News in Brief: Week of June 9-13

June 16, 2014 11:45 am News Staff

This roundup includes the following news briefs:

FDA, EPA Propose Updated Advice on Fish Consumption for Pregnant Women

The FDA and the Environmental Protection Agency (EPA) have proposed updates(www.fda.gov) to their 2004 joint advice on fish consumption by women who are pregnant or who might become pregnant, as well as those who are breastfeeding. The draft advice aligns with recommendations in the 2010 Dietary Guidelines for Americans and aims to maximize the health benefits of eating fish while minimizing the risks posed by possible mercury contamination.

The proposed update

  • recommends that these women eat at least 8 ounces and as much as 12 ounces per week of a variety of fish lower in mercury that fits within their calorie needs;
  • continues to recommend that these women avoid certain fish with the highest mercury concentrations: shark, swordfish, king mackerel and tilefish caught in the Gulf of Mexico;
  • advises these women that they may eat tuna but continue to recommend limiting white (albacore) tuna to 6 ounces per week;
  • retains recommendations included in the 2004 advice for fish caught in local streams, rivers and lakes, where levels of mercury are unknown and may be higher than in commercially available species; and
  • continues to call for the recommendations to apply to young children, as well, because their nervous systems are still developing.

The update accompanies the FDA's release of a new quantitative assessment(www.fda.gov) of the effects of eating commercial fish on fetal neurodevelopment.

Ebola Is Growing Concern in West Africa

Ebola hemorrhagic fever remains a serious threat to the West African countries of Guinea, Sierra Leone and Liberia. According to a CDC Ebola update(www.cdc.gov), the number of confirmed cases continues to climb.

As of June 10, the Ministry of Health of Guinea had reported 376 suspected and confirmed cases of Ebola hemorrhagic fever. This report includes 233 laboratory-confirmed cases; 241 cases have proved fatal. The Ministry of Health and Sanitation of Sierra Leone has reported 160 cases of Ebola as of June 9, including 43 lab-confirmed cases and 19 deaths. The Ministry of Health and Social Welfare of Liberia reported one new lab-confirmed case (and one death) on June 7, its first confirmed case since April 6.

Heinz Feldmann, M.D., addresses the frightening spread of Ebola in his article "Ebola -- A Growing Threat?"(www.nejm.org) published in the New England Journal of Medicine last month. In his writing, Feldmann said these outbreaks of Ebola shine a spotlight on "the limited ability of our public health systems to respond to rare, highly virulent communicable diseases. The medical and public health sectors urgently need to improve education and vigilance."

WHO Offers Polio Vaccination Guidance for Travelers

On May 5, the World Health Organization (WHO) declared the international spread of polio to be a public health emergency(www.who.int) of international concern and issued vaccination recommendations(www.who.int) for travelers in an effort to prevent further spread of the disease.

The recommendations pertain to patients planning to travel for periods longer than four weeks to countries with current poliovirus transmission. The 10 countries listed in the WHO statement include three that are designated as "exporting wild poliovirus" -- Cameroon, Pakistan and Syria -- and seven countries that are "infected with wild poliovirus" -- Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Nigeria.

U.S. citizens who plan to travel to any of the polio-infected countries should ensure they take with them documentation of a polio booster in their yellow International Certificate of Vaccination or Prophylaxis(www.who.int) documents to avoid travel delays. The CDC provides further information(wwwnc.cdc.gov) for travelers to read on visiting countries with active polio cases.

The 2014 recommended immunization schedule for children and adolescents jointly developed by the CDC, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists lays out the specifics of immunization with the inactivated poliovirus vaccine for people younger than 18.

Survey Finds Physicians Leading ACO Movement

Results of a national survey of accountable care organizations (ACOs)(content.healthaffairs.org) found that 51 percent of ACOs were physician-led and another 33 percent were led jointly by physicians and hospitals. Researchers also found that physicians owned 40 percent of ACOs. Furthermore, 78 percent of ACOs had a majority of physicians on their governing boards.

Researchers fielded the National Survey of Accountable Care Organizations from October 2012 to May 2013 and results were published in the June issue of Health Affairs.

In the article's abstract, authors concluded that "The broad reach of physician leadership has important implications for the future evolution of ACOs. It seems likely that the challenge of fundamentally changing care delivery as the country moves away from fee-for-service payment will not be accomplished without strong, effective leadership from physicians."

OIG Report Takes Aim at Coding, Payment Errors for E/M Services

A new report(oig.hhs.gov) recently released by HHS' Office of the Inspector General found that about 42 percent of 2010 Medicare claims for evaluation and management (E/M) services were incorrectly coded; another 19 percent of claims lacked proper documentation.

Report authors said their review of medical records showed that Medicare inappropriately paid out $6.7 billion for the claims and that the amount represented 21 percent of Medicare payments for E/M services in 2010.

Authors recommended that CMS educate physicians on coding and documentation requirements for E/M services, continue to encourage contractors to review E/M services billed for by high-coding physicians and follow up on claims for E/M services that were paid for in error.

HRT Improves Bone Density in Women With Primary Ovarian Insufficiency

Researchers found that hormone replacement therapy (HRT) in young women with primary ovarian insufficiency (POI) led to increases in their bone mineral density, according to a recent study(press.endocrine.org).

Spontaneous POI occurs when the ovaries stop producing sufficient estrogen. Women with the condition can have irregular or absent menstrual cycles, hot flashes and fertility problems. They also report abnormally low levels of reproductive hormones, including estradiol, a type of estrogen produced by the ovary, and testosterone, which is produced by women in small amounts.

Using bone density scans of the hip and lower spine, researchers measured the effects of two HRT regimens on the bone mineral density of women with POI who were between 18 and 42 years old. Participants in the study all received 100 mcg of transdermal estradiol per day plus 10 mg of oral medroxyprogesterone acetate per day (12 days per month) for a three-month run-in period, after which they were randomized to also receive either 150 mcg of transdermal testosterone or placebo daily.

Both groups reported significant increases in bone mineral density. Adding testosterone to the treatment regimen, however, did not significantly help increase bone mineral density.

The study was supported by the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development. The findings were published online in the Journal of Clinical Endocrinology & Metabolism.


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