News in brief - May 22/29, 2006

National pandemic plan revealed - Only healthy beverages in the nation's schools - Diabetes control improves overall but is not a goal for many patients - Heart attack risk from Cox-2 inhibitors may be highest in first two weeks of use

National pandemic plan revealed

Effective surveillance and a prompt response to an outbreak of influenza will be crucial to protect the nation's health, noted a new national strategy that was unveiled by President Bush May 3 for handling a pandemic.

Flu virus spreads quickly, infecting patients one to 1½ days after exposure. At about two days, most infected people will develop symptoms. Tracking the course of a pandemic should be performed in real time to permit the most advantageous distribution of resources to the health care system, according to the report.

The federal government has set two primary vaccine goals: to establish and maintain stockpiles of pre-pandemic vaccine adequate to immunize 20 million people and to expand the nation's capacity to produce enough vaccine for the entire population within six months.

The federal government also plans to stockpile enough antiviral medication to treat 75 million people and to have 6 million additional doses reserved for containment efforts.

The guidelines include a reminder that during a prolonged mass casualty event, people with unrelated medical conditions will continue to require care. Plus, consumable and durable medical resources may be in short supply, necessitating advance planning to ensure sufficient equipment. An adequate response to a pandemic must be community-based and coordinated at the regional level.

Only healthy beverages in the nation's schools

New guidelines that will allow only low-calorie and nutritious beverages to be sold in most of the nation's schools are expected to go into effect by the beginning of the 2008-09 school year. Only beverages that contain fewer than 100 calories per container, except for milks and juices with nutritional value that warrants the higher caloric content, would be available in the lower grades. High school students would have a broader choice of beverages, including diet sodas and sports drinks.

The healthier beverages are expected to be in 75% of schools within two years and in the rest of the schools by the 2009-10 school year. The guidelines would affect nearly 35 million students.

The nation's schools and school districts must also express a willingness to amend existing contracts with beverage manufacturers before the new menu choices would go into effect.

The guidelines were developed by soft-drink manufacturers and the Alliance for a Healthier Generation, which is a collaborative effort of the William J. Clinton Foundation, a charitable group founded by the former president, and the American Heart Assn. The agreement is the first to be reached with industry under the Alliance's Healthy Schools Program.

The AMA has also adopted policies aimed at combating childhood obesity that include the availability of healthier foods in schools.

Diabetes control improves overall but is not a goal for many patients

The average hemoglobin A1c score declined for those with diabetes, but many patients still have not reached the targets set by the American Diabetes Assn., according to a report issued by Quest Diagnostics last month.

The "Quest Diagnostics Health Trends 2006 Diabetes Report" analyzed the results of 14.3 million tests performed between 2001 and 2005. The monthly average A1c declined by 8%. There was also a 26% reduction in the number of tests that did not meet ADA goals. Men were more likely to have worse scores than women. Older patients tended to have better blood sugar control than those who were younger.

The authors suggest that these findings mean that those with diabetes who see a physician or other health care professional regularly may be achieving better glycemic control.

Experts praised the report for helping create a clearer picture of how the country is controlling this disease as a whole.

"These results are a great contribution to our understanding of the state of diabetes care and outcomes in the United States," said ADA past president Francine R. Kaufman, MD.

Heart attack risk from Cox-2 inhibitors may be highest in first two weeks of use

The risk of a myocardial infarction while taking rofecoxib is at its greatest during the first two weeks of taking it, does not increase with continuing use, and returns to normal within one month of discontinuing it, according to a paper published in the Canadian Medical Assn. Journal this month.

Researchers analyzed data from Quebec's computerized health databases regarding those older than age 65 without a previous heart attack who took either rofecoxib or celecoxib. A quarter who had a heart attack while on rofecoxib did so within the first two weeks. The heart attack risk from celecoxib in this time frame was not statistically significant.

"The period of highest susceptibility for most people taking [rofecoxib] may occur earlier than previously believed," said Linda Levesque, lead author and a doctoral student in epidemiology and biostatistics at McGill University in Montreal.

Rofecoxib (Vioxx) was voluntarily withdrawn in September 2004. Celecoxib (Celebrex) remains on the market, albeit with stronger warnings on the label.