Am Fam Physician. 2002 Mar 15;65(6):1225-1229.
Garlic Supplements and HIV Medication
The National Institutes of Health (NIH) has reported that garlic supplements have been shown to greatly reduce levels of saquinavir, a human immunodeficiency virus (HIV) protease inhibitor, in patients' blood. Blood concentrations of the drug in subjects who were also taking garlic were reduced by about 50 percent, which has prompted researchers to caution physicians and patients about using garlic supplements during HIV therapy.
Because use of certain HIV drugs causes cholesterol levels to rise, garlic supplement use among these patients has increased because of its natural cholesterol fighting abilities. It is unclear how garlic interferes with the uptake of saquinavir and whether it would also affect a combined drug regimen, which is commonly prescribed.
The study results appear in an online edition of Clinical Infectious Diseases (www.journals.uchicago.edu/CID/journal/home.html).
Report on Management of Diabetes
The Agency for Healthcare Research and Quality (AHRQ) has released a synthesis of research on managing diabetes indicating that patients with diabetes can accomplish good glycemic control and postpone major complications of the disease with a combination of intensive drug therapy and a team approach to their care.
The synthesis reports that the major components of diabetes management should include: (1) more frequent use of two oral medications or one oral medication plus insulin; (2) a minimum of three daily injections of insulin; (3) a minimum of four health care visits annually; and (4) visits with both physicians and nurse practitioners.
The synthesis, titled Improving Care for Diabetes Patients Through Intensive Therapy and a Team Approach, is available on the AHRQ Web site (www.ahrq.gov/research/diabria/diabetes.htm) and by e-mail request to the AHRQ Publications Clearing-house at email@example.com.
Updated ADA Position on Needle Reuse
The American Diabetes Association (ADA) recently updated its position on reusing needles. The updated statement appeared in the November 2001 issue of Diabetes Care.
Even though insulin syringes are designed to be used only once and then discarded, many patients—including those who have insurance that covers the cost of the needles—reuse syringes. Needles as well as pen needles should only be used once to ensure their sterility. Some persons, including those with poor personal hygiene, acute concurrent illness, and decreased resistance to infection, may be at increased risk of infection and, consequently, should never reuse a syringe or pen needle.
Reuse of newer, smaller needles (30 and 31 gauge) can cause the needle tip to bend and form a hook, which can lacerate the skin or cause the needle tip to break off in the skin.
Patients who do reuse needles must recap them after every use. The injection site should be inspected for redness or swelling, and patients should contact their physician if signs of inflammation are evident. Patients should discuss with their physicians the intention to reuse needles. Those who are considering needle reuse should be capable of safely recapping a syringe, which requires adequate vision, manual dexterity, and no tremor.
Syringes being reused can be stored at room temperature. Cleaning the needle with alcohol can remove the silicon coating that is designed to make skin puncture less painful.
More information about the ADA's revised position on needle reuse is available atwww.diabetes.org.
Cigarette Smoking in Adults
The Centers for Disease Control and Prevention (CDC) analyzed data from the 1999 National Health Interview Survey (NHIS) to gauge progress toward the 2010 national health objective to reduce the prevalence of cigarette smoking in adults to 12 percent or less. The survey results showed that about 46.5 million adults (23.5 percent) were current smokers. No significant changes were found to occur between 1998 and 1999; however, smoking prevalence has slightly declined since 1993. The report that summarized the data appears in the October 12, 2001 issue of Morbidity and Mortality Weekly Report.
The 2010 health objectives can be met, according to the 2000 report of the Surgeon General, if comprehensive strategies to control tobacco use are initiated. These strategies include the following: increasing the prices of tobacco products; implementing smoking restrictions and bans; and launching education campaigns targeted at a wide range of smokers. The CDC has recommended that smoking cessation strategies be incorporated into statewide programs such as those that have already been initiated in Arizona.
Other findings from the data showed: (1) more men than women were smokers (25.7 and 21.5 percent, respectively); (2) persons between 18 and 44 years of age had the highest prevalence of smoking; and (3) adults living below the poverty level had the highest prevalence of smoking.
National Poison Hotline Number
The American Association of Poison Control Centers (AAPCC) has announced the creation of a national hotline number––800-222-1222––that connects Americans to the nearest poison control center. Calls can be made to the toll-free number 24 hours a day, seven days a week from anywhere in the United States, and callers will be connected to specially trained physicians, pharmacists, and nurses.
Before the creation of this national number, local poison control centers were only accessible through local or statewide numbers. These numbers will continue to operate, but Americans are being encouraged to remember the new national hotline number so that they can access it at any time from any place in the United States.
The AAPCC has launched a public awareness campaign to promote the hotline number. Stickers, magnets, brochures, and posters with the new hotline number are available. The Web site iswww.1-800-222-1222.info.
Consumer Assessment of Health Care
The Agency for Healthcare Research and Quality (AHRQ) has released a report—the National CAHPS Benchmarking Database (NCBD)—that contains data about consumer's assessments of the medical care they receive. This marks the first time this information about Medicare, Medicaid, and commercial (employer-sponsored) health plans has been available from one source.
Findings from the report include:
Overall, participants in managed care plans gave high ratings for their health care and reported having positive experiences with physicians.
Participants in Medicaid, Medicare, and commercial plans all rated the care they received differently. Medicare participants reported having the most positive experiences.
Between 16 and 74 percent of participants gave their health care plans a very high rating.
The information contained in the report, which was compiled from three years of CAHPS survey results, provides a comprehensive overview of the quality of health care in the United States. The NCBD Annual Report is available at no charge from the AHRQ Publications Clearing-house at 800–358–9295 or by e-mail at: firstname.lastname@example.org.
Expert Consensus Guidelines for Managing Epilepsy
New “Expert Consensus Guidelines” for managing epilepsy have been developed and reported in the November/December 2001 issue of Epilepsy and Behavior. It is estimated that 2.3 million Americans have epilepsy and about one half of these are female.
Two major changes were made in the new guidelines. First, more trials of monotherapy were recommended before initiating trials of combination therapy. These trials consider the full range of available antiepileptic drugs (AEDs) based on seizure type and individual needs. Currently, 26 AEDs are available for treatment of epilepsy; eight of them were approved for use in the past decade. Second, special consideration was given to treatment strategies for women and older adults. Some research has indicated that AEDs may affect women's reproductive health and cause impaired cognition and sedation in older adults.
The Expert Consensus Guidelines were developed using a new process that analyzed responses to surveys made by persons considered to have developed expertise about epilepsy. The participants had an average of 20 years of experience in practice, and most worked in an academic clinical or research setting.
Combination Drug to Treat Cholesterol Disorders
The U.S. Food and Drug Administration has approved extended-release niacin/lovastatin tablets (Advicor), the first combination therapy for the treatment of cholesterol disorders. It is indicated for use in patients with hypercholesterolemia and mixed dyslipidemia who have been previously treated with either component and who require more lipid modification than was achieved by the individual components.
Policies and Attitudes about Secondhand Smoke
The Centers for Disease Control and Prevention analyzed data from the 2000 Behavioral Risk Factor Surveillance System that showed that state-specific (including the District of Columbia and Puerto Rico) smoking rates among adults ranged from 12.9 percent to 30.5 percent. The data also indicated high levels of public support for policies regarding smoking restrictions in many settings. This support existed among smokers and nonsmokers. The report summarizing this data was published in the December 14, 2001 issue of Morbidity and Mortality Weekly Report.
The 12 states with the highest rates of smoking were: Kentucky, Nevada, Missouri, Indiana, Ohio, West Virginia, North Carolina, Tennessee, New Hampshire, Alabama, Arkansas, and Alaska. The 12 areas with the lowest smoking rates were Utah, Puerto Rico, California, Arizona, Montana, Hawaii, Minnesota, Connecticut, Massachusetts, Colorado, Maryland, and Washington.
Exposure to secondhand smoke can be reduced by limiting smoking in public places. This report indicates that smokers and nonsmokers supported smoking bans, and both groups almost universally supported bans in schools and day care centers. Strong support was also indicated for smoking bans in indoor work areas and restaurants.
First Room-Temperature Drug for MS Approved
The U.S. Food and Drug Administration has approved interferon beta-1b (Betaseron), the first and only room-temperature therapy to treat relapsing-remitting multiple sclerosis. It will be available mid-2002.
This therapy option will allow patients to continue treatment uninterrupted and provide greater convenience to them. Common side effects of interferon beta-1b include influenza-like symptoms, shortness of breath, and injection site reactions.
New Study for Persons with HIV
About 6,000 persons eventually will be enrolled in a long-term study to evaluate which of two common HIV treatment strategies is better. The study, titled “Strategies for Management of Anti-Retroviral Therapies” (SMART), is being funded by the National Institute of Allergy and Infectious Diseases (NIAID).
During the first year of the expected seven-year trial, 1,000 participants who are HIV-infected will be enrolled and assigned to a “go-slow” or “hit-hard-early” treatment regimen. The latter strategy is currently recommended in guidelines used by many U.S. physicians. If favorable outcomes are detected after the first year of the study, 5,000 more participants will be enrolled during the following three years.
In contrast to previously conducted AIDS treatment trials, the SMART trial will be the first to study the efficacy and toxicity of HIV therapies over an extended time period. It will also measure the clinical progression of the disease (i.e., progression to full-blown disease or death) rather than indirect indicators (i.e., amount of virus). In an effort to extract findings that will apply to a broad range of patients, the enrollment criteria will include patients across the spectrum from teens to adults.
Information about the SMART trial is available atwww.clinicaltrials.gov (search term: “smart”).
Copyright © 2002 by the American Academy of Family Physicians.
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