Medicare Expands List of Covered Preventive Services to Include HIV Screening Tests

The Centers for Medicare & Medicaid Services (CMS) today announced its final decision to cover Human Immunodeficiency Virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries
of any age who voluntarily request the service. The decision is effective immediately.

Under the recently passed Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), CMS now has the flexibility of adding to Medicare's list of covered preventive services, if certain requirements are met. Prior to this law, Medicare could only cover additional preventive screening tests when Congress authorized it to do so.

"Today's decision marks an important milestone in the history of the Medicare program," said HHS Secretary Kathleen Sebelius. "Beginning with expanding coverage for HIV screening, we can now work proactively as a program to help keep Medicare beneficiaries healthy and take a more active role in evaluating the evidence for preventive services."

Under MIPPA, CMS can consider whether Medicare should cover preventive services that Congress has not already deemed as covered or non-covered by law. Among other requirements, the new services must have been "strongly recommended" or "recommended" by the U.S. Preventive Services Task Force. For instance, the Task Force graded HIV screening as "strongly recommended" for certain groups. More information about the Task Force is available online at
http://www.ahrq.gov/clinic/uspstfix.htm.

"Every adult should know their HIV status," said Dr. Howard K. Koh, HHS assistant secretary for health. "This decision by Medicare should help promote screening and save lives."

CMS uses the national coverage determination (NCD) process to make decisions on these types of preventive services. This process provides transparency about the evidence that CMS considers when making its decisions and allows opportunity for the public to comment on CMS'
proposals.

"Medicare's coverage of HIV screening tests is an important step forward in protecting beneficiaries from the potentially devastating and life-threatening complications of HIV and Acquired immunodeficiency Syndrome (AIDS)," said CMS Acting Administrator Charlene Frizzera.

AIDS is diagnosed when an HIV-infected person's immune system becomes severely compromised or a person becomes ill with an HIV-related infection. Of the more than one million estimated to have the HIV infection, the Centers for Disease Control and Prevention has estimated that about a quarter of them do not realize they are infected. Without treatment, AIDS develops within 8 to 10 years. While there is presently no cure for HIV, screening can help identify infected patients so that they can receive medical treatment that could help delay the onset of AIDS for years.

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

Secretary Pulls Cover Off the Work of Government Medical Panel

/PRNewswire/ -- U.S. Health and Human Services Secretary Kathleen Sebelius is to be commended for publicly stating the government panel opposing mammograms is "an outside independent panel of doctors and scientists who ... do not set federal policy and ... don't determine what services are covered by the federal government."

ZERO - The Project to End Prostate Cancer has long criticized this panel, known as the U.S. Preventive Services Task Force (USPSTF), for being out of touch due to its steadfast opposition to recognize the need for prostate cancer early detection as an important men's health issue.

Now, this panel is criticizing the need for mammograms.

Based on its advisory opinions on both breast cancer and prostate cancer, USPSTF has created much confusion among millions of women and men who are now being told that preventive health measures should not be followed as a means to detect cancer.

"Prostate cancer is essentially 'the forgotten illness' as far as this outside government panel is concerned," said ZERO's CEO Quentin "Skip" Lockwood.

"We're pleased the Secretary is speaking up in defense of a woman's right to continue receiving mammograms to protect her health," he said.

"We now call upon the Secretary to address the importance of prostate cancer early detection for men as well, since USPSTF has turned its back on this issue."

Advocates for mammograms and prostate cancer testing also question the membership of the USPSTF panel due to the glaring omission of medical specialists relating to women's and men's health in the fields of radiology, oncology and urology, for example.

Earlier today, the American College of Radiology called upon the Secretary to ensure the panel included "experts from the areas on which they will be advising lawmakers and submit their recommendations for comment and review," as is done with Medicare guidelines.

Ironically, the supporting data used by USPSTF does indicate mammography screening reduces breast cancer deaths by 15 percent annually. For prostate cancer, USPSTF references an ongoing screening study where early detection (using the PSA test) has so far reduced deaths by 20 percent.

"It's obvious this government panel has some explaining to do and hopefully, with prodding from the Secretary, we will get some answers to explain their contradictory position," Lockwood said.

Similarities between breast and prostate cancer data in the U.S. are striking. Each is the most frequently diagnosed noncutaneous cancer and the second leading cause of cancer death for their gender. In 2009, new cases of each cancer were at about 194,000. One in six men is struck with prostate cancer annually; for breast cancer, it's one in eight women.

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

Sebelius Statement on New Breast Cancer Recommendations

HHS Secretary Kathleen Sebelius issued the following statement today on new breast cancer screening recommendations from the U.S. Preventive Services Task Force:

"There is no question that the U.S. Preventive Services Task Force Recommendations have caused a great deal of confusion and worry among women and their families across this country. I want to address that confusion head on. The U.S. Preventive Task Force is an outside
independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don't determine what services are covered by the federal government.

"There has been debate in this country for years about the age at which routine screening mammograms should begin, and how often they should be given. The Task Force has presented some new evidence for consideration but our policies remain unchanged. Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions
as a result of this action.

"What is clear is that there is a great need for more evidence, more research and more scientific innovation to help women prevent, detect, and fight breast cancer, the second leading cause of cancer deaths among women.

"My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years - talk to your doctor about your individual history, ask questions, and make the
decision that is right for you."

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

Lives Will Be Lost With Proposed Changes to Mammography Guidelines

/PRNewswire/ -- "The recommendation to change breast screening is a huge step backwards," says Dr. Marisa Weiss, a leading breast oncologist and founder and president of Breastcancer.org.

The proposed new guidelines call for mammograms to start at age 50 and to be done every other year instead of every year starting at age 40, as recommended by current guidelines.

"The data simply does not account for the human perspective. It would be an enormous mistake to allow outdated data using older technology provided by computer-generated analysis to dictate how health care professionals screen women for early detection of breast cancer. These are real people with their lives at stake ... for whom mammography has a proven survival benefit."

The letter to the Breastcancer.org community follows:

Dear Breastcancer.org Member:

The U.S. Preventive Services Task Force recently recommended dramatic changes to current breast cancer screening guidelines. Breastcancer.org is strongly opposed to these recommendations.

The proposed new guidelines recommend starting regular screening mammograms at age 50, rather than at age 40 as current guidelines recommend. They recommend screening before age 50 only for women with a much-higher-than-average risk of breast cancer. The proposed new guidelines also call for mammograms to be done every other year instead of every year, as recommended by current guidelines.

The proposed new guidelines are based on research that looks at the effect of breast cancer screening on society from a public health perspective. This means the researchers were looking at how changing breast cancer screening guidelines would affect the overall public, rather than individual women. In proposing the changes, the task force members said that starting mammograms later in life and doing mammograms less often would save a large amount of money. It also means that about 3% more women would die from breast cancer each year. The task force members felt that the amount of money saved (from fewer mammograms and side effects of extra biopsies and treatment) was greater than the value of more lives saved (3% fewer women surviving breast cancer).

At Breastcancer.org, we are deeply troubled by both the analysis that led to these proposed guideline changes and the effect these proposed changes would have on the health and lives of women. Our specific concerns:

-- The analysis was based on older mammography techniques, meaning the
researchers mostly looked at results from film mammograms instead of
digital mammograms.
-- The analysis was based on some inaccurate assumptions about optimal
treatment after breast cancer is diagnosed. For example, it assumed
that women diagnosed with hormone-receptor-positive, early-stage
breast cancer would receive and benefit from hormonal therapy but not
chemotherapy, even though we know that many of these women do receive
and benefit from chemotherapy after surgery. Inaccurate assumptions
like this may have caused the researchers to underestimate the number
of lives that would be lost should the proposed changes in screening
be adopted.
-- The analysis did not adequately consider the combined benefit of early
detection (with current screening guidelines) and new treatments that
have resulted in steadily improving survival rates in recent years.
Screening cannot be looked at in isolation as a snapshot. Screening
happens as we continue to improve both diagnosis and treatment. But we
can't treat what isn't diagnosed.
-- The proposed guideline changes would mean that many breast cancers
would be diagnosed at a later stage, making it harder to become
cancer-free. Later-stage diagnoses result in more women with
metastatic disease (that has spread to other parts of the body) and
more women with large or multiple cancers requiring mastectomy (too
late for breast-conserving treatments).
-- The proposed guideline changes would mean that younger women would be
diagnosed later. Breast cancer in younger women tends to be more
aggressive, so early diagnosis and treatment is more critical for
them. It is the lives and futures of younger women that would be lost
if the proposed changes are adopted.

Expressed as nameless, faceless numbers, the 3% decrease in breast cancer survival might seem like an acceptable trade-off when compared to the economic benefits of changing breast cancer screening policies. But breast cancer affects a very large number of women, so 3% of that number is not insignificant. The reality is that more women -- mothers, daughters, sisters, grandmothers, and aunts -- will die each year from breast cancer, which is neither reasonable nor acceptable.

We at Breastcancer.org encourage medical professionals and everyone affected in any way by breast cancer to raise their voices against these surprising and dramatic proposed changes in the guidelines for breast cancer screening. Our belief is that lives should be saved, not lost, and our commitment to you is that we will continue to strongly advocate for policies that support this fundamental mission.

Marisa C. Weiss, M.D.
President and Founder, Breastcancer.org
Director of Breast Radiation Oncology, Director of Breast Health Outreach
Lankenau Hospital

Maxine Jochelson, M.D.
Director of Radiology
Evelyn H. Lauder Breast Center
Memorial Sloan-Kettering Cancer Center
Professional Advisory Board, Breastcancer.org

Emily F. Conant, M.D.
Professor of Radiology, Chief of Breast Imaging
Hospital of the University of Pennsylvania
Professional Advisory Board, Breastcancer.org

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

FDA Approves Donor Screening Test for Antibodies to HIV

/PRNewswire/ -- The U.S. Food and Drug Administration today announced approval of the Abbott Prism HIV O Plus assay, as a screening tool designed to detect the presence of certain antibodies to HIV. The assay is one of five assays that run on the fully automated Abbott Prism System.

There are two types of HIV. HIV type 1 consists of various subgroups, including group M, the most common subgroup of the virus in the United States, and group O, found primarily in Cameroon and other areas of West Africa.

HIV type 2 is found mostly in West Africa. Both types have been detected in the United States and Europe.

The Abbott Prism HIV O Plus assay detects antibodies to HIV type 1, groups M and O, and HIV type 2. It is the second donor screening test licensed for the detection of antibodies to HIV type 1, group O.

The Abbott Prism HIV O Plus assay is licensed to screen donated blood and blood specimens from other living donors for these specific types of HIV and subgroups of HIV type 1. The assay is also licensed to screen specimens from organ donors when specimens are obtained while the donor's heart is still beating and from cadavers. Positive results from the screening test require confirmation from supplemental tests.

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

HIV Screening Tests Proposed to Be Added to Medicare's List of Covered Preventive Services

The Department of Health and Human Services (HHS) today announced a new proposal that would cover Human Immunodeficiency Virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service.

"The President has set clear priorities for an improved national response to ending the HIV epidemic," said HHS Secretary Kathleen Sebelius. "Today's action by HHS' Centers for Medicare & Medicaid Services (CMS) sends a strong signal that this Administration takes prevention very seriously, especially when it comes to HIV and AIDS."

"While younger age groups account for most cases of HIV infection in the United States, the Centers for Disease Control and Prevention (CDC) estimates that in 2006, approximately 19 percent of all U.S. residents with AIDS were age 50 years or older when the disease was diagnosed, " she added. "Knowing about their HIV status can help patients live longer, fuller lives as well as avoid unintentional transmission of the virus to others."

CMS' efforts mark the first time that Medicare has proposed to expand its list of covered preventive services under a new authority established by Congress. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) gave CMS the ability to consider whether
Medicare should cover "additional preventive services," if certain requirements are met.

Acquired immunodeficiency syndrome (AIDS) is diagnosed when an HIV-infected person's immune system becomes severely compromised or a person becomes ill with an HIV-related infection. Of the more than one million Americans estimated to have the HIV infection, the CDC has estimated that about a quarter of them do not realize they are infected. Without treatment, the HIV infection usually develops into AIDS within 8 to 10 years. While there is presently no cure for HIV, screening can help identify infected patients so that they can receive medical
treatment that could help delay the onset of AIDS for years.

"This proposal to cover HIV screening for our Medicare population has great potential in terms of saving lives and improving the quality of life for many seniors, as well as beneficiaries under age 65," said Acting CMS Administrator Charlene Frizzera.

The White House's top HIV/AIDS official saluted the move by HHS, calling it a critical step in helping HIV and AIDS patients to get the treatment they need.

"The President is committed to re-focusing national attention on the domestic HIV epidemic and salutes this decision as an important step in our overall strategy," said Jeffrey S. Crowley, the Director of the White House Office of National AIDS Policy. "We are working with agencies across the government to achieve the President's goals of reducing HIV incidence, getting all people living with HIV/AIDS into care and improving health outcomes, and reducing HIV-related health disparities. The actions taken by the HHS today are an important part of
our efforts."

Under MIPPA, CMS can consider whether Medicare should cover preventive services that Congress has not already deemed as covered or non-covered by law, as long as they have been "strongly recommended" or "recommended" by the U.S. Preventive Services Task Force.. For
instance, the Task Force graded HIV screening as "strongly recommended." More information about the Task Force is available online at http://www.ahrq.gov/clinic.

CMS uses the national coverage determination process to make decisions on these types of preventive services. This process provides transparency about the evidence that CMS considers when making itsdecisions and allows opportunity for the public to comment on CMS'
proposals.

"We are pleased to be able to propose an expansion to Medicare's portfolio of preventive services," said Barry M. Straube, M.D., CMS Chief Medical Officer and Director of the Agency's Office of Clinical Standards & Quality. "Before the MIPPA law, CMS had not been able to
expand preventive services without Congressional action. Now we can take more active steps to evaluate the evidence about which services are reasonable and necessary to help keep Medicare beneficiaries healthy."

CMS will accept public comments on the proposed decision through Oct. 9, 2009, and will issue a final coverage decision by Dec. 8, 2009.

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

CDC Awards $22 Million for Colorectal Cancer Screening Program

The Centers for Disease Control and Prevention (CDC) has awarded a total of $22 million to 26 states and tribal organizations to provide colorectal cancer screening services for low-income people aged 50-64 years, who are underinsured or uninsured. Colorectal cancer is the second leading cause of cancer deaths among men and women aged 50 and older in the United States.

The awards range from $358,283 to $1.1 million. The awardees are expected to begin screening patients for colorectal cancer within six months.

The states receiving five-year awards are: Alabama, Arizona, California, Colorado, Connecticut, Delaware, Florida, Iowa, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, New York, Oregon, Pennsylvania, South Dakota, Utah, and Washington. The tribal organizations receiving awards are: Alaska Native Tribal Health Consortium, Arctic Slope Native Association, South Puget Intertribal Planning Agency, and Southcentral Foundation.

The funding will support screening and diagnostic follow-up care, data collection and tracking, public education and outreach, provider education, and an evaluation to measure the clinical outcomes, costs, and effectiveness of the program. The awardees can choose from among any of the recommended screenings for colorectal cancer - colonoscopy, sigmoidoscopy and stool testing.

"Colorectal cancer kills more people than any other cancer except lung cancer," said CDC Director Thomas Frieden, M.D., M.P.H. "These colorectal cancer screening awards will save lives. We need to reach more adults aged 50 and over and others at high risk to prevent colorectal cancer."

In 2005, more than 141,000 new cases of colorectal cancer were diagnosed and 53,000 people died from this disease. The number of new colorectal cancer cases could be reduced by as much as 90 percent if all precancerous polyps (abnormal growths in the colon or rectum), were identified using screening tests and removed before they become cancerous. However, only half of all U.S. adults aged 50 or older have been screened appropriately for colorectal cancer, and while screening rates are slowly increasing, disparities still exist. Screening rates remain higher for whites compared to all other races, for non-Hispanics compared to Hispanics, and for people with health insurance compared to those with no health insurance.

"Screening tests can detect colorectal cancer at its earliest stages, when it is most treatable," said Laura Seeff, M.D., medical director of CDC's colorectal cancer screening program. "This screening program has tremendous potential to address the disparities that exist in colorectal cancer screening and to save lives."

The goals of CDC's colorectal cancer screening program are to increase population-level screening among all persons aged 50 and older in the participating states and tribes, and to reduce health disparities in colorectal cancer screening, incidence and mortality.
---
Community News You Can Use
Follow us on Twitter: @gafrontpage
www.FayetteFrontPage.com
www.GeorgiaFrontPage.com
www.PoliticalPotluck.com
www.ArtsAcrossGeorgia.com
---

Free Prostate Screening at North Fulton Regional Hospital

Tuesday, September 15 & Wednesday, September 16
5:15–7:30 p.m.

North Fulton Regional Hospital Outpatient Surgery (3000 Hospital Boulevard)
Glover Little, MD John Moseley, MD

The screening consists of a PSA blood test and a physical exam.Who should participate:
- Men age 50 or older with no prior history of prostate cancer
- Men age 40 or older with a family history of prostate cancer
- African-American men age 40 or older
- Men who have not been seen by a urologist or been tested for prostate cancer within the last 12 months
- Men who have not already been diagnosed with prostate cancer

Screenings are by appointment only, and space is limited. To schedule your FREE screening, call 770-751-2660.
www.northfultonregional.com
---
Community News You Can Use
Follow us on Twitter: @gafrontpage
www.FayetteFrontPage.com
www.GeorgiaFrontPage.com
www.PoliticalPotluck.com
www.ArtsAcrossGeorgia.com
---

The HRSA Genetics Collaboratives are Bringing Genetic and Newborn Screening Services to Local Communities Around the United States

/PRNewswire/ -- Overcoming the challenges of bringing quality and cutting edge genetic and newborn screening (NBS) services to local communities and to children and families with hereditary diseases is extremely complex. It requires coordinated, multifaceted and multidisciplinary efforts that are national, regional, and local and include public, private and not-for-profit partnerships. In order to meet these challenges, the Health Resources and Services Administration/Maternal and Child Health Bureau (HRSA/MCHB) awarded the American College of Medical Genetics (ACMG) a cooperative agreement in 2004 and later renewed it until 2012 to serve as the National Coordinating Center (NCC) for seven similarly-funded Regional Genetics Collaboratives known as the HRSA Genetics Collaboratives (http://www.nccrcg.org/).

These seven HRSA/MCHB-funded HRSA Genetics Collaboratives and their National Coordinating Center (NCC) are working to improve access to local genetic and newborn screening services, information, and resources for individuals and families with heritable disorders. A major component of the NCC/Genetics Collaboratives system involves using a variety of approaches to link primary care providers, geneticists and other specialist providers, and public health services into a comprehensive medical home that meets all the needs of individuals and families with heritable conditions. Activities at all levels engage consumers and families, with new opportunities for partnerships continually emerging.

"Hundreds of professionals including public health officials, newborn screening program staff members, primary care providers, physician geneticists, genetic counselors, consumer advocates, and families are active in the HRSA Genetics Collaboratives. The Collaboratives are bringing genetic discoveries into local communities in every state in the country and are working hard to improve local access to newborn screening and genetic services for everyone by addressing the unique needs of the community," says Judith Benkendorf, MS, CGC, a genetic counselor and Project Director of the NCC. "Each regional Genetics Collaborative has fostered a variety of approaches to building linkages between public health, genetics specialists, primary care/the Medical Home and families. Some of activities are even being replicated nationally. A benefit of the current coordinated system is that each HRSA Genetics Collaborative has access to national expertise, positioning it to be a 'go to' resource for information about genetic and newborn screening services," added pediatrician Tracy L. Trotter, MD, FAAP, Senior Partner, San Ramon Valley Primary Care.

The NCC also facilitates collaborations between the HRSA Genetics Collaboratives and national projects, using local communities to pilot materials and programs for policymakers, health professionals and families. Many national organizational partners contribute additional resources.

NCC initiatives include:
-- building national capacity in the use of telegenetics;
-- establishing a searchable national network of genetic service and
subspecialty providers experienced in the diagnosis and management of
infants with heritable disorders detected through NBS programs;
-- collecting and disseminating data that establish the value of genetic
services to payers and policymakers;
-- developing disaster preparedness strategies to ensure that NBS
programs and treatment of patients with metabolic conditions are not
interrupted in the case of an emergency;
-- developing and distributing of management guidelines and "just in
time" resources for providers caring for patients with heritable
disorders;
-- addressing the transition of patients with heritable conditions from
pediatric to adult care; and
-- developing resources for state policymakers.

National data collection efforts include tracking pilot NBS programs and establishing and maintaining a patient follow-up database useful in rare disease research. Maximizing collaboration between the genetic services, primary care, NBS and public health communities is critical to the success of each of these efforts and to the collective impact of the NCC and the Genetics Collaboratives.

The Seven Regional HRSA Genetics Collaboratives

Region 1: The New England Regional Genetics Collaborative (NEGC), with CT, MA, ME, NH, RI and VT (www.negenetics.org/)

Region 2: New York-Mid-Atlantic Consortium for Genetic and Newborn Screening Services, with DC, DE, MD, NJ, NY, PA, VA, and WV (www.wadsworth.org/newborn/nymac/)

Region 3: The Southeast NBS and Genetics Collaborative, with AL, FL, GA, LA, MI, NC, SC, TN, PR, and USVI (http://southeastgenetics.org/)

Region 4: The Region 4 Genetics Collaborative with IL, IN, KY, MI, MN, OH, WI (http://region4genetics.org/)

Region 5: The Heartland Regional Genetics and Newborn Screening Collaborative, with AR, IA, KS, MO, ND, NE, OK, and SD (www.heartlandcollaborative.org/)

Region 6: Mountain States Genetics Regional Collaborative Center, with AZ, CO, MT, NM, NV, TX, UT, and WY (www.msgrcc.org/)

Region 7: Western States Genetic Services Collaborative, with AK, CA, HI, OR, WA, and US Pacific Basin (www.westernstatesgenetics.org/)

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

Test is Accurate and Economical for Diabetes and Prediabetes Screening

A test commonly used to help identify women with diabetes during pregnancy may be an accurate, convenient and inexpensive way to screen the general population for unrecognized diabetes and prediabetes, according to Emory University researchers.

The results of the study, "Glucose challenge test screening for prediabetes and undiagnosed diabetes" will be published online and in print in the journal Diabetologia.

"Widespread use of the glucose challenge test (GCT) to screen Americans for prediabetes and diabetes could provide a major opportunity to improve the health of more than 40 million people," said lead study author Lawrence S. Phillips, MD, Emory University School of Medicine Professor of Medicine, Division of Endocrinology.

The study screened 1,573 volunteer participants who had never been diagnosed with diabetes. At a first visit, at different times of the day and without restriction of meals, participants were given a 50-gram glucose drink. Glucose was measured both before the drink (random glucose) and an hour after the drink (GCT glucose).

At a follow-up visit held in the morning after an overnight fast, participants had measurement of hemoglobin A1c (a standard test used to monitor diabetes), and a 75-gram oral glucose tolerance test (OGTT). The OGTT is the "gold standard" for diagnosing diabetes and prediabetes.

After screening, researchers found that 4.6 percent of the participants had previously unrecognized diabetes, and 18.7 percent had prediabetes.

The GCT was the most accurate screening test for these problems, significantly better than the random glucose or A1c tests. Since the good performance of the GCT was unaffected by the time of day, or times after meals, the GCT could be performed during a routine office visit. If a patient's GCT glucose level is low, he/she wouldn't need to be screened again for another two or three years, but if the GCT glucose level is high, patients would need a confirmatory oral glucose tolerance test.

This approach is similar to screening women for diabetes during pregnancy. GCT screening is almost universal for women in their sixth month of pregnancy.

The GCT provided consistent results for a diverse group of patients - old and young, normal weight and overweight, men and women, with and without a family history of diabetes, etc. The GCT also appeared to be less expensive than other screening strategies.

Early diagnosis is a benefit both for people who have diabetes or prediabetes, and for their health care teams. Regular glucose challenge test screening (GCT first, then a follow-up OGTT if the GCT glucose is high) would be a way to assure early diagnosis, according to Phillips and team.

"Glucose challenge test screening could help improve disease management by permitting early initiation of therapy aimed at preventing or delaying the development of diabetes and its complications," says Phillips.

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life.

According to the American Diabetes Association, 23.6 million U.S. children and adults, or 7.8 percent of the population, have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, 5.7 million people are unaware that they have the disease.

Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes.

In addition to Phillips, study authors were: David Koch, PhD, K.M. Venkat Narayan, MD, MSc, MBA, Mary Rhee, MD, Viola Vaccarino, MD, PhD, and David Ziemer, MD, of Emory University; Ranee Chatterjee, MD, of the Johns Hopkins University School of Medicine; and P. Kolm and W.S. Weintraub, of the Christiana Care Health System in Newark, Del.

The research was supported in part by the National Institutes of Health and the National Center for Research Resources, and by the Veterans' Administration. The work was presented in part at the June 2008 national meeting of the American Diabetes Association.

From Woodruff Health Sciences Center

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

City Leaders Launch Medicare Diabetes Screening Project in Augusta

/PRNewswire/ -- Senator Ed Tarver (D - District 22), Jeanette Cummings, Director, Central Savannah River Area Regional Development Center (CSRA RDC) Area Agency on Aging (AAA), and other city and community leaders today urged all Augusta area seniors to learn more about their personal risk for diabetes, as they launched the Medicare Diabetes Screening Project (MDSP) in Augusta before a crowd gathered at the Henry H. Brigham Senior Center on Golden Camp Road. On a national level, the MDSP is co-chaired by the American Diabetes Association, the Health Care Leadership Council, and Novo Nordisk, and is supported by more than 20 organizations representing the interests of seniors and health care providers.

"Today, I am proud to announce the start of the Medicare Diabetes Screening Project in Augusta," said Sen. Tarver. "When diabetes is undiagnosed and untreated, it can be devastating, and new government statistics show that our senior citizens are especially vulnerable."

According to a study in the February 2009 issue of Diabetes Care, 32% of adults ages 65 and older have diabetes. What's more, almost half (46%) of those seniors with diabetes don't know they have it - they have not been diagnosed. In addition to those with diabetes, another 40% of adults ages 65 and older have pre-diabetes, putting them at very high risk of developing diabetes and heart disease, and it is likely that most of them are unaware of their status. When these statistics are applied to Richmond County, it is estimated that approximately 3,400 seniors ages 65 and older have undiagnosed diabetes, and an additional 9,300 seniors ages 65 and older have pre-diabetes.

"These statistics show why it is crucial that we create awareness of the benefits that Medicare offers for diabetes screening, and motivate our seniors to ask their health care providers about being tested for diabetes," said CSRA AAA Director, Jeanette Cummings.

Since 2005, Medicare has offered benefits for diabetes screening, but usage of these benefits has been minimal. For people who are ages 65 and older and have one risk factor for diabetes, Medicare offers a free diabetes-screening test in a health care provider's office, with no deductible and no co-pay. If seniors are found to have pre-diabetes, they are eligible for another free screening in six months.

To encourage use of these benefits, the Medicare Diabetes Screening Project was conceived and launched in 2007 in Columbus, Georgia. City and community leaders in Columbus developed a model for public awareness and outreach, and that model is being adapted for implementation here in Augusta.

"Augusta elected officials and other leaders from the community immediately saw the need for the Project," said Commissioner Jerry Brigham, "and they have quickly developed ideas and networks for reaching out to seniors and their health care providers with messages of what Medicare offers for diabetes screening. This type of collaboration represents the best of Augusta."

The MDSP will reach out to Augusta-area primary care physicians and their office managers via a letter signed by diabetes specialist Dr. Charles Shaefer of University Primary Care. "To complement public awareness activities, it is important that we directly inform physicians and their staff about the MDSP and the screening benefits that Medicare offers their patients," said Dr. Shaefer.

Also planned are a series of educational seminars at local senior centers, to be coordinated and implemented by the CSRA Area Agency on Aging. And according to Rev. Robert Ramsey, Pastor of the Gospel Water Branch Baptist Church, seniors and their family members will also hear about the MDSP and Medicare diabetes screening via the faith-based community. "Communicating health information to our congregants is not only possible, it's been proven successful," said Rev. Ramsey, who recently participated in a diabetes prevention faith-based program as part of a research study funded by the National Institutes of Health (NIH).

The most currently-available estimates from the Centers for Disease Control and Prevention (CDC) show that the prevalence of diabetes is 25% higher in the state of Georgia as compared to the national average (10% versus 8%, respectively). The CDC also estimates that 10.3% of all adults ages 20 and older in Richmond County have diabetes.

The Medicare Diabetes Screening Project in Augusta is a community-based effort to reach and motivate seniors who have undiagnosed diabetes or pre-diabetes, and encourage them to see their doctors or other health care providers, and take advantage of the free diabetes screening benefits offered by Medicare. To learn more, visit www.screenfordiabetes.org.

-----
Community News You Can Use
Follow on Twitter @GAFrontPage
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
www.artsacrossgeorgia.com
Arts Across Georgia

CDC Guidelines for Screening Swine-Origin Influenza A (H1N1)

Interim Guidance for Screening for Swine-Origin Influenza A (H1N1) by State and Local Health Departments, Hospitals, and Clinicians in Regions with Few or no Reported Cases of Swine Influenza A (H1N1)

This document provides interim guidance for state and local health departments, hospitals, and clinicians in regions with few or no reported cases of swine-origin influenza A (H1N1) (S-OIV) regarding which patients to evaluate for possible infection with swine influenza A (H1N1). As of April 29 1:00 PM, there were 91 laboratory confirmed cases of S-OIV infection identified in 14 states in the United States. Human cases of S-OIV infection also have been identified internationally. Based on the rapid spread of the S-OIV thus far, public health officials believe that more cases will be identified over the next several weeks, including in regions that currently have few or no reported cases.

CDC recommends that state and local health departments, hospitals, and clinicians in regions with few or no reported cases of S-OIV consider the following recommendations for testing of the following persons for S-OIV infection with a nasopharyngeal swab by PCR:

Patients presenting to providers participating in the US Outpatient Influenza-like Illness Surveillance Network (ILINet) who meet the case definition of influenza-like illness (ILI), or
Patients with an ILI who have traveled within 7 days to a community either within the United States or internationally where there are one or more confirmed swine influenza A (H1N1) cases, or
Patients admitted to the hospital with an ILI.
ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and a cough and/or a sore throat in the absence of a KNOWN cause other than influenza.

Specimen Collection and Testing
If swine flu is suspected, clinicians should obtain a respiratory swab for S-OIV testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory. State public health laboratories should perform subtype testing on all influenza A positive samples identified. State public health laboratories should submit all specimens that cannot be subtyped as human influenza A (H1N1) or (H3N2) to CDC for identification. Please notify CDC of all pending shipments by email at eocsciresource@cdc.gov or if email is not available, by phone at 404-553-7724. Please include shipment tracking information.

Investigation of Cases
Officials should conduct thorough case and contact investigations to determine the source of the swine influenza virus, extent of community illness and the need for timely control measures.

Interim Guidance
Interim Guidance is available, including:
Case definitions to be used for swine influenza A (H1N1) cases
Antiviral recommendations for patients with confirmed or suspected S-OIV infection and close contacts
Infection control for care of persons with confirmed or suspected S-OIV infection in a healthcare setting
S-OIV biosafety guidelines for laboratory workers.

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter and Facebook

Staying One Step Ahead of Osteoporosis

/PRNewswire-USNewswire/ -- Facts about osteoporosis are staggering. 75 million baby boomers are approaching the age where the disease is tightening its grip on their bones. Osteoporosis (http://orthoinfo.aaos.org/topic.cfm?topic=A00232) also contributes to an estimated 1.5 million bone fractures in the United States annually. According to new information presented today at the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) (http://www.aaos.org/), new steps to manage bone health and increase communication, will significantly help reduce the rate of fractures and increase the quality of life for the aging population.

"Decreasing the rate of hip fractures saves lives, prevents loss of function, and decreases costs," said Tad Funahashi, MD, regional chief of orthopedic surgery and assistant area medical director for Kaiser Permanente Southern California, and clinical professor of orthopaedic surgery at the University of California Irvine's College of Medicine. "If we screen for osteoporosis at the earliest onset of the disease," said Dr. Funahashi, "we can implement treatment and help to decrease the rate of hip fractures by 45 percent." Hip Fractures and Osteoporosis Study 474 (http://www3.aaos.org/education/anmeet/anmt2009/podium/podium.cfm?Pevent=474)

Osteoporosis is also a huge problem in other parts of the world. In another study, Leonid Kandel, MD, an orthopaedic surgeon at Hadassah-Hebrew University Medical Center in Jerusalem, Israel, looked at improving the diagnosis rate of osteoporosis in post menopausal women, who fracture the distal radius bone, which is located in the lower arm, near the wrist. Dr. Kandel says these fractures are often the first clinical symptom of osteoporosis, yet only 15 to 25 percent of these women are referred for a bone density test by a family physician after the fracture.

"It is important that patients understand the connection between their current problem, the fracture, and the possibility that the underlying cause is osteoporosis." Dr. Kandel also suggests that there should be a stronger connection and better communication between the hospital and the community. He feels this will increase the number of patients who are diagnosed and treated for the disease. Osteoporosis in Women after Distal Radius Fracture Study 475 (http://www3.aaos.org/education/anmeet/anmt2009/podium/podium.cfm?Pevent=475)

Francesco Pegreffi, MD, an orthopaedic surgeon in the Department of Shoulder and Elbow Surgery at Cervesi Hospital, Cattolica, Italy, along with Lorena Belletti, MD, and Professor Maria Teresa Mascia, in the Department of Rheumatology, University of Modena, Italy, studied a group of patients, 80 percent women and 20 percent men, who were affected by rheumatoid arthritis and under Vitamin D supplementation. "We wanted to analyze the correlation between a person's age, sex, how long they had rheumatoid arthritis, whether they were taking Vitamin D supplements and whether they had fragility fractures due to osteoporosis," said Dr. Pegreffi.

"We found that women affected by rheumatoid arthritis for more than three years were osteoporotic and had a fracture risk significantly higher than those without the disease. Also, Vitamin D therapy is not enough to prevent further bone loss and fragility fractures in these patients." Men in the study faired much better. Those with rheumatoid arthritis did not have a significant risk of fracture. Risk Factors in Osteoporotic Patients Study 477 (http://www3.aaos.org/education/anmeet/anmt2009/podium/podium.cfm?Pevent=477)

Fractures, especially in adults, maybe a tip off or early warning sign, that osteoporosis could be an issue. Many of these are painful fractures of the hip, spine, wrist, arm and leg, which often occur as a result of a fall or even a simple household task. One in two women and one in five men older than 65 years old, will sustain bone fractures caused by osteoporosis.

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

Heart Association Call for Routine Screening of Heart Patients for Depresssion is Premature, Johns Hopkins Expert Says

A Johns Hopkins cardiologist well known for his studies on the links between depression and heart attack says there is not nearly enough evidence yet to support a recent call by the American Heart Association (AHA) to begin routine screening of millions of Americans for depression.

Roy Ziegelstein, M.D., says the September 2008 recommendation is "premature," and "a massive undertaking" that would consume a vast amount of clinic staff time and effort to analyze and follow-up on the questionnaires involved in screening, without a demonstrated benefit in improving patient care.

An estimated 80 million Americans have some form of heart disease.

Reporting on a collection of more than 1,500 clinical studies from around the world, from which 17 were selected for detailed review, Ziegelstein and his colleagues point to the absence of any scientific proof that depressed heart patients live longer or fare better over the long term if they are screened for depression and treated with drugs and other therapy.

The team's report, believed to be the largest, most comprehensive review of all research in the field, is set to appear in the Nov. 12 edition of the Journal of the American Medical Association. Its publication is timed to coincide with the AHA's annual Scientific Sessions in New Orleans.

"Our analysis showed that depression screening tools worked reasonably well in identifying who is depressed and who is not, based on such symptoms as feeling blue or suddenly withdrawing from routine activities," says Ziegelstein, a professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute.

Yet he points out that that about one in five people with depression would not be picked up by screening and fewer than half of those identified as depressed by the screening process will actually be depressed when evaluated more thoroughly.

The team also found that treating depression in people with heart disease only accounted for a 1 percent to 4 percent change in symptoms compared to those treated with placebo. Ziegelstein says this is "too low to expect meaningful benefits for many people, particularly since screening methods are not very precise in identifying people who would benefit from the treatment."

In addition, he says, before routine screening, physicians need to consider the potential for harm to people, as no studies have fully analyzed any negative impact from treatment side effects, or misdiagnosis and labeling of heart patients as depressed.

"Understandably, then, we cannot in good conscience support screening all heart patients," says Ziegelstein, vice chairman of medicine at Johns Hopkins Bayview Medical Center.

"This is a difficult call for us to make, but it is in the best interests of patients at this time," he adds.

The AHA estimates that one in four heart attack patients experiences feelings of sadness and develops a gloomy outlook as a result of the injury. Such depression more than doubles the risk of death, according to some studies.

But rather than massive, costly screening at this point, Ziegelstein says physicians need to "get to know their patients better, as real people," and to make clinical assessments of each patient's mood for signs of depression as they talk to them about other things related to their health, including exercise routines, dietary habits, and use of medications.

"Physicians can start by listening more to their patients during examinations and by not interrupting them, which research shows often happens within the first 20 seconds after patients initiate conversation," he says.

Making a diagnosis of depression is not difficult, he adds, "if they use their examination time well and ask the right questions," not focusing only on the physical issues but also on the patient's overall state of well-being and daily routine.

"Look and listen for signs of low mood or sadness, or find out if a patient has recently stopped or cut back on social contacts or things they used to do for fun," says Ziegelstein.

As part of the research review, an international team of researchers sorted over 1,500 clinical studies of depression to identify studies that looked at screening heart patients for depression, treating and monitoring them. From these, the team, led by Johns Hopkins-trained psychologist Brett Thombs, Ph.D., now an assistant professor at McGill University in Montreal, grouped together the data from 11 studies that used proven depression screening tests.

Selected screening studies covered more than 4,000 men and women, and most involved one of four commonly used questionnaires to diagnose depression. Results showed that these tests were on average 80 percent accurate in detecting people who were actually depressed.

Another half-dozen clinical trials were evaluated for the immediate health effects of drug treatment and counseling among nearly 3,000 men and women who had been screened and found to be depressed. Drug treatment mostly involved prescribing mood-raising selective serotonin reuptake inhibitors.

Researchers could not find a single study that screened heart patients for depression and then demonstrated lasting improvements to health or even a longer lifespan.

"We don't have any evidence that screening for depression will benefit people with heart disease. What we really need is more research on how best to help them adopt healthy behaviors that combat depression, such as how to stop smoking, exercise regularly and maintain a healthy weight," says Thombs.

Ziegelstein says the team's collective research will contribute to a better understanding of how depression influences heart disease. He also says it will increase physician support to broaden clinical care of depressed heart patients to include increased input from psychologists, psychiatrists and internists, as part of what he calls a more "collaborative care model" that encompasses as much care of the mind and overall body as it does the physical heart.

Funding support for Ziegelstein's research was provided by the National Center for Complementary & Alternative Medicine, a member of the National Institutes of Health, and by the Miller Family Scholar Program.

In addition to Ziegelstein and Thombs, other researchers who contributed to this study were Cheri Smith, M.L.S., and Karl Soderlund, B.S., at Johns Hopkins. International co-investigators were Peter de Jonge, Ph.D., at the University Medical Center Groningen, Netherlands; James Coyne, Ph.D., at the University of Pennsylvania School of Medicine, in Philadelphia; Mary Whooley, M.D., at the University of California, San Francisco; Nancy Frasure-Smith, Ph.D., also at McGill; Alex Mitchell, M.Sc., M.R.C. Psych, at the Leicester Royal Infirmary, United Kingdom; Marij Zuidersma, M.Sc., also at Groningen; Chete Eze-Nliam, M.D., M.P.H., at Interfaith Medical Center in Brooklyn, N.Y.; and Bruno Lima, at Federal University of Ceara School of Medicine, in Fontalez-ce, Brazil.

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

New Study Shows Colorectal Cancer Screening Rates Increasing Among U.S. Adults - Disparities in screening still persist in certain populations

The percentage of U.S. adults aged 50 years and older getting screened
for colorectal cancer is increasing according to a study released by the
Centers for Disease Control and Prevention's (CDC) Morbidity and
Mortality Weekly Report. The study uses state-level Behavioral Risk
Factor Surveillance Survey (BRFSS) data that have been combined to
estimate that 60.8 percent of adults were current with colorectal cancer
screening recommendations in 2006, compared with 53.9 percent in 2002.

"While we are encouraged to see an increase in colorectal cancer
screening rates, certain groups are still not getting screened as
recommended," said Djenaba A. Joseph, M.D., the report's lead author
and medical officer, Division of Cancer Prevention and Control. "We
need to ensure that all adults have access to these life-saving tests
because there is strong scientific evidence that screening can prevent
colorectal cancer deaths."

Screening prevalence was lower among all racial and ethnic minorities
studied compared to whites. The study also reports that screening rates
continue to be lower among those without health insurance, with low
income, and with less than a high school education.

Colorectal cancer is the nation's second leading cause of cancer deaths.
In 2004, almost 145,000 people in the United States were diagnosed with
colon cancer and more than 53,000 died from the disease.

Regular screening is recommended for men and women beginning at age 50,
using one or a combination of these screening tests:

* Home Fecal occult blood test (FOBT) - a test that checks for
hidden blood in the stool.
* Colonoscopy - an examination of the rectum and entire colon
using a colonscope (a lighted instrument).
* Flexible sigmoidoscopy - an examination of the rectum and lower
colon using a sigmoidoscope (a lighted instrument).
* Double contrast barium enema - a series of x-rays of the entire
colon and rectum.

Screening tests for colorectal cancer can find precancerous polyps
(abnormal growths) in the colon and rectum before they turn into cancer.
Screening also helps find this cancer at an early stage when treatment
can be most effective.

To estimate the current rates of colorectal cancer screening and to
measure changes in use of screening, CDC scientists compared data from
the 2002, 2004, and 2006 BRFSS telephone surveys. For this report,
sigmoidoscopy and/or colonoscopy are described as lower endoscopy.

Significant findings from this study show:

* The percentage of adults aged 50 years and older who reported
having had a home FOBT within one year and/or lower endoscopy within 10
years before the survey increased from 54 percent in 2002, 57 percent in
2004, and to 60 percent in 2006.

* The percentage of adults who reported having had a home FOBT
within one year before the survey declined from 22 percent in 2002, 19
percent to 2004, and to 16 percent in 2006.

* The percentage of adults who reported having had lower endoscopy
within 10 years before the survey increased from 45 percent in 2002, to
50 percent in 2004, and to 56 percent in 2006.

* The percentage of adults who reported never being screened for
colorectal cancer decreased from 34 percent in 2004, 32 percent in 2004,
and to 30 percent in 2006.

* In 2006, the percentage of adults who reported having had a home
FOBT and/or lower endoscopy within 10 years before the survey ranged
from 52 percent in Mississippi to 71 percent in Connecticut.

To address the disparities in screening, in 2005, CDC established
colorectal cancer screening demonstration programs at five sites in the
United States for persons with low income and inadequate or no
colorectal cancer screening insurance coverage. Additional information
about these programs is available at
http://www.cdc.gov/cancer/colorectal/what_cdc_is_doing/demonstration/.

CDC's Screen for Life: National Colorectal Cancer Action Campaign is
aimed at informing men and women aged 50 years or older about the
importance of having regular colorectal cancer screening tests.
Information about Screen for Life can be found at
http://www.cdc.gov/cancer/colorectal/sfl/.

Speak with your doctor or health care professional about getting
screened for colorectal cancer, using one or more of the recommended
screening tests.