Clinical Briefs

Am Fam Physician. 2000 Aug 1;62(3):666-668.

New Report on Work-Related Lung Disease Surveillance

The National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC) has released the Work-Related Lung Disease (WoRLD) Surveillance Report for 1999.

According to a notice to readers in the March 24, 2000 issue of Morbidity and Mortality Weekly Report, the WoRLD Surveillance Report is the fifth in a series of WoRLD reports that present summary tables and figures on various occupationally relevant respiratory diseases, including pneumoconioses, occupational asthma, other diseases of the airway and other respiratory conditions.

The report is divided into three main sections: summary highlights and limitations, disease-specific tables and figures, and appendices that describe data sources, methods and supplementary information.

The WoRLD report presents national and state summary statistics such as counts of crude and age-adjusted mortality rates, and years of potential life lost to age 65 and to life expectancy. U.S. maps showing the geographic distribution of mortality by state are included, as are tables and figures that summarize selected occupational exposure data for asbestos, coal and coal mine dust, silica dust, cotton dust and other substances. The report also includes tables summarizing silicosis and asthma surveillance data collected by states funded by the Sentinel Event Notification Systems for Occupational Risks Program.

The 1999 WoRLD Surveillance Report may be obtained by writing to the Surveillance Branch, Division of Respiratory Disease Studies, NIOSH, CDC, 1095 Willowdale Rd., Morgantown, WV 26505-2888; fax: 304-285-6111; or e-mail: WoRLD@cdc.gov.

New CDC Web-Based Training Program on Hepatitis C Virus Infection

On May 15, 2000, the Centers for Disease Control and Prevention (CDC) posted an interactive Web-based training program for health professionals on hepatitis C virus (HCV) infection. “Hepatitis C: What Clinicians and Other Health Professionals Need to Know” may be accessed on the CDC Web site at http://www.cdc.gov/hepatitis.

The program will allow users to access current information on the epidemiology, diagnosis and management of HCV infection and HCV-related chronic disease. Study questions at the end of each section and case studies at the end of the program are available for users who want to test their knowledge of the program material. Continuing medical and nursing education credits are available free from the CDC on completion of the training. The American Academy of Family Physicians (AAFP) will also grant AAFP education credits on completion of training and filing with the AAFP.

FDA Approval of Uterine Balloon Therapy

The U.S. Food and Drug Administration (FDA) has approved the Thermachoice II uterine balloon therapy system for the treatment of excessive menstrual bleeding from benign causes in premenopausal women who have completed child-bearing. The device is designed to reduce excessive bleeding to normal levels of menstruation or less.

Using the balloon therapy, global endometrial ablation is performed under local anesthesia as an outpatient procedure. Heat is used to remove the endometrial lining of the uterus, which is the main source of excessive menstrual bleeding. A balloon catheter is inserted vaginally through the cervix and into the uterus. The balloon is inflated with sterile fluid, which is then heated to 87°C (188°F) for eight minutes. After treatment is completed, the balloon is deflated and the catheter is withdrawn and discarded. The entire procedure typically takes less than 30 minutes. Following the procedure, an over-the-counter, nonsteroidal anti-inflammatory drug is given to patients to relieve pain. Patients are usually able to resume normal activities the next day.

The Thermachoice II system is contraindicated in women who want to have children because pregnancies after ablation could be dangerous for the fetus and the mother. If there is a chance that pregnancy could occur, contraception or sterilization should be used after treatment. Rare adverse events associated with the Therma-choice II system may include blood loss, heat burn of internal organs, electrical burn, perforation or rupture of the uterine wall, or leakage of heated fluid from the balloon or tissue into the cervix or vagina. Accumulation of blood or tissue in the uterus and/or fallopian tubes during the months following the procedure is also possible; correction may require an outpatient procedure. Infection is a possibility, but infection usually can be managed with oral antibiotics.

For more information on the Thermachoice II uterine balloon therapy system, visit the manufacturer's Web site at http://www.gynecare.com.

ACSM Statement on Stress Fractures

The American College of Sports Medicine (ACSM) has released an official statement on stress fractures. The statement appears in the ACSM's Current Comments, February 2000.

According to the ACSM, stress fractures make up between 0.7 and 15.6 percent of all athletic injuries. Runners, jumpers, gymnasts and dancers are especially at risk for stress fracture, and women have higher rates than men. The bones most often injured are the metatarsals, fibula and tibia.

The ACSM reports that the following factors contribute directly or indirectly to the incidence of stress fracture: changes in training (e.g., terrain, shoes, activity, intensity); running and jumping activities; inappropriate footwear; muscle inflexibility or weakness; excessive muscle strength; lower extremity alignment anomalies; poor running technique; previous history or injury; low bone mineral density.

Positive symptoms of stress fracture are local tenderness, pain with direct and/or indirect percussion, and pain with weight bearing. Rest is an effective treatment under most conditions; however, prevention is the best management approach.

The ACSM makes the following recommendations to minimize the risk of stress fracture and promote recovery:

During training :

  • Wear lightweight athletic shoes appropriate for the specific activity and replace them when needed.

  • Increase training intensity gradually over several weeks.

  • Maintain adequate dietary calcium intake (at least 1,200 mg per day for persons younger than 25 years; 800 mg for those older) to allow healthy bone mineralization during remodeling.

When injured:

  • Maintain aerobic fitness when injured with a reduced weight-bearing exercise such as pool running and bicycling.

  • Resume normal training gradually.

  • If a fast return to activity is necessary, use protective devices such as a brace to splint bones from strain during weight bearing.

Do not:

  • Excessively stretch adjacent muscles when acutely injured.

  • Perform local muscle-strengthening exercises when acutely injured.

  • Engage in pain-producing activities when injured.

  • Train on unusually soft or uneven surfaces.

Current Comments are official statements by the ACSM concerning topics of interest to the public at large. More information may be obtained by calling 317-637-9200 or by writing the ACSM at P.O. Box 1440, Indianapolis, IN 46206-1440.

Brochure for Women on the Proper Use of Medication

The Office of Women's Health of the U.S. Food and Drug Administration (FDA), in collaboration with the National Association of Chain Drug Stores, has developed a new brochure titled “My Medicines.” The brochure was created for distribution during the “Take Time to Care” public awareness campaign, which gave millions of women access to specialized information about the proper use of medications.

The brochure provides women with four main goals related to medication: (1) read the label, (2) avoid problems, (3) ask questions, and (4) keep a record. According to the brochure, women should closely read the label of any medications for a list of ingredients, warnings and an expiration date. Women can avoid medication-related problems by discussing side effects with a health care professional, by organizing their medications, by not sharing or skipping medication, and by not taking medication in the dark. The brochure provides a list of questions women might ask their physicians or pharmacists about medications they are taking. The brochure also provides areas for listing over-the-counter and prescription medications.

“Women are the most active health care decision makers and that's why the FDA Office of Women's Health is encouraging women to be particularly vigilant when taking or giving medications to their families, children and themselves,” said Jane E. Henney, M.D., commissioner of the U.S. Food and Drug Administration.

The brochure is available in several languages. To receive a free copy of “My Medicines,” call 888-8-PUEBLO (888-878-3256) or visit the Office of Women's Health Web site at http://www.fda.gov/womens/tttc.html.

FDA Approval of AndroGel

The U.S. Food and Drug Administration (FDA) recently approved a new testosterone gel, AndroGel 1 percent, for the treatment of testosterone deficiency in men. This is the first testosterone replacement gel to be labeled by the FDA for therapy in men for conditions associated with low testosterone. Because the clear, colorless, topical gel is safe, effective and easy to use, it may be an attractive alternative to existing therapies that require the use of painful deep muscle injections and potentially irritating patches.

According to the manufacturer of AndroGel, hypogonadism affects about 4 to 5 million men in the United States. This condition is related to a lowered interest in sex, impotence, reduced lean body mass, decreased bone density and lowered mood and energy levels.

AndroGel should be applied once per day to the shoulders, upper arms and/or abdomen. As the gel dries, it is absorbed into the skin and slowly enters the bloodstream. Normal testosterone levels are restored soon after application.

Studies have found that AndroGel is well tolerated. The manufacturer warns that androgens should not be used in men with carcinoma of the breast, or known or suspected carcinoma of the prostate. Use of androgens in geriatric patients may increase the risk of development of prostatic hyperplasia and prostatic carcinoma. Because AndroGel has not been evaluated in women, it is not indicated for use in women. Some of the testosterone in AndroGel can be transferred to untreated persons during vigorous skin to skin contact. Residual testosterone on the skin can be removed with soap and water. Pregnant women should avoid skin contact with application sites because testosterone can harm the fetus.

Full prescribing information may be obtained by calling 877-463-7645 or by visiting the manufacturer's Web site (http://www.Unimed.com).

AHRQ Report on Hospital Care

The U.S. Agency for Healthcare Research and Quality (AHRQ; formerly the Agency for Health Care Policy and Research) has released a new report titled “Hospitalization in the United States, 1997.” The illustrated report examines hospital care in the United States and includes charts and statistics on length of stay, charges, insurance coverage, discharge status and in-hospital morbidity. The information in the report is based on 1997 data from the AHRQ's Nationwide Inpatient Sample.

The report shows that more than one third of all hospital patients are admitted through the emergency department. This includes four of every 10 pediatric admissions and one half of the admissions of the very elderly. According to the report, the leading causes of hospitalization of patients who are initially seen in the emergency department include pneumonia, heart disease, stroke, chronic obstructive lung disease, asthma and septicemia.

The report also illustrates that regardless of how they were admitted, more than one half of all patients had at least one other comorbidity. The most common comorbidity was high blood pressure. The top comorbidities of adolescents and adults up to 44 years of age were drug abuse, psychoses and depression. Among patients 18 to 64 years of age, alcohol abuse was also common.

Copies of “Hospitalization in the United States, 1997,” HCUP Fact Book No. 1 (AHRQ Publication No. 00-0031) are available free of charge by writing the AHRQ Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907 or by calling 800-358-9295.


Copyright © 2000 by the American Academy of Family Physicians.
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