Living Well Blog

Although prescription medications that may increase the risk of birth defects are commonly used by women in their childbearing years, only about half receive contraceptive counseling from their health care providers, according to a large-scale study from the University of Pittsburgh School of Medicine reported in the Sept. 18 issue of the Annals of Internal Medicine.

“We found that over the course of a year, one in six women of reproductive age filled a prescription for a medication labeled by the Food and Drug Administration as increasing the risk of fetal abnormalities,” said Eleanor Bimla Schwarz, M.D., assistant professor in the departments of medicine and obstetrics, gynecology and reproductive medicine at the University of Pittsburgh School of Medicine and first study author. “Unfortunately, many women filling prescriptions that can increase risk of birth defects remain at risk of pregnancy.”

Half of pregnancies in the United States are unintended, according to national estimates. While regular use of contraception can prevent unplanned pregnancies, women filling prescriptions that can increase the risk of birth defects are no more likely to use contraception than other women, the study authors note.

For this investigation, Dr. Schwarz and colleagues studied patient data related to all prescriptions filled by 488,175 reproductive-aged women enrolled with a large managed health care plan during 2001. Prescriptions involved drugs considered safe for use in pregnancy and those labeled as posing a fetal risk.

The researchers examined use of contraception and results of pregnancy tests. When they compared medications labeled as increasing the risk of birth defects to safer medications, the researchers found little difference in rates of contraceptive counseling, use of contraception or subsequent pregnancy test results.

“Many women — and perhaps their physicians — may be unaware of the risks associated with the use of some medications, the chance that women may become pregnant, or both,” said Dr. Schwarz, who also is an assistant investigator at the Pitt-affiliated Magee-Womens Research Institute. “The scary thing is that we know women in other primary care health care settings are even less likely to get information about birth control.”

While about half of the women in this study had received contraceptive counseling, other studies have shown that nationwide, only about 20 percent of women are advised to use birth control when they receive potentially dangerous medications.

“While efforts are needed to ensure that women get information about birth control and the risk of medication-induced birth defects, it also is important to realize that different birth control methods are not equally effective,” she said. “Women who were using the most effective methods of contraception, such as the intrauterine device or IUD, were least likely to have a positive pregnancy test after filling a prescription for a potentially dangerous medication.”

The researchers found that internists and family practitioners prescribed the largest proportion (48 percent) of riskier medications to women of childbearing age. Psychiatrists prescribed 15 percent of these drugs; dermatologists, 12 percent; obstetrician/gynecologists, 6 percent; and pediatricians, 3 percent, according to the study.

“Women should not avoid using prescription medications, but clinicians need to remember that sometimes birth control is needed until a woman is ready to have a healthy pregnancy and a healthy baby,” Dr. Schwarz added.

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This study was funded by the National Institute of Child Health and Human Development and an unrestricted grant from Duramed Pharmaceuticals.

In addition to Dr. Schwarz, other authors are Debbie A. Postlethwaite, R.N.P.; Yun-Yi Hung, Ph.D.; and Mary Anne Armstrong, M.A., of Kaiser Permanente Northern California.

Source: Michele Baum

University of Pittsburgh Schools of the Health Sciences

In October the American College of Physicians (ACP) will publish “The Fenway Guide to LGBT Health.” Edited by Dr. Harvey Makadon, Dr. Ken Mayer, and Hilary Goldhammer of The Fenway Institute at Fenway Community Health, and Dr. Jennifer Potter of Beth Israel Deaconess Medical Center, the textbook is designed to teach current and future medical providers about the unique health care needs of sexual and gender minorities.

“The American College of Physicians is pleased to present this outstanding text, which fulfills an important but currently unmet educational need for a broad range of health care providers,” said Steven Weinberger, MD, FACP, Senior Vice President, Medical Education and Publishing at ACP.

LGBT (lesbian, gay, bisexual and transgender) Americans, in addition to having the same basic health needs as the general population, also experience health disparities because of continuing discrimination and ignorance related to sexual orientation or gender identity. For example:

* LGBT people as a whole are 40 to 70 percent more likely to smoke than non-LGBT people;

* Gay and bisexual men continue to be at increased risk for HIV and other STD acquisition and transmission;

* Many providers have little knowledge of transgender people and their specialized medical and mental health needs;

* LGBT youth are often isolated and at higher risk for depression and attempted suicide;

* Lesbians may be at greater risk than other women for certain kinds of cancer.

Despite these disparities, many medical providers are unaware of specific health issues impacting LGBT people or are unskilled in making their practices welcoming and inclusive of LGBT patients. “The Fenway Guide to LGBT Health” draws on Fenway Community Health’s more than 35 years providing medical and mental health care to the LGBT community to address this common disconnect between doctor and patient.

“We as medical providers need to be as knowledgeable as possible about health issues impacting all of our patients, especially groups with unique health disparities, like LGBT people,” said Dr. Makadon, Director of Training & Education at The Fenway Institute and associate professor at Harvard School of Medicine. “We also need to be comfortable talking to sexual and gender minorities in a non-judgmental way about behaviors and situations that result in these disparities so that they are comfortable being honest and open with us. Doctor-patient communication is an essential component of providing quality health care.”

“The Fenway Guide to LGBT Health” contains chapters on subjects as diverse as adolescence and coming out; LGBT couples and families with children; health promotion and disease prevention; mental health and substance abuse; transgender health; and patient communication and creating a more welcoming office environment.

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An ACP Press title, “The Fenway Guide to LGBT Health” will be distributed by all major distributors and medical book sellers, including Ingram Book Group. It is also available to readers at acponline/fenway, amazon/, and barnesandnoble/.

The American College of Physicians (acponline/) is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 124,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults.

For more than thirty-five years, Fenway Community Health has been working to improve the physical and mental health of our community, especially those who are traditionally underserved like lesbian, gay, bisexual and transgender people, women, those living with HIV/AIDS, and people from communities of color. Fenway Community Health is one of only seven LGBT-specific health centers in the U.S. The Fenway Institute at Fenway Community Health works to increase the health of the larger community through research and evaluation, education, outreach and health policy advocacy. For more information, visit fenwayhealth/.

Source: Steve Majewski

American College of Physicians

A small difference in DNA sequence predicts the degree of disability after a stroke, according to a paper published online on February 28 in the Journal of Experimental Medicine. Stroke, the consequence of disturbed blood flow to the brain, can impair speech, movement and vision, but it is currently difficult for clinicians to predict the severity of these side effects or the long-term prognosis.

Strokes result in the death of brain cells called neurons. Angeles Almeida and co-workers found that variations in a gene known to control cell death – Tp53 – influence stroke outcome.

Tp53 comes in two flavors in humans: R and P. The R variant triggers cell death more efficiently. In two distinct groups of stroke patients, those exclusively expressing the R variant suffered more severe disability several months after the stroke. Neurons expressing the R variant were more vulnerable to death caused by oxygen deprivation, a condition that mimics the brain environment during stroke.

Future work is needed to determine if this Tp53 variation can also predict prognosis of patients with other disorders characterized by neuronal death, such as Alzheimer’s or Parkinson’s disease.

Notes:

Gomez-Sanchez, J.C., et al. 2011. J. Exp. Med. doi:10.1084/jem.20101523

Source:
Rita Sullivan
Rockefeller University Press

State Medicaid directors and more than 100 organizations on Monday plan to send a letter to congressional leaders to seek a one-year delay of a rule that will require pharmacists to reject paper prescriptions for Medicaid beneficiaries not written on tamper-resistant paper, according to Martha Roherty, director of the National Association of State Medicaid Directors, USA Today reports. The rule, part of a supplemental appropriations bill for military operations in Iraq and Afghanistan enacted earlier this year, will take effect on Oct. 1.

According to critics, the rule could affect access to medications for Medicaid beneficiaries and force pharmacies to return reimbursements when they fill prescriptions improperly. Jamila Edwards of the California Primary Care Association said, “Nobody really knew where this came from,” adding, “The patient’s going to be in the middle thinking, ‘How come I didn’t get my medication?’” Washington state Medicaid Director Doug Porter said, “In our state, very few doctors use these kinds of pads,” adding, “I think some people will be denied service, and that will be a very bad situation.”

However, Jeffrey Kelman of CMS said that the rule will allow pharmacists to fill prescriptions not submitted on tamper-resistant paper, provided that they obtain confirmation from the physicians who wrote the prescriptions by telephone, fax or e-mail within three days. He added that the rule should help to prevent overdoses and other problems caused by fraudulent prescriptions (Wolf, USA Today, 9/17).

Pharmacy Reimbursements
In related news, Rep. Frank Pallone (D-N.J.) might introduce legislation to revise a rule recently finalized by CMS that will reduce Medicaid reimbursements to pharmacies for generic medications, according to a congressional source, CongressDaily reports (Edney, CongressDaily, 9/14).

The rule, mandated by the Deficit Reduction Act of 2005 and scheduled to take effect on Dec. 30, seeks to ensure that Medicaid can obtain prescription drug discounts similar to those obtained by private entities. The rule will redefine the average manufacturer price for brand-name and generic medications. States use AMPs to calculate Medicaid reimbursement rates for medications. Under the rule, the federal government will post AMPs on a Web site that consumers could access. In addition, the rule will limit the federal share of the cost of brand-name medications when at least three generic versions are available. The rule will exclude pharmacy benefit managers, and pharmacies in nursing homes and assisted living facilities. According to CMS, the rule will save the federal government and states $8.4 billion over the next five years (Kaiser Daily Health Policy Report, 7/10).

According to the source, Pallone might introduce legislation similar to a bill (S 1951) sponsored by Sen. Max Baucus (D-Mont.) that would exclude mail-order pharmacies from the rule and exclude rebates and discounts not provided to pharmacies from the calculation of AMP. The bill sponsored by Baucus also would increase Medicaid reimbursements for medications to 300% of AMP from 250%. Pharmacies, which maintain that the rule will prevent their participation in Medicaid, said that they support the bill.

Charles Sewell, vice president of government affairs for the National Community Pharmacists Association, said, “Right now, our biggest concern is getting something passed because there’s a ticking time bomb when this goes into effect in January.” Paul Kelly, vice president of government affairs for the National Association of Chain Drug Stores, said that the bill represents a “much better policy than exists today” (CongressDaily, 9/14).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Pope Benedict XVI on Thursday urged Slovakia to ratify a treaty that includes a “conscience clause” that would allow citizens to “refuse to act in [a] way that his or her conscience thinks is contrary” to Catholic tenets, AFP/EUBusiness reports. Critics say the clause would allow doctors to object to performing abortions, teachers to refuse to teach the theory of evolution and employees to refuse to work on Sunday, according to AFP/EUBusiness.

The issue prompted early elections in Slovakia last year after then Prime Minister Mikulas Dzurinda declined to support the clause. Dzurinda argued that the clause would grant special status to the country’s Catholic majority. The European Commission’s juridical consultative committee in January last year also criticized the clause. During a ceremony for Jozef Dravecky, the new Slovakian ambassador to the Holy See, the pope said he commends “the republic’s reassurance that it is committed to finalizing the basic accord concerning conscientious objection” (AFP/EUBusiness, 9/13).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Several newspapers reported on recent medical malpractice developments in several states. Summaries of the articles appear below.
Connecticut: Physicians in Connecticut might pay lower premiums for malpractice insurance in 2008 because some insurers took action to reduce premiums and another wants to enter the market, the Hartford Courant reports. Connecticut Medical Insurance Company on Wednesday said that its base rates are not changing for 2008 and that it will increase credits given to physicians who have not had claims filed against them for at least five years, meaning their premiums might be reduced. Medical Protective’s 24% rate cut was approved by state regulators and took effect Aug. 1. ProMutual Group is not planning any rate hikes in the state this year. Meanwhile, Professional Liability Insurance Company of America — which sells malpractice insurance in Missouri, Illinois and Texas — has expressed interest in expanding into Connecticut, which could increase competition, according to the Courant (Levick, Hartford Courant, 9/13).

Maryland: The Maryland Insurance Administration on Thursday blocked a plan by the state’s largest malpractice insurer, Medical Mutual Liability Insurance Society of Maryland, to pay a nearly $69 million dividend, saying it will hold a hearing to determine how much money should go to the state and how much to policyholders, the Baltimore Sun reports. Maryland Insurance Commissioner Ralph Tyler on Thursday said that the state paid almost $80 million to subsidize the company’s premiums since a four-year program was enacted less than three years ago to address increasing premium rates. He said the dividend calls into question whether the program was necessary. The hearing is scheduled for Oct. 5 (Smith Hopkins, Baltimore Sun, 9/14).

Mississippi: Medical Assurance Company of Mississippi, the state’s largest malpractice insurer, on Sept. 5 decided to cut premiums by 15.5% in 2008, bringing the company’s rates down 45% since 2004, the Jackson Clarion-Ledger reports. Gov. Haley Barbour (R), whose 2003 campaign had tort reform as a focus, announced the reduction on Wednesday, saying, “It’s made a difference. Doctors are staying in the state. Doctors are going back to delivering babies. Doctors are no longer afraid to do emergency surgery.” Mississippi Association of Justice President Joey Diaz said that Barbour is taking credit for 2002 tort reform work by former Gov. Ronnie Musgrove (D). However, Randy Easterling, chair of the Mississippi State Medical Association, said Barbour’s plan has had a larger effect on the rates (Hipp, Jackson Clarion-Ledger, 9/13).
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

The first ever guide on prescribing written specially for practice based commissioners, GPs and other frontline teams – is published by the Primary Care Pharmacists’ Association and the NHS Alliance.

The guide highlights the contribution pharmacists can make to patient care and practice budgets, from strategic issues to patient-level support. For instance, at a GP practice in Lancashire the practice pharmacist has developed medicines protocols for long term conditions, promoting the use of evidence-based drugs, while pharmacist-led clinics have rationalised prescribing for patients on multiple medicines. The practice has improved care for its patients at the same time as cutting prescribing costs.

Prescribing Support and Prescribing Advice for Practice Based Commissioners – A guide for commissioning groups and GPs is free to all NHS Alliance members and is priced ВЈ10 for non-members. It is available from the NHS Alliance head office, email officenhsalliance.

Shailen Rao, PCPA Chair, said:

“Primary Care Pharmacists are a valuable and as yet, largely untapped resource within Practice Based Commissioning. The prescribing budget makes up a significant proportion of the primary care budget and PBC provides an excellent opportunity to further increase the quality of prescribing.

“In the past, the medicines management agenda has been utilised to drive forward service redesign and improvements via initiatives such as prescribing incentive schemes and supporting the GMS contract. Forward thinking PBC groups who take on the prescribing budget and associated support from primary care pharmacists will be in a position to direct this valuable resource towards delivering their own priorities”.

NHS Alliance chairman Dr Michael Dixon said:

“This useful, readable and much needed guide will inform every GP practice and every practice-based commissioning group of the contribution that pharmacists can make to patient care and practice budgets”.

1. This publication complements the NHS Alliance guides to practice based commissioning for PECs and PEC chairs. It is available free of charge to NHS Alliance members via their website nhsalliance

Complementary treatment use is high in regional Australia, but patients often don’t tell their doctors, according to a University of Queensland researcher, who will conduct the world’s first study in this area.

The study, by social scientist Dr Jon Adams, aims to help improve rural health outcomes by investigating the practices and perspectives of regional general practitioners (GPs) regarding complementary and alternative medicine (CAM). CAM treatments include therapies such as acupuncture, naturopathy and herbal medicine.

Dr Adams has been awarded $85,000 as one of the 2007 winners of the UQ Foundation Research Excellence Awards and Awards for Excellence in Research Higher Degree Supervision, announced last night at Brisbane’s Customs House.

Now in their ninth year, the UQ Foundation Research Excellence Awards, worth $505,000 in 2007, recognise outstanding performance and leadership potential, and form part of UQ Research Week (September 17-21).

Dr Adams said the results of the research would be important for rural health delivery because the high use of CAM could have potential safety issues when combined with conventional healthcare.

“GPs are key healthcare providers, particularly in rural areas and it’s vitally important that they have as much information as possible about CAM and their patients’ use of CAM,” Dr Adams said.

“Better communication and co-ordination of services between GPs and CAM practitioners can avoid potential complications and help manage the patient journey.”

The study will focus on GPs and provide the first grassroots examination of the day-to-day understanding, experience and relationship of GPs with regard to CAM providers and medications.

It will examine a number of issues, including how many GPs practise CAM and refer patients to CAM practitioners, what type of patients this is most likely to involve and GPs’ perceptions and experiences of various CAM. Other key areas to be examined are the relationship of CAM to rural GP training and education.

“The results of the study will better equip rural healthcare providers in their bid to co-ordinate and manage healthcare for their patients. It will also give rural GPs a perspective on how their colleagues are managing the challenges of the CAM-GP interface,” Dr Adams said.

The 12-month study, to begin next year, will involve a survey to be sent out to GPs in rural New South Wales and interviews with 20 GPs.

Dr Adams said he expected this study would highlight the need for future funding in this area of research.

“CAM is an area that is growing quickly and needs as many areas of expertise as possible focused on it to help our understanding of the role CAM plays in health delivery in Australia,” he said.

Dr Adams is a senior lecturer with UQ School of Population Health. He has been researching primary health care and the practice and consumption of CAM for more than 10 years.

Looking for an expert? Contact details for more than 1500 UQ academics and researchers who can provide media with expert comment are available online at uq.edu.au/uqexperts.

The University of Queensland, Brisbane Australia

Contrary to concerns that restricting work hours for surgical residents negatively affects the quality of patient care or the residents’ education, a study in the September issue of the Journal of the American College of Surgeons found that limiting work hours does not compromise education or the quality of care. In addition, the study found that the new model improved overall teaching effectiveness and increased the amount of operating room experience that residents receive.

However, researchers concluded that duty-hour restrictions could amplify job dissatisfaction and work hours among faculty and necessitate an increase in physician assistant and nurse staffing.

Four years ago, the Accreditation Council for Graduate Medical Education (ACGME) mandated the “Common Duty Hours Standard,” which required a dramatic redesign of the country’s resident training programs. Among the key requirements were to limit resident work hours to no more than 80 hours per week averaged over a four-week period, restrict shifts to 30 hours, and permit at least a 10-hour rest period in between shifts. As a result of the mandate, many surgical educators were prompted to rethink their programs’ organizational structures to adhere to the new requirements.

“These findings cannot be ignored. In this environment, limits on duty hours require us to reorganize our residency programs to promote high-quality education, safe patient care, and resident well-being and to carefully monitor the results of this reorganization to be sure that all of these requirements are being satisfied,” Joseph R. Schneider, MD, FACS and lead author of the study, said.

The study, “Implementation and Evaluation of a New Surgical Residency Model,” which was conducted by the department of surgery at the Northwestern University Feinberg School of Medicine, involved the four core hospitals that make up the school’s McGaw Medical Center. This new model included a mixture of apprenticeship, small team, and night-float models. The study evaluated the impact of their reengineered residency program and scheduling structure.

According to rotation evaluation forms completed by residents, the new program improved resident satisfaction with the quality of the teaching they received on rounds, in conferences, in the clinic and in the operating room. In addition, residents were more satisfied that they met the objectives of their rotations. The study also addressed a widespread concern that shortened resident hours would negatively affect patient care and patient outcomes. The authors found no evidence for deterioration in any patient outcome measures. In fact, continuity of care actually improved and residents were more likely to see patients after the operation as a result of the new system.

“Although duty-hour restrictions did not cause a deterioration of surgical residents’ educational experience, these restrictions have the potential to produce new challenges,” added Dr. Schneider. “Faculty surveys showed perceived increases in work hours and job dissatisfaction after implementation of the new program structure. Also, 10 new physician assistant and nurse positions were hired as a result of the duty-hour restrictions.” The department of surgery at the Northwestern University Feinberg School of Medicine implemented a new residency program structure on July 1, 2003, to include a mixture of apprenticeship, small team, and night-float models. Before this change was made, the residency program used the traditional team-based approach with call being taken every third or fourth night, depending on the rotation. This study describes the organization of the new program structure and subsequent evaluation findings from measures taken over three years, beginning one year before, and completed two years after, the program implementation.

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About the American College of Surgeons

The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 71,000 members and is the largest organization of surgeons in the world. For more information, visit facs/.

ACS has been publishing educational articles on its Web site to assist surgery program directors in training and managing surgical residents in the era of the 80-hour-work week, see: facs/education/rap/foreword.html.

Source: Sally Garneski

Weber Shandwick Worldwide

Outbreaks of HIV linked to blood transfusions have occurred throughout Central Asia since an outbreak of the virus was discovered at a children’s hospital in Shymkent, Kazakhstan, the Chicago Tribune reports (Rodriguez, Chicago Tribune, 9/16).

Twenty-one health workers and health officials in Shymkent were put on trial for medical malpractice following the HIV outbreak. A medical investigation conducted by CDC identified transfusions of tainted blood as the source of the Shymkent HIV outbreak. Since summer 2006, 118 children who received blood transfusions at the hospital have tested positive for HIV. Ten of the children have died from AIDS-related illnesses. Seventeen health workers in Shymkent in June were sentenced to prison after being convicted of criminal negligence following the outbreak (Kaiser Daily HIV/AIDS Report, 6/28).

Attorneys for the convicted doctors claimed that the children contracted HIV through mother-to-child transmission. However, the women were tested and found to be HIV-negative, Katira Bekbolova, a lawyer for the parents of the HIV-positive children, said. According to court records, officials tried to cover up the outbreak. A court-ordered evaluation of supplies and procedures at the hospitals found that syringes and catheters routinely were reused and that the hospitals did not have an adequate supply of catheters (Chicago Tribune, 9/16).

The parents of the HIV-positive children say that doctors charged them $20 for 14 ounces of blood and shared the profits with the local blood bank. Some of the doctors in Shymkent say their low wages force them to find ways of earning additional income, and a profit of up to $10 on each blood transfusion is a significant amount because doctors’ salaries begin at $175 monthly. Judge Ziyadinkhan Pirniyaz, who presided over the case, gave suspended sentences to senior health official Nursulu Tasmagambetova and three others. The remaining defendants received jail sentences ranging from a few months to eight years. Pirniyaz listed evidence of negligence, abuse of patients and theft of health funds. The attorneys for the children’s parents said they will appeal the decision.

“Salaries are very low, and even increases don’t make a difference because of inflation,” Amangeldy Shopaer — deputy chief physician at the Shymkent Infectious Diseases Hospital, where all the HIV-positive children have received treatment — said. The children’s families say government neglect has compounded their situation. In addition, many of the children’s families have been forced to move after experiencing HIV/AIDS-related discrimination (Kaiser Daily HIV/AIDS Report, 6/28). Kazakh authorities have reacted to the outbreak by building a new children’s hospital in Shymkent. In addition, old hospitals will receive new equipment, doctors will be retrained and hospital administrations will undergo weekly inspections, the Tribune reports.

According to the Tribune, nine people in Andijan, Uzbekistan, in March contracted HIV after receiving blood transfusions from an HIV-positive donor who recently had been released from prison. In addition, officials in Osh, Kyrgyzstan, in July fired several doctors for infecting 22 people, including 17 children, with HIV.

Although HIV prevalence is low in Central Asia compared with other former Soviet republics, experts say the region could experience an increase in cases if prevention is not made a priority, the Tribune reports. “Shymkent rang a bell for Central Asia,” Nicolas Cantau — regional director of the AIDS Foundation East-West office in Almaty, Kazakhstan — said, adding that the region is “in the same place Ukraine was seven years ago, when authorities missed an opportunity to contain the problem and now have seen (nearly) 1% of their population become HIV-positive.” There are an estimated 12,000 HIV cases in Kazakhstan, the Tribune reports (Chicago Tribune, 9/16).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.