The Vitals - January 2016

January 2016, Vol 4, No 1 - The Vitals

In This Article

Aerobic Fitness in Late Adolescence Associated with Risk for Early Death

Researchers examining the link between early death and aerobic fitness late in adolescence have found a relationship between the 2, with the risk for early death being higher in fit, obese people than in unfit people of normal weight, according to an article published in the International Journal of Epidemiology.

Prompted by an existing association between fitness level, obesity, and death in older populations, Gabriel Högström, postgraduate student, Department of Community Medicine and Rehabilitation, Umeå University, Sweden, and colleagues conducted a cohort study of 1,317,713 Swedish men with a mean age of 18 years between 1969 and 1996.

The authors used an electrically braked cycle test to assess the participants’ aerobic fitness, and tracked causes for death with national registers.

A total of 44,301 patients died during a mean follow-up period of 29 years. Patients in the highest fifth percentile of aerobic fitness were at lower risk for death from any cause, compared with patients in the lowest fifth percentile. Alcohol and narcotics abuse were strongly associated with mortality.

“Aerobic fitness was associated with a reduced risk of death from any cause in normal-weight and overweight individuals, whereas the benefits were reduced in obese individuals,” Mr Högström and colleagues concluded. “Furthermore, unfit normal-weight individuals had 30% lower risk of death from any cause than did fit obese individuals.”

  1. Högström G, Nordström A, Nordström P. Aerobic fitness in late adolescence and the risk of early death: a prospective cohort study of 1.3 million Swedish men. Int J Epidemiol. 2015 Dec 20. Epub ahead of print.

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United States Still Facing Challenges in Improving Care for Patients with HIV

Although human immunodeficiency virus (HIV) screening and targeted testing have increased, patients with HIV are living longer, and the number of diagnoses of HIV has decreased in the past decade, according to an essay published in the New England Journal of Medicine. In addition, hundreds of thousands of patients with HIV are not receiving antiretroviral treatment or care, the study authors added.

“The greatest loss of patients in the HIV continuum of care occurs between diagnosis and engagement in medical care,” explained Thomas R. Frieden, MD, MPH, Director, Centers for Disease Control and Prevention, Atlanta, GA, and colleagues.

Even though advances have been made in sensitivity of diagnostic testing, efficacy of medications, and efforts to educate people on the potential benefits of pre-exposure prophylaxis, there are still challenges surrounding the implementation of these efforts to reduce the rates of new HIV infections.

“[M]ost people living with HIV infection in the United States are not receiving antiretroviral treatment; notification of partners of infected people remains the exception rather than the norm; and several high-risk behaviors have become more common,” they stated. These high-risk behaviors include anal intercourse among homosexual and bisexual men without the use of a condom, and sharing needles and other injection paraphernalia.

Dr Frieden and colleagues stressed the need for healthcare providers, clinical systems, and public health and community organizations to work together to apply public health principles and identify people newly and previously diagnosed with HIV, with the goal of providing continuous care and antiretroviral treatment to suppress their viral load.

  1. Frieden TR, Foti KE, Mermin J. Applying public health principles to the HIV epidemic—how are we doing? N Engl J Med. 2015;373:2281-2287.

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FDA Proposes Safety Measures for Use of Tanning Beds

As part of its commitment to protect public health by informing consumers about the risks of indoor tanning, the US Food and Drug Administration (FDA) has proposed steps for preventing the use of sunlamp products (ie, indoor tanning beds) by minors, and reducing the risks of these devices in adults.

Citing data from the American Academy of Dermatology, the statement asserted that, compared with people who have never used indoor tanning devices, people who have been exposed to radiation from indoor tanning are 59% more likely to develop melanoma. The effects of ultraviolet (UV) radiation exposure add up during a person’s lifetime, which means that children and teenagers who are exposed to UV radiation are at a greater risk for skin and eye damage later in life.

The 2 proposed rules issued by the FDA include (1) restricting the use of sunlamp products to people aged ≥18 years, and (2) requiring sunlamp manufacturers and tanning facilities to take extra steps to improve the overall safety of these devices (eg, making warnings on the device more prominent and easier to read, including an emergency shutoff switch or panic button, and limiting the amount of light allowed through protective eyewear).

“[These proposed rules are] intended to help protect young people from a known and preventable cause of skin cancer and other harms,” said Stephen Ostroff, MD, acting FDA Commissioner, in a statement released by the organization. “The FDA understands that some adults may decide to continue to use sunlamp products. These proposed rules are meant to help adults make their decisions based on truthful information and to ensure manufacturers and tanning facilities take additional steps to improve the safety of these devices.”

  1. US Food and Drug Administration. FDA proposes tanning bed age restrictions and other important safety measures. Published December 18, 2015. Accessed December 28, 2015.

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Nurse Reuses Syringes, Jeopardizes Injection Safety at New Jersey Clinic

An experienced nurse reused syringes for multiple patients in an employee influenza vaccination clinic on the premises of a business in West Windsor, NJ, according to a report by Laura Taylor, PhD, New Jersey Department of Health (NJDOH), Communicable Disease Service, and colleagues, which was published by the Centers for Disease Control and Prevention (CDC).

The nurse, who was supposed to administer vaccines from manufacturer-prefilled, single-dose syringes, brought 3 multiple-dose vials of the vaccine (which were intended for use at another event), and used 2 syringes to administer the vaccines to 67 employees. She reported that she had wiped the syringes with alcohol, and used a new needle for each patient.

A vaccine recipient who saw the syringe reuse alerted business managers, who notified the health services company that was contracted to provide the influenza vaccinations.

The NJDOH has recommended testing the 67 patients who were vaccinated for human immunodeficiency virus (HIV), hepatitis C virus, and hepatitis B virus.

“Reuse of syringes for multiple patients, with or without reuse of needles, is recognized as a serious infection control breach that poses risks for bloodborne pathogen transmission,” Dr Taylor and colleagues explained. Further investigation of this event led to the discovery of additional administration, storage, and handling concerns; the nurse had not administered the recommended dose of influenza vaccine, and had neglected to monitor the temperature of the vaccines, among others.

“In response to these injection safety and vaccine administration errors, the NJDOH, in consultation with CDC, recommended notification and testing of the New Jersey business employees who participated in the vaccination clinic for [HIV], hepatitis C virus, and hepatitis B virus,” the authors explained.

The nurse involved voluntarily surrendered her license ≤1 week after the initial report.

  1. Taylor L, Greeley R, Dinitz-Sklar J, et al. Notes from the field: injection safety and vaccine administration errors at an employee influenza vaccination clinic—New Jersey, 2015. MMWR Morb Mortal Wkly Rep. 2015;64:1363-1364.

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AMP Increases Exceed Inflation Factor Applicable to Brand Name Drugs

A report released by the US Department of Health & Human Services (HHS) reviewed the top 200 generic drugs annually from 2005 through 2014, and found that 22% of these drugs had average manufacturer price (AMP) increases that exceeded the specified statutory inflation factor applied to brand name drugs.

During the 2005-2014 HHS review, each generic drug was assigned a baseline AMP, and each quarterly AMP was compared with the inflation-adjusted baseline AMP. Additional rebates were calculated for the top 200 generic drugs for each quarter, where quarterly AMPs exceeded inflation-adjusted baseline AMPs.

Similar to their previous review, the findings indicated that Medicaid would receive additional rebates if the provision for brand name drugs were extended to generic drugs.

The Bipartisan Budget Act of 2015 was ultimately enacted on November 2, 2015. Its provisions include extending the additional rebate to generic drugs; these additional rebates for generic drugs will begin to take effect during the first quarter of 2017.

  1. US Department of Health & Human Services. Average manufacturer prices increased faster than inflation for many generic drugs. Published December 16, 2015. Accessed December 28, 2015.

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Last modified: February 4, 2016
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