1. Low risk of international Zika virus spread due to Brazil Olympics
Free content: http://www.annals.org/article.aspx?doi=10.7326/M16-1628
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Travelers to Brazil for the 2016 Olympics face minimal risk of contracting or spreading Zika virus, according to an article published in Annals of Internal Medicine.
Brazil is the most severely affected country in the ongoing Zika virus epidemic in Latin America and also the host country for the 2016 Olympic and Paralympic Games. With a projected attendance of 350,000 to 500,000 visitors to Rio de Jeneiro from August to September, public health experts have expressed concern that visitors may contract Zika in Brazil and spread the virus to their own countries upon their return. Some members of the international academic community have recently advocated measures such as postponing the Olympics or relocating events to another country to prevent travel-associated infections and exportation. In contrast, the World Health Organization advised that travelers who are not pregnant can safely attend the Olympics while taking precautions to avoid Zika infection.
According to experts at the Yale School of Public Health, this controversy underscores the need for quantitative determinations of the risk that infected travelers will introduce Zika to their home countries by mosquito-borne or sexual modes of transmission. The authors calculated the worst-case estimates of travel-associated Zika virus by assuming visitors encounter the same infections exposures as local residents. This is highly unlikely, as visitors would be staying in screened and air-conditioned accommodations, as well as taking personal preventive measures. But under the authors' pessimistic conditions, they estimate an individual traveler's probability to acquire infection in Rio de Janeiro is quite low. Specifically, they estimate anywhere from 6 to 80 total infections with between and one and 16 of those infected experiencing any symptoms. Because few pregnant women are likely to attend, the estimates reiterate previous statements of the low personal impact of Zika virus to travelers.
Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Dr. Joseph Lewnard, please contact Michael Greenwood at michael.greenwood@yale.edu or 203-737-5151.
2. Pregnancy delays alone not enough to curtail Zika-related birth abnormalities
Free content: http://www.annals.org/article.aspx?doi=10.7326/M16-0919
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Pregnancy delays can have a substantial effect on reducing cases of microcephaly but can exacerbate the Zika virus outbreak if the timing and duration of the delay is insufficient. To be effective, a strategy to delay pregnancy should be initiated early in a Zika outbreak, should last longer than 6 months, and should be combined with mosquito-control measures. The findings are published in Annals of Internal Medicine.
Prenatal exposure to Zika virus has been linked to microcephaly, other serious neurological conditions, and fetal death. As such, health officials in Zika-prone areas have advised women to postpone pregnancy. However, the recommended duration of pregnancy delay varies from place to place and there is little action from governments to facilitate adherence. Since a surge in pregnancies is likely to occur after a period of abstention, there is an urgent need to evaluate the effectiveness of pregnancy delay policies for mitigating Zika virus infection.
Researchers developed a data-driven disease transmission model to evaluate the effectiveness of pregnancy delay recommendations in reducing the incidence and prevalence of prenatal Zika virus infection in Colombia. The assumption was that the effectiveness of mass pregnancy delays would depend on the duration of the delay, the population-level adherence to the policy recommendation, and the timing of the initiation relative to peak incidence of infection within the community. The researchers found that pregnancy delay strategies are more effective if they last more than 6 months and start early in an outbreak. Anything less would be likely to exacerbate prenatal exposure due to the surge in pregnancies after the period of abstinence.
Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Dr. Martial L. Ndeffo-Mbah, please contact Michael Greenwood at michael.greenwood@yale.edu or 203-737-5151.
3. National survey shows public lukewarm on physician-patient gun discussions
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M16-0739
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According to a nationally representative survey of adults in the United States, about 2 out of 3 people agree that it is at least sometimes appropriate for health care providers to discuss guns with their patients. Opinions varied by demographic characteristics. The findings are published in Annals of Internal Medicine.
In 2014 in the United States, there were 33,599 firearm deaths and an additional estimated 81,000 nonfatal firearm injuries. The majority (59 percent) of gun deaths are attributed to suicide. Unsafe gun storage practices can contribute to the death rate. Recognizing that education from health care providers may help reduce unsafe storage practices, many medical and public health organizations have advocated firearm safety counseling by health care providers, especially when there are children or teens at home or when a patient is at risk for harm to self or others. It is not known whether patients think it is appropriate for physicians to ask their patients about guns.
Using a probability-based online survey, researchers sought to estimate the perceived appropriateness of provider discussions about guns. More than 3,900 English-speaking adults were asked "In general, would you think it is never, sometimes, usually, or always appropriate for physicians and other health professionals to talk to their patients about firearms." A majority (66 percent) of participants said that it is at least sometimes appropriate for doctors to inquire about guns. Specifically, 23 percent said these discussions were always appropriate, 14 percent said usually appropriate, and 30 percent said sometimes appropriate. Gun owners were less likely (54 percent) than nonowners (70 percent) to say that provider discussions were at least sometimes appropriate. According to the authors, the observed heterogeneity in opinions highlights the need for communications research to better understand the viewpoints of all types of firearm owners when created targeted firearm safety educational materials and interventions.
Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Dr. Marian Betz, please contact David Kelly at david.kelly@ucdenver.edu or 303-724-1525.
4. Evidence lacking to support use of currently available pancreatitis mortality prediction models
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M16-0650
Editorial: http://www.annals.org/article.aspx?doi=10.7326/M16-1581
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Current mortality prediction models in acute pancreatitis lack evidence to support their use. A systematic review is published in Annals of Internal Medicine.
The severity of acute pancreatitis (AP) ranges widely from mild, self-limited disease to serious illness characterized by systemic complications and multiorgan failure. AP is severe in approximately 25 percent of patients, in whom the mortality rate is about 20 to 30 percent. Because the prognosis is not always obvious on presentation or early in the disease course, several prediction approaches exist to help physicians determine the aggressiveness of treatment and counsel patients on prognosis. Clinical utility of these prediction tools is uncertain and clinical guidelines differ on which test should be used and how results should guide therapy.
Researchers reviewed published studies to evaluate the test characteristics (prognostic accuracy, incremental predictive value) and clinical utility (effect on patient outcomes) of severity scores for predicting mortality in AP. The researchers found that despite the many decades since prediction models of mortality in AP were proposed, evidence establishing their prognostic accuracy is incomplete and available data do not provide clear guidance on which models should be used in specific patient populations and how those models should direct therapy. The authors suggest future research to clarify these issues.
Note: For an embargoed PDF, please contact Cara Graeff. The lead author, Dr. Joseph Lau, can be reached through Karen Scanlan at Karen_Scanlan@brown.edu or 401-863-3375.
Also new in this issue:
Medical Improv: A Novel Approach to Teaching Communication and Professionalism Skills
Katie Watson, JD, and Belinda Fu, MD
Ideas and opinions
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2239
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Journal
Annals of Internal Medicine