In the first study, Robert Nadelman, MD and colleagues conducted a randomized, double-blind, placebo-controlled trial of treatment with a single 200 mg dose of doxycycline in 482 subjects who had removed attached I. scapularis ticks from their bodies within the previous 72 hours.

The study concluded that a single 200 mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease.

The second paper by Mark S. Klempner, MD and colleagues examined patients with well-documented, previously treated Lyme Disease who had persistent musculoskeletal pain, neurocognitive symptoms, or dysesthesia, often associated with fatigue. The paper describes two randomized trials: one in 78 patients who were seropositive for IgG antibodies to Borrelia burgdorferi at the time of enrollment and the other in 51 patients who were seronegative.

The studies conclude that "there is considerable impairment of health-related quality of life among patients with persistent symptoms despite previous antibiotic treatment for acute Lyme Disease. However, in these two trials, treatment with intravenous and oral antibiotics for 90 days did not improve symptoms more than placebo."

In 1999, the Centers for Disease Control (CDC) received reports of 16,019 cases of Lyme Disease. Ninety-two percent of those cases were in nine states, mostly in the northeastern United States.

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CDC Issues Report on TB

On June 12th the CDC released its latest report on the number of new cases of tuberculosis in the U.S., which indicated that TB declined by 7% from 1999 to 2000, continuing an eight year decline since the TB epidemic peaked in 1992. The ten states with the highest TB rates were (in ranking order) Alaska, Hawaii, California, New York, Georgia, Arkansas, Louisiana, Florida, Texas, and South Carolina. More information or copies of the report are available from the CDC at www.cdc.gov or 404.639.8896.

Fewer than half the American population receives some of the most valuable healthcare services. In a study, jointly sponsored by the CDC and Partnership for Prevention, 30 preventive health services were prioritized based on the services’ health benefits and cost-effectiveness. Several services ranked high on the list, yet currently reach less than half the Americans: tobacco cessation counseling, screening older adults for undetected vision impairments, screening adults 50+ for colorectal cancer, screening young women for chlamydia, screening and counseling adults for problem drinking, and vaccinating older adults against pneumococcal disease.

"The study will help decision makers in the healthcare industry prioritize the preventive services that not only save the most lives, but also the most money in the long run," said CDC Director Jeffrey Koplan, MD, MPH. "These gaps in care should be closed for the benefit of everyone." Two articles about the study appeared in the July 2001 issue of the American Journal of Preventive Medicine (AJPM). More information is available at the web sites of the two sponsoring organizations: www.cdc.gov or www.elsevier.com (for AJPM).

Employers Increase Prevention & Cost Containment Offerings

Despite double-digit healthcare cost increases and a slowing economy, more employers are offering health promotion and management programs, according to a new survey from Hewitt Associates. Some type of education or training program is in place at 71% of the companies surveyed, up 5% from 1995. Corporate financial incentive and disincentive programs, such as gifts or monetary awards for employee health appraisal participation, or higher insurance premiums for smokers, are on the rise, at 40% now compared with 32% in 1995. Increasingly, employers are looking for creative and effective solutions, such as health promotion and medical management programs that can provide cost savings, reduce absenteeism, and increase productivity. For more, go to www.hewitt.com.