A recent study in theJournal of the American Medical Association recommended that all United States Doctors should be screening patients for alcohol abuse. This recommendation is an update from the previous guidance set forth in 2013 which stated that screening should take place if alcohol misuse was suspected.
Alcohol misuse, according to the previous study, was used to define a wide range of drinking behaviors including risky alcohol use, harmful alcohol use, and alcohol abuse or alcohol addiction.The most recent update to the US Preventive Services Task Force (USPSTF) recommendation on alcohol screenings states that individuals that are suspected of any unhealthy alcohol use should be screened. The study found, “the net benefit of screening and brief behavioral counseling interventions for unhealthy alcohol use in adults, including pregnant women, is moderate.” Evidence from the study is insufficient to determine a balance between the benefits and harms associated with screening and brief counseling for unhealthy alcohol use in adolescents.
Excluding the cost of providing assessment, the
recommendations of the USPSTF that all doctors offer risk assessment screening
for alcohol use, is based on both benefits and potential harms associated with
the service. Recognizing that clinical decisions often involve
considerations versus evidence alone, the USPSTF recommends that clinicians
make individual decisions as to screening necessity based on specific patient
What is Considered Unhealthy Alcohol Use?
A standard drink, according to the CDC, “contains 0.6 ounces (14.0 grams or 1.2 tablespoons) of pure alcohol.” This is generally the amount of alcohol that is found in:
A 12-ounce beer.
An 8-ounce glass of malt liquor.
5 ounces of wine.
1.5 ounces or about a shot of 80-proof distilled
spirits or liquor such as vodka, whiskey, rum or gin.
According to theAmerican Society of Addiction Medicine (ASAM), hazardous use of alcohol occurs when an individual drinks to a point in which the use of alcohol increases the risk of future negative health consequences. Unfortunately, a worldwide consensus as to what constitutes risky drinking has yet to be reached. However, any alcohol use among pregnant women is considered unhealthy and potentially hazardous.
Consumption of more than 1 drink per day for women, or more than 2 drinks per day for men, is considered potentially unhealthy. Excessive drinking can lead to dependence and physical withdrawal. Individuals that become addicted to alcohol often require professional alcohol detox to safely overcome the addiction.
Benefits of Physician Counseling for Alcohol Use
Although more research is necessary before the
task force can fully attest as to the benefits of modest physician counseling
or potential drawbacks of screening patients for alcohol use disorders, current
data suggests that there are zero risks associated with such interventional
treatment by physicians.
In fact, the only possible drawbacks found are
related to the possible stigma related to drinking habits and differences
between doctors in establishing clear guidelines as to what they consider to be
“unhealthy habits.” Likewise, patients may feel that the intimacy of the
patient-doctor relationship suffers as a result of the alcohol risk assessment,
but the potential for this outcome hardly negates the recommendations imposed.
Early detection of alcohol use disorder, or
potentially risky alcohol use, especially in pregnant women, leads to reduced
unhealthy alcohol use and improved behaviors. As such, the USPSTF has found
that brief behavioral counseling interventions in adults that screen positive
for risky or unhealthy alcohol use increases the likelihood that alcohol use is
reduced. Furthermore, in cases of pregnant women, counseling interventions
increase the likelihood that women abstain from alcohol use during pregnancy.
Fast-food restaurant chain Chipotle has announced it is changing its cooking methods in an effort to address food safety concerns, sparked by an E. coli outbreak at several of its restaurants.
Chipotle has been battling the outbreak since late October. More than 50 cases of E. coli have been reported in eight states.
As a result Chipotle’s share price has dropped 18% since October.
The company outlined the changes on its website and said it was taking “aggressive actions”.
Photo Chipotle Mexican Grill
“In the wake of recent food safety-related incidents at a number of Chipotle restaurants, we have taken aggressive actions to implement pioneering food safety practices,” a statement on the website said.
Chipotle restaurants will now dip fresh ingredients, like onions, in boiling water to kill off any germs. The company is also preparing ingredients, such as tomatoes, in a centralized kitchen where they can be washed, chopped and tested before being sent to restaurants.
Chicken will be marinated in plastic bags rather than bowls and coriander will be added to hot rice to allow the heat to remove any microbes.
In February, Chipotle warned investors it had a greater risk of exposure to food-borne illness than its rivals.
In its annual report the company said its use of fresh ingredients rather than frozen and traditional stovetop cooking, rather than automated, put it at greater risk than competitors like McDonalds.
The Centers for Disease Control and Prevention (CDC) has been unable to identify the specific cause of the E. coli spread.
Chipotle partnered with food safety consulting firm IEH Laboratories, to come up with the new preparation methods.
IEH also will conduct external assessments of individual branches. These will take place alongside weekly and quarterly food safety audits.
Chipotle shares have slumped more than 12% on November 20 after the Center for Disease and Control (CDC) reported more cases of E. coli linked to the Mexican restaurant chain.
According to the CDC, 45 people had been infected with a strain of E. coli, 43 of whom reported eating at a Chipotle restaurant.
The cases were in California, Minnesota, New York and Ohio.
Earlier this month, Chipotle temporarily closed 43 outlets in and around Washington and Oregon states.
This was after health officials investigated an E. coli outbreak that made at least 22 people ill.
Photo The Columbian
“The epidemiologic evidence available at this time suggests that a common meal item or ingredient served at Chipotle Mexican Grill restaurants in several states is a likely source of this outbreak,” the CDC said.
“The investigation is still ongoing to determine what specific food is linked to illness.”
Chipotle shares are now down by almost 19% this year, valuing the company at $17.3 billion.
coli, short for Escherichia coli, is a type of bacterium present in the gut of humans and other animals.
Most strains are harmless but some can produce toxins that cause sickness in humans.
According to Mayo Clinic, E. coli infection typically begins three or four days after exposure to the bacteria, though you may become ill as soon as one day after to more than a week later. Signs and symptoms include:
Diarrhea, which may range from mild and watery to severe and bloody
Abdominal cramping, pain or tenderness
Nausea and vomiting, in some people
Contact your doctor if your diarrhea is persistent, severe or bloody.
Fifty one labs in 17 states and three foreign countries have been mailed samples of live anthrax, Pentagon officials have said on June 3.
The announcement doubled the number of incidents in the US. A smaller number of shipments were revealed last week.
Staff members at some of the labs have been treated for anthrax exposure as a precaution, but no-one has fallen ill.
The Pentagon has maintained there is no risk to the general public.
The Centers for Disease Control and Prevention (CDC) is leading the investigation into the incidents.
Photo Getty Images
According to defense official Robert Work, the number of affected laboratories is expected to rise.
Experts in biosafety have heavily criticized the lapse and called for improved precautions.
Symptoms of anthrax exposure include skin ulcers, nausea, vomiting and fever, and can cause death if untreated.
The military has ordered all of its labs that have previously received inactive anthrax samples to test them. In addition it is advising all labs to cease working with these samples until told otherwise.
Pentagon officials say there was no sign the live samples were sent due to any deliberate action.
The samples were mailed from a Utah army facility by commercial post to laboratories over the past 10 years.
In addition to the US labs, samples were sent to facilities in Australia, Canada and South Korea.
Blue Bell Ice Cream has suspended operations at its Oklahoma plant after health officials linked the deaths of three people to contaminated ice cream.
“We are taking this step out of an abundance of caution to ensure that we are doing everything possible to provide our consumers with safe products and to preserve the trust we have built with them and their families for more than a century,” the company said in a statement on April 3.
Last month, Blue Bell and health officials said a 3-ounce cup of ice cream contaminated with listeriosis was traced to a plant in Broken Arrow, Oklahoma. The now-recalled ice cream product — cups of chocolate, strawberry and vanilla — is not sold in retail locations and is shipped in bulk to “institutional accounts” such as hospitals in 23 states that comprise less than 5% of the company’s sales.
“We recommend that consumers do not eat any Blue Bell brand products made at the company’s Oklahoma facility and that retailers and institutions do not sell or serve them,” the U.S. Centers for Disease Control and Prevention (CDC) said on April 3.
Ten products recalled earlier in March were from a production line at a plant in Brenham, Texas, the company’s headquarters.
The recall, the first in Blue Bell’s 108-year history, began when five patients at Via Christi St. Francis hospital in Wichita, Kansas, became ill with listeriosis while hospitalized at some point from December 2013 to January 2015. Officials determined at least four drank milkshakes that contained Blue Bell ice cream. Three of the patients later died.
Listeriosis is a life-threatening infection caused by eating food contaminated with bacteria called Listeria monocytogenes, according to the CDC. The disease primarily affects pregnant women, newborns, older adults and people with weakened immune systems.
The CDC also said on April 3 that it has identified six patients with listeriosis between 2010 and 2014 that was indistinguishable from that found in the 3-ounce cup ice cream product traced to the Oklahoma plant.
Four of the six patients were hospitalized in Texas for unrelated problems before developing listeriosis, according to the CDC.
The one patient for whom information is available reported eating ice cream in a Texas hospital before developing listeriosis and the Texas Department of State Health Services reported the hospital had received Blue Bell brand ice cream cups, the CDC said.
The “investigation to determine whether these illnesses are related to exposure to Blue Bell products is ongoing,” the CDC said.
Blue Bell said it will conduct a “careful and complete examination” of its Oklahoma plant “to determine the exact cause of the contamination.”
“Once our investigation is complete and we have made all necessary improvements, it will return to operation,” according to Blue Bell’s statement.
“Our other plants continue to operate and supply our products to retail stores and institutional customers.”
The FDA has been notified of Blue Bell’s decision to voluntarily shut down the plant, the company said.
In addition to the Broken Arrow plant, Blue Bell has two plants in Brenham and one in Sylacauga, Alabama.
The recalled ice cream had been shipped to Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nevada, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wyoming.
Ten US healthcare workers are being evacuated from Sierra Leone after another aid worker back from the West African country had tested positive for Ebola and was being treated in hospital near Washington DC.
The evacuees may have been in contact with the Ebola patient and are being flown back on non-commercial transport.
The Centre for Disease Control and Prevention (CDC) said none were currently showing Ebola symptoms.
They will stay in voluntary isolation for a 21-day incubation period. If any start to show symptoms they will be taken to one of three hospitals which are equipped to deal with Ebola cases.
On March 13, the CDC sent a team to Sierra Leone to investigate how the healthcare worker became exposed and determine who might have been in contact with the infected person.
The patient is being treated at the National Institutes of Health in Maryland.
It is the 11th person with the deadly virus to be treated in the US.
More than 10,000 people have died in the current Ebola outbreak.
Dr. Tom Frieden, head of the Centers for Disease Control and Prevention (CDC), has said a mistake was “clearly” made by staff treating Thomas Eric Duncan who died of Ebola in Texas, resulting in one being infected.
The female health worker infected is in an isolation ward in stable condition, awaiting confirmation of her diagnosis.
Tom Frieden said a full inquiry would be made into how the transmission occurred.
He said 48 other people who may also have had contact were being observed.
The health worker at Texas Health Presbyterian Hospital wore full protective gear while treating Ebola victim Thomas Eric Duncan, health officials in Dallas say.
Thomas Eric Duncan, who caught the virus in his native Liberia, died on October 8.
The current Ebola outbreak, concentrated in Liberia, Guinea and Sierra Leone, has resulted in more than 8,300 confirmed and suspected cases, and at least 4,033 deaths.
Dr. Thomas Frieden said a full investigation would be conducted into how the infection had occurred.
A female health worker at Texas Health Presbyterian Hospital has been infected with Ebola virus after treating Thomas Eric Duncan
“Clearly there was a breach in protocol,” he told CBS.
The CDC investigation, he told reporters, would focus on possible breaches made during two “high-risk procedures”, dialysis and respiratory intubation.
Education and training of health workers would be stepped up, he said, and efforts would be made to reduce the number of staff treating Ebola cases.
Dr. Daniel Varga, of the Texas Health Resource, said the health worker had worn a gown, gloves, mask and shield when providing care to Thomas Eric Duncan during his second and final hospital admission.
Following a positive preliminary test for Ebola, follow-up tests on the infected health worker are due to be completed on Sunday, October 12.
Police are guarding the apartment complex where the woman lives in Dallas as decontamination work is carried out.
No details of her identity or position at the hospital have been given, in accordance with family wishes.
Thomas Eric Duncan tested positive in Dallas on September 30, 10 days after arriving on a flight from Monrovia via Brussels.
He had become ill a few days after arriving in the US, and went to the hospital in Dallas with a high fever.
However, despite telling medical staff he had been in Liberia, Thomas Eric Duncan was sent home with painkillers and antibiotics.
Thomas Eric Duncan was later put into an isolation unit at the hospital but died despite being given an experimental drug.
According to a CDC report, the US government infectious disease labs mishandled dangerous pathogens five times in the last decade.
In 2014, workers mishandled samples of anthrax and the highly-infectious H5N1 avian flu.
In response, the Center for Disease Control and Prevention (CDC) has closed the two labs involved.
The agency has also temporarily barred high-security labs from transporting dangerous pathogens.
There have been no reported infections from previous cases, and no-one potentially exposed to anthrax has shown signs of illness, CDC officials said.
“These events should never have happened,” CDC Director Tom Frieden told reporters on Friday.
A CDC report revealed that the US government infectious disease labs mishandled dangerous pathogens five times in the last decade
“I’m disappointed, and frankly I’m angry about it,” he said, adding later he was “astonished that this could have happened here”.
The incidents were listed in a report on a potential anthrax exposure in June, which occurred when researchers in a high-level biosecurity laboratory failed to follow proper procedures and did not deactivate the bacteria.
The samples were then moved to a lower-security lab in the agency’s Atlanta campus.
“This is not the first time an event of this nature has occurred at CDC, nor the first time it occurred from the [bioterror response] laboratory,” the report said.
The CDC only recently learned of a separate incident in May in which a sample of the avian flu was cross-contaminated with a highly pathogenic version of the virus and then shipped to an agriculture department laboratory.
The influenza lab and the bioterror response laboratory have been temporarily closed in response.
The other incidents reported by the CDC:
In 2006, the CDC’s bioterror lab transferred anthrax DNA to outside labs, believing the sample had been deactivated
Also in 2006, samples from a different CDC lab were found to contain live botulism bacteria
Researchers sent an infectious strain of the bacterium Brucella to outside laboratories as early as 2001 because they mistook it for a vaccine version; newly available test methods in 2009 confirmed it was not.
The revelations come just days after US officials announced long forgotten vials of smallpox left in a cardboard box had been discovered by a government scientist at a research centre near Washington.
The virus was located in six freeze-dried and sealed vials, according to the CDC.
On Friday, the CDC announced that at least two of the vials contained the live virus but that no infections had been reported as a result of the incident.
It is believed to be the first time unaccounted-for smallpox was been discovered in the US. The disease was officially declared eradicated in the 1980s.
The US Centers for Disease Control and Prevention (CDC) has said the number of health workers potentially exposed to anthrax has risen to 84.
The count of those at risk of illness has risen from the 75 initially reported on Thursday.
The CDC said researchers in a high-level biosecurity laboratory failed to follow proper procedures and did not inactivate the bacteria.
The exposure occurred in Atlanta at the weekend, the CDC has said.
The FBI is helping the CDC to investigate. The agency said it was too early to determine whether the transfer was accidental or intentional.
Eighty four Atlanta-based CDC scientists were possibly exposed to live anthrax
Symptoms of anthrax exposure include skin ulcers, nausea and vomiting and fever, and can lead to death.
Anthrax bacteria live primarily in inactive spores and are found naturally in the soil, but people can ingest or inhale spores, which can make the anthrax active.
Not everyone will fall sick when exposed to anthrax but left untreated, anthrax illness can turn very serious or lead to death.
Tests to confirm anthrax exposure include a blood swab.
Anthrax entered the US national consciousness in 2001, when shortly after the 9/11 attacks, letters containing powdered anthrax arrived at news organizations and the offices of US senators. Twenty-two people became ill and of those, five people died.
In a statement, the CDC said the anthrax samples were moved from a high-security lab to a lower-security one at their Atlanta headquarters.
“Workers, believing the samples were inactivated, were not wearing adequate personal protective equipment while handling the material,” the agency said.
“The unintentional exposure was discovered June 13 when the original bacterial plates were gathered for disposal and B. anthracis colonies [live bacteria] were found on the plates.”
The normal incubation period for anthrax illness can take up to seven days, but there have been cases of illness occurring as many as 60 days after exposure.
Fifty-four of the 84 identified employees had been treated at the CDC’s health clinic by Thursday morning, with two refusing a course of antibiotics. Twenty-seven employees also began the anthrax vaccine.
The Centre for Disease Control and Prevention is urging people to get vaccinated after a spike in measles cases in the US this year.
The CDC reported 288 cases of measles in the first five months of 2014 – the largest number for 20 years.
The outbreak is thought to be linked to US citizens travelling to the Philippines.
The CDC says timely vaccination is the best way to prevent measles.
Dr. Anne Schuchat, director of CDC’s National Centre for Immunizations and Respiratory Diseases, said many US healthcare providers had never seen or treated a patient with measles because of the country’s robust vaccination efforts and rapid response to outbreaks.
The CDC reported 288 cases of measles in the first five months of 2014, the largest number for 20 years
Measles was eliminated from the US in 2000, meaning that for more than 12 months there was no longer any continuous measles transmission.
She said: “The current increase in measles cases is being driven by unvaccinated people, primarily US residents, who got measles in other countries, brought the virus back to the United States and spread to others in communities where many people are not vaccinated.”
“Many of the clusters in the US began following travel to the Philippines where a large outbreak has been occurring since October 2013.”
Of the 288 cases, 280 were thought to have been imported from at least 18 countries.
Ninety per cent of all measles cases in the US occurred in people who were not vaccinated or whose vaccination status was unknown.
More than one in seven cases has led to stays in hospital.
In the US, the CDC recommends two doses of measles, mumps, and rubella (MMR) vaccine for everyone starting at age 12 months.
For those travelling abroad, the CDC recommends that babies older than six months receive the MMR vaccine.
Measles is a serious viral illness that is highly contagious.
The initial symptoms of measles develop around 10 days after infection. These can include cold-like symptoms, red eyes and sensitivity to light, a high temperature or fever and greyish white spots in the mouth and throat.
After a few days, a red-brown spotty rash will appear. This usually starts behind the ears and then spreads around the head and neck before spreading to the rest of the body.
Measles is still common in many parts of the world, including countries in Europe, Asia, the Pacific, and Africa.
The Centers for Disease Control and Prevention (CDC) officials have confirmed a second case in the country of MERS, a virus that has killed at least 145 people, mostly in Saudi Arabia.
The CDC identified the patient as a healthcare worker who travelled from Saudi Arabia to Orlando, Florida.
Middle East respiratory syndrome (MERS) causes fever and kidney failure but is not considered highly contagious.
The patient has been isolated in hospital, health officials said.
MERS belongs to the coronavirus family, which includes the common cold and SARS, or severe acute respiratory syndrome, which caused some 800 deaths globally in 2003.
MERS belongs to the coronavirus family, which includes the common cold and SARS
Health officials say MERS only appears to spread through close contact, but there is no known cure.
“This is unwelcome but not unexpected news,” CDC director Tom Friden told reporters on Monday of the Florida case.
The Florida patient is not connected to the first confirmed US case, reported two weeks ago in Indiana, although the patients’ circumstances are similar.
A healthcare worker who “works and resides” in Saudi Arabia, the Florida patient took a flight on May 1st from Jeddah to London’s Heathrow Airport, then continued on to Boston, Atlanta and finally Orlando.
Health officials said they were contacting passengers on those flights “out of an abundance of caution” and directing them to look out for symptoms which include high fever, cough and shortness of breath.
The first confirmed MERS patient, also a healthcare worker in Saudi Arabia, has been released from hospital and is “fully recovered”.
CDC officials said they had found no secondary infections from the Indiana case and genome testing suggested the virus was not changing, despite a growing number of cases reported in Saudi Arabia since March.
According to the World Health Organization (WHO), 538 MERS cases have been reported worldwide since 2012, with 145 deaths. The vast majority of cases have been found in Saudi Arabia, especially among healthcare workers.
On Sunday, Saudi Arabia urged its citizens to wear masks and gloves when dealing with camels so as to avoid spreading MERS.