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FEDERAL HEALTH UPDATE

December 14, 2007

Produced by Kate Connelly Theroux in collaboration with the U.S. Medicine Institute for Health Studies (USMI)

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  • The Senate Veterans Affairs Committee unanimously approved the nomination of Dr. James Peake to be Secretary of Veterans Affairs on Dec. 13, 2007.
  • On Dec. 12, 2007, President Bush vetoed H.R. 3963, the Children's Health Insurance Program Reauthorization Act of 2007.  This is the second time that President Bush has vetoed legislation that would have reauthorized and expanded SCHIP.
  • The House Veterans Affairs Committee held a hearing “Stopping Suicide and Ending Homelessness: Mental Health Challenges Within the Department of Veterans Affairs,” on Dec. 12, 2007. Post Traumatic Stress Disorder experts, as well as the parents of a soldier who committed suicide, testified before the Committee about the issues facing veterans returning home from combat.  On behalf of the VA, Dr. Ira Katz, deputy chief patient care services, office of mental health in the Veterans Health Administration, testified that the VA can meet the needs of the more than 100,000 of the 750,000 veterans of Iraq and Afghanistan who have mental health issues.  
  • The House passed H. J. RES. 69, on Dec. 13, 2007.  This legislation provides further continuing appropriations for the fiscal year 2008, and for other purposes.
  • On Dec. 12, 2007, the House passed the conference report for the National Defense Authorization Act (H.R. 1585).  This legislation authorizes appropriations for fiscal year 2008 for military activities of the Department of Defense, for military construction, and for defense activities of the Department of Energy, to prescribe military personnel strengths for the fiscal year, and for other purposes.  The legislation includes a provision that prevents increases to enrollment fees, premiums, and pharmacy co-payments for TRICARE.

    Two dozen individuals from both government and industry were selected based on their accomplishments as well as their potential as an up-and-coming future leader in “the first third of their career.”

    With U.S. forces engaged in combat operations in both Iraq and Afghanistan, the role of the Military Health System (MHS) cannot be overstated, TMA said. 

    Goodge is responsible for insuring a secure information infrastructure is deployed where and when it is needed throughout the MHS. This complex infrastructure supports network communications connecting 477 direct care facilities worldwide 24/7. Goodge oversees a team of 80 employees, primarily in San Antonio, Texas, and Falls Church, Va., who provide onsite and remote support to MHS facilities, evaluating the state of network health and connectivity.

    This infrastructure allows medical staffs to have the most up-to-date medical information on wounded troops as they are transported from the battlefield, to regional hospitals and back to U.S. facilities. http://www.tricare.mil/pressroom/news.aspx?fid=351 

  • On Dec. 12, 2007, ABC News aired a report that the Veterans Affairs (VA) Health Care System was one of the best health care systems in the United States.  This is due to the electronic health records system that the VA uses for the more than five million veterans that receive health care. 

    According to health experts, the life-long relationship between the VA and its patients gives the VA a strong financial incentive to invest in technology that aids in preventative medicine.  According to a number of studies, this investment has resulted in fewer medical errors, more effective treatments, lower costs and higher patient satisfaction.  This is all done at a cost of less than $1,500 per patient.

    The report suggests that the private sector should adapt the VA’s basic concept into their systems to improve the quality of care and lower costs.  http://abcnews.go.com/print?id=3991225 
     
     

  • The National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health (NIH), launched a new Spanish language Web site, which provides free, accurate information on many neurological disorders. The Web site is available at espanol.ninds.nih.gov.

    Health information featured on the new Web site includes publications on stroke, dementia, Parkinson’s disease, epilepsy, and autism, as well as many other neurological disorders. The publications can be downloaded or ordered free of charge. The Web site also provides information on clinical studies, links to non-profit organizations that offer information and assistance on neurological disorders, and a contact form where people can submit questions on topics related to health and biomedical research.

    Providing health information to the nation’s Spanish-speaking population is an important part of NINDS’ outreach efforts, which support its mission to reduce the burden of neurological disease. According to the 2000 United States Census, 28.1 million people in the U.S. who are age 5 or older speak Spanish in their homes.  http://www.nih.gov/news/pr/dec2007/ninds-07.htm

  • On Dec. 10, 2007, the U.S. Food and Drug Administration (FDA) announced that long-term use of Prilosec and Nexium is not likely to be associated with an increased risk of heart problems.

    The FDA completed a comprehensive, scientific review of known safety data for Prilosec and Nexium after two long-term studies conducted by AstraZeneca, the drugmaker, raised a question about whether long-term use of these drugs increases the risk of heart attacks, heart failure, and heart-related sudden death in patients taking either one of the prescribed drugs compared to patients who received surgical treatment. The FDA found that the reported difference in the frequency of heart attacks and other heart-related problems seen in the earlier analyses of the two small long-term studies does not indicate the presence of a true effect. Therefore, FDA continues to conclude that long-term use of these drugs is not likely to be associated with an increased risk of heart problems. 

  • The Substance Abuse and Mental Health Services Administration (SAMHSA) announced the selection of Transformation Transfer Initiative program funding awards to 10 states and the commonwealth of Puerto Rico.

    The states selected are Alabama, Florida, Iowa, Illinois, Kentucky, Minnesota, North Carolina, North Dakota, Pennsylvania and Tennessee.  Each of these states and Puerto Rico will receive an award for up to $105,000 for one year.   

    The Transformation Transfer Initiative will support new and expanded efforts to improve the capacity and effectiveness of mental health systems that foster recovery and meet the multiple needs of consumers. 

    The pilot programs will also explore new ways of getting mental health care services to everyone in need – a critical public health challenge. These programs will implement a number of innovative approaches to meeting these mental health challenges, including:

    • Developing new, comprehensive peer support services for adults with serious mental illness and for youth with serious emotional disturbances.
    • Enhancing juvenile forensic mental health services by providing courts with alternative ways of conducting mental health evaluations.  Instead of  requiring all juveniles involved in the criminal justice system to undergo involuntary examinations performed at traditional inpatient settings, such as hospital psychiatric wards, new systems would be established to offer the courts the discretion to have juveniles undergo mental health screening and pretrial evaluations in outpatient settings, such as community mental health centers. 
    • Developing strategic plans to better address the continuing needs of individuals with mental illnesses and co-occurring substance abuse disorders. http://www.samhsa.gov/newsroom/advisories/0712110604.aspx
  • According to a recent study by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, chest pain is still the most common sign of a heart attack for most women.  The study also found that women are more likely than men to have symptoms other than chest pain or discomfort when experiencing a heart attack or other form of acute coronary syndrome (ACS).

    On Dec. 10, 2007, an article, "Symptom Presentation of Women With Acute Coronary Syndromes — Myth vs. Reality," was published in the Archives of Internal Medicine online edition. In the study, researchers examined 35 years of research that yielded 69 studies.   The research found that, depending on the size of the study (which ranged from large trials to single centers and interviews), between 30 percent and 37 percent of women did not have chest discomfort during a heart attack. In contrast, 17 percent to 27 percent of men did not experience chest discomfort. Overall, the majority of women — and men — in the reviewed studies had chest discomfort with heart attack (two-thirds to three-quarters, depending on study size).

    Study authors also found that older people are more likely to have heart attack without chest discomfort. However, because women are on average nearly a decade older than men at the time of their initial heart attack, the researchers call for more studies to determine the degree to which gender independently influences heart attack symptoms.

    They conclude that current research does not indicate a need to differentiate heart attack symptoms in women from those in men, and public health messages should continue to emphasize chest pain or discomfort, shortness of breath, and other common signs of heart attack. Coronary heart disease is the leading cause of death among U.S. women, and affects one in 10 women over the age of 18.

    The authors also report that women are more likely than men to experience other forms of cardiac chest pain syndromes, such as unstable angina, and they appear to report a wider range of symptoms associated with ACS.  For example, women are more likely to report pain in the middle or upper back, neck, or jaw; shortness of breath; nausea or vomiting; indigestion; loss of appetite; weakness or fatigue; cough; dizziness; and palpitations.

    Absence of chest discomfort is a strong predictor for missed diagnosis and treatment delays. Noting that many studies exclude patients who do not report chest pain, the researchers call for additional research from well-designed studies to further investigate gender differences in heart attack symptoms. This includes expanding symptom definitions and greater standardization in data collection and reporting of women's symptoms.

  • On Dec. 12, 2007, Merck & Co. voluntarily recalled 11 lots of the PedvaxHIB vaccine and two lots of the COMVAX vaccine, which were manufactured after April 2007. Both provide protection against Haemophilus influenzae type B because of possible microbial contamination.

    The recall amounts to about 1.2 million doses of vaccine and will result in a serious vaccine shortage.  Merck decided to recall the vaccines after tests at its Pennsylvania manufacturing plant revealed a malfunction in the sterilization process.

    The Centers for Disease Control and Prevention (CDC) advised that children who already have received vaccinations from the recalled lots be monitored for a few days for reactions such as "redness, rash or bumps." If there is no reaction, then the child "is out of the woods."

    An additional 14 million doses of Hib vaccine are needed nationwide to meet recommended immunizations for infants and toddlers.

    Until the company can return to production, the CDC will try to ease shortages by distributing some of the 750,000 doses of Hib vaccine it has stockpiled. The agency is working with Sanofi-Pasteur, the only other licensed manufacturer of Hib vaccine, to bolster supplies. 

  • The total number of Guard and Reserve currently on active duty has increased by 837 from the last report to 91,317. The totals for each service are Army National Guard and Army Reserve, 71,553; Navy Reserve, 5,422; Air National Guard and Air Force Reserve, 6,360; Marine Corps Reserve, 8,468; and the Coast Guard Reserve, 351. www.defenselink.mil
  • The GAO published “Military Base Realignments and Closures: Cost Estimates Have Increased and Are Likely to Continue to Evolve,” (GAO-08-159) on Dec. 11, 2007.  In this report, the GAO compared the BRAC Commission's cost and savings estimates to The Department of Defense’s (DoD's) current estimates; assessed potential for change in DoD's current estimates; and identified broad implementation challenges.  GAO compared the BRAC Commission's estimates, which were the closest estimates available associated with final BRAC recommendations, to DOD's current estimates.  http://www.gao.gov/new.items/d08159.pdf
  • The GAO published “Military Base Realignments and Closures: Impact of Terminating, Relocating, or Outsourcing the Services of the Armed Forces Institute of Pathology,” (GAO-08-20) on Nov. 9, 2007.  This report discusses key services AFIP provides to the military and civilian communities; the Department of Defense’s plans to terminate, relocate, or outsource services currently provided by AFIP; and the potential impacts of disestablishing AFIP on military and civilian communities. http://www.gao.gov/new.items/d0820.pdf
  • The GAO released “VA Health Care: Many Medical Facilities Have Challenges in Recruiting and Retaining Nurse Anesthetists,” (GAO-08-56) on Dec. 13, 2007.  In the report, the GAO identified VA certified registered nurse anesthetists (CRNA) workforce challenges that VA medical facilities may experience related to VA CRNAs; identified the key mechanisms that VA medical facilities can use to recruit and retain VA CRNAs; and determined the extent to which facilities use the key mechanisms.  http://www.gao.gov/new.items/d0856.pdf
  • H.R.4367 (introduced Dec. 11, 2007): To name the Department of Veterans Affairs outpatient clinic in Aiken, South Carolina, as the "Matthew V. Dillon Department of Veterans Affairs Outpatient Clinic" was Referred to the House Committee on Veterans' Affairs. 
    Sponsor: Representative Gresham J. Barrett [SC-3]
  • H.R.4451 (introduced Dec. 11, 2007): To amend the Public Health Service Act to establish a competitive grant program for research on preventing, treating, and finding the cure for Methicillin Resistant Staphylococcus Aureus was referred to the House Committee on Energy and Commerce. 
    Sponsor: Representative Cliff Stearns [FL-6]
  • H.R.4460 (introduced Dec. 12, 2007): To amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce was referred to the House Committee on Energy and Commerce. 
    Sponsor: Representative John B. Shadegg [AZ-3]
  • H.R.4463 (introduced Dec. 12, 2007): To amend title 38, United States Code, to improve the quality of care provided to veterans in Department of Veterans Affairs medical facilities, to encourage highly qualified doctors to serve in hard-to-fill positions in such medical facilities, and for other purposes was referred to the Committee on Veterans' Affairs, and in addition to the Committee on Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. 
    Sponsor: Representative Jerry F. Costello [IL-12]
  • S.2456 (introduced Dec. 12, 2007): A bill to amend the Public Health Service Act to improve and secure an adequate supply of influenza vaccine was referred to the Committee on Health, Education, Labor, and Pensions. 
    Sponsor: Senator Hillary Rodham Clinton [NY]
  • S.2460 (introduced Dec. 12, 2007): A bill to extend by one year the moratorium on implementation of a rule relating to the Federal-State financial partnership under Medicaid and the State Children's Health Insurance Program and on finalization of a rule regarding graduate medical education under Medicaid and to include a moratorium on the finalization of the outpatient Medicaid rule making similar changes was referred to the Committee on Finance. 
    Sponsor: Senator Jeff Bingaman [NM]
  • No hearings are scheduled for next week.

If you need further information on any of the items in the Federal Health Update, please contact Kate Connelly Theroux at (703) 447-3257 or by e-mail at kate@usminstitute.org. To subscribe, please visit http://usminstitute.org/subscriber.cfm. To unsubscribe, please send an email to update@usminstitute.org with UNSUBSCRIBE as the subject.

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