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Adult Vaccines: Most Doctors Don’t Stock All Of Them

Less than one in three primary care practices offer all 10 recommended adult vaccines, citing a variety of financial and logistical reasons.

Researchers sponsored by the Centers for Disease Control and Prevention sampled 993 family physicians and 997 general internists. Of the respondents, 27 percent (31 percent of family practitioners and 20 percent of internists) stocked all 10. Results appear in the Feb. 17 issue of the journal Vaccine.

The 10 vaccines were hepatitis A; hepatitis B; human papillomavirus vaccine (HPV); combined measles, mumps, and rubella (MMR); meningococcal conjugate vaccine (MCV4); pneumococcal polysaccharide (PPSV23); tetanus diphtheria (Td); combined tetanus, diphtheria, and pertussis (Tdap); varicella; and zoster.

Of the responding practices, two percent plan to stop vaccine purchases, 12 percent plan to increase them and the rest had no plans to change their vaccination stocking habits. But physicians who identified themselves as their respective practices’ decision makers for stocking vaccines were more likely to decrease the number of different vaccines stocked for adults (11 percent vs. three percent; P=.0001).

The National Vaccine Advisory Committee, a group that advises the various federal agencies involved in vaccines and immunizations, arrived at even bleaker figures in 2009, reported the April 2009 issue of ACP Internist. For example, 62 percent of decision makers in practices said they had delayed purchase of a vaccine at some time in the prior three years due to financial concerns. And in the prior year, 16 percent of practice decision makers had seriously considered stopping vaccinations for privately-insured patients due to the cost and reimbursement issues. Read more »

*This blog post was originally published at ACP Internist*

Fungus: An Unwanted Yoga Partner

Yoga is good for your mind and body, including your skin. Yoga mats, on the other hand, might not be. Using someone else’s yoga mat for an hour could lead to an infection.

Fungal infections are common and appear as athlete’s foot, toenail fungus, and ringworm. Unfortunately, the fungus can survive on surfaces like mats long after the infected person has left. Although most people blame the gym locker room when they develop athlete’s foot, you can catch the fungus from a variety of places anytime you walk barefoot.

Fortunately, even if the fungus comes into contact with your skin, it doesn’t always lead to infection. Dry, cracked skin, or soft, wet skin disrupt your primary defense against the fungus — the densely packed barrier of skin cells, oils and proteins on your healthy skin’s surface. Here are five ways to prevent taking a fungus home with you from your next yoga class:

1. Bring your own mat. At least you know what you have.

2. Use an alcohol sanitizer on your hands and feet after your class. Sanitizers with at least 60 percent alcohol are excellent at drying up the fungus and killing it long before it has a chance to infect you. Read more »

*This blog post was originally published at The Dermatology Blog*

Cardiologists As “Heart Whisperers”

From the Dallas Morning News, a creative moniker if there ever was one, but it should probably be reserved for primary care specialists instead:

DALLAS — Heart attacks are the No. 1 cause of death and a major cause of disability in America. For nearly half of the casualties, the first symptom is the last. That’s how cardiovascular disease has earned the nickname “silent killer” — you never know when it will strike.

Doctors are trying to change that by treating heart disease as a progressive problem. They are becoming “heart whisperers,” seeking new tests to read the small stresses that can, unchecked, grow into big ones.

“By the time someone rolls in with a heart attack, his family will look at me bewildered, and the patient may say, ‘Doc, what happened?'” says Dr. Bruce Gordon of Heart Hospital Baylor Plano. “But it’s not what happened. It’s what’s been happening. The process has been going on for decades.”

It’s a process that can be accelerated by high cholesterol, high blood pressure, obesity, diabetes, tobacco use and secondhand smoke.

-WesMusings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*

The Forecast For Heart Disease: Gloomy With A Chance Of “Boomers”

As a youngster, I loved being part of the baby boom — it meant there were dozens of kids on my block who were ready to play hide-and-seek or join mysterious clubs. Now that I’m of an AARP age, there’s one club I don’t want to join: The one whose members have bypass scars, pacemakers, or other trappings of cardiovascular disease. The American Heart Association’s (AHA) gloomy new forecast on cardiovascular disease tells me it won’t be easy to avoid.

The AHA foresees sizeable increases in all forms of cardiovascular disease (see table) between now and 2030, the year all of the boomers are age 65 and older. Those increases will translate into an additional 27 million people with high blood pressure, eight million with coronary heart disease, four million with stroke, and three million with heart failure. That will push the number of adult Americans with some form of heart disease to 110 million.

AHA cardiovascular disease forecast

(Percentages refer to the percentage of Americans aged 18 years and older.)

If the AHA’s projections are accurate, the cost of treating cardiovascular disease would balloon from $272 billion today to $818 billion in 2030. Add in the cost of lost productivity, and it jumps to more than $1 trillion. Yikes!

Although obesity and inactivity are part of the problem, much of the increase comes from the graying of the baby boom. We can’t stop boomers from aging, but we can fight cardiovascular disease, a condition the AHA calls “largely preventable.” Read more »

*This blog post was originally published at Harvard Health Blog*

A New Twist On Food Allergies In Kids

The current New Yorker unfolds an engaging story on childhood food allergies. As related by Dr. Jerome Groopman, there’s a shift in how some doctors think about how these conditions  are best managed and, even better — might be prevented. The article feeds into recent discussion that medical science, and even dogma, too-often turns out to be incorrect.

Groopman interviews Dr. Hugh Sampson, director of the Jae Food Allergy Institute at Mount Sinai Medical Center in New York:

…“This increase in the incidence of food allergy is real,” Sampson said when we spoke recently. He cannot say what is causing the increase, but he now thinks the conventional approach to preventing food allergies is misconceived. For most of his career, he believed, like most allergists, that children are far less likely to become allergic to problematic foods if they are not exposed to them as infants. But now Sampson and other specialists believe that early exposure may actually help prevent food allergies.”

I recommend the full read if you can get it: Groopman probes potential causes of discordant food allergy rates in children of different geographic regions. I learned a number of details on how some doctors in the U.S. use protein-breakdown methods to desensitize children to food allergies, how in Israel newly-speaking infants are said to ask eagerly for Bamba, a manufactured, peanut-containing snack (which, for the record, I don’t particularly endorse), and how in some cultures parents chew their young children’s food in a manner that might that might facilitate breakdown of complex proteins by enzymes in saliva.

All interesting. Of course it’s hard to know exactly what’s true in this, and the causes of allergies are likely to vary among children. There’s a randomized LEAP study (Learning Early About Peanut Allergy) in the U.K. that may provide some hard evidence on this, one way or another.

*This blog post was originally published at Medical Lessons*

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