Availability of immune globulin intravenous for treatment of immune deficient patients--United States, 1997-1998

Immune globulin intravenous (IGIV) is a lifesaving treatment for patients with primary immunodeficiency. Since November 1997, a shortage of IGIV has existed in the United States. In 1998, the Food and Drug Administration (FDA) required pharmaceutical companies to increase the frequency of reporting on IGIV distribution from biannually to monthly; in addition, FDA facilitated IGIV distribution and informed clinicians about the ongoing shortage. To assess the impact of the IGIV shortage on patient care, in 1998 the Immune Deficiency Foundation (IDF) surveyed physicians caring for immunodeficient patients about whether they have had difficulty obtaining IGIV, measures they have taken because of the shortage, and the effect of the shortage on their patients. This report summarizes data reported to FDA and data obtained from the IDF survey and provides recommendations for IGIV use during the shortage.     

Decline in cigarette consumption following implementation of a comprehensive tobacco prevention and education program--Oregon, 1996-1998

In November 1996, residents of Oregon approved a ballot measure increasing the cigarette tax by 30 cents (to 68 cents per pack). The measure stipulated that 10% of the additional tax revenue be allocated to the Oregon Health Division (OHD) to develop and implement a tobacco-use prevention program. In 1997, OHD created Oregon's Tobacco Prevention and Education Program (TPEP), a comprehensive, community-based program modeled on the successful tobacco-use prevention programs in California and Massachusetts. To assess the effects of the tax increase and TPEP in Oregon, OHD evaluated data on the number of packs of cigarettes taxed before (1993-1996) and after (1997-1998) the ballot initiative and implementation of the program. Oregon's results also were compared with national data. This report summarizes the results of the analysis, which indicate that consumption of cigarettes in Oregon declined substantially after implementation of the excise tax and TPEP and exceeded the national rate of decline.     

World's population to reach six billion

The United Nations (UN) estimates that the world's population will reach six billion on October 12, 1999. The world's population reached one billion in 1804; subsequently, one billion increases came at intervals of 123, 33, 14, 13, and 12 years. Population growth rates increased over time because of high fertility rates and declines in mortality rates, especially since the early to mid-1900s. The UN projects that it will take 14 years for the world's population to reach 7 billion and another 15 years to reach 8 billion.     

Frequency of vaccine-related and therapeutic injections--Romania, 1998

In Romania and other countries, therapeutic injections have been associated with transmission of hepatitis B and C viruses, human immunodeficiency virus type 1 (HIV-1), and other bloodborne pathogens. During 1997-1998, acute hepatitis B was associated with recent injections in Romanian children aged <5 years. Injection-associated bloodborne pathogen transmission occurs when infection-control practices are inadequate, and overuse of injections to administer medications might increase opportunities for transmission. To estimate the frequency of therapeutic injections and to describe the attitudes and practices of adults about injections to administer medications, local health departments in Romania surveyed the general population of four districts (Hunedoara, Iasi, Mures, and Prahova [1997 combined population: 2.8 million]) in June 1998. This report summarizes results from these surveys, which indicate that injections are used frequently to administer medications in Romania.     

Psychotherapy as an element in supported employment for persons with severe and persistent mental illness

Recent literature has urged that vocational and clinical services for persons with severe and persistent mental illness should be integrated. Unclear in this model is what role psychotherapy could play. In particular, it is unknown whether psychotherapy can make a unique contribution and whether there are issues it might systematically address in the context of vocational rehabilitation. To examine these questions we report on the psychotherapy of six consumers enrolled in supported employment, a prominent form of vocational rehabilitation. Using these cases as illustrations, we suggest that in an integrative team approach, psychotherapy can facilitate vocational rehabilitation by helping consumers reconstruct aspects of personal narratives related to disability and work and by processing painful affects evoked by work. We report how within a reflective and nonhierarchical relationship consumers were allowed to reframe old ideas, question inconsistencies, and keep track of the structure and content of revised narrative until fully integrated into memory. Despite a wide range of severe impairments, this process enabled consumers to incorporate work into a now more complete and coherent life narrative. Implications for practice and research are discussed.     

Practice protocol for the examination of specimens removed from patients with carcinoma of the urinary bladder, ureter, renal pelvis, and urethra

This article details a practice protocol for the examination and reporting of specimens removed from patients with carcinoma of the urinary bladder, ureter, renal pelvis, or urethra. It was created by a multidisciplinary task force of pathologists and oncologists established by the Cancer Committee of the College of American Pathologists. Documentation for the protocol was obtained from the previously published protocol, the medical literature, personal experience, and consultation with colleagues. After creation and review by the task force, the protocol was sent to 1000 randomly selected practicing pathologists as a survey. Their comments and suggestions were addressed in the final version. The protocol was approved by the Board of Governors of the College of American Pathologists.