Women Hit Hard in Rising Toll From Painkiller Overdoses

Source: New York Times 7-2-2013

Prescription painkiller addiction has long been seen as mainly a man’s problem, but a new analysis of federal data released Tuesday shows that in recent years the death rate has risen far faster among women.

Fatal overdoses from prescription pain pills increased fivefold among women from 1999 to 2010, the most recent year for which the federal government has final data. The rate among men tripled over the same period, according to the analysis, which was conducted by the Centers for Disease Control and Prevention.

More women die from drug overdoses than from cervical cancer or car accidents. Four times as many died over the last decade from drug overdoses than from homicides. And while the absolute number of overdose deaths is still higher for men, women are catching up.

The rising rate of overdoses among women is what Dr. Thomas R. Frieden, the director of the C.D.C., called “a sleeper problem.” Even medical professionals who work in the field expressed surprise, he said.

“It’s a big problem among women,” Dr. Frieden said. “It’s underrecognized.”

Experts offered medical theories for the rise. Women have smaller body mass than men, so the gap between a therapeutic dose and a dangerous dose is narrower. Some studies have found that women are more likely to have chronic pain. Other patterns in women are not well understood. For example, they are more likely to be given higher doses of painkillers, and more likely than men to use them for a long time.

Women addicts interviewed for this article said they believed that it had to do with the changing nature of American society. The rise of the single-parent household has thrust immense responsibility on women, who are both the primary breadwinner and parent. Some said they craved the numbness that drugs bring as a response to feeling overwhelmed by life’s responsibilities. Others said highs brought feelings of prettiness, strength and productiveness.

The rate among women for all drug overdose deaths — not just those from painkillers — was highest for those ages 45 to 54, the C.D.C. analysis found. In 2010, 15,323 women died of drug overdoses, compared with 23,006 men. Among men and women, the highest death rate was among Native Americans and whites.

Ola de frio en Europa

Image via Wikipedia

La ola de frío ya dejó más de 480 muertos en Europa

Un frío glacial acompañado de fuertes nevascas y ráfagas de viento persistía este miércoles en Europa, donde causó más de 480 muertos en apenas dos semanas, la mayoría en el Este del continente, aunque también afectaba duramente a Italia y a la región de los Balcanes.

En Polonia, el número de muertos por hipotermia se eleva ya a 74, con cinco más en apenas 24 horas, informó la policía. Y hay que sumarles unas 50 personas muertas a causa de chimeneas defectuosas, que provocaron asfixia por monóxido de carbono y varios incendios.

El frío ya provocó 24 muertos en la República Checa, 23 en Lituania, 10 en Letonia, tres en Eslovaquia y uno en Estonia.

En la madrugada del miércoles las temperaturas habían caído en Moscú a 22 grados centígrados bajo cero, aunque en la región de Iakutie, en la Siberia oriental, los termómetros indicaban 34 grados negativos.

En lo que va de año el frío provocó la muerte de por lo menos 110 adultos, de acuerdo con el Ministerio de Salud.

Los servicios de previsión meteorológica indicaron que "las temperaturas permanecerán muy bajas en la región del centro de la Rusia europea, y el frío se acentuará más en el fin de semana".

Pese a que el país está acostumbrado a los inviernos crudos, el clima de los últimos días es difícil de soportar.

"Es difícil enfrentar este frío", dijo Katya, de 24 años, protegida con un enorme sombrero de lana roja. Según Pavel Sterlikov, de 27 años, "un frío como éste sólo lo tenemos cada cinco años".

Bulgaria era el miércoles uno de los países más afectados, con enormes tempestades de nieve que paralizaron literalmente todos los transportes en el nordeste y el este del país, mientras que en el sur el tránsito continuaba suspendido a raíz de las inundaciones del lunes, que dejaron ocho muertos.

En diversas localidades del país la situación era caótica, con testimonios de automovilistas varados en la nieve sin combustible ni información y aldeas enteras aisladas sin comida ni electricidad.

Puestos fronterizos de Bulgaria con Turquía y con Rumania tuvieron que ser cerrados, así como los grandes puertos búlgaros sobre el mar Negro, en Varna y Burgas. Las autoridades decidieron que las escuelas permanecerán cerradas hasta nuevo aviso, ante la previsión de nuevas nevadas.

En la parte más occidental, Italia es el país con nevadas más espectaculares, y desde el 1 de febrero el número de muertos asciende a 40.

En Venecia, una estatua de 9 metros de altura del artista Guerrino Lovato, símbolo del célebre carnaval de este año, fue derribada por violentas ráfagas de viento de hasta 80 km por hora.

A su vez, en Turín el hielo provocó la ruptura de caños que inundaron cuatro estaciones del metropolitano.

La situación era muy difícil incluso en el sur del país, a raíz de un manto de nieve que llegó a casi tres metros de espesor en la región de Basilicata. Toda la región italiana próxima al mar Adriático sufrirá nevascas en los próximos días.

En Serbia, Croacia, Bosnia, Macedonia y Montenegro por lo menos 70.000 personas llevan días aisladas en aldeas recónditas a causa del cierre de rutas por el exceso de nieve.

Sera el cambio climatico ?

El cierre del tráfico fluvial por el río Danubio el miércoles, ante congelamiento de centenas de kilómetros, también provocó enormes trastornos en la región.

En Bosnia, donde las temperaturas cayeron a 20 grados centígrados bajo cero, más de 15.000 personas en la región de Mostar (en el sur del país) se encontraban el miércoles sin energía eléctrica.

Tres personas murieron por hipotermia en Rumania en las últimas 24 horas, elevando a 41 el total desde el 24 de enero. Todo el sur de Rumania se mantiene en estado de alerta ante la previsión de nuevas nevascas.

En tanto, en Hungría, el saldo de víctimas por hipotermia se elevó a 16 con la muerte de tres personas el martes, de acuerdo con los servicios de socorro.

En los otros países de la región se vivía el miércoles un escenario similar. En Austria, la muerte de un jubilado de 70 años elevó el saldo de víctimas fatales a cinco desde la llegada de la ola de frío.

El saldo de muertos en Alemania se mantiene en cuatro, pero las autoridades alertaron a la población ante la previsión de nuevas tempestades de nieve. El tráfico fluvial en el río Meno fue suspendido.

Las autoridades francesas informaron que el número de muertos se elevó a cinco, con la muerte de cuatro personas por intoxicación con monóxido de carbono.

Ginebra, en Suiza, seguía tratando de resolver el caos de tráfico provocado por la ruptura de un enorme caño de desagüe a causa del exceso de hielo.

bur-pm/jls/ahg/erl

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Pediatric deaths due to varicella are becoming a thing of the past

                       Image via Wikipedia Source: MD Consult

ST LOUIS (MD Consult) - With implementation of the varicella vaccination program in the United States, deaths due to the disease among children and adolescents have virtually ceased, finds a study reported in the August 2011 issue of Pediatrics.

Using data from the Mortality Multiple Cause-of-Death records of the US National Center for Health Statistics, investigators analyzed temporal patterns of deaths among individuals of all ages for which varicella was listed as an underlying or contributing cause between 1990 and 2007. The vaccination program was introduced in 1995.

Over the first 12 years of the program, the annual average mortality rate for varicella listed as the underlying cause fell by 88%, from 0.41 per million population in 1990-1994 to 0.05 per million population in 2005-2007.

The same pattern was evident across all age-groups. The reduction was 97%, 90%, and 67% among children and adolescents younger than 20 years, among adults aged 20 to 49 years, and among adults aged 50 years or older, respectively.

In the last 6 years analyzed (2002-2007), there were 3 deaths each among children aged 1 to 4 years and aged 5 to 9 years; in sharp contrast, there were an average of 13 and 16 deaths annually, respectively, before the vaccine was introduced.

All of the deaths among children and adolescents younger than 20 years in 2002-2007 occurred in those who did not have high-risk conditions as strictly defined by the study, although 3 occurred in children or adolescents having conditions that could increase risk.

"The impressive decline in varicella deaths can be directly attributed to successful implementation of the 1-dose vaccination program," the investigators conclude. "With the current 2-dose program, there is potential that these most severe outcomes of a vaccine-preventable disease could be eliminated."

Pediatrics. 2011;128:214-220. 

 

• Did the varicella zoster vaccine prove to be effective long term?
• A prospective cohort study evaluated the long-term effectiveness of the vaccine, its impact on varicella and herpes zoster epidemiology, and the impact of a second dose of the vaccine.
• Long-term follow-up demonstrated that varicella vaccination was effective at preventing chicken pox and seemed to lower risk of herpes zoster over a 14-year period.

---

SUMMARY

Practice Update Editorial Team

Vaccination of children for varicella zoster virus (VZV) has substantially decreased incidence of disease. Before the vaccine was licensed and recommended in the United States, VZV infection was highly prevalent, with more than 90% of people experiencing an infection by the age of 20 years. The efficacy of one dose of this medication was shown to be high in clinical trials, with a recent implementation of a second dose showing increased effectiveness in multiple studies. The overall effect of this vaccination on herpes zoster (HZ) incidence is not well understood.
In this prospective cohort study, Baxter et al aimed to assess the long-term effectiveness of the vaccine, its impact on varicella and HZ epidemiology, and the impact of the second dose, which was introduced in 2006. The study was conducted at multiple Kaiser Permanente Northern California sites and included children 12 to 23 months of age who received varicella vaccination in 1995. Consenting parents were interviewed via telephone every 6 months for 14 years, until 2009. Outcomes included breakthrough cases of varicella, number of lesions, and rates of HZ. Person-time was calculated based on the interview cycle.
The analytic cohort included 7386 patients and a total of 103,098 person-years (PY) were collected. In the 14 years after varicella vaccination, there were 1505 cases of breakthrough varicella. All cases followed the first vaccine dose. No cases of breakthrough were reported after the second dose was received. The average incidence was 15.9 cases per 1000 PY (95% CI, 15.1–16.7). This finding represented a 9 to 10 times lower rate of incidence as compared with same-aged children in the era preceding vaccination. Effectiveness was 89% to 90%, depending on the reference study. Of the 113 reported cases of HZ, 46 cases were confirmed. This finding represented an incidence rate of 0.45 per 1000 PY (95% CI, 0.33–0.60). Compared to similar children who experienced naturally acquired varicella, this finding suggested a 40% decreased incidence in those who were vaccinated.
This prospective cohort study showed, over 14 years of follow-up, varicella vaccination was effective in preventing VZV, with no evidence of waning effectiveness. Further, findings suggested a decreased incidence rate of HZ among vaccinated children as compared with unvaccinated children of the same age.

 

Long-term Effectiveness of Varicella Vaccine: A 14-Year, Prospective Cohort Study

1. Roger Baxter, MD^a,
2. Paula Ray, MPH^a,
3. Trung N. Tran, MD, PhD^b,
4. Steve Black, MD^c,
5. Henry R. Shinefield, MD^d,
6. Paul M. Coplan, ScD, MBA^e,
7. Edwin Lewis, MPH^a,
8. Bruce Fireman, MA^a, and
9. Patricia Saddier, MD, PhD^b

+ Author Affiliations

1. ^aKaiser Permanente Vaccine Study Center, Oakland, California;
2. ^bEpidemiology Department, Merck Sharp & Dohme Corp, Whitehouse Station, New Jersey;
3. ^cCenter for Global Health, Cincinnati Children’s Hospital, Cincinnati, Ohio;
4. ^dUniversity of California San Francisco Medical Center, University of California, San Francisco, San Francisco, California; and
5. ^ePurdue Pharma, Stamford, Connecticut

Abstract from Pediatrics

BACKGROUND: Varicella vaccine was licensed in the United States in 1995 for individuals ≥12 months of age. A second dose was recommended in the United States in June 2006. Varicella incidence and vaccine effectiveness were assessed in a 14-year prospective study conducted at Kaiser Permanente Northern California.

METHODS: A total of 7585 children vaccinated with varicella vaccine in their second year of life in 1995 were followed up prospectively for breakthrough varicella and herpes zoster (HZ) through 2009. A total of 2826 of these children received a second dose in 2006–2009. Incidences of varicella and HZ were estimated and compared with prevaccine era rates.

RESULTS: In this cohort of vaccinated children, the average incidence of varicella was 15.9 per 1000 person-years, nine- to tenfold lower than in the prevaccine era. Vaccine effectiveness at the end of the study period was 90%, with no indication of waning over time. Most cases of varicella were mild and occurred early after vaccination. No child developed varicella after a second dose. HZ cases were mild, and rates were lower in the cohort of vaccinated children than in unvaccinated children during the prevaccine era (relative risk: 0.61 [95% confidence interval: 0.43–0.89]).

CONCLUSIONS: This study confirmed that varicella vaccine is effective at preventing chicken pox, with no waning noted over a 14-year period. One dose provided excellent protection against moderate to severe disease, and most cases occurred shortly after the cohort was vaccinated. The study data also suggest that varicella vaccination may reduce the risks of HZ in vaccinated children.