[Press release] Living with chronic pain: The daily struggle with a ‘new self’

Finding it easy to empathize with these patients because of a short term musculoskeletal condition.
Hoping that health care providers will be able to find ways to treat all who experience this chronic  condition without  interference from the government.

From the 3 December 2013 University of Warwick  press release via EurekAlert

People who suffer with chronic musculoskeletal pain face a daily struggle with their sense of self and find it difficult to prove the legitimacy of their condition.

A new study, funded by the National Institute for Health Research Health Services and Delivery Research (HS&DR) Programme, systematically searches for, and makes sense of, the growing body of qualitative research on musculoskeletal pain to help understand the experiences of patients suffering from chronic pain.

A number of concerning themes arose from the study, published today in the Health Services and Delivery Research journal, which highlighted:

• Patients struggling with the fundamental relationship with their body, and a sense that it is no longer ‘the real me’.
• A loss of certainty for the future, and being constantly aware of the restrictions of their body.
• Feeling lost in the health care system; feeling as though there is no answer to their pain.
• Finding it impossible to ‘prove’ their pain; “if I appear ‘too sick’ or ‘not sick enough’ then no one will believe me”

Kate Seers, Professor of Health Research at Warwick Medical School and Director of the Royal College of Nursing Research Institute, was a collaborator on this study. She explains, “Being able to collate this vast amount of information from patients paints a worrying picture about the experiences they have with chronic non-malignant pain. Our goal has to be to use this information to improve our understanding of their condition and, consequently, the quality of care we can provide.”

“Having patients feel that they have to legitimise their pain, and the sense that doctors might not believe them, is something that should really concern us as health care professionals.”

The study also identified a number of ways in which patients can move forward with their lives.

The key for some people appears to be building a new relationship with the body and redefining what is ‘normal’, rather than trying to maintain the lifestyle before the pain. Developing an understanding of what the body is capable of and becoming confident to make choices can aid the process of living with musculoskeletal pain.

Dr Francine Toye, of Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, explains, “This paper shows there can be value in discussing the condition with other people who are going through the same experience and knowing that you are not alone. Of course you can learn about your condition from various sources, but sharing your experience seems to really help people to move forward.”

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77 studies of chronic musculoskeletal pain were included in the meta-ethnography, with collaborators from Nuffield Orthopaedic Centre, the University of Warwick, Glasgow Caledonian University, Leeds Metropolitan University, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and the University of Calgary.

 

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[Press release] Dispelling an urban legend, new study shows who uses emergency departments frequently

“…frequent emergency department users have a substantial burden of disease, often having multiple chronic conditions and many hospitalizations.”

From the 3 December 2013 New York University press release via EurekAlert

While it has often been said that the most frequent users of overburdened hospital emergency departments are mentally ill substance abusers, a study out today (Dec. 3) by researchers from NYU Wagner and the University of California, San Francisco, has found that this belief is unfounded – an “urban legend.”

Co-authored by John Billings of NYU’s Robert F. Wagner Graduate School of Public Service and Maria C. Raven of the University of California and published in the December issue of Health Affairs, the new analysis of hospital emergency department (ED) use in New York City by Medicaid patients reveals that conditions related to substance abuse and mental illness are responsible for a small share of the emergency department visits by frequent ED users, and that ED use accounts for a small portion of these patients’ total Medicaid expenditures. However, according to the study, frequent emergency department users have a substantial burden of disease, often having multiple chronic conditions and many hospitalizations.

The article, “Dispelling an Urban Legend: Frequent Emergency Department Users Have Substantial Burden of Disease,” analyzes data on emergency department visits by 212,259 New York City residents who received their first emergency department care in 2007. The researchers reviewed each patient’s eligibility, ED use, Medicaid fee-for-service spending, and diagnostic history. The main part of the analysis covers the three years before each patient’s first visit to a hospital emergency department, the 12 months after the initial visit, and the subsequent two years. As the authors write, “contrary to urban legend, most repeat users in the study did appear to have relatively strong linkage to ambulatory care, at least as evidenced by their high rates of primary and specialty care visits. Except for ED users with ten or more visits in the index [initial] year, ambulatory care visit rates actually exceeded ED visit rates.”

While hospital emergency department use is not a major cost driver for the Medicaid program, an improved understanding of Medicaid beneficiaries who frequently obtain ED care could help inform the current policy debate over how to meet the significant needs of this population and how to contain Medicaid expenditures, according to the researchers.

Importantly, the analysis indicates that “predictive modeling” based on information provided at a patient’s initial ED visit could be used to identify individuals likely to return to the emergency department frequently. Billings and Raven write that the predictive modeling approach, coupled with an understanding of the characteristics of frequent ED users, offers health care institutions an opportunity to design targeted, cross-system health care interventions to keep future high users from having to return to the hospital for emergency care.

“It is also important to note that only a small number of ‘frequent fliers’ are ultra-high ED users or serial high ED users, with frequent ED use year after year,” Billings and Raven assert. “To date, most thinking by providers and policy makers about the problem of frequent ED users has focused on these serial users, but the overwhelming majority of frequent users have only episodic periods of high ED use, instead of consistent use over multiple years. More needs to be learned about these patients (they, too, could be interviewed in the ED), and predictive modeling and quick intervention will probably be critical since their repeat ED use is unlikely to continue over time.”

 

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John Billings is a professor of health policy and public service at NYU Wagner, where he directs the Health Policy and Management Program. Maria C. Raven is an assistant professor in the Department of Emergency Medicine at the University of California, San Francisco, School of Medicine.

The authors are available for interview about their findings: contact NYU public affairs officer Robert Polner via the phone number or email address listed with this release.

 

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• Dispelling an urban legend, new study shows who uses emergency departments frequently (medicalxpress.com)
• [NCHS Data Brief] Emergency Department Visits by Persons Aged 65 and Over: United States, 2009 – 2010 (jflahiff.wordpress.com)
• Homeless people much more frequent users of emergency department and other health-care services (eurekalert.org)

 

[Press release] First real-time flu forecast successful

“This season the forecasts will be more readily available to the public on a website hosted by Columbia’s Mailman School of Public Health expected to launch in the coming weeks.”

 

From the 3 December 2013 Columbia University’s Mailman School of Public Health press release via EurekAlert

Researchers take a page from weather forecasting to predict seasonal influenza outbreaks in 108 cities across the country

Scientists were able to reliably predict the timing of the 2012-2013 influenza season up to nine weeks in advance of its peak. The first large-scale demonstration of the flu forecasting system by scientists at Columbia University’s Mailman School of Public Health was carried out in 108 cities across the United States.

Results are published online in the journal Nature Communications.

The flu forecasting system adapts techniques used in modern weather prediction to turn real-time, Web-based estimates of influenza infection into local forecasts of the seasonal peak by locality. Influenza activity peaked in cities in the southeast as early as December 2012, but crested in most of the country in the first weeks of 2013.

Year to year, the flu season is highly variable. It can happen anywhere from December to April. But when it arrives, cities can go from practically no cases to thousands in a very short time. “Having greater advance warning of the timing and intensity of influenza outbreaks could prevent a portion of these influenza infections by providing actionable information to officials and the general public,” says first author Jeffrey Shaman, PhD, assistant professor of Environmental Health Sciences at Columbia University’s Mailman School of Public Health.

For the public, the flu forecast could promote greater vaccination, the exercise of care around people sneezing and coughing, and a better awareness of personal health. For health officials, it could inform decisions on how many vaccines and antiviral drugs to stockpile, and in the case of a virulent outbreak, whether other measures, like closing schools, are necessary.

Study Results

The new study builds on the researchers’ 2012 study that used the system to retrospectively predict the peak of the flu in New York City for the years 2003-2008. That research was limited to one city and performed as a test of the system. The current study is the first to make predictions in actual real-time and for the whole country.

Beginning in late November of 2012, the researchers used the flu forecasting system to perform weekly estimates for 108 cities. They shared the results with the CDC and posted them online in an academic archive. Near the end of 2012, four weeks into the flu season, the system had predicted 63% of cities accurately. As the season progressed, the accuracy increased. By week four, it successfully predicted the seasonal peak in 70% of the country. It was able to give accurate lead-times up to nine weeks in advance of the peak; most lead-times were two to four weeks.

The flu forecasts were also much more reliable than those made using alternate, approaches that rely on historical data. “Our method greatly outperformed these alternate schemes,” says Dr. Shaman.

The researchers saw regional differences in the accuracy of the system, but they were likely within normal variation. “As an example, retrospectively, we’ve been able to predict the flu in Chicago very well; this year we did a terrible job in that city. For other cities, the opposite held. It averages out. On the whole the system performed very well,” Dr. Shaman says. However, there were hints of geographical differences. “We were able make better predictions in smaller cities. Population density may also be important. It suggests that in a city like New York, we may need to predict at a finer granularity, perhaps at the borough level. In a big sprawling city like Los Angeles, we may need to predict influenza at the level of individual neighborhoods.”

Google Flu Trends Goes “Off the Rails”

The researchers designed the flu forecasting system to use combined data from 1) Google Flu Trends, which makes estimates of outbreaks based on the number of flu-related search queries, and 2) region-specific reports from the Centers for Disease Control on verified cases of flu. The system approach is analogous to weather forecasting, which employs real-time observational data to reduce model forecasts error. In the last year, the researchers slightly modified the system to be more representative of flu rather than flu and other respiratory problems. Nevertheless, there was unusual level of “noise” in the data related to problems with Google Flu Trends.

How did this happen? One explanation is the high number of media stories about the flu, including some about the flu forecasting system itself. The result was a spike in people using Google to research the flu, which could have overloaded the Flu Trends algorithm. It’s an irony not lost on Dr. Shaman. “There was a tremendous amount of media attention accorded to the flu last year. I was part of the problem myself,” he says. Another factor may have been the particular strain of flu in circulation. “The flu was very virulent and was making people very sick, more so than previous seasons,” says Dr. Shaman. Again this could have led to spike in flu-related Google search queries. (In October, Google announced that it has revised the Flu Trends, which Dr. Shaman hopes will make flu forecasting more accurate.)

The system will be put back in action as soon as the flu season begins again. “Right now there are few cases of the flu, but as soon as the needle starts to move, we will start making predictions,” says Dr. Shaman. This season the forecasts will be more readily available to the public on a website hosted by Columbia’s Mailman School of Public Health expected to launch in the coming weeks.

Worldwide, influenza kills an estimated 250,000 to 500,000 people each year, according to the World Health Organization. In the U.S. 3,000-49,000 die from the flu every year, and about 45% of Americans were vaccinated for the flu, according to the CDC.

 

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Co-authors include Wan Yang and James Tamerius, post-doctoral students of Dr. Shaman (Dr. Tamerius is currently at the University of Iowa); Alicia Karspeck at the National Center for Atmospheric Research; and Marc Lipsitch at the Harvard School of Public Health.

Funding was provided by the National Institutes of Health (GM100467, ES009089) and the Department of Homeland Security. Dr. Lipsitch discloses consulting or honorarium income from the Avian/Pandemic Flu Registry (Outcomes Sciences; funded in part by Roche), AIR Worldwide, Pfizer and Novartis. All other authors declare no competing financial interests.

 

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[Pew Report] Fixing the Oversight of Chemicals Added to Our Food

From the 7 November 2013 report summary

Overview

From 2010 to 2013, The Pew Charitable Trusts conducted a comprehensive assessment of the federal food additives regulatory program. Relying on a transparent process that engaged stakeholders, Pew examined food additive issues in partnership with the food industry, the public interest community, and the federal government, including the U.S. Food and Drug Administration, or FDA. We held five expert workshops and published six reports in peer-reviewed journals. This report summarizes our findings and provides recommendations to address the problems that we identified.

With more than 10,000 additives allowed in food, Pew’s research found that the FDA regulatory system is plagued with systemic problems, which prevent the agency from ensuring that their use is safe. The cause of this breakdown in our food safety regulatory process is an outdated law with two significant problems:

First, the law contains an exemption intended for common food ingredients; manufacturers have used this exception to go to market without agency review on the grounds that the additive used is “generally recognized as safe,” or GRAS, in regulatory parlance. FDA has interpreted the law as imposing no obligation on firms to tell the agency of any GRAS decisions. As a result, companies have determined that an estimated 1,000 chemicals are generally recognized as safe and have used them without notifying the agency. The firms usually use their own employees, consultants, or experts whom they select and pay to make the safety decision with no disclosure or apparent efforts to minimize the inherent conflicts of interest.

Second, the law does not give FDA the authority it needs to efficiently obtain the information necessary to identify chemicals of concern that are already on the market; set priorities to reassess these chemicals; and then complete a review of their safety. Moreover, the agency has not been given the resources it needs to effectively implement the original 1958 law. As a result, FDA has not reevaluated the safety of many chemicals originally approved decades ago, generally rechecking safety only when requested by a company to do so, or when presented with allegations of serious adverse health effects.

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What FDA says today about the safety of additives

“It’s perhaps a time to look at what the legal framework looks like and what opportunities there are now to ask and answer questions in new ways because of advances in science and technology.”

— FDA Commissioner Margaret Hamburg, (Reuters, May 2013)

“We’re not driven by a sense that there is a pressing public health emergency. But there are decisions being made based on data that we don’t have access to, and that creates a question about the basis on which those decisions are made.”

— FDA Deputy Commissioner for Foods Michael Taylor, (Associated Press, March 2013)

“FDA plans to issue guidance to industry on meeting the GRAS criteria established under the Act.”

— FDA spokeswoman Theresa Eisenman, (USA Today, August 2013)

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To remedy these problems, Pew’s report recommends that Congress update the Food Additives Amendment of 1958 to ensure that FDA:

• Approves the first use of all new chemicals added to food.
• Reviews new uses or changes to existing uses of previously approved additives.
• Streamlines its decision-making process so it is timely and efficient.
• Upgrades its science to determine safety.
• Uses the scientific tools and data it needs to set priorities to reassess the safety of chemicals already allowed in food and to take action where necessary.

– See more at: http://www.pewhealth.org/reports-analysis/reports/fixing-the-oversight-of-chemicals-added-to-our-food-85899518122#sthash.cQHyqL0p.dpuf

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