Am Fam Physician. 2002 Feb 15;65(4):731-738.
CFSAN Web Site for Foodborne Illness
With an estimate from the Centers for Disease Control and Prevention (CDC) of 76 million annual cases of foodborne illness in the United States, the Center for Food Safety and Applied Nutrition (CFSAN) has created a new Web site for health care professionals that addresses this area of concern. Information is divided into three main categories, outlined below, and can be accessed at http://www.foodsafety.gov.
Foodborne illness: includes “The Bad Bug Book” and fact sheets containing information on food-related bacteria and other food agents that may cause illness. “Diagnosis and Management of Foodborne Illness: A Primer for Physicians” is available through a link to the CDC and provides clinical features and laboratory tests to confirm the presence of organisms responsible for foodborne illness. Also included is information about when to contact local or state health departments.
Resources for your patients: the Web site contains information for at-risk populations (e.g., elderly) and addresses food allergies and dietary supplements.
Medical publications: the site provides resources such as Morbidity and Mortality Weekly Report and Emerging Infectious Disease Journal.
Fluoroquinolone Resistance to Streptococcus pneumoniae
Fluoroquinolone prescription data from 1995 through 1999 collected by the National Hospital Ambulatory Medical Care Survey (NHAMCS) and analyzed by the Active Bacterial Core Surveillance (ABCs), an ongoing population-based surveillance system for invasive pneumococcal disease, suggest a trend toward fluoroquinolone-resistance to Streptococcus pneumoniae. The report is published in the September 21, 2001 issue of Morbidity and Mortality Weekly Report (MMWR).
The older fluoroquinolones (ciprofloxacin and ofloxacin) and the newer fluoroquinolones (levofloxacin, gre-pafloxacin, gatifloxacin, and moxi-floxacin) that have a higher in vitro activity against pneumococcus are used in the treatment of pneumonia in adults.
According to MMWR, susceptibility testing was performed on isolates from persons with pneumococcal invasive disease. Results indicate that ofloxacin-resistant isolates were more common in persons 18 years or older and the percentage of resistant isolates increased from 3.1 to 4.5 percent during the period from 1995 through 1997. Levofloxacin-resistant isolates reported for 1998 and 1999 remained statistically similar (0.2 to 0.3 percent, respectively). While the data for this report cover the years 1995 through 1999, data on prescriptions written for fluoroquinolones from 1993 through 1998 were included and indicate an increase from 3.1 to 4.6 per 100 persons per year.
While the increased use of fluoroquinolones most likely contributes to the report of resistance to pneumococci, resistance with the use of the newer fluoroquinolones is not as clear. Isolates that were fluoroquinolone-resistant were more common in persons 65 years and older, corresponding with the higher number of prescriptions for fluoroquinolones written for this population. The ABCs' data analysis provides an estimated national pattern that warrants consideration given that the mechanism of resistance between ofloxacin and the new fluoroquinolones is similar and suggests a trend toward what may occur with the newer fluoroquinolones.
The report urges continued vigilance against overprescribing antibiotics. Recommendations for appropriately prescribing antibiotics in adults are available at http://www.cdc.gov/antibioticresistance/technical.htm.
Scientific Exhibit Deadlines for AAFP Assembly
A call for scientific exhibits has been issued by the American Academy of Family Physicians (AAFP) for possible presentation at the 2002 Scientific Assembly occurring October 16–20, 2002 in San Diego. Applications must be submitted by April 12, 2002. Membership in the AAFP is not a prerequisite for submission. Scientific exhibits provide a forum for the presentation of research that is of interest and educational value to family physicians. The exhibits include those presented by residents and medical students.
Travel grants of $1,000 may be awarded to a maximum of 15 resident/student scientific exhibitors whose applications are accepted for presentation at the assembly. In addition, cash awards for first, second, third, and fourth places may be presented to resident/student exhibitors. Application forms may be obtained from Vicky Binder, Scientific Program Department, AAFP, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211; telephone: 800–274–2237, ext. 6564; or by visiting the AAFP Web site at http://www.aafp.org/assembly/research.
Influence of Media Violence on Children
The Committee on Public Education of the American Academy of Pediatrics (AAP) has issued a policy statement on the effects of media violence on children. The statement appears in the November 2001 issue of Pediatrics.
Exposure to and the influence of media violence directly correlates to violent behavior, according to the AAP statement. By the age of 18, children and adolescents witness more than 200,000 violent acts on television alone. Between the ages of two and 18, an estimated six hours per day is spent using media (e.g., television, video games, computer). Because behavior is learned through observation and imitation, children are especially vulnerable to the increased violence portrayed in the media.
Physical and mental health problems (e.g., aggression, fear, desensitization to violence) are associated with exposure to media violence, supported by more than 3,500 research studies. The danger, according to the AAP report, is the context in which the violence is portrayed—the difference is learning about violence rather than learning to be violent. Interactive media games allow children to participate in the violence; to “learn” to be violent by rewarding players for successful violent behavior. The statistics support the effects on children of media violence: homicide, suicide, and trauma are the leading causes of mortality, with a cumulative death rate for children between five and 14 years and between 15 and 21 years of 22.8 and 114.4 per 100,000, respectively.
Physicians play a critical role in addressing this growing problem. The AAP recommendations are outlined, in part, below.
A history of media use should be a routine part of health maintenance examinations. Activities such as reading or participating in sports should be offered as alternatives.
Parents should be encouraged to follow the AAP Media Education recommendations (e.g., limiting exposure to media, using the v-chip) published in the August 1999 issue ofPediatrics.
In office waiting areas, only non-violent programs should be available.
Physicians should interact with and encourage parents, schools, and communities to educate children about how the media works and how to make responsible decisions about viewing.
Interact with state and national agencies and organizations to keep media violence as part of the public health agenda.
Advocate for a simplified content-based media rating system.
Remind parents that they can impact the market—media with content detrimental to children will not be produced if it is not purchased or used.
Call for Papers of Family Practice Research Presentations
A call for papers has been issued by the American Academy of Family Physicians (AAFP) for possible presentation at the 2002 Scientific Assembly occurring October 16–20, 2002 in San Diego. Applications must be submitted by April 12, 2002. Membership in the AAFP is not a prerequisite for submission.
Applications may be submitted in two different categories. Category I is for original research relevant to family practice; Category II includes case studies and literature reviews. Each category has six author classifications: family physicians and fellows primarily in academic medicine, family physicians primarily in clinical practice, family practice residents, medical students, international attendees, and others. The international attendee classification is open to anyone outside the United States who conducted clinical or educational research relevant to family medicine.
Up to six first place winners in Category I and one first place winner in Category II will each receive a cash award of $1,000. Up to six runners-up in Category I and one runner-up in Category II will receive $250 cash awards. All awards are given at the discretion of the Subcommittee on Family Practice Research Presentations. Application forms may be obtained by visiting the AAFP Web site at http://www.aafp.org/assembly/abstract or from Carrie Vickers, Scientific Program Department, AAFP, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211; telephone: 800–274–2237, ext. 6568.
AHRQ Report on Breast Disease
Under its Evidence-based Practice Program, the Agency for Healthcare Research and Quality (AHRQ) has published an evidence report/technology assessment on the “Diagnosis and Management of Specific Breast Abnormalities.” The information is intended as a resource for agencies and organizations in developing practice guidelines or other quality-related measures.
The review focuses on women with clinical or mammographic breast abnormalities who have specific risk factors for breast cancer, specific biopsy findings, and initial management after a diagnosis of breast cancer. The report is based on a review of 109 studies (plus 11 kinship studies) involving 39,560 patients. Study designs included randomized, controlled studies, and observational, retrospective, prospective, and cross-sectional studies, with North America and Europe as the primary locations.
Printed copies of the report— Evidence Report/Technology Assessment No. 33, Diagnosis and Management of Specific Breast Abnormalities (AHRQ Publication No. 01-E046)—can be obtained from the AHRQ Publications Clearinghouse by calling 800–358–9295. The full report may also be accessed online at http://www.ahrq.gov/clinic/epcix.htm.
NIA Guide for Older People on Communicating with Physicians
The National Institute on Aging (NIA) has released a new edition of their publication, “Talking with Your Doctor: A Guide for Older People.” The 30-page booklet contains information on how older persons can effectively communicate with their physician. In addition, guidance on assessing medical information on the World Wide Web is included. Some of the issues discussed in the NIA publication include:
Getting started with a new physician.
Discussing physical and emotional health.
Preparing for an appointment and sharing pertinent information about medications and medical history.
Discussing sensitive subjects (e.g., depression, incontinence).
To obtain single or bulk copies, contact the NIA Information Center at 800–222–2225 or TTY 800–222–4225.
Copyright © 2002 by the American Academy of Family Physicians.
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