Thursday, November 10, 2005

Health news roundup

Johns Hopkins flu expert calls for mandatory vaccination of health care workers

View is subject of debate

Johns Hopkins' senior hospital epidemiologist and flu expert is calling for mandatory vaccination of all health care workers as the best means of protecting patients and hospital staff from widespread outbreaks of the viral illness. Studies by other United States researchers show that voluntary vaccination programs don't do the job and that each year, nearly 40,000 Americans die from influenza, many of them elderly or ill, with weakened immune systems that cannot readily fend off the disease.

In an editorial to be published in the journal Infection Control and Hospital Epidemiology online Nov. 9, Trish Perl, M.D., M.Sc., concludes that mass vaccination policies are required to prevent patients from accidentally contracting the virus directly from an infected medical staff worker or indirectly from other patients or visitors via medical staff.

Previous research from Hopkins showed that annual flu shots have been almost 88 percent effective at reducing the risk of flu infection and that they reduced by one-half the number of deaths among hospital patients from the disease.

Perl's view, which is likely to inform further debate on the subject of voluntary versus mandatory worker vaccination programs, is based on research showing that despite free and ready access to the vaccine, only 40 percent of all health care workers actually get a flu shot.

"We have gone as far as possible with vaccination programs emphasizing education and health promotion," says Perl, an associate professor of medicine and pathology at The Johns Hopkins University School of Medicine. "It's now time to go the extra step, requiring active declination or even making vaccination a mandatory part of the job, linked to patient safety, along with such tasks as keeping hands clean and getting mandatory TB tests."

Neither state nor federal law requires workers to provide medical details when they call in sick so it is difficult to precisely link seasonal hospital absenteeism and high rates of non-vaccination, she notes.

http://tinyurl.com/9lb8o



New screening test proves earlier, more accurate predictor for Down syndrome

Columbia-led study of more than 38,000 women enables faster, first trimester prenatal testing for leading cause of mental retardation and birth defects

A new study from Columbia University Medical Center researchers at NewYork-Presbyterian Hospital/Columbia of more than 38,000 pregnant women at 15 U.S. centers demonstrates the high accuracy of non-invasive screening for Down syndrome (also known as trisomy 21) in the first trimester of pregnancy, at 11 weeks. The findings are a significant advantage over the current standard screening, a blood test performed in the second trimester of pregnancy.
"These results will undoubtedly change national practice – all pregnant women should have the option of early screening for Down syndrome in their first trimester," said Mary E. D'Alton, M.D., principal investigator of the study. She is Chair of the Department of Obstetrics and Gynecology at Columbia University College of Physicians and Surgeons, and Chief of Obstetrics and Gynecology at NewYork-Presbyterian Hospital/Columbia. "Down syndrome screenings based on either maternal age alone, or an ultrasound or sonogram alone, are no longer justified protocols."


New, Earlier Tests Seen Better at Fetal Down Syndrome Detection

By BLOOMBERG NEWS

New tests in the first trimester of pregnancy are better at identifying fetuses with Down syndrome than standard tests done later in pregnancy, according to a government-financed study.  The first-trimester tests detected as many as 87 percent of fetuses with the extra chromosome that causes Down syndrome, compared with 81 percent found by tests in the second trimester, the authors write in today's issue of The New England Journal of Medicine.  Down syndrome affects more than two million people worldwide, causing physical and mental disabilities. It occurs about once in 700 to 900 live births.  The study, conducted at 15 hospitals and involving more than 38,000 women, is the government's most comprehensive effort to help expectant couples best determine their risk of having a baby with Down syndrome, the world's leading cause of developmental disability.  The study's findings suggest that parents will have a better opportunity to seek an abortion earlier in gestation, Dr. Joe Leigh Simpson, a Baylor College obstetrics and gynecology professor, wrote in an editorial accompanying the study.  "Pregnancy terminations are earlier, more private and far safer than in the second trimester," Dr. Simpson said. The maternal death rate for first-trimester abortions is 1.1 per 100,000 abortions, compared with 7 to 10 per 100,000 in the second trimester, Dr. Simpson wrote.

http://tinyurl.com/dtp42



Down Syndrome Now Detectable In 1st Trimester
Earlier Diagnosis Allows More Time for Decisions
By Rob Stein

Washington Post Staff Writer
Thursday, November 10, 2005; Page A01  A first-trimester screening test can reliably identify fetuses likely to be born with Down syndrome, providing expectant women with that information much earlier in a pregnancy than current testing allows, according to a major study being released today.  The eagerly awaited study of more than 38,000 U.S. women -- the largest ever conducted -- found that the screening method, which combines a blood test with an ultrasound exam, can pinpoint many fetuses with the common genetic disorder 11 weeks after conception. That allows women to decide sooner whether to undergo the riskier follow-up testing needed to confirm the diagnosis.

http://tinyurl.com/82st6



Is home test for HIV a good idea?
The 20-minute swab-based test is already being used in US clinics, but what are the ramifications of people testing themselves at home?

IMAGINE if testing for HIV was as simple as a pregnancy stick test. A quick swab of your gums, and 20 minutes later a thin red line on the device could be the difference between a healthy life and coping with a deadly disease.

The test, called OraQuick Advance and made by OraSure Technology of Bethlehem, Pennsylvania, is already being used in clinics in the US. Last week the US Food and Drug Administration (FDA) started debating whether the kit should be available for people to test for HIV in their own homes, potentially drawing out the estimated 300,000 or more Americans who live with the infection but don't know about it. These people are the cause of 65 per cent of all new HIV infections in the US each year. People who know they are infected are 50 per cent less likely to transmit HIV than those who do [not]...

http://tinyurl.com/eypkd



When it comes to babies learning language, the eyes have it

Infants begin pulling off an amazing feat sometime in the final three months of their first year of life. They learn an important social interaction by following the gaze of an adult, a step that scientists believe gives babies a leg up on understanding language.
University of Washington psychologists Rechele Brooks and Andrew Meltzoff have pinpointed this developmental step as beginning somewhere in the 10th or 11th month of life, and have found that infants who are advanced in gaze-following behavior before their first birthday understand nearly twice as many words when they are 18 months old.
Writing in the current issue of the journal Developmental Science, Brooks and Meltzoff provide further evidence for the importance of eyes in human social interactions and trace how gaze-following develops in infants. Three years ago they reported that 12- 14- and 18-month-old infants are much more likely to look at an object when a person turns toward it with open eyes rather than closed eyes.
"Our work shows that babies can look where an adult is looking but that it isn't easy, particularly at home where there are a lot of distractions," said Brooks, who is a research associate at the UW's Institute for Learning and Brain Sciences.
"We have found that at 9 months babies are beginning to do this by following the movement of the head. At 10 and 11 months they are following the head and the eyes. The eyes add important information and the babies are more consistently following the head when the eyes are open. It is as if a light is going off in their head. This is a clear shift and an important advance."

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