Am Fam Physician. 1999;60(5):1570-1575
AAP Statement on Cord Blood Banking
No strong evidence is available to recommend routine cord blood banking for an infant's future use, according to a policy statement from the American Academy of Pediatrics (AAP) that was published in the July 1999 issue of Pediatrics. The AAP states that no accurate estimates exist of the likelihood that children would need their own stored cells, which makes it hard to recommend that parents store their children's cord blood. The AAP statement is intended to give physicians information to use when they discuss umbilical cord blood banking with parents.
The following recommendations were excerpted from the statement:
Given the difficulty of making an accurate estimate of the need for autologous transplantation and the ready availability of allogeneic transplantation, private storage of cord blood as “biologic insurance” is unwise.
Conditions such as leukemia or severe hemoglobinopathy may indicate the need for directed donor cord blood banking for sibling cord blood transplantation.
Philanthropic donation of cord blood for banking at no cost for allogeneic transplantation is encouraged. In such cases, the parents should be informed of the appropriate operational recommended principles.
The policy statement also contains recommendations for institutions or organizations involved in programs for umbilical cord blood banking.
AHCPR Report on Dysphagia in Acute-Care Stroke Patients
Research on dysphagia suggests that hospital stroke management plans that include programs to diagnose and treat dysphagia may yield dramatic reductions in pneumonia rates, according to a report sponsored by the Agency for Health Care Policy and Research (AHCPR) under its evidence-based practice program. The report also found that use of comprehensive examinations performed at the patient's bedside detected most serious swallowing problems. A full bedside examination includes taking a detailed history, performing a physical examination of the mouth and throat, and observing the patient attempting to swallow various consistencies and sizes of foods and liquids.
The research was conducted by ECRI, an AHCPR evidence-based practice center located in Plymouth Meeting, Pa. It is the eighth in a series of evidence reports and technology assessments to provide comprehensive, science-based information on common, costly conditions and health care technologies. The report's conclusions are based on a systematic review of the best available evidence from published research.
Other findings in the report include the following:
The limitations of available evidence do not allow one to determine the extent to which invasive procedures like videofluoroscopy or fiberoptic endoscopy reduce pneumonia rates more than full bedside examinations. Although these procedures may provide additional information, existing studies are insufficient to determine this information's usefulness.
The evidence is inconclusive about how the frequency of swallow therapy sessions affects patient outcomes.
The only controlled trial that compared a soft diet with a traditional pureed diet found that a soft diet resulted in lower pneumonia rates among stroke patients with a history of aspiration pneumonia.
The complete document titled “Diagnosis and Treatment of Swallowing Disorders (Dysphagia) in Acute-Care Stroke Patients” (AHCPR no. 99-E023) is available by calling the AHCPR Clearinghouse at 800-358-9295 or writing to the Clearinghouse at P.O. Box 8547, Silver Spring, MD 20907.
FDA Advisory on Consumption of Raw Sprouts
The U.S. Food and Drug Administration (FDA) has issued an updated advisory to make all persons aware of the health risks associated with eating raw sprouts, such as alfalfa, clover and radish. Reports of increasing numbers of illnesses associated with eating raw sprouts have included males and females in all age categories. According to the FDA, children, the elderly and persons who have weakened immune systems are particularly at high risk of developing serious illness caused by a foodborne disease. These people should not eat raw sprouts.
The advisory is updated from a previous health advisory issued in August 1998. Two recent outbreaks of salmonellosis were associated with clover sprouts; one outbreak was in California and one was in Colorado. In addition, an outbreak of salmonellosis affecting approximately 85 persons in western states was associated with the consumption of alfalfa sprouts.
The FDA is working closely with the sprout industry to establish preventive controls to protect consumers. A copy of this advisory is available on the FDA's Web site at http://www.fda.gov.
Cultural Competence Book on Asian Americans and Pacific Islanders
The Health Resources and Services Administration's Bureau of Primary Health Care (BPHC) and the Department of Health and Human Services' Office of Minority Health and Substance Abuse and Mental Health Services Administration have released the fifth volume of its Cultural Competence Series. The volume is titled “Developing Cultural Competence in Asian American and Pacific Islander Communities: Opportunities in Primary Health Care and Substance Abuse Prevention.”
Two more editions of this cultural competence series are scheduled for release this year, focusing on American Indians, Alaska Natives and Latino Americans.“The focus of the volumes is to help health care professionals understand the similarities and differences among the diverse cultural groups in the United States and its jurisdictions,” states the BPHC's Leonard G. Epstein, managing editor of the series.
Each addition of the series is a collection of articles about approaches to providing culturally competent health care. To receive a copy of these publications, contact the National Clearinghouse for Primary Care at 800-400-2742.
Report on Technologies for Cervical Cancer Screening
The Health Technology Advisory Committee (HTAC) has published a report on new technologies for cervical cancer screening. HTAC was established in 1992 by the Minnesota state legislature. It is an independent, non-partisan advisory body that evaluates new and emerging health care technologies based on existing scientific research and technology assessment.
The 61-page report is intended to provide information to help health care professionals in responding to patient questions regarding the accuracy of Papanicolaou (Pap) testing and the value of the new technologies. It discusses background information, Pap smear methods and strategies to lower the rate of cervical cancer. The report also has a review of peer-reviewed, published literature and a list of recommendations. The classification systems for cervical cytology are included in an appendix to the report.
The report emphasizes that physicians should educate all women in their care about the importance of periodic Pap testing and discuss the new technologies for cervical cancer screening. In addition, health plans should incorporate Pap testing of women into quality improvement goals for their clinics.
This report and others published by HTAC may be obtained by calling 651-282-6374 or by e-mail (htac@health.state.mn.us/htac/index/htm). There is no charge for the reprints. All HTAC reports are also available on the HTAC Web site (http://www.health.state.mn.us/htac/index/htm).
AAP Update on Intake of Folic Acid by Women
Most women of childbearing age still do not consume enough folic acid, according to a new policy statement from the American Academy of Pediatrics (AAP) published in the August 1999 issue of Pediatrics. The AAP states that fewer than one in three women consume the recommended amount of folic acid to prevent neural tube defects (NTD) in their infants. Recommendations by the AAP include those for women with no history of a previous NTD-affected pregnancy, for women who have had a previous NTD-affected pregnancy and for women at high risk for an NTD-affected pregnancy.
The AAP endorses the U.S. Public Health Service recommendation that all women who are capable of becoming pregnant consume 400 μg daily of folic acid, usually through a multivitamin supplement. Meeting this dietary requirement could prevent 50 percent or more of these birth defects.
In addition, the AAP recommends that women who have had a previous NTD-affected pregnancy be offered treatment with 4,000 μg of folic acid per day starting one month before becoming pregnant and throughout the first trimester, unless contraindiated because of a medical reason.
Women at high risk for an NTD-affected pregnancy should discuss the appropriate folic acid intake with their physician. Women at risk, according to the AAP, include those with a close relative with an NTD, women with diabetes mellitus or those taking certain antiseizure medications.
Paroxetine for Persons with Social Anxiety Disorder
Paroxetine (Paxil) has been approved by the U.S. Food and Drug Administration for the treatment of persons with social anxiety disorder. Paroxetine, a selective serotonin reuptake inhibitor, is also indicated for mood and anxiety disorders, namely depression, panic disorder and obsessive-compulsive disorder.
In clinical trials, patients receiving paroxetine had significantly reduced social anxiety, increased participation in social activities and improved overall clinical condition as measured by the Clinical Global Impression Score and the Liebowitz Social Anxiety Scale, compared with patients receiving a placebo. The recommended starting dosage is 20 mg daily for social anxiety disorder.
The most common adverse events associated with the use of paroxetine were sweating, nausea, dry mouth, constipation, decreased appetite, somnolence, tremor, decreased libido, yawning, abnormal ejaculation, female genital disorders and impotence. Concomitant use of paroxetine in patients taking monoamine oxidase inhibitors is contraindicated.
For more information on social anxiety disorder, contact the Social Anxiety Disorder Coalition at 800-934-6276.
A New Medicine for Treatment of Influenza
The U.S. Food and Drug Administration has approved zanamivir (Relenza), an inhaled antiviral drug, for the treatment of patients with either influenza A or B viruses. Zanamivir belongs to a new class of compounds called neuraminidase inhibitors. The drug is indicated for uncomplicated acute illness in adults and adolescents 12 years of age and older who have been symptomatic for no more than two days. Zanamivir is taken twice daily for five days using a hand-held, breath-activated plastic inhaler device called a Diskhaler.
In clinical studies, patients with influenza A or B of less than two days' duration who received zanamivir had shorter times to improvement in influenza symptoms compared with patients receiving a placebo. There was no consistent difference in treatment effect in patients with influenza A, compared with influenza B, although most of the patients in the studies had influenza A.
The most common side effects included sinusitis, diarrhea and nausea. The safety and efficacy in patients with asthma or other chronic lung or heart diseases have not been established. The manufacturer suggests that patients receive adequate training on the correct way to use the inhaler.
NRHA Issue Paper on Mental Health in Rural America
The National Rural Health Association (NRHA) has prepared a new issue paper that addresses the scope and impact of mental health in rural areas. The paper discusses the current infrastructure, the impact on health care organizations and consumers, and the need for research that examines the mental health conditions of rural residents. Ten ways to better serve the mental health needs of rural and frontier populations are discussed by the NRHA.
The complete text of “Mental Health in Rural America” and other NRHA policy issue papers are available in the advocacy section of the NRHA Web site at http://www.NRHArural.org. Copies may also be obtained by contacting the Communications Department in the NRHA office at 816-756-3140.
Treatment for Atopic Dermatitis in Children
Fluticasone (Cutivate Cream) has been approved by the U.S. Food and Drug Administration for the treatment of atopic dermatitis in children three months of age or older. It is the only topical corticosteroid approved for use in this age group.
The recommended dosage in pediatric patients is an application of a thin film once or twice daily to the affected skin areas. Fluticasone should not be used in the diaper area unless directed by a physician. The safety and efficacy of use of the cream for longer than four weeks in the pediatric population have not been established nor have the safety and efficacy been established for infants less than three months old.
In a clinical study of 119 pediatric patients with atopic dermatitis, fluticasone was shown to be effective in 86 percent of patients. Side effects were generally mild and self-limited. The most common adverse events seen in patients in the study were itching, dryness, numbness of fingers and burning.