Posts Tagged ‘CDC’

Coming Soon? Restored Breathing for Spinal Cord Injury Patients

Wednesday, July 20th, 2011

image from msstrength.com

The online version of the journal Nature publishes an article today about a potential breakthrough in the treatment of spinal cord patients. While I do not have access to the full article, medicalnewstoday.com provides an overview of the research work. The highlight is that the researchers from Case Western Reserve University School of Medicine were able to restore breathing in rodents with spinal cord injuries.

This research provides optimism for similar success in humans (clinical trials with humans are hopefully forthcoming). In the recently released studies, the scientists combined “…an old technology a peripheral nerve graft, and a new technology an enzyme” to be able to restore 80-100% of breathing function in the rodents.

Using a graft from the sciatic nerve, surgeons have been able to restore function to damaged peripheral nerves in the arms or legs for 100 years. But, they’ve had little or no success in using a graft on the spinal cord. Nearly 20 years ago, [Jerry Silver, professor of neurosciences at Case Western Reserve and senior author,] found that after a spinal injury, a structural component of cartilage, called chondroitin sulfate proteoglycans, was present and involved in the scarring that prevents axons from regenerating and reconnecting. Silver knew that the bacteria Proteus vulgaris produced an enzyme called Chondroitinase ABC, which could break down such structures. In previous testing, he found that the enzyme clips the inhibitory sugary branches of proteoglycans, essentially opening routes for nerves to grow through.

In this study, the researchers used a section of peripheral nerve to bridge a spinal cord injury at the second cervical level, which had paralyzed one-half of the diaphragm. They then injected Chondroitinase ABC. The enzyme opens passageways through scar tissue formed at the insertion site and promotes neuron growth and plasticity. Within the graft, Schwann cells, which provide structural support and protection to peripheral nerves, guide and support the long-distance regeneration of the severed spinal nerves. Nearly 3,000 severed nerves entered the bridge and 400 to 500 nerves grew out the other side, near disconnected motor neurons that control the diaphragm. There, Chondroitinase ABC prevented scarring from blocking continued growth and reinnervation.

“All the nerves hook up with interneurons and somehow unwanted activities are filtered out but signals for breathing come through,” Silver said. “The spinal cord is smart.”

Three months after the procedure, tests recording nerve and muscle activity showed that 80 to more than 100 percent of breathing function was restored. Breathing function was maintained at the same levels six months after treatment”

From medicalnewstoday.com

This could be life-changing for those spinal cord injury patients who currently need ventilators to survive. If human studies prove the efficacy of such treatment, patients would have the hope of being able to breath on their own again. Not only would this dramatically improve these patients’ quality of life, but it would also provide a dramatically improved outcome for these patients. Currently, “[r]estoration of breathing is the top desire of people with upper spinal cord injuries. Respiratory infections, which attack through the ventilators they rely on, are their top killer.”

The BBC is reporting that “[r]esearchers hope to begin trials in humans. They are also investigating whether bladder function can be restored, which can be lost when the lower spine is damaged.”

The CDC’s most recent statistics, which are a few years old, suggest that there are currently about 200,000 people in the United States who are living with spinal cord injuries. This number increases by approximately 12,000-20,000 new patients annually. If some portion of these individuals could be provided hope for breathing on their own and or regaining bladder function, their lives could be dramatically improved.

Related Articles:

Spinal Cord Injury Updates: More Reasons for Optimism?

New Treatment Holds Promise for Patients With Spinal Cord Injuries

New Microchip Promises to Make Life Much Easier for Paraplegic Patients

Can Copper Surfaces and Duct Tape Reduce Hospital Infections and Deaths?

Thursday, July 7th, 2011

Image from medgadget.com

How many times have you heard about someone entering the hospital healthy, or relatively so, and developing a dangerous infection while hospitalized? What about the number of times that you may have visited your own doctor’s office or your child’s pediatrician’s office and wondered whether the cold you got a few days later was coincidence or the result of having been in the waiting and exam rooms following other sick patients? Have you ever considered what cleaning procedures are done in hospital rooms when one patient is discharged before another takes their place?

In the past, Brian Nash and the other legal bloggers here at Eye Opener have written posts and made mention of the importance of hospital cleanliness and sterility, see the related posts below. We have been involved in cases involving the devastating results of infections. However, everyone knows that there are going to be germs in hospitals. Even the best hospitals have to work to keep the patients, rooms and visitors clean and safe.

Well, there is news that may make keeping hospitals and other health care environments less germy in the future. Two recent articles have focused on seemingly simple solutions, copper and duct tape, that may have major impacts on infection control.

Copper Surfaces Dramatically Reduce Infections by Killing Bacteria

A Reuters’ article reports that a recent study “presented at the World Health Organization’s 1st International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland” shows that “replacing the most heavily contaminated touch surfaces in ICUs with antimicrobial copper will control bacteria growth and cut down on infection rates.” According to the Reuters’ article:

[a]ntimicrobial copper surfaces in intensive care units (ICU) kill 97 percent of bacteria that can cause hospital-acquired infections, according to preliminary results of a multisite clinical trial in the United States. The results also showed a 40 percent reduction in the risk of acquiring an infection.

This news could have a profound impact on health-care costs, disease spread, and most importantly lives lost. If hospitals are able to replace some of their current surfaces with copper surfaces, at least in the parts of the hospital that are most frequently the source of infections, there could be a dramatic improvement in hospital-acquired infections.

Hospital-acquired infections (HAIs) are the fourth leading cause of death in the United States behind heart disease, strokes and cancer.

According to estimates provided by the Centers of Disease Control and Prevention, nearly one in every 20 hospitalized U.S. patients acquires an HAI, resulting in 100,000 lives lost each year.

From Reuters

Perhaps even more infections could be prevented if these changes could be made outside of just ICUs. For instance, perhaps copper surfaces could replace highly touched surfaces on sink handles, the doors to hospital rooms, hospital bed rails, or in out-patient surgery centers and long-term care facilities that are not housed within hospitals.

Duct Tape Warnings Keep Others Far Enough Away from Infected Patients

Image from ducttapesales.com

An article from Medicalnewstoday reports that some hospitals are using plain duct tape – just colored red – to achieve a reduction in infection rates from highly infectious patients without having to deal with the hassle and expense of all visitors or hospital personnel who enter the room having to rescrub and use new gowns every time they enter the room of an infected patient. The study looked at highly infectious diseases like C. diff that require isolation of patients and very careful hand washing to avoid spreading the infection. So how does duct tape help?

The Association for Professionals in Infection Control and Epidemiology (APIC) commissioned a study to corner off a three foot perimeter around the bed of patients in isolation. Medical personnel could enter the room unprotected if they stayed outside the perimeter. Direct patient contact or presence inside the perimeter meant a redo of the cleansing process. The concept, called “Red Box” employs red duct tape, a color used as it provides a strong visual reminder to those who enter the room to be aware.

The study found that 33% of all who entered the rooms could do so without the addition of gowns and gloves, saving the environment, hospital and patient costs, and time without compromising the patient or the medical personnel.

From Medicalnewstoday

How Else Can We Reduce Infections?

What ideas do you have for the use of copper surfaces? Do you think that copper surfaces or duct tape could make a dramatic difference in the safety of hospital admission? What about the cost? Do you think that hospitals would pay the upfront costs of replacing surfaces with copper to be able to dramatically cut infection rates? What about other low cost solutions like duct-tape around the perimeter of the bed? Can you think of other low-cost solutions that could minimize infections and maximize safety?

Related Posts:

New federal study finds ‘lax infection control’ at same-day surgery centers

FDA warning to healthcare professionals: use sterile prep pads!

Skin Cancer: Types, Causes and How to Protect Yourself

Tuesday, June 28th, 2011

Image from psvresort.com

From the (guest) editor:  Although today’s weather forecast is for thunderstorms, we should keep in mind that the summer season is upon us.  It is time to protect one of our largest organs — our skin!

–Jason

The news last week about the new FDA regulations on sunscreen had me prepared to write a blog article this week about the changes. I wanted to clarify what the new rules will mean for consumers – how to choose the correct product, what the various claims actually mean about protection, whether safety has been considered. However, as I delved deeper into the topic, I realized that the first concern has to be sun exposure and cancer in general. There is too much information – medical and legal – out there for one post. So, I am going to write a brief series. The first topic – today – will be about the startling statistics about various skin cancers. I will discuss various types of skin cancers, their prevalence and the survival and death rates from these cancers. In future posts, I plan to examine the original issue – whether the new regulations will help consumers choose a product that will help protect from some of these risks and how these legal steps may fall short of the final goal. Finally, I will look at the issue of tanning beds. Should children or teens be allows to use them? What about parental consent? There are medical and legal ramifications surrounding the use of tanning beds – I will look at a few of those. Along the way, please comment and let me know your thoughts. Or, if you are just daydreaming about enjoying summer…you can let us know that too (for my own personal idea of a great summer vacation see today’s photo).

Not All Skin Cancer is Created Equal

Personally, I tend to lump all skin cancer together in my mind. Unfortunately, whether you are putting yourself at risk for or are diagnosed with squamous cell, basilar cell or malignant melanoma makes a big difference. The rates of these diseases and the survival statistics are dramatically different.

So, first, what are these diseases?

Image from www.cancer.org

 

The National Cancer Institute at NIH explains the different types of skin cancers:

Skin cancer that forms in melanocytes (skin cells that make pigment) is called melanoma. Skin cancer that forms in the lower part of the epidermis (the outer layer of the skin) is called basal cell carcinoma. Skin cancer that forms in squamous cells (flat cells that form the surface of the skin) is called squamous cell carcinoma. Skin cancer that forms in neuroendocrine cells (cells that release hormones in response to signals from the nervous system) is called neuroendocrine carcinoma of the skin.

How Common are these Cancers?

According to the Skin Cancer Foundation, skin cancer is the most common form of cancer in the United States. Of the various types of skin cancer, basal cell carcinoma is the most common (2.8 million/year the US), followed by squamous cell carcinoma (700,000/year), and finally melanoma (115,000). However, the death rates caused by melanoma are much higher than the other types of cancer. The statistics on the Skin Cancer Foundation website are shocking (just a sampling):

  • One person dies of melanoma every hour (every 62 minutes).
  • One in 55 people will be diagnosed with melanoma during their lifetime.
  • Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old.
  • The incidence of many common cancers is falling, but the incidence of melanoma continues to rise at a rate faster than that of any of the seven most common cancers. Between 1992 and 2004, melanoma incidence increased 45 percent, or 3.1 percent annually.
  • An estimated 114,900 new cases of melanoma were diagnosed in the US in 2010 – 46,770 noninvasive (in situ) and 68,l30 invasive, with nearly 8,700 resulting in death.
  • Melanoma accounts for less than five percent of skin cancer cases, but it causes more than 75 percent of skin cancer deaths.

I was particularly taken by this last fact – while accounting for “less than five percent of skin cancer cases, [melanoma] causes more than 75 percent of skin cancer deaths.” This is startling because “[t]he survival rate for patients whose melanoma is detected early, before the tumor has penetrated the skin, is about 99 percent.” However, ‘”[t]he survival rate falls to 15 percent for those with advanced disease.” So the key here is clearly prevention and early detection.

Unfortunately, the melanoma incidence rate is rising annually. Melanoma is responsible for approximately 8,700 deaths a year in the US, as compared to rare deaths from basal cell carcinoma and approximately 2,500 deaths a year from squamous cell carcinoma.  And this is not just a problem for those with light skin – the Skin Cancer Foundation explains that “[w]hile melanoma is uncommon in African Americans, Latinos, and Asians, it is frequently fatal for these populations.”

Given the high incidence rate and the high survival rate for early-diagnosed melanomas, it seems key that people should know the risks factors and causes for melanoma. The better the prevention, the less likely that you should develop this type of cancer. Secondly, if you are in a high-risk category, you should be seeing a dermatologist regularly since the key to survival is early detection.

Causes of Melanoma

The CDC provides confirmation that “[s]kin cancer is the most common form of cancer in the United States” and that the incidence of melanoma of the skin has “increased significantly by 3.1% per year from 1986 to 2006 among men” and 3% among woman from 1993 to 2006.Yet, we know many of the risk factors for melanoma.

The CDC reports that “[a]bout 65%-90% of melanomas are caused by exposure to ultraviolet (UV) light.” This is the kind of radiation that come from the sun – and tanning beds (more on that in a later post). There are three different types of ultraviolet light and two of them have a role to play in changing and damaging skin cells.

The three types of UV rays are ultraviolet A (UVA), ultraviolet B (UVB), and ultraviolet C (UVC)-

  • UVA is the most common kind of sunlight at the earth’s surface, and reaches beyond the top layer of human skin. Scientists believe that UVA rays can damage connective tissue and increase a person’s risk of skin cancer.
  • Most UVB rays are absorbed by the ozone layer, so they are less common at the earth’s surface than UVA rays. UVB rays don’t reach as far into the skin as UVA rays, but they can still be damaging.
  • UVC rays are very dangerous, but they are absorbed by the ozone layer and do not reach the ground.

Too much exposure to UV rays can change skin texture, cause the skin to age prematurely, and can lead to skin cancer. UV rays also have been linked to eye conditions such as cataracts.

From the CDC website

In addition to sun exposure, there also additional risk factors to consider:

  • A lighter natural skin color.
  • Family history of skin cancer.
  • A personal history of skin cancer.
  • Exposure to the sun through work and play.
  • A history of sunburns early in life.
  • A history of indoor tanning.
  • Skin that burns, freckles, reddens easily, or becomes painful in the sun.
  • Blue or green eyes.
  • Blond or red hair.
  • Certain types and a large number of moles.

From the CDC website

Children and Adults are Not Doing Enough to Protect Themselves

Certainly, some of these risk factors are immutable, but others, like sun exposure and tanning are risks that can be avoided or at least minimized. The CDC says they have supported surveys that show that “U.S. youth and adults are being exposed to ultraviolet radiation and can do more to protect themselves. More than one-third of the U.S. population reported a sunburn in the previous year, with rates higher among men and the non-Hispanic white population.”

I found the CDC statistics troubling given how long it has been known that sun exposure and damage lead to skin cancer:

In 2005, only 56% of adults said they usually practice at least one of the three sun-protective behaviors (use sunscreen, wear sun-protective clothing, or seek shade).

  • 30% reported usually applying sunscreen (27% applied sunscreen with an SPF of 15 or higher).
  • 18% reported usually wearing some type of fully sun-protective clothing.
  • 33% usually sought shade.
  • Only 43% of young adults aged 18-24 used one or more sun protective methods, whereas 58% of those 25 years of age and older reported using one or more methods. Among men 18 and older, only 47% reported usually using one or more methods of sun protection, in contrast to 65% of women 18 and older.

Among high school students, when they were outside for more than an hour on a sunny day-

  • 11.7% of girls and 6.3% of boys reported they routinely used a sunscreen with an SPF of 15 or higher.
  • 15.9% of girls and 20.5% of boys reported they routinely stayed in the shade, wore long pants, wore a long-sleeved shirt, or wore a hat that shaded their face, ears, and neck.

Nearly 9% of teens aged 14-17 years used indoor tanning devices. Girls aged 14-17 years were seven times more likely than boys in the same age group to use these devices.

From the CDC – internal resources omitted.

The recommendations are clearly not being followed. To best protect yourself from sun damage, there are 3 simple steps:

  • Use Sunscreen
  • Wear Protective Clothing (including hats and sunglasses)
  • Find Shade

Do not forget that these tips are important whether you are at the beach or just around town and on both cloudy and sunny days. It is especially important to be careful during the peak times of 10 am to 4 pm.

Of course, “use sunscreen” is oversimplifying how to protect oneself. It is within this context that I will look into the various legal and marketing changes coming soon to sunscreens in my next post.

Did you know all of these facts about skin cancer? Did you know that melanoma was so common and so deadly, despite being very survivable when detected early?

Decreasing Obesity Risks in Children: Another Benefit of Breastfeeding

Friday, March 25th, 2011

Image from fooducate.com

In the United States today, one of the major health problems is obesity. The CDC reports that “[i]n 2009, only Colorado and the District of Columbia had a prevalence of obesity less than 20%.”  The number of both adults and children who are obese is huge and continues to rise dramatically.  The CDC website provides maps that show just how prevalent this problem is in our country. Particularly troubling is that “[t]hirty-three states had a prevalence equal to or greater than 25%; nine of these states (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and West Virginia) had a prevalence of obesity equal to or greater than 30%).  This represents an enormous number of people in our country who are at risk for major health complications, such as “cardiovascular disease, certain types of cancer, and type 2 diabetes.”

While there has been an emphasis in our country on various ways to decrease these obesity statistics (including improving nutrition and increasing exercise), I wonder whether additional emphasis should be paid to children being given a great start to health. A recent article in the Baltimore Sun caught my attention. The article explains how diabetic moms, including those who had gestational diabetes during pregnancy but are not otherwise diabetic, are both more likely to give birth to a larger than average baby and also how their child is “more likely to become obese in childhood.”  The good news, the article explains, is that:

…a new study says that if you breastfeed your baby for at least six months, your child will be no more likely to put on weight than those whose moms are not diabetic.

This is just one more example of how breastfeeding for at least six months can dramatically improve your child’s chances of lifelong health.  Through breastfeeding alone, these moms can erase the increased risk that these children will become obese.

What they found appears to be a real advantage for breastfeeding: If the babies had been breastfed for six months or more, children born to diabetic moms looked nearly the same as the children of non-diabetic moms. And they were no more likely to be obese.

On the other hand, children who were breastfed for less than six months — and who had been exposed to diabetes in the womb — had significantly higher BMIs, thicker waists and stored more fat around their midsections than the other children in the study.

While I was excited to read about one more reason to support breastfeeding, I was concerned about whether this is a realistic choice for many families in our country.  Many moms who are committed to breastfeeding their children and who are successful at the start, do not continue breastfeeding for at least six months. The CDC Breastfeeding Report Card for 2010 says that “…3 out of every 4 new mothers in the United States now starts out breastfeeding… However, rates of breastfeeding at 6 and 12 months as well as rates of exclusive breastfeeding at 3 and 6 months remain stagnant and low.”  The national average is that while 75% of moms have breastfed, only 43% are breastfeeding at all at 6 months and only a mere 13.3% are exclusively breastfeeding at 6 months.  At 3 months, a time when infants would not have started solid food, only 33% of moms are still exclusively breastfeeding.  This means that there is a large drop off from what moms do when their babies are born and what they are doing by the time their babies reach 3 months.

However, the study about diabetes found that at least six months of breastfeeding was essential in protecting these kids from the increased risks of obesity. From both personal experience and anecdotal evidence, I suspect that many families are facing hard decisions about employment and breastfeeding. I suspect that a significant part of the large drop off between the numbers of moms’ breastfeeding at birth and those breastfeeding exclusively at 3 months has to do with employment. Given that the US lags so far behind other countries in paid parental leave, most moms have no choice but to go back to work full-time by the time their infants are 3 months (if not earlier).  Many moms face no choice at that point but to stop or severely limit breastfeeding, as few employers offer the time, space or scheduling to truly make moms successful at the difficult job of trying to pump while working.

I believe that the health care costs of treating individuals with obesity and all of the associated health problems should be examined against the costs of providing more complete support to new families.  What do you think?  Could employers better support breastfeeding in an attempt to increase the number of healthy children whose risks of obesity are lowered? Do you think that lack of paid leave or increased support in the workplace for breastfeeding is really the reason for decreased breastfeeding or are there other factors at play?