jueves, 11 de febrero de 2016

Foreword | MMWR

MMWR Supplements

Vol. 65, Supplement, No. 1

February 12, 2016

In this report


Thomas R. Frieden, MD, MPH.
MMWR Suppl 2016;65(Supplement, No. 1):1

One of the four overarching goals of Healthy People 2020 is to eliminate health disparities. In 

2011 and 2013, CDC’s published Health Disparities and Inequalities reports that assessed disparities 

across a wide range of factors. As a follow up to the reports, CDC is publishing reports that present 

specific interventions that have proven effective in reducing disparities. This report is the second in 

the series and address particular disparities observed by race and ethnicity, socioeconomic status, 

geographic location, disability, and sexual orientation across a range of conditions, including asthma, 

infection with HIV and Hepatitis A, use of colorectal cancer screening, youth violence, food security, 

and health-related quality of life.

Background and Rationale

Ana Penman-Aguilar, PhD; Karen Bouye, PhD; Leandris Liburd, PhD; et al.
MMWR Suppl 2016;65(Supplement, No. 1):2–3

Health Promotion and Diabetes Prevention in American Indian and Alaska Native Communities — Traditional Foods Project, 2008–2014

Dawn Satterfield, PhD; Lemyra DeBruyn, PhD; Marjorie Santos, MPH; et al.
MMWR Suppl 2016;65(Supplement, No. 1):4–10

Community Asthma Initiative to Improve Health Outcomes and Reduce Disparities Among Children with Asthma 

Elizabeth R. Woods, MD; Urmi Bhaumik, ScD; Susan J. Sommer, MSN; et al.
MMWR Suppl 2016;65(Supplement, No. 1):11–20

Use of Evidence-Based Interventions to Address Disparities in Colorectal Cancer Screening

Djenaba A. Joseph, MD; Diana Redwood, PhD; Amy DeGroff, PhD; et al.
MMWR Suppl 2016;65(Supplement, No. 01):21–28

Progress Toward Eliminating Hepatitis A Disease in the United States

Trudy V. Murphy, MD; Maxine M. Denniston, MSPH; Holly A. Hill, MD, PhD; et al.
MMWR Suppl 2016;65(Supplement, No. 1):29–41

Adaptation and National Dissemination of a Brief, Evidence-Based, HIV Prevention Intervention for High-Risk Men Who Have Sex with Men

Jeffrey H. Herbst, PhD; Jerris L. Raiford, PhD; Monique G. Carry, PhD; et al.
MMWR Suppl 2016;65(Supplement, No. 01):42–50

The HoMBReS and HoMBReS Por un Cambio Interventions to Reduce HIV Disparities Among Immigrant Hispanic/Latino Men

Scott D. Rhodes, PhD; Jami S. Leichliter, PhD; Christina J. Sun, PhD; et al.
MMWR Suppl 2016;65(Supplement, No. 1):51–56

Preventing Violence Among High-Risk Youth and Communities with Economic, Policy, and Structural Strategies

Greta M. Massetti, PhD; Corinne David-Ferdon, PhD.
MMWR Suppl 2016;65(Supplement, No. 1):57–60

Living Well with a Disability, a Self-Management Program

Craig Ravesloot, PhD; Tom Seekins, PhD; Meg Traci, PhD; et al.
MMWR Suppl 2016;65(Supplement, No. 01):61–67


Leandris C. Liburd, PhD; Karen E. Bouye, PhD; Ana Penman-Aguilar, PhD.
MMWR Suppl 2016;65(Supplement, No. 1):68–69

Foreword | MMWR

CDC. Centers for Disease Control and Prevention. CDC 24/7: Saving Lives. Protecting People.


Thomas R. Frieden, MD, MPH

Director, CDC
View suggested citation

Reducing health disparities is a major goal of public health. Despite the persistence of disparities, progress is being made. Since 2011, CDC Health Disparities and Inequalities Reports (1,2) and the inaugural Strategies for Reducing Health Disparities report (3) have highlighted effective public health programs that have demonstrably reduced disparities. The reports in this supplement add to this record of progress.
There are six key components to effective public health program implementation: innovation, a technical package of evidence-based interventions, performance management, partnerships, effective communication, and political commitment (4). Among these, performance management, the real-time monitoring and evaluation of programs to ensure continuous program improvement, is particularly important to reduce disparities.
Public health programs can be particularly difficult to manage because of the inability to track program performance in real time. Moreover, results might not be apparent for months or even years. As a result, all programs must include sustainable monitoring systems that provide simple, accurate information on progress in program implementation and long-term impact. Even the best-designed programs might fail without timely, honest evaluation.
The reports in this Supplement detail various CDC or CDC-funded programs that incorporate effective performance management. For example:
  • Over a decade, the Advisory Committee on Immunization Practices made incremental changes to hepatitis A (HepA) vaccination recommendations intended to increase coverage for children and persons at high risk for HepA infection. CDC analysis of data sets established that the recommended vaccinations eliminated most disparities in HepA disease by age, racial and ethnic group, and geographic area. The analysis also documented an increased proportion of HepA among an emerging population of susceptible adults, underscoring the importance of improving programs and avoiding complacency (5).
  • After conducting a needs assessment over two years, Boston Children’s Hospital and CDC researchers developed a program at Harvard Medical School to address disparities in pediatric asthma mortality. Targeting primarily black and Hispanic low-income neighborhoods served by Boston Children’s Hospital, the program offered families advanced asthma care, including care coordination, case management, and home visits. Evaluation compared program enrollees with children with asthma living in demographically similar areas. The program significantly improved asthma outcomes over a three-year period and has been adapted and replicated in other cities and states (6).
  • Racial and ethnic minority groups, persons without health insurance, and households with low educational attainment and income have lower rates of colorectal cancer (CRC) screening. Since 2009, CDC’s Colorectal Cancer Control Program has worked with states and tribal organizations to create and implement programs to increase CRC screening. Evaluation of two programs, one by the Alaska Native Tribal Health Consortium and another by Washington State’s Breast, Cervical and Colon Health program, indicated that they increased CRC screening in underserved populations each year to levels similar to statewide rates in which patient navigators coordinate CRC screening services and perform community outreach. Previous studies validated the efficacy of patient-navigator services in increasing medical screening rates (7,8).
These and other reports in this supplement demonstrate that public health disparities can be overcome by innovative, well-designed, and consistently evaluated programs that build viable and sustainable long-term partnerships and inspire political commitment through effective implementation and communication.


  1. CDC. CDC health disparities and inequalities report—United States, 2011. MMWR 2011;60(Suppl; January 14, 2011).
  2. CDC. CDC health disparities and inequalities report—United States, 2013. MMWR 2013;62(No. Suppl 3).
  3. CDC. Strategies for reducing health disparities—selected CDC-sponsored interventions, United States, 2014. MMWR 2014;63(Suppl; April 18, 2014).
  4. Frieden TR. Six components necessary for effective public health program implementation. Am J Public Health 2014;104:17–22 . CrossRef
  5. Murphy TV, Denniston M, Hill HA, et al. Progress toward eliminating hepatitis A in the United States. MMWR Suppl 2016:65(No. Suppl 1).
  6. Woods ER, Bhaumik U, Sommer SJ, et al. Community asthma initiative to improve health outcomes and reduce disparities among children with asthma. MMWR Suppl 2016:2016(No. Suppl 1).
  7. Joseph DA, Redwood D, DeGroff A, Butler EL. Use of evidence-based interventions to address disparities in colorectal cancer screening. MMWR Suppl 2016:2016;65(No. Suppl 1).
  8. Community Preventive Services Task Force. Updated recommendations for client- and provider-oriented interventions to increase breast, cervical, and colorectal cancer screening. Am J Prev Med 2012;43:92–6 . CrossRef
Suggested citation for this article: Frieden TR. Foreword. MMWR Suppl 2016;65:1. DOI: http://dx.doi.org/10.15585/mmwr.su6501a1.
Foreword | MMWR

Check out the updated Alzheimer’s clinical trials search & new studies

e-Update from the Alzheimer's Disease Education and Referral Center, a service of the National Institute on Aging at N I H

Interested in participating in Alzheimer’s and related research? Find clinical trials and studies with the NIA’s newly updated search tool! With the tool’s fresh look and enhanced search capability, you can search by keyword, location, and type of trial—and get customized results in seconds.
Below are the newest trials in NIA’s listing. Click on a trial name below for details, including contact information.

Mild Cognitive Impairment

Brain Imaging

Other Dementias

Other Trials


  • GeneMatch (nationwide)—enroll to get matched to Alzheimer’s genetics studies
  • Alzheimer’s Prevention Registry (nationwide)—get information and updates about participating in future Alzheimer’s prevention trials.
  • Brain Health Registry (nationwide)—sign up for an online study of brain health and learn about possible research-study opportunities.

Get more information about these and other Alzheimer’s clinical trials. Or, call the ADEAR Center at 1-800-438-4380 (toll-free) or email adear@nia.nih.gov.

Help us spread the word about Alzheimer’s and related clinical trials!

  • Forward this email to anyone who may be interested.
  • Share via social media:

    Looking for #Alzheimer’s and related clinical trials and studies? Find information here: http://1.usa.gov/Y1zmEN

Clarifying What We Mean When We Talk About Biomarkers: An NIH/FDA Joint Leadership Council Success | FDA Voice

Clarifying What We Mean When We Talk About Biomarkers: An NIH/FDA Joint Leadership Council Success | FDA Voice

Clarifying What We Mean When We Talk About Biomarkers: An NIH/FDA Joint Leadership Council Success

By: Melissa A. Robb, B.S.N., M.S. (RegSci), and Robert M. Califf, M.D.
What if there was a more uniform way to convey key technical terms to help advance scientific progress? Thanks to the Biomarkers, Endpoints, and other Tools (BEST) Resource, we’re one step closer to that goal.
Melissa Robb
Melissa A. Robb, B.S.N., M.S. (RegSci), FDA’s Associate Director for Regulatory Affairs, Office of Medical Policy, Center for Drug Evaluation and Research
Now available on the National Center for Biotechnology Information’s Bookshelf, the BEST Resource was developed through a collaboration of the Food and Drug Administration (FDA) and the National Institutes of Health (NIH). It includes a glossary of terms and definitions that will ensure the consistency and clarity needed to drive progress in biomedical research and clinical care.
Why is this textbook so important? In the spring of 2015, the FDA-NIH Joint Leadership Councilidentified a problem: Confusion about the definitions and inconsistent use of key terms–including biomarkers, surrogates, and clinical outcome assessments. This can deter progress in developing medical products and thereby potentially compromise efficiency in achieving public health benefits.
Accordingly, the council identified a high priority: harmonizing terms—or making sure that everyone is “speaking the same language”–that describe and categorize types of endpoints.
Members from multiple FDA Centers and NIH institutes formed a working group to focus on creating a glossary. This was the first step to a publicly available and open access textbook that could be continuously updated and expanded.
Robert Califf
Robert M. Califf, M.D., is FDA’s Deputy Commissioner for Medical Products and Tobacco
As the basis of their work, the group considered existing terminology and definitions. Those include FDA guidance documents and other literature, especially a seminal FDA-sponsored Institute of Medicine study.
The use of biomarkers has recently expanded widely to include fields such as mechanistic biomedical research, clinical trials, drug discovery, medical product development, clinical care, and regulatory science. Recognizing this broad influence and the accepted vernacular of these varied fields, the group sought to first reach consensus around biomarker taxonomy.
For example, there’s misunderstanding about the various types of biomarkers and the distinction between biomarkers and surrogate endpoints. One challenge was to settle upon definitions that were broad enough to be used by diverse communities, including biomedical scientists, translational researchers, clinical researchers, medical product developers, and clinicians, and also across diverse types of products.
Where possible, to provide more context and insight into important terms, examples are given alongside many definitions in the BEST Resource. NIH and FDA intend to use the definitions included in this glossary when communicating on topics related to its contents (e.g., biomarkers) to ensure a consistent use of the terms and therefore, a common understanding of the issues. FDA’s Biomarker Working Group, with representation from all of our Centers, contributed to developing these definitions.
Now we need your help. We need your feedback and comments on the glossary. You can provide them at the BEST (Biomarkers, EndpointS, and other Tools) Resource.
In the meantime, we’ll continue to work on adding context to terms related to regulatory science, clinical trials, and laboratory science.
Effective, unambiguous communication is essential for efficient translation of promising scientific discoveries into approved medical products. Once we are all speaking the same language, we can tackle other challenges to bring the promises of biomedical research and clinical care to fruition.
The FDA-NIH Biomarker Working Group members include: from FDA – Shashi Amur, Robert L. Becker, Robert Califf, Aloka G. Chakravarty, David S. Cho, Nina L. Hunter, Ilan Irony, Christopher Leptak, Kathryn M. O’Callaghan, Michael A. Pacanowski, Elektra J. Papadopoulos, Vasum Peiris, Melissa Robb, Hobart L. Rogers, Rachel E. Sherman, Robert J. Temple, Ann Marie Trentacosti, and Sue Jane Wang; and from the NIH – Holli Hamilton, Pamela McInnes, Lisa M. McShane, and Monica R. Shah.
Melissa A. Robb, B.S.N., M.S. (RegSci), is FDA’s Associate Director for Regulatory Affairs, Office of Medical Policy, Center for Drug Evaluation and Research
Robert M. Califf, M.D., is FDA’s Deputy Commissioner for Medical Products and Tobacco

Latest Article Alert from Orphanet Journal of Rare Diseases

Orphanet Journal of Rare Diseases - IMPACT FACTOR 3.358

The following new article has just been published in Orphanet Journal of Rare Diseases

Letter to the Editor  
Dias R, Buchanan C, Thomas N, Lim S, Solanki G, Connor S, Barrett T, Kapoor R
Orphanet Journal of Rare Diseases 2016, 11 :14 (10 February 2016)

Adult Survivors of Childhood Brain Tumors May Have Lingering Troubles: Study: MedlinePlus

Adult Survivors of Childhood Brain Tumors May Have Lingering Troubles: Study: MedlinePlus

MedlinePlus Trusted Health Information for You

Adult Survivors of Childhood Brain Tumors May Have Lingering Troubles: Study

Intelligence, memory and attention can be affected by treatments, researchers say
By Robert Preidt
Monday, February 8, 2016
MONDAY, Feb. 8, 2016 (HealthDay News) -- Adults who survived childhood brain tumors may have significant treatment-related thinking, attention and memory problems, a new study suggests.
"Our study was the most comprehensive analysis of a large cohort of adult survivors of pediatric brain tumors, with direct assessment of their cognitive functioning and the resulting impact on social attainment. Also, it was the first to report on the long-term outcomes for multiple types of brain tumors," said study leader Tara Brinkman, from the departments of Epidemiology and Cancer Control, and Psychology, at St. Jude Children's Research Hospital in Memphis, Tenn.
The research included 224 adults who survived childhood brain tumors. They were between the ages of 19 and 53.
The survivors had been treated with either radiation to the whole brain and spinal cord, radiation only to the tumor location, or no radiation. Some also needed a shunt to drain fluid from the brain -- a condition called hydrocephalus.
Compared to those who received no radiation, survivors treated with radiation to the brain and spinal cord were nearly three times more likely to have severe intelligence deficits, as well as attention and memory problems, the study showed.
The study also found that the survivors had a nearly fourfold increased risk of major shortfalls in academic skills.
They were also more likely to be unemployed and to be living with parents or caretakers, the study revealed. Hydrocephalus was also associated with poor mental function decades after treatment, the researchers found.
The study was published online recently in the Journal of Clinical Oncology.
Previous studies indicated that adult survivors of childhood brain tumors were at risk for reduced mental function, but they evaluated survivors only five to 10 years after treatment and many included only a small number of patients.
The new findings could help lead to new ways to prevent and treat such problems, the study authors.
"We hope to help these kids while they are on therapy, to prevent the onset of some of these neurocognitive difficulties," Brinkman said in a hospital news release.
"For the survivors who have finished therapy, we want to intervene to mitigate such problems, so they don't develop into the severe problems we are seeing with the current adult survivors," Brinkman added.
SOURCE: St. Jude Children's Research Hospital, news release, Feb. 1, 2016
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Cancer--Living with Cancer

White House Seeks $1.8 Billion to Fight Zika Virus: MedlinePlus

White House Seeks $1.8 Billion to Fight Zika Virus: MedlinePlus

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White House Seeks $1.8 Billion to Fight Zika Virus

Emergency funds from Congress would combat the global health threat, officials say
Monday, February 8, 2016
HealthDay news image
MONDAY, Feb. 8, 2016 (HealthDay News) -- The Obama administration is seeking $1.8 billion in emergency funds from Congress to combat the threat of the mosquito-borne Zika virus, the White House announced Monday.
The funding will allow an expansion of mosquito control programs, speed development of a vaccine, develop diagnostic tests and improve support for low-income pregnant women, the Associated Press reported.
In an interview on CBS Monday morning, President Obama said, "What we now know is that there appears to be some significant risk for pregnant women and women who are thinking about having a baby."
The White House move followed a World Health Organization (WHO) emergency declaration last week that the Zika virus was now a global health threat, based on the suspicion that the virus may be to blame for thousands of birth defects in Brazil in the past year.
Though a cause-and-effect link has not been proven, many public health experts fear the virus causes microcephaly, a condition in which babies are born with permanent brain damage and very small heads.
The U.S. action also followed a new advisory from the U.S. Centers for Disease Control and Prevention that pregnant women with a male sexual partner who has traveled to, or lives in, an area affected by active Zika virus transmission should refrain from sex or use condoms until the pregnancy is over.
The CDC said the precaution is in place "until we know more" about the dangers of sexual transmission of the virus.
The Feb. 4 advisory followed a report out of Texas that one confirmed case of Zika virus infection was transmitted through sex, not a mosquito bite.
Speaking at a Feb. 5 news conference, CDC director Dr. Tom Frieden said the agency is investigating Brazilian research that detected Zika virus in patients' saliva and urine. At this point, however, the CDC's guidance to pregnant women does not include anything about kissing, he said.
"We're not aware of any prior mosquito-borne disease associated with such a potentially devastating birth outcome on a scale anything like appears to be occurring with Zika in Brazil," Frieden added.
"Because this phenomenon is so new, we are quite literally discovering more about it each and every day," he said.
In the new advisory, the CDC added two new countries, Jamaica and Tonga, to its travel alert list of nations that pregnant women should avoid due to ongoing Zika virus transmission.
While the Zika epidemic first surfaced in Brazil last spring, Zika virus has since spread to 30 countries and territories in South and Central America and the Caribbean. The WHO now estimates there could be up to 4 million cases of Zika in the Americas in the next year, AP reported.
But over the weekend, a small ray of hope on that front emerged in Colombia. Although 3,177 pregnant women in the country have been diagnosed with the virus, President Juan Manuel Santos said there's no evidence Zika has caused any cases of the birth defect, according to the AP.
Meanwhile, health officials in the Dallas County Health and Human Services Department reported last week that an unidentified patient had become infected with the Zika virus after having sex with an individual who had returned from Venezuela, one of the Latin American countries where Zika is circulating.
Scientists have suspected that Zika could be transmitted sexually, and there have been scattered reports of similar occurrences in recent years.
If research proves that the virus can be spread through sex, it could complicate efforts to contain infections from the virus, which health officials have said is "spreading explosively" across South and Central America.
Ashley Thomas Martino is an assistant professor of pharmaceutical sciences at St. John's University, in New York City, who teaches infectious disease.
"We are dealing with an emerging strain of this virus. Zika is not new -- it has been around since the 1950s -- but this strain is showing that it can be transmitted from the mother to the developing fetus," he said. "So, the occurrence of sexual transmission may be new, but it's not that surprising given that we're dealing with a new strain of this virus."
Martino added that "most cases will be transmitted via mosquito, and this form of sexual transmission is likely to be a rare occurrence of infection."
The blood supply is also being monitored closely. The American Red Cross on Feb. 3 asked potential blood donors who have traveled to areas where Zika infection is active to wait 28 days before giving blood.
The chances of Zika-infected blood donations remain extremely low in the United States, Dr. Susan Stramer, vice president of scientific affairs at the American Red Cross, said in a statement
According to the White House, the CDC has reported 50 laboratory-confirmed cases among U.S. travelers from December 2015 through Feb. 5, 2016. There has so far been no transmission of the Zika virus by mosquitoes within the United States, but some Americans have returned to the U.S. with infections from affected countries in South America, Central America, the Caribbean and the Pacific Islands, the AP reported.
The Zika virus was first identified in Uganda in 1947, and until last year was not thought to pose serious health risks. In fact, approximately 80 percent of people who become infected never experience symptoms.
But the increase of cases and birth defects in Brazil in the past year -- suspected to exceed more than 4,100 -- has prompted health officials to warn pregnant women or those thinking of becoming pregnant to take precautions or consider delaying pregnancy.
SOURCES: Feb. 5, 2016 news conference with Tom Frieden, M.D., director, U.S. Centers for Disease Control and Prevention; Feb. 4, 2016, CDC statement; Feb. 3, 2016, statement, American Red Cross; Feb. 2, 2016, statement, Dallas County Health and Human Services; Feb. 1, 2016, statement, Margaret Chan, M.D., director general, World Health Organization, Geneva, Switzerland; Ashley Thomas Martino, Ph.D., assistant professor of pharmaceutical sciences, St. John's University, New York City; Associated Press
More Health News on:
Zika Virus