Health Officials Investigate Virus Carried by Rodents, Rhode Island

Rhode Island Department of Health announced the preliminary results of an investigation into the unfortunate deaths of
three recent recipients of organ transplants (2-MA/1-RI). The following investigation of the cause of death, by the Rhode
Island Department of Health, the Massachusetts Department of Public Health, the CDC, the New England Organ Bank and the
transplant centers, pointed to a viral infection (known as LCMV). In cooperation with the New England Organ Bank and the CDC,
the infection was traced back to a RI donor who died from unrelated causes. The source of the infection appears to involve
exposure to the urine or feces of common house mice or rodent pets (such as hamsters). At least one pet at the donor’s
residence tested positive for LCMV.

“We continue to investigate the source of infection and events leading to this sad outcome,” said David R. Gifford, MD, MPH,
Director of Health. “Also, because LCMV infection has been associated with miscarriage and neurological illness in the
newborn, we are taking the precaution of advising pregnant women in the first and second trimester of pregnancy to avoid
exposure to rodent urine or feces-including household pets such as hamsters.”

This chain of events represents only the second time transmission of LCMV through organ transplant has ever been seen. The RI
Department of Health is working collaboratively with the Department of Environmental Management (DEM) and CDC to evaluate the
risk to the public from LCMV in pet hamsters. HEALTH is also disseminating information to the general public and the medical
community on how to prevent exposure to LCMV and other rodent associated infections.

LCMV infection can be prevented by avoiding or minimizing direct physical contact with wild rodents or exposure to rodent
urine or feces. Pregnant women should avoid contact with hamsters or other rodents. For more information about LCMV go to: health.ri or to cdc. For health-related calls contact the Family Health Information Line at 1-800-942-7434
during regular business hours. For calls about animal-related questions contact DEM Division of Agriculture 222-2781 during
regular business hours or go to: www.dem.ri/topics/agriculture/cdchealthypets.

Rhode Island Health Dept

Quality Associates Introduces H1N1 Flu Vaccine Forms Processing Service For States, Municipalities And Healthcare Providers

Quality Associates, Inc. (QAI), an established provider of services and solutions for large-scale document management, imaging, and archiving, announced the launch of its H1N1 Flu Vaccine Forms Processing Service, a comprehensive approach to help states, cities, counties, and providers in the private sector successfully and accurately capture and record essential demographic and health data from medical consent forms – a critical step in the administration of the H1N1 vaccine to millions nationwide beginning this fall.

As part of the two-step inoculation process, each patient is required to fill out a printed medical consent form before each shot is given. More than 100 million vaccinations are expected to become available this fall, which is creating a serious and urgent need for states, municipalities and the private sector to immediately develop a clear strategy to effectively capture vital personal and healthcare-related information. Once information is collected, it must be converted into a useable electronic format for insurance, reporting, and statistical needs. Without a digital capture methodology in place, municipalities and private healthcare providers risk losing funds due to lost or inaccurate recipient insurance information. Additionally, government agencies such as the Centers for Disease Control and Prevention could lose important data regarding vaccine distribution and efficacy.

QAI’s H1N1 Flu Vaccine Forms Processing Service involves several steps that ensure information is captured and recorded accurately:

- Step 1 – Consultation: QAI works closely with vaccine administrators to understand the scope of each project, and then helps guide the entire process.

- Step 2 – Forms Design: Using experience gained by processing millions of healthcare forms collected during the administration of the yearly flu vaccine, QAI designs user-friendly forms that collect information as completely and accurately as possible.

- Step 3 – Forms Processing: QAI uses state-of-the-art high-volume scanners, intelligent data recognition software, and technology to capture information on each form. Quality assurance steps ensure the accuracy of all captured data. Additionally, QAI’s controlled, on-shore processing protects sensitive patient information.

- Step 4 – Data Integration: QAI submits all original documentation and captured data back to the client. Data can be provided in one of several formats to ensure compatibility with the provider’s own systems.

Scott Swidersky, director, Information Systems, Quality Associates, Inc., said, “At this moment, every state, local government, and private firm involved in the H1N1 vaccine administration is facing numerous, complex logistical and technical hurdles that must be resolved quickly. In a matter of weeks, the H1N1 vaccine will become available and administration will begin. From a data capture standpoint, QAI is in the unique position of having the vast experience required to successfully pull information from millions of hard-copy documents. We have processed millions of forms used in the administration of yearly flu programs, and are ready to lend our expertise to help in the nationwide H1N1 vaccine administration effort.”

Quality Associates, Inc.

World Osteoporosis Day 20 October

Osteoporosis affects one in every two women and one in every three men over 60, making World Osteoporosis Day on 20 October an event relevant to us all.

We can all work towards the prevention of osteoporosis by getting adequate calcium, vitamin D and exercise .

For those already managing the symptoms of osteoporosis, such as chronic pain, disability and even loss of independence , Tunstall Healthcare provides solutions to assist people living with special conditions to maintain their independence in the home.

Tunstall’s 24 hour response centre allows people to make a quick and easy call when they need help.

Where possible, the response centre operator will speak with the resident to identify what assistance they need, such as a friend or family member to be contacted, after hours GP to be organised or ambulance to be called.

An alarm call for assistance can be initiated by a personal alarm pendant that the resident keeps with them at all times, or by other specialty sensors relevant to the residents’ condition, such as a fall detector or chair occupancy sensor.

Worn on the hip, the fall detector quickly detects a fall and initiates a call for assistance, preventing the resident from being left lying on the floor.

The chair occupancy sensor detects if the resident has not got up for long periods of time, suggesting they may be in pain and unable to get up and seek assistance.

Tunstall offers a range of solutions to help people living with osteoporosis to manage their condition and maintain their independence and safety in the home.

To find out more about osteoporosis visit here.


Tunstall Healthcare

Diagnostic Evaluation Of Urinary Incontinence In Women

UroToday – The incontinent patient is evaluated in order to make a presumptive diagnosis so that treatment can be offered. The evaluation begins with a history and a physical examination. The history focuses on the description of the patient’s incontinence.

Although the history may define the patient’s problem it may be misleading. Urge incontinence may be triggered by activities such as coughing so that by history the patient would seem to have stress incontinence. A patient who only complains of urge may also have stress incontinence. Mixed incontinence is very common with at least 65% of patients with stress incontinence having associated urgency or urge incontinence. It may be impossible to determine by history alone which is the more significant problem. Assessing the patient’s bother and determining their expectations of treatment may further guide how aggressive one needs to be both with the evaluation and the presentation of treatment options.

The important parts of the physical exam are an examination of the abdomen and pelvis including a provocative stress test. If the test is done supine and there is no leakage it should be repeated standing, as this will increase the patient’s abdominal pressure. A urinalysis and a post-void residual (PVR) should be performed in all incontinent patients.

Incontinence questionnaires, voiding diaries, and pad weight tests can provide more objective data than the history alone. Upper tract imaging is indicated in the patient with a history of hematuria and in patients with suspected hydroureteronephrosis. Other imaging may be useful to further evaluate other suspected pelvic pathology. Urodynamics are performed to determine if the incontinence is due to bladder or urethral dysfunction or both, to assess if the patient has a storage or emptying problem and lastly in an effort to identify patients whose upper tracts are at risk due to high bladder storage pressures.

The most common abnormality of bladder function is detrusor over activity that causes urge incontinence. Detrusor over activity is defined as the inability to suppress involuntary detrusor contractions during filling.1 A cystometrogram may fail to demonstrate any detrusor over activity in a patient who has urge incontinence by history. Any patients with symptoms of urge incontinence by history should be presumed to have urge incontinence. The purpose of urodynamics is not to diagnose detrusor over activity but to examine compliance, to diagnose stress incontinence, to rule out obstruction as a cause of either overflow or urge incontinence and to insure that the patient has a reasonable, safe, bladder capacity.

The diagnosis of stress incontinence is best made with measurement of the abdominal pressure required to induce urinary loss, the Valsalva or abdominal leak point pressure and, or fluoroscopy. Stress incontinence is diagnosed if there is urethral loss of urine associated with an elevation of abdominal pressure. Valsalva leak point pressure (VLPP) is used to diagnose stress incontinence since it is abdominal pressure that is the expulsive force in stress incontinence. Measurement of the VLPP allows for quantification of the degree of urethral dysfunction. A normal urethra will not leak at any pressure. A mobile urethra will leak at high abdominal pressures (>120 cm H2O) and a poorly functioning intrinsic sphincter will leak at low pressures (

World Heart Federation Warns That Burden Of Tobacco Epidemic Continues To Worsen Societies And Economies

G-20 leaders pledged to provide the International Monetary Fund with $500
billion to help struggling economies, sparking global controversy. Yet
startling research shows that the combined costs of tobacco-related death and
related productivity losses, healthcare expenditures, employee absenteeism,
and widespread environmental harm are responsible for draining the same
amount – $500 billion – from the global economy each year and it receives
much less attention than it deserves.

In recognition of World No Tobacco Day on 31st May, the World Heart
Federation insists on bringing more attention to the impact of tobacco on
health and disease. Tobacco use is the leading preventable cause of death and
is closely linked to cardiovascular disease, which is the leading cause of
death worldwide. In 2010, it is estimated that six million people will die
from the effects of tobacco – more than from HIV/AIDS, malaria and
tuberculosis combined – and nearly three-quarters (72%) will be in low- and
middle-income countries. Using tobacco causes clogging of the arteries, heart
disease, stroke, sudden death and heart failure.

Dr. Pekka Puska, President of the World Heart Federation stated: “This
year we embrace the WHO theme of tobacco health warnings and demand that the
tobacco industry display pictorial warnings on all tobacco packages in order
to clearly and effectively communicate tobacco’s deadly consequences.”

Studies show that pictorial warnings work: they effectively motivate
users to quit and reduce the appeal of tobacco for those who are not yet
addicted. The World Heart Federation supports its members around the world to
advocate for pictorial labeling, working with Ministries of Health, the media
and businesses. But 9 out of 10 people live in countries that do not require
warnings with pictures on tobacco packages.

One successful example is in the Caribbean. Debbie Chen, Executive
Director of the Heart Foundation of Jamaica, coordinates a coalition of
partners, which includes the Heart and Stroke Foundation of the Barbados and
the InterAmerican Heart Foundation, with a Bloomberg Award grant for Global
Tobacco Control. She said: “We were convinced that labeling could help us
when we read research from other countries. We have accelerated the process
in the region and are determining which warnings will have the strongest
impact in four Caribbean countries.”

Worldwide, tobacco control is one of the simplest ways to reduce
cardiovascular disease; in low-resource settings its feasibility and
cost-effectiveness only magnifies its importance.

About World No Tobacco Day and Warnings

To know more about the World No Tobacco Day, and download toolkits,
please visit: To know more about the
Framework Convention, please visit: fctc. To know more about
countries that are working on ensuring tobacco products have pictorial
labels, please visit: tobaccolabels/labelima

World Heart Federation

Wellgate For Women Provides Support For Athletes And Winter Sports

Whether women are ice skating, skiing, playing ice hockey, snowboarding, or simply running on the treadmill at home, the right support is important to fully enjoy all winter activities. Simply walking on ice and through snow can be stressful for women’s limbs and requires the right support to help prevent injury and fractures, such as the specially-designed braces crafted by Wellgate for Women.

“From cross-country skiing to speed skating, active women should have the best support possible in order to perform at their best,” said NYC Physical Therapist, Megan Barclay. “Winter sports can be utterly brutal, and Wellgate’s braces and supports can give women the edge they need to win, or just have a good time, on the slopes and in the rink.”

Braces and supports made for men simply don’t do the job, as women’s bodies respond to stresses and pressures differently as a result of different body structures. For instance, women are more susceptible to ankle injuries since they have narrower feet than men, and their heels – in particular – are narrower compared to the front of the foot.

“Winter sports such as skating and skiing are all about having the right equipment,” said April Elsinger, Brand Manager for Wellgate. “Our Ultra-Light Knee Support fits comfortably under clothes, is specifically contoured to fit women’s bodies and is available in various sizes, included Queen size. We want to see women do their very best and not have to worry about the fit of their equipment.”

“Women need support for their wrists, ankles, and knees and we provide special braces and supports for all three,” said Elsinger. “From snowboarding to curling to simply surfing the internet, we’ve got women covered where they need it most.”

Wellgate products are available at Wal-Mart stores throughout the U.S. and Canada and other retailers nationwide. Visit wellgateproducts.

Wellgate for Women

Statistical Technique To Find Mix Of Biomarkers Predicting Mortality Used By Researchers

Previous research has uncovered a range of biological markers that can predict disability, morbidity and mortality in older adults. In this study, the researchers analyzed 13 biomarkers representing neuroendocrine and vascular functions and immune and metabolic activity over 12 years in 1,189 high-functioning men and women aged 70-79 enrolled in the MacArthur Study of Successful Aging. The goals were to identify biomarker combinations (or high-risk pathways) associated with high levels of mortality in men and women, determine whether the biomarkers that most closely predicted mortality differed in men and women and develop prediction rules based on combinations of biomarker conditions. The researchers also sought to present “recursive partitioning,” a statistical technique for identifying multiple and interacting predictors of an outcome, as a useful analytical tool for addressing research questions in the biomedical sciences. Using recursive partitioning, they found that combinations of neuroendocrine and immune markers frequently appeared in high-risk male pathways, while systolic blood pressure was present, in combination with other biomarkers, in high-risk female pathways.

IMPACT: Clinicians and researchers may be able to use recursive partitioning to identify the biological regulatory system’s importance in predicting mortality in later life.


AUTHORS: Tara L. Gruenewald, Teresa E. Seeman and Arun S. Karlamangla of UCLA; Carol D. Ryff of the University of Wisconsin, Madison; and Burton H. Singer of the Institute on Aging at the University of Wisconsin, Madison, and the Office of Population Research, Princeton University.

JOURNAL: Proceedings of the National Academy of Sciences, Sept. 19 issue.

FUNDERS: National Institute on Aging; the John D. and Catherine T. MacArthur Foundation.

Contact: Enrique Rivero

University of California – Los Angeles

Swine Flu In Somerset – Briefing Note, UK

Public health experts throughout the UK and Somerset are now implementing new national guidance regarding the treatment and management of swine flu in the UK.

Up until last week, public health doctors in Somerset had seen few ‘confirmed’ cases of swine flu (only eight confirmed cases by 1st July) and were still implementing a process called ‘containment’.

This involved isolating individuals who believed they might be infected with swine flu (asking them to remain at home); mouth swab testing them and sending their swab sample for laboratory testing and virus confirmation.

Close contacts of anyone ‘confirmed’ with the H1N1 swine flu virus were being offered the antiviral drug, Tamiflu as a precautionary measure.

Symptoms of swine flu are similar to the symptoms of regular seasonal flu and include fever, fatigue, lack of appetite, coughing, sore throat, pain in muscles and joints, headache and chills. Some people with swine flu have also reported vomiting and diarrhoea.

Public health doctors are still stressing that in most confirmed cases of swine flu the patient has displayed only mild symptoms. The infection is ‘self limiting’ and the majority of patients recover quickly after resting at home.

Since Thursday 2nd July and following an announcement by the Secretary of State for Health, Andy Burnham and the Chief Medical Officer, Sir Liam Donaldson, the Health Protection Agency and Somerset’s public health services are only implementing a ‘treatment’ response to any clinically diagnosed cases of swine flu. (‘clinically’ diagnosed means a GP believes the symptoms shown by the patient look like swine flu)

The ‘Treatment’ Phase

This ‘treatment’ phase means that from now on:

- GPs will be able to diagnose and treat swine flu on the basis of patients’ symptoms rather having to waiting for ‘confirmation’ via
laboratory results

- The routine tracing of people who have come into contact with confirmed cases of swine flu will end. However people considered to be at high risk by their doctor may still be offered antivirals in some situations as a preventive measure.

- Schools and other institutions will close only if local circumstances warrant it, for example if a significant number of pupils or teachers are ill.

Advice To The Public To Reduce The Spread Of The Swine Flu Virus

- To help limit the spread of swine flu it’s important to make sure that if you have symptoms, you don’t leave the house – don’t visit
your GP or hospital – you should phone your GP or call NHS Direct on 0845 46 47 or go to the website nhs

- Hygiene measures are important to help to reduce the spread of all viruses, including the swine flu virus. This includes:

* Covering your nose and mouth when coughing or sneezing and using a tissue when possible
* Disposing of dirty tissues promptly and carefully

* Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus
from your hands to your face or to other people
* Cleaning hard surfaces (such as door handles) frequently using a normal cleaning product.
- If you’re not poorly and do not have any symptoms there’s no reason that you shouldn’t continue to go about your daily routine.


View drug information on Tamiflu capsule.

States Begin Taking Steps To Address Collective $1 Trillion Unfunded Retiree Health Care Liability

State and local governments have begun to take “aggressive steps” to reduce liabilities of more than $1 trillion for health benefits for about 25 million current and future retirees as a result of a new accounting rule that took effect on Friday, USA Today reports (Cauchon, USA Today, 12/18). Under the rule, established by the Governmental Accounting Standards
Board, state and local governments for the first time must report their current and future liabilities for health and other benefits — such as dental, vision and life insurance. State and local governments must pay their liabilities over a 30-year period (Kaiser Daily Health Policy Report, 11/2). In response to the rule, state and local governments have begun to reduce retiree health benefits, allocate funds to cover future liabilities and shift costs to Medicare. For example:The West Virginia pension board on Wednesday plans to vote on a measure that would shift prescription drug coverage for retirees to Medicare;

North Carolina will require state employees hired after Oct. 1 to work 20 years, rather than five years, to qualify for full health benefits;

The San Diego City Council this month eliminated retiree health benefits for some city employees; and

South Carolina Gov. Mark Sanford (R) plans to propose a $245 million trust fund to help cover liabilities for retiree health benefits, and Georgia, New York City, Vermont and Virginia have established or considered similar trust funds.Ted Cheatham, director of the West Virginia Public Employees Insurance Agency, said, “By tackling this early, we hope to save money in the long run.” Charles Agerstrand, a retirement consultant for the Michigan Education Association, said, “These benefits are affordable as long as we do something now. If not, we’re heading for a major collision” (USA Today, 12/18).

“Reprinted with 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.

Public Employers Must Disclose Retiree Medical Benefits Costs After Dec. 15, According To New Rule

The Wall Street Journal on Thursday examined a new Governmental Accounting Standards Board rule, set to take effect the first fiscal year beginning after Dec. 15, that will require public employers to disclose costs of retiree medical benefits (Mincer, Wall Street Journal, 11/9). Under the rule, public agencies will have to report the current and future costs of health care and other benefits — such as dental, vision and life insurance — for the nation’s estimated 24.5 million public employees. GASB, a not-for-profit organization that establishes accounting standards for public agencies, created the rules in 2004 and allowed governments several years to put them in place. Under the rules, states must pay their liabilities over a 30-year period. If state officials choose not to earmark funds to cover the payments each year, the liabilities will count against the state’s net assets (Kaiser Daily Health Policy Report, 11/2). The new rule applies to state and local government employees, teachers, and county and city employees. Public employers with a minimum of $100 million in annual revenue will have to begin reporting the data the first fiscal year beginning after Dec. 15, while those with revenue of $10 million to $100 million have to report beginning by the same date in 2007. Employers with revenue under $10 million have until after Dec. 15, 2008. According to the Journal, in order to meet the new standard, “many states and cities will have no choice but to increase taxes and reduce services and benefits to meet these costs” (Wall Street Journal, 11/9).

“Reprinted with 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.