News in brief - July 10, 2006

AMA continues efforts to improve medical response to disasters - AMA opposes buprenorphine limits - MRSA has gone global - Teen risky behaviors up and down

AMA continues efforts to improve medical response to disasters

The American Medical Association will produce a manual on state licensure and medical liability coverage for physicians providing care in the aftermath of a disaster. The AMA also will work with relief organizations to improve plans and protocols for supplying health care in mass evacuation shelters. To address needs of physicians who also might be victimized by these events, the Association will develop planning tools to make it easier for doctors to recover records and resume their practices, according to policy adopted at the AMA Annual Meeting in Chicago last month.

These actions are being taken to enhance the ability of physicians to cope with catastrophes such as Hurricane Katrina that devastated the Gulf Coast in August 2005.

"Hurricane Katrina was a painful lesson in the importance of disaster preparedness and response," said AMA Trustee J. James Rohack, MD. "The new AMA policy will take the necessary steps to secure a solid disaster response plan and prepare Americans for the unexpected."

AMA opposes buprenorphine limits

Restrictions on the number of opioid-dependent patients one physician may treat with buprenorphine should be lifted, stated policy adopted at the American Medical Association Annual Meeting in Chicago last month.

The drug buprenorphine was approved by the Food and Drug Administration in October 2002, but practices were limited to treating 30 patients on this drug at any one time. According to surveys by the Substance Abuse and Mental Health Services Administration, this rule has been one of the major impediments to using the treatment more widely. The practice limitation was scrapped last August, and legislation is now in the U.S. Senate that would eliminate this restriction for individual physicians.

"There's an enormous population out there that cannot obtain treatment," said Stuart Gitlow, MD, MPH, the delegate from the American Society of Addiction Medicine.

"I find it rather amazing that doctors can prescribe thousands of patients simultaneously something like OxyContin, but, then I try to treat those patients with something like buprenorphine, I can only treat 30 of them."

MRSA has gone global

Methicillin-resistant Staphylococcus aureus is the most commonly identified antibiotic-resistant pathogen in many parts of the world, including Europe, north Africa, the Middle East and east Asia, according to the authors of a review published online June 21 in The Lancet.

MRSA rates have been increasing worldwide for the past decades, the authors say. Even in the Scandinavian countries and the Netherlands, where rates had been fairly low and stable for many years, the frequency is beginning to rise.

Of the expected two billion individuals carrying S. aureus worldwide, conservative estimates based on either Dutch or U.S. prevalence figures indicate that between two million and 52 million carry MRSA, they said.

The authors also warn of community-acquired MRSA. Genetic changes in strains of community acquired MRSA had led to the evolution of "fitter" strains that combine antimicrobial resistance with transmissibility and virulence. If these strains are sufficiently fit to maintain a high prevalence in the community, the MRSA situation in hospitals could become potentially explosive, they warn.

"The onus is therefore on health-care authorities to develop not only surveillance systems that are able to monitor the clonal dynamics of MRSA over wide geographical areas but also to provide the resources for early recognition of MRSA carriers through rapid screening," they conclude.

Teen risky behaviors up and down

High school students are drinking, smoking and having sex less frequently than they were 15 years ago, according to a survey by the Centers for Disease Control and Prevention. Fewer are also carrying weapons.

In this latest study, 43% of the 14,000 high school students surveyed said they were using alcohol, compared with 51% in the 1991 survey.

But there were some upward trends. Marijuana and cocaine use had increased compared with 1991.

There were racial and ethnic differences, with black students more likely to have engaged in sexual activity and white students admitting frequent cigarette use and episodic heavy drinking. Hispanic students reported more frequent suicide attempts and more use of some drugs such as cocaine, heroin and methamphetamines.

The 2005 National Youth Risk Behavior Survey also found that safety belt use has improved, with only 10% of those surveyed reporting that they never buckled up.

In 2003, 18% said they never used a seat belt, and in 1991 26% went beltless.

Black students also were the most likely to report such sedentary behaviors as watching television for three or more hours per day.

National, state and local student surveys are conducted every two years and monitor health risk behaviors that lead to unintentional injuries and violence.