The week in review: May 13‑19, 2012
MedWire News: Among this week's featured stories are a cautionary tale about the hazard of household batteries, a new national plan to address Alzheimer's disease and lead poisoning, a snapshot of the nation's health, and troubling news about football and head trauma.
Button battery choking hazard
Battery-related emergency-department (ED) visits in the USA increased from 2591 in 1990 to 5525 in 2009. Much of the increase was accounted for by young children who had swallowed button-type batteries they found in toys or in other items not intended for their use, including remote controls, flashlights, watches, and calculators, report Gary Smith (Nationwide Children's Hospital, Columbus, Ohio), and colleagues in Pediatrics.
Smith et al looked at a nationally representative sample from the National Electronic Injury Surveillance System to identify battery-related ED visits in the USA from 1990 to 2009. They reviewed diagnosis codes and case narratives for exposures by swallowing, mouth contact, ear canal insertion, and nasal cavity insertion.
They identified an estimated 66,788 children younger than 18 years who were seen in US EDs for battery-related exposures.
More than three-quarters (76.6%) of visits were for battery ingestion, while 10.2% were for nasal cavity insertion, 7.5% for mouth exposure, and 5.7% for ear canal insertion.
Button batteries accounted for 83.3% of visits where the type of battery was documented.
"The increased prevalence of the higher voltage 20 mm lithium batteries is concerning because it coincides with an alarming 113% increase in battery ingestions and insertions by young children. When a button battery is swallowed and gets caught in a child's esophagus, serious, even fatal injuries can occur in less than 2 hours," Smith said in a statement.
Sports head trauma mimics blast injury
Football may be surpassing baseball in the hearts of Americans, but the heads of young football players are paying the price, indicates a new report showing the traumatic brain injury experienced by young amateur football players and at least one professional wrestler is virtually identical to that of soldiers exposed to blasts from improvised explosive devices (IEDs).
Postmortem examination of a series of brains obtained from veterans of the US military who had been exposed to blasts or concussive injuries showed evidence of chronic traumatic encephalopathy (CTE) similar to that seen in the brains of young athletes who had sustained concussions playing football, and to that of a professional wrestler with a history of repeated concussive injuries.
The tau protein-linked neurodegenerative changes associated with CTE were not in evidence in the brains of normal, age-matched controls with no previous histories of blast exposures, concussive injuries, or neurologic diseases, write Leo Goldstein (Boston University School of Medicine, Massachusetts) and co-authors in Science Translational Medicine.
The authors found evidence of blast-associated CTE-linked tau neuropathology that "was indistinguishable from the tau neuropathology, neuroinflammation, and neurodegeneration observed in the brains of young-adult athletes with histories of repeat concussive injury."
The investigators found similar evidence of histopathologic, structural, and biochemical evidence of CTE-linked neuropathology after 2 weeks in the brains of mice exposed to a single controlled blast, and deficits in hippocampal-dependent learning that persisted for at least 1 month.
HHS launches national Alzheimer's strategy
In other neurologically focused news, US Secretary of Health and Human Services (HHS) Kathleen Sebelius announced the launch of a comprehensive national plan to combat Alzheimer's disease (AD) with increased research funding, training of clinicians, caregiver support, and public awareness.
Details of the National Plan to Address Alzheimer's Disease were released at an AD summit hosted by the National Institute on Aging at the National Institutes of Health (NIH) in Bethesda, Maryland.
The plan has five specific, overarching goals:
- Prevention and effective treatment of AD by 2025
- Optimization of AD care quality and efficiency
- Expansion of patient and caregiver support
- Enhancement of public awareness and engagement
- Tracking of progress and driving improvement.
The initiative includes NIH support to the tune of $ 7.9 million for a clinical trial of an insulin nasal spray for treating AD, and $ 16 million for a prevention trial in people who are at the highest risk for the disease due to genetic factors.
HHS, through its geriatric education centers, is furnishing an additional $ 2 million in funding for training clinicians to recognize the signs and symptoms of AD and most effectively manage patients with the disease.
The plan includes a new website, (www.alzheimers.gov), designed as a central clearinghouse for AD patients and caregivers.
CDC report: The healthy, wealthy, and wise
Healthcare in the USA is great ‑ if you're educated and can pay for it, suggest results of the "Health, United States, 2011" report from the Centers for Disease Control and Prevention (CDC).
The report authors found that from 2007 through 2010, boys and girls from the ages of 2 to 19 years had lower rates of obesity when they lived in households where the head of household had higher levels of education. In households headed by a man or woman with a bachelor's degree or higher, 11% of boys and 7% of girls were obese. In contrast, in households where the head did not graduate from high school, 24% of boys and 22% of girls were obese.
Obesity prevalence also varied by education levels among adult women but not among men. Women aged 25 years or older who did not have a bachelor's degree had obesity rates ranging from 39% to 43%, compared with 25% for women with bachelor's or master's degrees or a doctorate.
More highly educated adults were also less likely to be current smokers, the report's authors found. In 2010, the prevalence of smoking among adults 25‑65 years of age was 31% among those with a high school diploma or less, compared with 24% for adults with some college education, and 9% of holders of a college degree or higher.
The overall percentage of US adults aged 18 and over who were current smokers was down slightly from the previous year, declining from 21% in 2009, to 19% in 2010.
The report also shows that despite an increasing prevalence of obesity (but not of overweight) from 1988‑1994 to 2007‑2010, the prevalence of uncontrolled high blood pressure (mean systolic blood pressure of 140 mmHg or higher, or mean diastolic pressure of 90 mmHg or higher) declined for all age groups of both men and women. Nonetheless, blood pressure was uncontrolled in nearly half of all adults with hypertension in 2007‑2010, the report notes.
Getting the lead out
In a busy week for the CDC, the agency announced that it is lowering the cutoff for defining lead poisoning in children under 6 years of age to 5 µg/dL of blood. The former cutoff, used for the past 20 years, was 10 µg/dL.
The agency announced the new standard in its formal response to the recommendations of its Advisory Committee for Childhood Lead Poisoning Prevention (ACCLPP). The committee issued its recommendations in a report in January 2012. The response was prepared by staff of the CDC's National Center for Environmental Health.
Approximately 450,000 children in the USA have blood lead levels higher than the new reference value, according to the report. The value is based on the childhood blood lead level of the 97.5th percentile of the population in children aged 1‑5 years. About 250,000 children met the definition of having lead poisoning under the former reference value, the CDC says.
The committee also recommended that the CDC should update the reference value every 4 years based on the most recent surveillance data.
But the CDC has more of the will than the way to enact the changes: the agency notes that funding in the 2012 fiscal year for the CDC's Childhood Lead Poisoning Prevention programs was significantly lower than that for 2011.
"As a result, funding is not available for state and local Childhood Lead Poisoning Prevention Programs. In many instances, these reductions limit CDC's ability to fully implement many of these recommendations in the short term," the CDC says in its response.
The CDC has agreed to use the reference value in recommendations for follow-up testing of blood lead levels in children, to identify high-risk populations and geographic areas most in need of primary prevention, and to provide the information about at-risk populations and regions to other federal, state, and local government and non-government organizations.
By Neil Osterweil