the region.”
Finally, they suggest that disease control policies designed to restrict border crossings and sales of possibly infected meat have been ineffective:”What is certain is that these policies…raised anxiety and, in some places, fuelled rumors that led to counter-productive behaviors.”
The CDC is reporting that cases of the mosquito-borne chikungunya virus are on the increase in the United States. The disease, whose symptoms include fever, rash, headache, and severe joint pain, had been confirmed in 29 states and territories as of early last month. So far, all of the U.S. cases have been linked to Caribbean travel, but CDC officials say that as more travelers come into the U.S. from the American tropics, there may be local transmission. The aggressive Asian tiger mosquito, which carries the virus, reportedly has spread as far north as New York City and Chicago.
Chikungunya testing is performed at CDC, a few state health departments, and one commercial laboratory, Focus Diagnostics. Diagnosis is accomplished by testing serum or plasma to detect virus, viral nucleic acid, or virus-specific immunoglobulin (IgM) and neutralizing antibodies. Viral culture may detect virus in the first three days of illness; however, chikungunya virus should be handled under BSL 3 conditions. During the first eight days of illness, chikungunya viral RNA can often be identified in serum. Chikungunya virus antibodies normally develop toward the end of the first week.
Testing
New study analyzes physicians’ inconsistent record of ordering lab tests for drug level monitoring. A new study, published recently in the Journal of General Internal Medicine, seeks to pinpoint the factors that influence whether physicians order laboratory tests to monitor patients’ levels of high-risk medications. Researchers at the Meyers Primary Care Institute in Massachusetts studied the electronic medical records of 31,417 patients and 278 providers in a large multispecialty New England group practice. The study includes information about prescriptions for 34 high-risk conditions and their 60 associated tests. You can visit the study at http://link.springer.com/article/10.1007/s11606-014-2907-9.
For recommended tests, the rate of physician ordering varies greatly. For example 95% of patients taking potassium receive an order for a potassium level, but less than half of patients on Lithium receive orders for a blood count (42%) or creatinine level (49%), as is recommended. Tests measured yearly (e.g., Digoxin level) were more likely to be ordered than those required more often (e.g., AST/ALT levels in patients on Rifampin). Test ordering also was affected by patient characteristics such as age and gender; single vs. multiple tests; whether the physician was a specialist or not; and even the age of the physician, among other factors.
Cancer
An association between high blood cholesterol and breast cancer has been found in a study of more than a million patients over a 14-year time period in the United Kingdom. Lead researcher Rahul Potluri, PhD, says “Our preliminary study suggests that women with high cholesterol in their blood may be at greater risk of getting breast cancer. It raises the possibility of preventing breast cancer with statins.”
The researchers conducted a retrospective analysis of more than a million patients between 2000 and 2013. Included were 664,159 women; of these, 22,938 had hyperlipidemia and 9,312 had breast cancer. Some 530 women with hyperlipidemia developed breast cancer. Researchers used a statistical model to study the association between breast cancer and high blood cholesterol. They found that having hyperlipidemia increased the risk of breast cancer by 1.64 times (95% confidence interval 1.50-1.79). The study is not definitive, but it is intriguing.
Drugs of Abuse
Healthcare providers wrote 259 million prescriptions for opioid painkillers in 2012—many more in some states than in others. So says a Vital Signs report released recently by the Centers for Disease Control and Prevention (CDC) that highlights the danger of overdose.
Healthcare providers in the highest prescribing state, Alabama, wrote almost three times as many of these prescriptions per person as those in the lowest prescribing state, Hawaii. Most of the highest prescribing states were in the South. Previous research has shown that regional variation in use of prescriptions cannot be explained by the underlying health status of the population.
The Vital Signs report also contains a study highlighting the success of Florida in reversing prescription drug overdose trends. Results showed that after statewide legislative and enforcement actions in 2010 and 2011, the death rate from prescription drug overdose decreased 23% between 2010 and 2012. Florida officials had taken these actions in response to a 28% increase in the drug overdose death rate over the preceding years (2006-2010).
