Category: Healthcare

Dangers firefighters face include higher cancer risks

Mary Pat Campbell

Link: https://www.upi.com/Health_News/2024/05/10/firefighters-face-cancer-dangers/8411715363541/

Excerpt:

Compared to the general public, firefighters have a 9% higher rate of certain cancers, likely due to their exposure to high levels of carcinogens released into the air as buildings burn. The incidence of multiple myeloma — the first cancer Perez developed — is about 50% higher in firefighters than in the general population.

….

Dr. C. Ola Landgren has been researching links between occupational exposures and multiple myeloma for a number of years — particularly in first responders such as firefighters. At Memorial Sloan Kettering Cancer Center in New York and the National Cancer Institute, Landgren began to recognize patterns.

In New York, for example, Landgren had three myeloma patients who lived on the same block on Staten Island. Their houses had been covered by dust after the World Trade Center towers fell in 2001.

“Myeloma has a precursor condition known as MGUS, which is more common in the population, allowing us to identify risks earlier,” Landgren said. “We’ve actually observed higher rates of MGUS in first responders compared to the general population.”

MGUS — which stands for monoclonal gammopathy of undetermined significance — has also been linked to pesticide use among farmers and exposure to Agent Orange among veterans of the Vietnam War. Levels also were higher in firefighters, police officers and construction workers who were on-site immediately after the 9/11 attacks.

Author(s): Lori Saxena, HealthDay News

Publication Date:

Publication Site:

Causal Inference About the Effects of Interventions From Observational Studies in Medical Journals

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jama/fullarticle/2818746?guestAccessKey=66ec96e3-d156-46cf-928b-ff8b2a8fc35e&utm_source=silverchair&utm_medium=email&utm_campaign=content_max-jamainternalmedicine&utm_content=olf&utm_term=051324&utm_adv=000004014036

Additional editors’ note: https://jamanetwork.com/journals/jama/fullarticle/2818747?guestAccessKey=8b28cc16-c1e5-4a09-bec6-1f77abfe98db&utm_source=silverchair&utm_medium=email&utm_campaign=content_max-jamainternalmedicine&utm_content=olf&utm_term=051324&utm_adv=000004014036

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Abstract:

Importance  Many medical journals, including JAMA, restrict the use of causal language to the reporting of randomized clinical trials. Although well-conducted randomized clinical trials remain the preferred approach for answering causal questions, methods for observational studies have advanced such that causal interpretations of the results of well-conducted observational studies may be possible when strong assumptions hold. Furthermore, observational studies may be the only practical source of information for answering some questions about the causal effects of medical or policy interventions, can support the study of interventions in populations and settings that reflect practice, and can help identify interventions for further experimental investigation. Identifying opportunities for the appropriate use of causal language when describing observational studies is important for communication in medical journals.

Observations  A structured approach to whether and how causal language may be used when describing observational studies would enhance the communication of research goals, support the assessment of assumptions and design and analytic choices, and allow for more clear and accurate interpretation of results. Building on the extensive literature on causal inference across diverse disciplines, we suggest a framework for observational studies that aim to provide evidence about the causal effects of interventions based on 6 core questions: what is the causal question; what quantity would, if known, answer the causal question; what is the study design; what causal assumptions are being made; how can the observed data be used to answer the causal question in principle and in practice; and is a causal interpretation of the analyses tenable?

Conclusions and Relevance  Adoption of the proposed framework to identify when causal interpretation is appropriate in observational studies promises to facilitate better communication between authors, reviewers, editors, and readers. Practical implementation will require cooperation between editors, authors, and reviewers to operationalize the framework and evaluate its effect on the reporting of empirical research.

Author(s): Issa J. Dahabreh, MD, ScD1,2,3,4,5; Kirsten Bibbins-Domingo, PhD, MD, MAS6,7,8

Publication Date: 9 May 2024

Publication Site: JAMA

doi:10.1001/jama.2024.7741

A Lawyer Abandoned Family and Career to Follow the Voices in His Head

Mary Pat Campbell

Link: https://www.wsj.com/us-news/homeless-california-mental-illness-care-court-f63d2027

Excerpt:

Disruptions in mental-health care during the pandemic left many Americans vulnerable. Among people ages 18 to 44, insurance claims related to psychotic episodes rose 30% to 2 million in 2023 from 2019, according to LexisNexis Risk Solutions, a data-analytics company. Around the U.S., hospitals are overwhelmed. Emergency rooms are adding security guards. Jails serve as a last resort for those unable to care for themselves. 

Author(s): Julie Wernau

Publication Date: 23 Mar 2024

Publication Site: WSJ

4 out of 5 autoimmune disease patients are women. New study offers clue as to why

Mary Pat Campbell

Link: https://www.cnn.com/2024/02/09/health/why-autoimmune-disease-affects-more-women-study-scn/index.html

Excerpt:

Why women are at greater risk of autoimmune disease such as multiple sclerosis, lupus and rheumatoid arthritis is a long-standing medical mystery, and a team of researchers at Stanford University may now be a step closer to unraveling it.

How the female body handles its extra X chromosome (the male body has just one plus a Y chromosome) might be a factor that helps explain why women are more susceptible to these types of disorders, a new study has suggested. The predominantly chronic conditions involve an off-kilter immune system attacking its own cells and tissues.

While the research involving experiments on mice is preliminary, the observation, after further study, may help inform new treatments and ways to diagnose the diseases, said Dr. Howard Chang, senior author of the paper published in the journal Cell on February 1.

….

Other researchers had focused on the disorders’ “female bias” by analyzing sex hormones or chromosome counts. Chang instead zoned in on the role played by a molecule called Xist (pronounced exist) that is not present in male cells.

The Xist molecule’s main job is to deactivate the second female X chromosome in embryos, ensuring that the body’s cells don’t get a potentially toxic double whammy of the chromosome’s protein-coding genes.

“Xist is a very long RNA, 17,000 nucleotides long, or letters, and it associates with approximately almost 100 proteins,” Chang said. Xist molecules work with those proteins to shut down gene expression in the second X chromosome.

Author(s): Katie Hunt

Publication Date: 9 Feb 2024

Publication Site: CNN Health

Reports of COVID-19 Vaccine Adverse Events in Predominantly Republican vs Democratic States

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816958?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=032924

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Abstract:

Importance  Antivaccine sentiment is increasingly associated with conservative political positions. Republican-inclined states exhibit lower COVID-19 vaccination rates, but the association between political inclination and reported vaccine adverse events (AEs) is unexplored.

Objective  To assess whether there is an association between state political inclination and the reporting rates of COVID-19 vaccine AEs.

Design, Setting, and Participants  This cross-sectional study used the AE reports after COVID-19 vaccination from the Vaccine Adverse Event Reporting System (VAERS) database from 2020 to 2022, with reports after influenza vaccines from 2019 to 2022 used as a reference. These reports were examined against state-level percentage of Republican votes in the 2020 US presidential election.

Exposure  State-level percentage of Republican votes in the 2020 US presidential election.

Main Outcomes and Measures  Rates of any AE among COVID-19 vaccine recipients, rates of any severe AE among vaccine recipients, and the proportion of AEs reported as severe.

Results  A total of 620 456 AE reports (mean [SD] age of vaccine recipients, 51.8 [17.6] years; 435 797 reports from women [70.2%]; a vaccine recipient could potentially file more than 1 report, so reports are not necessarily from unique individuals) for COVID-19 vaccination were identified from the VAERS database. Significant associations between state political inclination and state AE reporting were observed for all 3 outcomes: a 10% increase in Republican voting was associated with increased odds of AE reports (odds ratio [OR], 1.05; 95% CI, 1.05-1.05; P < .001), severe AE reports (OR, 1.25; 95% CI, 1.24-1.26; P < .001), and the proportion of AEs reported as severe (OR, 1.21; 95% CI, 1.20-1.22; P < .001). These associations were seen across all age strata in stratified analyses and were more pronounced among older subpopulations.

Conclusions and Relevance  This cross-sectional study found that the more states were inclined to vote Republican, the more likely their vaccine recipients or their clinicians reported COVID-19 vaccine AEs. These results suggest that either the perception of vaccine AEs or the motivation to report them was associated with political inclination.

Author(s):David A. Asch, MD, MBA1,2; Chongliang Luo, PhD3; Yong Chen, PhD2,4,5Author(s):

Publication Date: 29 Mar 2024

Publication Site: JAMA Network Open

Mounting research shows that COVID-19 leaves its mark on the brain, including with significant drops in IQ scores

Mary Pat Campbell

Link:https://theconversation.com/mounting-research-shows-that-covid-19-leaves-its-mark-on-the-brain-including-with-significant-drops-in-iq-scores-224216

Excerpt:

From the very early days of the pandemic, brain fog emerged as a significant health condition that many experience after COVID-19.

Brain fog is a colloquial term that describes a state of mental sluggishness or lack of clarity and haziness that makes it difficult to concentrate, remember things and think clearly.

Fast-forward four years and there is now abundant evidence that being infected with SARS-CoV-2 – the virus that causes COVID-19 – can affect brain health in many ways.

In addition to brain fog, COVID-19 can lead to an array of problems, including headaches, seizure disorders, strokes, sleep problems, and tingling and paralysis of the nerves, as well as several mental health disorders.

Author(s): Ziyad Al-Aly

Publication Date: 28 Feb 2024

Publication Site: The Conversation

How Should the Government Negotiate Medicare Drug Prices? A Guide for the Perplexed

Mary Pat Campbell

Link:https://www.ineteconomics.org/perspectives/blog/how-should-the-government-negotiate-medicare-drug-prices-a-guide-for-the-perplexed

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Excerpt:

Now, at last, thanks to the Inflation Reduction Act (IRA), the federal government will be allowed to negotiate a “maximum fair price” for drugs covered by Medicare Part D. This historical change, taking place in the face of intense industry opposition, incrementally reverses policies that have prohibited the government from engaging in price negotiations since Medicare Part D was first established in 2003. While only ten drugs will be subject to negotiation in the first year of the IRA and 90 over the first five years, negotiations are now ongoing.

….

It has been suggested that the government should negotiate for value-based pricing that would benchmark the Medicare Part D price measures of the health benefit provided to those using these drugs. This would be analogous to the approach currently used by most European countries for drug pricing. We believe this approach is inadequate and fails to provide the public with a return on the massive US government investments in biomedical research related to these drugs that enabled these products to be developed and commercialized in the first place.

….

In our new INET working paper, we extend these analyses to the ten drugs selected for Medicare price negotiation in the first year of the IRA. Our analysis reveals that the NIH spent $11.7 billion on basic or applied research related to the drugs selected for Medicare price negotiations, representing a median investment cost of $895.4 million per drug and, by making this research available to industry, saving industry a median of $1,485 million per drug. While data on industry investments in these ten drugs is not publicly available, this level of NIH investment is comparable to reported investment by industry in the drugs approved from 2010 to 2019.

Paper PDF: https://www.ineteconomics.org/uploads/papers/WP_219-Federal-spending-on-drugs-Ledley-et-al-final.pdf

Author(s): Fred Ledley

Publication Date: 4 Mar 2024

Publication Site: Institute for New Economic Thinking

Few Nursing Facility Residents and Staff Have Received the Latest COVID-19 Vaccine

Mary Pat Campbell

Link: https://www.kff.org/medicaid/issue-brief/few-nursing-facility-residents-and-staff-have-received-the-latest-covid-19-vaccine/

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Excerpt:

Uptake of the current COVID-19 vaccine is higher in non-profit facilities than in for-profit or government facilities (Figure 2). The percentage of nursing facility residents who received the updated vaccine is 46% in non-profit facilities compared with 35% in for-profit facilities and 43% in government facilities. Uptake of the fall 2022 vaccine was also highest in non-profit facilities and lowest in for-profit facilities. Rates of vaccine uptake for nursing facility staff were low in all types of facilities with minimal variation across facility types (data not shown).

Author(s): Priya Chidambaram and Alice Burns

Publication Date: 13 Feb 2024

Publication Site: KFF, Medicaid

Lessons Learned During the Pandemic Can Help Improve Care in Nursing Homes

Mary Pat Campbell

Link: https://oig.hhs.gov/documents/evaluation/9808/OEI-02-20-00492.pdf

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Excerpt:

OIG recommends that the Centers for Medicare & Medicaid Services (CMS):

1. Implement and expand upon its policies and programs to strengthen the nursing home workforce.

2. Reassess nurse aide training and certification requirements.

3. Update the nursing home requirements for infection control to incorporate lessons learned from the pandemic.

4. Provide effective guidance and assistance to nursing homes on how to comply with updated infection control requirements.

5. Facilitate sharing of strategies and information to help nursing homes overcome challenges and improve care.

CMS did not explicitly state its concurrence or nonconcurrence for the five recommendations.

Author: Christi A. Grimm

Publication Date: February 2024

Publication Site: Office of the Inspector General, HHS

Staffing shortages, poor infection control plague nursing homes

Mary Pat Campbell

Link: https://www.upi.com/Health_News/2024/03/01/nursing-home-staffing-shortage/8751709302182/

Excerpt:

Although the pandemic has ended, staffing shortages and employee burnout still plague U.S. nursing homes, a new government report finds.

But the problems didn’t end there: The report, issued Thursday by the Inspector General’s Office at the U.S. Department of Health and Human Services, showed that infection-control procedures were still sorely lacking at many facilities.

Not only that, COVID-19 booster vaccination rates remain far lower than they should be, with only 38% of residents and 15% of staff up-to-date on their shots, according to a recent KFF report.

Author(s): Robin Foster

Publication Date: 1 Mae 2024

Publication Site: UPI

Cognitive impairment after long COVID-19: current evidence and perspectives

Mary Pat Campbell

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10423939/

Published online 2023 Jul 31. doi: 10.3389/fneur.2023.1239182

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Abstract:

COVID-19, caused by the SARS-CoV-2 virus, is a respiratory infectious disease. While most patients recover after treatment, there is growing evidence that COVID-19 may result in cognitive impairment. Recent studies reveal that some individuals experience cognitive deficits, such as diminished memory and attention, as well as sleep disturbances, suggesting that COVID-19 could have long-term effects on cognitive function. Research indicates that COVID-19 may contribute to cognitive decline by damaging crucial brain regions, including the hippocampus and anterior cingulate cortex. Additionally, studies have identified active neuroinflammation, mitochondrial dysfunction, and microglial activation in COVID-19 patients, implying that these factors may be potential mechanisms leading to cognitive impairment. Given these findings, the possibility of cognitive impairment following COVID-19 treatment warrants careful consideration. Large-scale follow-up studies are needed to investigate the impact of COVID-19 on cognitive function and offer evidence to support clinical treatment and rehabilitation practices. In-depth neuropathological and biological studies can elucidate precise mechanisms and provide a theoretical basis for prevention, treatment, and intervention research. Considering the risks of the long-term effects of COVID-19 and the possibility of reinfection, it is imperative to integrate basic and clinical research data to optimize the preservation of patients’ cognitive function and quality of life. This integration will also offer valuable insights for responding to similar public health events in the future. This perspective article synthesizes clinical and basic evidence of cognitive impairment following COVID-19, discussing potential mechanisms and outlining future research directions.

Author(s):Zhitao Li,# 1 , 2 , † Zhen Zhang,# 3 , † Zhuoya Zhang,# 4 , † Zhiyong Wang, 3 , * and Hao Li

Publication Date: 2023 Jul 31

Publication Site: Frontiers in Neurology

COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes During 2020

Mary Pat Campbell

Link: https://oig.hhs.gov/oei/reports/OEI-02-20-00490.pdf

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Excerpt:

The overall mortality rate in nursing homes rose 32 percent in 2020. The pandemic had far-reaching implications for all nursing home beneficiaries, beyond those who had or likely had COVID-19. Among all Medicare beneficiaries in nursing homes, 22.5 percent died in 2020, which is an increase of one-third from 2019 when 17.0 percent of Medicare beneficiaries in nursing homes died. This 32-percent increase amounts to 169,291 more deaths in 2020 than if the mortality rate had remained the same as in 2019. Each month of 2020 had a higher mortality rate than the corresponding month a year earlier.

Almost 1,000 more beneficiaries died per day in April 2020 than in the previous year. In April 2020 alone, a total of 81,484 Medicare beneficiaries in nursing homes died. This is almost 30,000 more deaths—an average of about 1,000 per day—compared to the previous year. This increase in number occurred even though the nursing home population was smaller in April 2020. Overall, Medicare beneficiaries in nursing homes were almost twice as likely to die in April 2020 than in April 2019. In April 2020, 6.3 percent of all Medicare beneficiaries in nursing homes died, whereas 3.5 percent died in April 2019.

The mortality rates also rose at the end of 2020. In November, 5.1 percent of all Medicare beneficiaries in nursing homes died, and in December that increased to 6.2 percent. Again, these rates are markedly higher than the previous year. In November 2019, 3.6 percent of all Medicare beneficiaries in nursing homes died, and, in December 2019, 3.8 percent did.

Author(s): Jenell Clarke-Whyte and team

Publication Date: June 2021

Publication Site: Office of Inspector General, HHS