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Am Fam Physician. 2002 Jul 15;66(2):332-336.

AAFP Policy on Smallpox Immunization

The American Academy of Family Physicians (AAFP) has released a new policy on smallpox immunization. The AAFP now advocates immunizing a limited number of people at the federal, state, and local levels who are pre-designated by bioterrorism and public health authorities. These people would be called on to investigate smallpox cases and contain outbreaks should they occur. This policy statement is in addition to the Centers for Disease Control and Prevention's Interim Smallpox Response Plan and Guidelines, which were endorsed by the AAFP last fall. The complete AAFP policy is available online at www.aafp.org/immunization/smallpox.html.

In case of an outbreak, ring containment immunization (immunizing all people the patient came in contact with prior to diagnosis and quarantine) should receive highest priority with other immunization programs initiated if needed. If federal authorities determine that the threat level has changed, a more aggressive immunization program should be considered.

The AAFP does not advocate a widespread smallpox vaccination at this time. The potential death risk and complications that could occur by vaccinating all people in the United States outweigh the current risk of a bioterrorist attack. It is important to note that the smallpox vaccine contains live smallpox virus. The person vaccinated against the disease can spread the virus up until the time the injection site heals (up to six weeks).

HHS Report on Women's Health

The Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) has published a report on the status of women's health in the United States. The report, “Women's Health USA 2002,” is available online at www.mchb.hrsa.gov/data/women.htm or by calling the HRSA at 888-ASK-HRSA (888-275-4772).

The report used current and historical data from several sources to provide a comprehensive overview of the health status of American women. According to the report, certain health conditions have a “disproportionate impact” on women compared with men. Among diseases disproportionately affecting women are osteoporosis, asthma, diabetes, and systemic lupus erythematosus.

The report includes data showing that most U.S. women 40 years of age and older in 1998 had received a mammogram in the previous two years and a Papanicolaou smear in the previous three years.

Other highlights from the report include:

  • Women's life expectancy in the year 2000 was 79.5 years—a new record high. While black females had the greatest life-expectancy gain (12.3 years) between 1950 and 2000, there was still a five-year difference in life expectancy between white (80 years) and black (75 years) females.

  • More American women than ever are getting prenatal care in their first trimester of pregnancy. In 2000, 83 percent received early prenatal care, up from 75 percent in 1989.

  • Nearly 87 percent of women had health insurance coverage in 2000. About one fourth of women between 18 and 24 were without insurance in 2000.

  • Women's enrollment in medical school increased by 66 percent from 1980–81 to 1999–2000, while dental school enrollment rose 122 percent during the same period. In 1999–2000, 67 percent of public health students and 65 percent of pharmacy students were women.

  • In 2000, 10,459 cases of acquired immunodeficiency syndrome were diagnosed in females age 13 and older; 38 percent were exposed through heterosexual contact. Almost one half of U.S. women under age 45 have been tested for human immunodeficiency virus.

USPSTF Depression Screening Recommendations

The U.S. Preventive Services Task Force (USPSTF) now finds sufficient evidence to encourage physicians to screen their adult patients for depression. Formal screening can make it easier to identify depression, which is a common and treatable condition that often is not recognized by patients or their physicians. (The recommendation is ranked as a “B” intervention: physicians should routinely provide the service to eligible patients; there is at least fair evidence that the intervention improves important health outcomes and that the benefits outweigh the harms.) The updated recommendation is available online at www.ahrq.gov.

The USPSTF believes that physicians should have systems in place to assure accurate diagnosis, effective treatment, and follow-up if patients are to benefit from screening.

The recommendation updates the USPSTF 1996 recommendation, which identified depression as an important clinical problem and encouraged physicians to remain alert for signs of depression in their patients. At the time, the USPSTF concluded there was insufficient evidence to recommend for or against regular formal screening. Since then, the USP-STF has reviewed new evidence from randomized trials and found that patients fared best when physicians recognized the symptoms of depression and made sure that patients received appropriate treatment.

Although there are many tools available to screen for depression, according to the USPSTF, there is little evidence to recommend one over another. Physicians can choose tools that are appropriate for their patients and practice setting.

According to the USPSTF, an affirmative response to the following two questions may be as effective as using longer screening instruments, or may indicate the need for the use of more in-depth diagnostic tools: (1) over the past two weeks, have you ever felt down, depressed, or hopeless?; and (2) have you felt little interest or pleasure in doing things?

The USPSTF states that there is insufficient evidence to recommend for or against routine screening of children or adolescents for depression. Physicians should remain alert for possible signs of depression in younger patients.

FDA Recalls OB-GYN, Surgical Devices

The U.S. Food and Drug Administration (FDA) warns that some of the medical devices manufactured since 1999 by A&A Medical Inc. of Alpharetta, Ga., may not have been sterilized and could cause “serious and possibly life-threatening infections.”

Curettes, uterine dilators, and mucous samplers are on the long list of OB-GYN and surgical devices made and marketed under the A&A Medical label as well as under the labels Rocket USA and Lifequest. A complete list of products and distributors is available at www.fda.gov/cdrh/recalls/recall31402.html.

ACOG Opinion Paper on Bone Density Screening

The Committee on Gynecologic Practice of the American College of Obstetricians and Gynecologists (ACOG) has issued an opinion paper on bone density screening for osteoporosis. ACOG Committee Opinion No. 270 appears in the March 2002 issue of Obstetrics and Gynecology.

According to the ACOG opinion paper, bone mineral density (BMD) testing is an effective approach for the early detection of osteopenia and osteoporosis. Osteoporosis is a significant health problem in the United States.

BMD testing is recommended for all postmenopausal women aged 65 years or older and for all post-menopausal women who present with fractures. The committee also concludes that BMD testing may be recommended to postmenopausal women younger than 65 years who have one or more risk factors for osteoporosis. BMD testing also may be useful for premenopausal and postmenopausal women who present with certain diseases or medical conditions and those who take certain drugs associated with an increased risk of osteoporosis.

CDC Antimicrobial Resistance Campaign

The Centers for Disease Control and Prevention (CDC) has initiated a campaign aimed at physicians to prevent antimicrobial resistance in health care settings. Information about the CDC campaign is available online at www.cdc.gov/drugresistance/health-care.

The campaign, “Prevent Antimicrobial Resistance,” is built on the following four key strategies for preventing antimicrobial resistance in health care settings: (1) preventing infection, (2) diagnosing and treating infection effectively, (3) using antimicrobials wisely, and (4) preventing transmission of drug-resistant pathogens.

Within these strategies are 12 specific action steps derived from evidenced-based guidelines and recommendations already developed by the CDC and other organizations that physicians can use to prevent antimicrobial resistance in hospitalized adults. The action steps are (1) give influenza vaccine to at-risk patients; (2) remove catheters when no longer essential; (3) target the pathogen with appropriate therapy; (4) consult infectious disease experts for patients with serious infections; (5) engage in local antimicrobial control efforts; (6) know your antibiogram; (7) treat infection, not contamination; (8) treat infection, not colonization; (9) know when to say “no” to vanco(mycin); (10) stop antimicrobial treatment when infection is treated or unlikely; (11) isolate the pathogen; and (12) break the chain of contagion.

The CDC will announce in the future similar action steps for physicians who care for dialysis patients, emergency department patients, obstetric patients, critical care patients, patients in long-term care facilities, and children.

Antimicrobial resistant infections in health care settings are a major threat to patient safety. Each year, an estimated 2 million hospitalized patients acquire infections that result in more than 90,000 deaths. More than one half of these infections are caused by bacteria that are resistant to at least one of the antimicrobials commonly used to treat those infections, according to the CDC.

AAFP Annual Scientific Assembly

The annual Scientific Assembly of the American Academy of Family Physicians (AAFP) will be held in San Diego, October 16–20.

This year's program focuses on practical continuing medical education (CME) that can be applied to patients. The program features more than 300 sessions in 54 major subject areas. There are 33 program elements, 24 of which are free to registrants. Elements include clinical seminars, computer classes, mainstage lectures, dialogue sessions, and clinical procedures workshops. Persons can accrue up to 46.25 hours of prescribed CME credit during the meeting.

From publications, to medical and practice management equipment, to pharmaceuticals, more than 400 companies will exhibit their latest products in the exposition hall. Scientific exhibits, showcasing important medical information, will also be on display.

AAFP members are invited to participate in the activities of the Congress of Delegates, which convenes October 14–16. Complimentary evening events during the assembly include the fellowship convocation, the presidents' reception and the Assembly Celebration at SeaWorld Adventure Park. Guest tours and courses, as well as youth program activities, are available for your family.

AAFP members may register online (http://www.aafp.org/assembly) or by mail or fax. Early registration is encouraged to ensure adequate accommodations and access to high-demand courses that require preregistration. After September 10, registration for assembly activities will be available on-site only. Information about the meeting can be obtained by calling the AAFP assembly hotline at 800-926-6890, or by e-mailing your request to assemblyinfo@aafp.org.



Copyright © 2002 by the American Academy of Family Physicians.
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