American Red Cross and American Heart Association Jointly Announce Revised First Aid Guidelin

From the October 18 news announcement

WASHINGTON, Monday, October 18, 2010 — The American Red Cross and American Heart Association today announced changes to guidelines for administering first aid. Among the revisions are updated recommendations for the treatment of snake bites, anaphylaxis (shock), jellyfish stings and severe bleeding. The First Aid Guidelines are being published in Circulation: Journal of the American Heart Association.

Volunteer experts from more than 30 national and international organizations joined the Red Cross and the American Heart Association in reviewing 38 separate first aid questions. Experts analyzed the science behind them and worked to reach consensus on the treatment recommendations. Last revised in 2005, these recommendations form the recognized scientific basis for most first aid training around the world.

“It is vital that the first aid community come to consensus and speak in a clear voice on these life and death issues,” said David Markenson, M.D. first aid science advisor to the American Red Cross. “We are proud to help set the standard for first aid training around the globe.”

“Prompt and effective first aid can save lives and prevent many medical situations from worsening, so it’s important that everyone learn about the changes the American Heart Association and American Red Cross have made to the first aid guidelines,” said Jeff Ferguson, M.D., American Heart Association volunteer co-chair of the first aid guidelines writing group.

In looking at the treatment of jellyfish stings, the revised guidelines reaffirm the recommendation to use vinegar to treat the sting. The vinegar neutralizes the venom and may prevent it from spreading. After the vinegar deactivates the venom, immersing the area in hot water for about 20 minutes is effective for reducing pain. The treatment for snake bites has been amended slightly to recommend applying a pressure immobilization bandage to any venomous snake bite, with pressure being applied around the entire length of the bitten extremity.

Under the revised guidelines for treating anaphylaxis, if symptoms persist after a few minutes of giving the patient an epinephrine injection from a prescribed auto-injector and medical help is delayed, the first aid provider can give a second epinephrine injection from a prescribed auto-injector. The guidelines also recommend that the general public not routinely use hemostatic agents (substances used to help stop bleeding) to control bleeding because of significant variability in effectiveness and the potential for adverse effects. Tourniquets and hemostatic agents should be considered alternatives for professional rescuers when direct pressure is not possible or fails to control bleeding.

The expert panel also reaffirmed some key first aid recommendations, including use of aspirin when helping someone experiencing persistent chest pain or discomfort associated with a cardiac emergency. Bystanders should call 9-1-1 and activate the emergency medical services (EMS) system for anyone with chest discomfort. While waiting for EMS personnel to arrive, the person being treated may be advised to chew two low dose baby aspirin or one adult (non-enteric-coated) aspirin, if they are not allergic to aspirin or have had a stroke or recent bleeding.

About the American Heart Association:
The American Heart Association is the nation’s oldest and largest voluntary health organization dedicated to fighting heart disease and stroke. Our mission is to build healthier lives by preventing, treating and defeating these diseases – America’s No. 1 and No. 3 killers. We fund cutting-edge research, conduct lifesaving public and professional educational programs, and advocate to protect public health. To learn more or join us in helping all Americans, call 1-800-AHA-USA1 or visit americanheart.org.

About the American Red Cross:
The American Red Cross shelters, feeds and provides emotional support to victims of disasters; supplies nearly half of the nation’s blood; teaches lifesaving skills; provides international humanitarian aid; and supports military members and their families. The Red Cross is a charitable organization — not a government agency — and depends on volunteers and the generosity of the American public to perform its mission. For more information, please visit www.redcross.org or join our blog athttp://blog.redcross.org.

International variation in the usage of medicines

A review of the literature

From a Rand Corporation item by Ellen Nolte, Jennifer Newbould, Annalijn Conklin

The report reviews the published and grey literature on international variation in the use of medicines in six areas (osteoporosis, atypical anti-psychotics, dementia, rheumatoid arthritis, cardiovascular disease/lipid-regulating drugs (statins), and hepatitis C).

We identify three broad groups of determinants of international variation in medicines use:

(1) Macro- or system level factors: Differences in reimbursement policies, and the role of health technology assessment, were highlighted as a likely driving force of international variation in almost all areas of medicines use reviewed. A related aspect is patient co-payment, which is likely to play an important role in the United States in particular. The extent to which cost-sharing policies impact on overall use of medicines in international comparison remains unclear.

(2) Service organisation and delivery: Differences in access to specialists are a likely driver of international variation in areas such as atypical anti-psychotics, dementia, and rheumatic arthritis, with for example access to and availability of relevant specialists identified as acting as a crucial bottleneck for accessing treatment for dementia and rheumatoid arthritis.

(3) Clinical practice: Studies highlighted the role of variation in the use and ascertainment methods for mental disorders; differences in the use of clinical or practice guidelines; differences in prescribing patterns; and reluctance among clinicians in some countries to take up newer medicines.

Each of these factors is likely to play a role in explaining international variation in medicines use, but their relative importance will vary depending on the disease area in question and the system context.

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Legalizing Marijuana in California Will Not Dramatically Reduce Mexican Drug Trafficking Revenues

[Editor Flahiff’s note: This item was included partly  because the attending violence with drug trafficking is a public health issue.
While the conclusions in this document may be controversial, it has been added  because it seriously addresses many often cited facts and claims]

From the Rand Corporation summary [Oct 12, 2010]

Legalizing marijuana in California will not dramatically reduce the drug revenues collected by Mexican drug trafficking organizations from sales to the United States, according to a new RAND Corporation study.

The only scenario where legalization in California could substantially reduce the revenue of the drug trafficking organizations is if high-potency, California-produced marijuana is smuggled to other U.S. states at prices that are lower than those of current Mexican supplies, according to the study from the RAND Drug Policy Research Center. RAND is a nonprofit research organization.

The study calculates that Mexican drug trafficking organizations generate only $1 billion to $2 billion annually from exporting marijuana to the United States and selling it to wholesalers, far below existing estimates by the government and other groups.

The RAND study also finds that the often-cited claim that marijuana accounts for 60 percent of gross drug export revenues of Mexican drug trafficking organizations is not credible. RAND’s exploratory analysis on this point suggests that 15 percent to 26 percent is a more credible range. Given that California accounts for about 14 percent of the nation’s marijuana use, this suggests that if marijuana legalization in California only influences the California market, it would have a small effect on drug trafficking organizations — cutting total drug export revenues by perhaps 2 to 4 percent.

However, the impact of legalization on Mexican drug trafficking organizations’ bottom line could be magnified if marijuana cultivated in California is smuggled into other states, according to the study. After legalization, if low-cost, high-quality marijuana produced in California dominates the U.S. marijuana market, then the Mexican drug trafficking organizations’ revenue from exporting marijuana could decline by more than 65 percent and probably closer to 85 percent. In this scenario, results from the RAND study suggest the drug trafficking organizations would lose roughly 20 percent of their total drug export revenues……..

 

 

 

 

 

 

NOAA and FDA announce chemical test for dispersant in Gulf seafood

All Samples Test Within Safety Threshold

From an October 29, 2010 US Food and Drug Administration news release

Building upon the extensive testing and protocols already in use by federal, state and local officials for the fishing waters of the Gulf, NOAA [US National Oceanic and Atmospheric Administration] and FDA have developed and are using a chemical test to detect dispersants used in the Deepwater Horizon-BP oil spill in fish, oysters, crab and shrimp. Trace amounts of the chemicals used in dispersants are common, and levels for safety have been previously set.

Experts trained in a rigorous sensory analysis process have been testing Gulf seafood for the presence of contaminants, and every seafood sample from reopened waters has passed sensory testing for contamination with oil and dispersant. Nonetheless, to ensure consumers have total confidence in the safety of seafood being harvested from the Gulf, NOAA and FDA have added this second test for dispersant when considering reopening Gulf waters to fishing.

Using this new, second test, in the Gulf scientists have tested 1,735 tissue samples including more than half of those collected to reopen Gulf of Mexico federal waters. Only a few showed trace amounts of dispersants residue (13 of the 1,735) and they were well below the safety threshold of 100 parts per million for finfish and 500 parts per million for shrimp, crabs and oysters. As such, they do not pose a threat to human health.

The new test detects dioctyl sodium sulfosuccinate, known as DOSS, a major component of the dispersants used in the Gulf. DOSS is also approved by FDA for use in various household products and over-the-counter medication at very low levels. The best scientific data to date indicates that DOSS does not build up in fish tissues.

“The rigorous testing we have done from the very beginning gives us confidence in the safety of seafood being brought to market from the Gulf,” said Jane Lubchenco, Ph.D., Under Secretary for Commerce and NOAA Administrator. “This test adds another layer of information, reinforcing our findings to date that seafood from the Gulf remains safe.”

“This new test should help strengthen consumer confidence in Gulf seafood,” said Margaret A. Hamburg, M.D., Commissioner of the Food and Drug Administration. “The overwhelming majority of the seafood tested shows no detectable residue, and not one of the samples shows a residue level that would be harmful for humans. There is no question Gulf seafood coming to market is safe from oil or dispersant residue.”

The 1,735 samples tested so far were collected from June to September and cover a wide area of the Gulf. The samples come from open areas in state and federal waters, and from fishermen who brought fish to the docks at the request of federal seafood analysts. The samples come from a range of species, including grouper, tuna, wahoo, swordfish, gray snapper, butterfish, red drum, croaker, and shrimp, crabs and oysters.

Previous research provided information about how finfish metabolize DOSS, and at FDA’s Dauphin Island, Alabama lab, scientists undertook further exposure experiments on fish, oysters and crab; similar experiments on shrimp were held at NOAA’s Galveston, Texas lab. These exposure studies further support that fish, crustaceans and shellfish quickly clear dispersant from their tissues, and provided samples with known concentrations for use as standards for validating the methodology. Samples undergoing chemical analysis are always accompanied by standards with known concentrations of DOSS, to verify the equipment continues to measure the compound accurately.

Nearly 9,444 square miles, or about 4 percent of the federal waters in the Gulf are still closed to commercial and recreational fishing.

For more information:

• Gulf of Mexico Oil Spill Update
• RestoreTheGulf.gov
• NOAA: Deepwater Horizon/BP Oil Spill
• EPA Response to BP Spill in the Gulf of Mexico