Caregivers Ignoring Car Seat Safety Guidelines .

Caregivers are largely ignoring child passenger safety guidelines, often transitioning children out of rear-facing seats and booster seats too early, according to an American Journal of Preventive Medicine study.

Researchers observed safety restraint use for more than 20,000 children under age 13 years during 2007–2009. Among the findings:

  • Well under 20% of children aged 0 to 3 years were rear-facing, even though 84% of children in this age group were younger than 1.
  • After age 7, less then 2% of children used booster seats, which are recommended until kids reach roughly 4 feet, 9 inches tall.
  • Many children over age 6 rode in the front seat, including one quarter of 8- to 10-year-olds; guidelines say children should remain in the back seat until age 13.

The researchers direct clinicians to the American Academy of Pediatrics 2011 guidelines on child passenger safety for help in counseling parents.

Source: American Journal of Preventive Medicine article


Meta-Analysis: Progestin-Only Pills, IUDs Don’t Increase VTE Events.

Progestin-only pills and intrauterine devices do not increase the risk for venous thromboembolic events, according to a meta-analysis in BMJ. However, an association between injectable progestin and VTE could not be ruled out.

The meta-analysis included three retrospective cohort studies and five case-control studies comparing progestin-only contraception use with no hormone use. Overall, progestin-only methods were not associated with VTE risk — a finding that held true in subanalyses of progestin-only pills and IUDs. Use of injectable progestin was associated with a doubling of risk, although only two studies evaluated this formulation.

The authors call for more research into the potential increase in risk with injectable progestin. “In the interim,” they conclude, “we suggest consideration of non-injectable forms of progestin-only contraception for highest risk women.”

Source: BMJ

Statins’ Benefits Outweigh Diabetes Hazard in High-Risk Patients .

Use of statins is associated with increased risk for developing diabetes, according to a retrospective cohort study in the Journal of the American College of Cardiology. However, the authors say the benefits of statins outweigh the dangers in high-risk and secondary-prevention groups.

Researchers from Taiwan examined medical records of 8400 statin users and 34,000 controls who did not use statins. Over 7.2 years’ median follow-up, the annual rate of incident diabetes was higher among statin users than nonusers (2.4% vs. 2.1%). However, patients taking statins had reduced risk for myocardial infarction (HR, 0.82) and in-hospital death (HR, 0.61).

The authors conclude: “Continuous surveillance of signals of dysglycemia should be incorporated into the care program to optimize overall risk management.”

Source: JACC


158 cases of new swine flu strain from pigs.

 Don’t pet the pigs.

That’s the message state and county fair visitors got Thursday from health officials who reported a five-fold increase of cases of a new strain of swine flu that spreads from pigs to people. Most of the cases are linked to the fairs, where visitors are in close contact with infected pigs.

This flu has mild symptoms and it’s not really spreading from person to person.

“This is not a pandemic situation,” said Dr. Joseph Bresee of the Centers for Disease Control and Prevention.

But any flu can be a risk for some people, and people should be cautious when they can, he added.

The case count jumped from 29 a week ago to 158 this week, thanks to a wave of new cases in Indiana and Ohio, said Bresee, the agency’s chief of influenza epidemiology.

Most of the infected patients are children — probably because many were working closely with raising, displaying and visiting pigs at the agricultural fairs, Bresee said.

The recent cases include at least 113 in Indiana, 30 in Ohio, one in Hawaii and one in Illinois, Bresee said in a conference call with reporters.

The count is changing rapidly. Indiana health officials on Thursday afternoon said they had seven more confirmed cases than Bresee noted. That would raise the grand total to 165 so far.

Also, diagnosis of cases has become quicker in the last week. CDC no longer must confirm a case with its own lab. Now states are using CDC test kits to confirm cases on their own on, speeding the process along. The newly reported cases were likely infected a week or two ago.

The CDC has been tracking cases since last summer. A concern: The new strain has a gene from the 2009 pandemic strain that might let it spread more easily than pig viruses normally do.

The good news is the flu does not seem to be unusually dangerous. Almost all the illnesses have been mild and no one has died. Two of the recent cases were hospitalized, but both recovered and were discharged, Bresee said.

More good news is that all of the recent cases appear to have spread from pigs to humans, meaning it’s not very contagious, at least between people. But there probably will be more cases in the weeks ahead, and it won’t be surprising if at least a few of them involve person-to-person transmission, Bresee said.

Pigs spread flu virus just like people do, with coughing, sneezing and runny noses, so people can get it by touching pigs or being near them.

Health officials don’t think it’s necessary to cancel swine shows, but are urging people to take precautions.

Fairgoers should wash their hands and avoid taking food and drinks into livestock barns, officials said, while pregnant women, young children, the elderly and people with weakened immune systems should be particularly careful.

Source: Yahoo news.



Study Finds No Link Between Migraine and Cognitive Decline in Women.

Women who experience migraine — with aura or without — aren’t at increased risk for cognitive decline, according to a prospective cohort study in BMJ.

Over 6300 women aged 65 and older participating in the Women’s Health Study reported their experiences with migraine and then completed cognitive assessments during follow-up. About 13% reported ever having migraine; of these, about half had migraine in the previous year, while the rest were considered to have a past history of migraine.

At roughly 3.5 years’ follow-up, women who reported migraine with aura, migraine without aura, or a past history of migraine showed no greater declines in cognitive function than those who’d never had migraine.

The researchers conclude that “patients with migraine and their treating doctors should be reassured that migraine may not have long term consequences on cognitive function.”

Source: BMJ

CDC Issues Guidance on Pre-Exposure Prophylaxis for HIV in Heterosexual Adults.

The CDC has released interim recommendations on providing pre-exposure prophylaxis (PrEP) to prevent HIV in very-high-risk heterosexual adults — for example, those whose partners are infected.

Among the recommendations, published in MMWR:

  • Before prescribing PrEP, clinicians should screen patients for sexually transmitted infections and hepatitis B.
  • Clinicians should explain to women that the effect of the drugs on the developing fetus is not fully known, but no harms have been reported so far. Breast-feeding mothers should not receive PrEP.
  • When pregnant women take PrEP, clinicians can anonymously submit data on the pregnancy to the Antiretroviral Pregnancy Registry.
  • Tenofovir disoproxil fumarate (TDF) 300 mg plus emtricitabine (FTC) 200 mg (i.e., one Truvada tablet) should be taken daily, and patients should be given no more than a 90-day supply.
  • HIV tests should be administered every 2 to 3 months.
  • Women should take a pregnancy test at each follow-up visit.

Source: MMWR


What’s the Optimal HbA1c Level in Elders?

In an observational study, glycosylated hemoglobin between 8% and 9% was best.

Experienced clinicians have long recognized that tight glycemic control can be perilous in frail older patients with type 2 diabetes. Now, an observational study addresses that concern. Researchers in San Francisco studied 367 community-dwelling, older patients (mean age, 80) with diabetes who participated in a comprehensive adult day-care program and were unable to live independently. Glycosylated hemoglobin (HbA1c) levels were measured at baseline, and functional decline and death were tracked during 2 years of follow-up (during which, average HbA1c levels didn’t change much).

Analyses were adjusted for potentially confounding variables. Compared with patients in the reference category (HbA1c levels, 7%–8%), patients whose HbA1c levels were between 8% and 9% had a significantly lower incidence of functional decline or death (relative risk, 0.88), and those with HbA1c levels <7% had a nearly significant higher incidence of functional decline or death. Overall, the relation between HbA1c level and functional decline or death was somewhat U-shaped, with the best outcomes among patients in the 8% to 9% range. These basic patterns were noted both among patients who took only oral antidiabetic drugs and those who took insulin.

Comment: This observational study is subject to residual confounding, but it suggests that an HbA1c target in the 8% to 9% range is reasonable for older patients with diabetes who are unable to live independently. The findings support a recent guideline in which less-tight glycemic control is acceptable in older adults with long-standing diabetes (JW Gen Med Jul 24 2012).

Source: Journal Watch General Medicine.