Reports from the Field

Lack of specialty care factors into diabetics’ mortality

Lack of specialty care, particularly for minority patients, is a contributing factor to the continued increase in mortality for people with diabetes, according to the American Association for Clinical Endocrinologists (AACE).

"Patients with diabetes have special health needs which they and their physicians need to address," says Rhoda H. Cobin, MD, president of AACE. "Studies have shown that patients who receive care from endocrinologists have better health outcomes. It is a critical component for managing this chronic condition."

Cobin cites statistics from the Atlanta-based Centers for Disease Control and Prevention that show deaths from diabetes and its complications continue to increase despite an overall decrease in other causes of death. Many patients are not even aware that there are diabetes specialists, she says. "Minority patients — who are disproportionately impacted by diabetes — are the least likely to seek or have access to specialty care," she adds.

Headache test can determine potential lost productivity

There is a direct correlation between productivity at work and scores on a self-administered test that measures the impact of headaches, a new study has concluded. The study, presented at the International Headache Congress, demonstrates that patients lose the equivalent of two days a month at work because of severe migraine headaches. The study gave the HIT-6 (Headache Impact Test), a list of six questions, to 648 headache sufferers to determine the impact headaches have on lost productivity in the workplace.

"The adverse effect of headaches on businesses is a worldwide problem. Workplace productivity can be considered impaired as a result of migraine headaches," says Andrew Dowson, director of King’s Headache Services at King’s College Hospital in London. "It is essential to treat the condition appropriately to reduce the attacks and the cost to industry."

According to Dowson, studies have put the annual direct cost of migraine headaches at $11.8 billion worldwide. He anticipates that employers could save $5,154 per year per migraine patient by treating the condition.

Multi-drug resistant TB remains a national threat

The current education and treatment of multi-drug resistant tuberculosis (MDR TB) does not adequately reflect the seriousness of the disease as a national public health concern, according to a new study. The disease remains a threat, particularly in areas that are heavily populated by immigrants, the elderly, and people with immune system problems, researchers reported in the August issue of CHEST, the journal of the American College of Chest Physicians based in Northbrook, IL.

MDR TB is a deadly form of tuberculosis that is resistant to two or more of the primary drugs used to treat the disease. It is transmitted through the air and can develop because of a lack of treatment, improper treatment, or non-compliance with drug therapy in patients who have active TB.

"With expert care, we have the tools to diagnose and the means to cure TB and MDR strains, yet this disease continues to kill people in the U.S. and around the world," says study author David Ashkin, MD, FCCP, medical executive director at A. G. Holley State Tuberculosis Hospital in Lantana, FL. In the study, Ashkin examined the outcomes of Florida patients treated at least partially in a specialty treatment center and those treated only in outpatient community care. Of the 81 patients with MDR TB (out of 5,516 cases of active TB), 45% of patients who received outpatient care died vs. 18% of patients treated in the inpatient specialty facility.

Few seniors are screened for peripheral arterial disease

Less than half of the older Americans who have symptoms commonly associated with peripheral arterial disease are being screened for the disease by health care professionals, according to a survey by the National Council on the Aging (NCOA). The survey also showed that two-thirds of Americans older than 50 are unaware of the disease.

"It is clear that we need to increase consumer and physician awareness so that seniors can get testing, timely treatment, and the advice they need about this potentially critical disease," says James Firman, MD, president and chief executive officer of Washington, DC-based NCOA.

The disease is characterized by blockage of the arteries in the legs and sometimes the arms due to plaque formation. The most common symptom is leg pain including muscle cramping, tightness and fatigue during moderate exercise. People who smoke, who are over age 70, and who have diabetes have a one-in-three chance of developing the disease. Peripheral arterial disease is determined by a simple test comparing blood pressure readings from a patient’s arm and ankle.

For more information, see the NCOA website at or the Vascular Disease Foundation website at

Chicken pox vaccination campaign launched

An estimated 3 million children are at risk of chicken pox, according to the National Association of Pediatric Nurse Practitioners (NAPNAP) in Cherry Hill, NJ. These are children who have neither been vaccinated against the virus nor have had chicken pox. The organization has launched a campaign to make sure that the children who are risk for chicken pox are vaccinated. The campaign is aimed at children ages 6 to 12 who were born before the vaccine became available in 1995.

A NAPNAP-sponsored survey shows that 50% of parents whose children are at risk for chicken pox say they would rather their child have the disease than the vaccine. One in four parents are reluctant to vaccinate because they don’t feel it’s important, and 42% of parents said they didn’t know a vaccine for chicken pox is available. More than 90% of the parents were unaware the chicken pox could have serious complications, including death, and 36% believe that is it only as harmful as acne.

Older people, including teenagers and young adults, are much more likely than children to develop complications from chicken pox, points out Linda Juszczak, DNSc, MPH, CPNP, spokeswoman for NAPNAP.

For more information, visit the NAPNAP website at

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