[News article] Study reveals lack of data on opioid drugs for chronic pain — ScienceDaily

Study reveals lack of data on opioid drugs for chronic pain — ScienceDaily.
http://www.cdc.gov/media/releases/2014/p0303-prescription-opioids.html

 

From the article

Date:January 15, 2015

Source:University of Connecticut

Summary:Researchers have found little to no evidence for the effectiveness of opioid drugs in the treatment of long-term chronic pain, despite the explosive recent growth in the use of the drugs.

Read the article here

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[Report] Medicare Hospices Have Financial Incentives To Provide Care in Assisted Living Facilities | Full Text Reports…

 

From the executive summary of the January 2015 report by Department of Health and Human Services, OFFICE OF INSPECTOR GENERAL

WHY WE DID THIS STUDY
Medicare hospice care is intended to help terminally ill beneficiaries continue life with
minimal disruption and to support families and caregivers. Care may be provided in
various settings, including a private home or other places of residence, such as an assisted
living facility (ALF). Pursuant to the Patient Protection and Affordable Care Act, the
Centers for Medicare & Medicaid Services (CMS) must reform the hospice payment
system, collect data relevant to revising payments, and develop quality measures. This
report provides information to inform those decisions and is part of the Office of
Inspector General’s (OIG) larger body of work on hospice care. While the report focuses
on ALFs, many of the issues identified pertain to the hospice benefit more broadly.
HOW WE DID THIS STUDY
We based this study on an analysis of all Medicare hospice claims from 2007 through
2012. We used Certification and Survey Provider Enhanced Reports data and Healthcare
Cost Report Information System reports for information on hospice characteristics.
WHAT WE FOUND
Medicare payments for hospice care in ALFs more than doubled in 5 years, totaling
$2.1 billion in 2012. Hospices provided care much longer and received much higher
Medicare payments for beneficiaries in ALFs than for beneficiaries in other settings.
Hospice beneficiaries in ALFs often had diagnoses that usually require less complex care.
Hospices typically provided fewer than 5 hours of visits and were paid about $1,100 per
week for each beneficiary receiving routine home care in ALFs. Also, for-profit hospices
received much higher Medicare payments per beneficiary than nonprofit hospices. This
report raises concerns about the financial incentives created by the current payment
system and the potential for hospices to target beneficiaries in ALFs because they may
offer the hospices the greatest financial gain. Together, the findings in this and previous
OIG reports show that payment reform and more accountability are needed to reduce
incentives for hospices to focus solely on certain types of diagnoses or settings.
WHAT WE RECOMMEND
We recommend that CMS, as part of its ongoing hospice reform efforts: (1) reform
payments to reduce the incentive for hospices to target beneficiaries with certain
diagnoses and those likely to have long stays, (2) target certain hospices for review, (3)
develop and adopt claims-based measures of quality, (4) make hospice data publicly
available for beneficiaries, and (5) provide additional information to hospices to educate
them about how they compare to their peers. CMS concurred with all five
recommendations.

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[Repost] Women’s pain: Common, treatable and often overlooked or mismanaged — ScienceDaily

Women’s pain: Common, treatable and often overlooked or mismanaged — ScienceDaily.

Excerpts from the 19 January article

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“I can’t tell you the number of women I see who have been told they just have to live with the pain,” Dr. Thomas said. “It’s just heart breaking because many of these women have been suffering a long time. Women, especially older women, are less likely to speak up and seek treatment for their pain.”

Credit: Image courtesy of American Society of Anesthesiologists (ASA)

[Click to enlarge image]

Despite the variety of effective treatments, and physicians who specialize in treating pain, women often suffer unnecessarily from conditions ranging from backaches to pain after cancer surgery, and also treat their pain with medications that may be ineffective and possibly harmful, according to a review of research related to women and pain by the American Society of Anesthesiologists® (ASA®).

Related Articles

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• Opioid drug
• Anesthesia
• Chronic pain
• Pain
• Back pain
• Gate control theory of pain

ASA conducted the literature review and issued the Women’s Pain Update to help raise awareness of the many options available to women for controlling both acute and chronic pain, and how a pain medicine specialist can help them choose the right treatment. Among other things, the studies showed that remedies such as music, yoga and rose oil are proven effective for several types of pain, that opioids are often used inappropriately, and that the type of anesthesia used during breast cancer surgery can affect how quickly and comfortably a woman recovers from the operation.

Physician anesthesiologists are doctors who focus on anesthesia and critical care medicine and are among the medical specialists who are experts in the subspecialty of pain medicine, seeing patients in private practices and pain clinics.

Donna-Ann Thomas, M.D., a member of ASA’s Committee on Pain Medicine, frequently sees women who have been suffering in silence for years, with conditions such as a type of back pain that can develop after childbirth, and chronic pain after breast cancer surgery.

“I can’t tell you the number of women I see who have been told they just have to live with the pain,” Dr. Thomas said of women who come to her with sciatica, a type of back pain that radiates down the leg. “It’s just heart breaking because many of these women have been suffering a long time. Women, especially older women, are less likely to speak up and seek treatment for their pain.”

Related articles

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• Pain in Women – The Common Treatable Condition but Mismanaged
• Doctors Need More Evidence About Opioids, Report Says
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• Pain Depends on Many Brain Pathways, Not Just One

[Reblog] Keep America Beautiful – Prevent Cigarette Litter

Keep America Beautiful – Prevent Cigarette Litter.

Excerpts from the Guide to Cigarette Litter Prevention

A cigarette butt or cigar tip dropped to the ground seems insignificant.  But follow that butt as it’s carried off by rain into storm drains and eventually to streams and rivers. It now adds up to a big impact on the places we live: In fact, 32% of litter at storm drains is tobacco products.¹

Cigarette butt litter creates blight. It accumulates in gutters, and outside doorways and bus shelters. It’s the number one most littered item anywhere. Increasing amounts of litter in a business district, along riverfronts, or recreation areas create a sense that no one cares, leading to more community disorder and crime.²

Cigarette butts and cigar tips don’t disappear.  About 95% of cigarette filters are composed of cellulose acetate, a form of plastic which does not quickly degrade and can persist in the environment.³Cigar tips, too, are predominantly plastic.

Filters are harmful to waterways and wildlife. Litter traveling through storm drains and water systems, ends up in local streams, rivers, and waterways. Nearly 80% of marine debris comes from land-based sources. Cigarette butt litter can also pose a hazard to animals and marine life when they mistake filters for food⁴.

Learn more about why cigarette litter matters:

• What is the economic impact of cigarette litter?
• What are some common misconceptions about cigarette litter?

¹“Litter in America” 2009 KAB Research
² “Can the Can” The Economist http://www.economist.com/science/displaystory.cfm?story_id=12630201
³ Clean VA Waterways http://www.longwood.edu/cleanva/cigarettelitterhome.html
⁴ Faris, J. and Hart, K., Seas of Debris: A Summary of the Third International Conference on Marine Debris, N.C. Sea Grant College Program and NOAA, 1994, title page.

Related articles

• ‘Tobacco litter challenge to health, environment’

[Repost] Sitting for long periods increases risk of disease and early death, regardless of exercise — ScienceDaily

Sitting for long periods increases risk of disease and early death, regardless of exercise — ScienceDaily.

Excerpts from the 19 January 2015 article

Source:

University Health Network (UHN)

Summary:

The amount of time a person sits during the day is associated with a higher risk of heart disease, diabetes, cancer, and death, regardless of regular exercise, according to a review study.

The amount of time a person sits during the day is associated with a higher risk of heart disease, diabetes, cancer, and death, regardless of regular exercise.

Credit: © elen31 / Fotolia

The amount of time a person sits during the day is associated with a higher risk of heart disease, diabetes, cancer, and death, regardless of regular exercise, according to a review study published today in the Annals of Internal Medicine.

“More than one half of an average person’s day is spent being sedentary — sitting, watching television, or working at a computer,” said Dr. David Alter, Senior Scientist, Toronto Rehab, University Health Network (UHN), and Institute for Clinical Evaluative Sciences. “Our study finds that despite the health-enhancing benefits of physical activity, this alone may not be enough to reduce the risk for disease.”

……

The authors found the negative effects of sitting time on health, however, are more pronounced among those who do little or no exercise than among those who participate in higher amounts of exercise.

……

“Avoiding sedentary time and getting regular exercise are both important for improving your health and survival,” said Dr. Alter. “It is not good enough to exercise for 30 minutes a day and be sedentary for 23 and half hours.”

In the interim, Dr. Alter underlines strategies people can use to reduce sitting time. The target is to decrease sedentary time by two to three hours in a 12-hour day.

…..

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[Reblog] My Health Data Is Killing Me | The Health Care Blog

My Health Data Is Killing Me | The Health Care Blog.

Excerpt from the 20 January post

We are still in the dark ages when it comes to health and fitness data. It reminds me of the early 1990s when I had a paper day planner for a calendar, a business card holder for contacts, and a map.

Then along came the Microsoft Outlook and LotusNotes platform. These two platforms slugged it out like Uber verses Lyft. Then Microsoft integrated MS Office with MS Outlook and it was “game over.” I finally had one place to find everything I needed to do 90% of my job.

I’m waiting for that moment to come to the realm of my fitness data. It’s extremely difficult for me to access my medical and fitness data as it is, and yet the recent CES conference presented hundreds of new ways to collect more of my data. There will be wearables, scales, patches, contact lenses, smartphones, watches, etc. Maybe even a drone to fly overhead and watch what I eat for lunch. It is overwhelming. How overwhelming, you ask?

Read the rest of the article here

[Report] Regulation of Clinical Tests: In Vitro Diagnostic (IVD) Devices, Laboratory Developed Tests (LDTs), and Genetic Tests

From the summary of the December 2014 report by the Congressional Research Service

In vitro diagnostic (IVD) devices are used in the analysis of human samples, such as blood or
tissue, to provide information in making health care decisions. Examples of IVDs include (1)
pregnancy test kits or blood glucose tests for home use; (2) laboratory tests for infectious disease,such as HIV or hepatitis, and routine blood tests, such as cholesterol and anemia; and (3) tests forvarious genetic diseases or conditions. More recently, a specific type of diagnostic test—called acompanion diagnostic—has been developed that may be used to select the best therapy, at the right dose, at the correct time for a particular patient; this is often referred to as personalized or precision medicine.

…
In June 2010, FDA announced its decision to exercise its authority over all LDTs. A provision in
the Food and Drug Administration Safety and Innovation Act of 2012 stipulates that the agency
“may not issue any draft or final guidance on the regulation” of LDTs without, “at least 60 days
prior to such issuance,” first notifying Congress “of the anticipated details of such action.” On
July 31, 2014, in fulfillment of this statutory requirement, the FDA officially notified the Senate
Committee on Health, Education, Labor and Pensions and the House Committee on Energy and
Commerce that it will issue draft guidance on the regulation of LDTs, and included the
anticipated details of that regulatory framework. On October 3, 2014, the FDA formally issued
these documents as draft guidance in the Federal Register, giving 120 days for comment.
The draft guidance identifies groups of LDTs that will be (1) exempt from regulation entirely; (2)
only required to meet notification and adverse event reporting requirements; and (3) required to
meet notification, adverse event reporting, applicable premarket review, and other regulatory
requirements. FDA will use the information obtained through the notification requirement to
classify LDTs, based on risk, using a public process involving advisory panels and public
comment. Once classification has taken place, the FDA will enforce premarket review
requirements, prioritizing the highest-risk tests. The agency anticipates the entire process of
bringing all LDTs into compliance will take nine years to complete.

 

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• Lawmakers work on bipartisan legislation to accelerate cures

[Reblog] Science Matters: the power of vitamins

https://www.flickr.com/photos/mcbill/2319466919/in/photostream/

From the January 14, 2015 article at Prospect – Journal of International Affairs at USCD by prospectjournalucsd

Vitamins have become a booming industry in recent years. Businesses like The Vitamin Shoppe and Nature Made have made millions by isolating specific vitamins and minerals necessary for metabolic activity. However, recent studies have shown that an excess of certain vitamins may not only be unnecessary, but also harmful. In 2014, Nature published a piece which summarized the debate among scientists and health professionals regarding the use of vitamins in society, and several studies have shown that vitamins have no significant health benefit in terms of fighting cardiovascular disease or cancer.

….

According to David Agus, physician and best-selling author of “The End of Illness”, Americans spend $28 billion per year in dietary supplements, including both vitamins and herbals. Researchers at Johns Hopkins University have gone so far as to propose that the US cease producing vitamin supplements, because most of the money and the resources go to waste.

…

Related Resources

• Drugs, Supplements, and Herbal Information  (US National Institutes of Health)
• Dietary Supplements Labels Database  (US National Institutes of Health)
• Health Resources for All (editor of this blog)

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[Reblog] Imprisonment and public health

From the  December 8, 2014 post at thefeverblog

Mass incarceration in the United States goes beyond the logistical issues of overcrowded prisons. A shallow mindset wouldn’t identify the connection between mass incarceration and public health, but it’s prevalent and significance is being recognized. An article published in the New York Times briefly discusses the impact mass incarceration has on public health. It touches on a report published by the Vera Institute of Justice, which is an organization that focuses on making justice systems fairer through research and innovation. Most people in prisons come from impoverished communities, and therefore have low health-status.  Specifically, people in prisons have higher rates of chronic disease, mental illness, and substance abuse.

But that’s really the obvious part of the mass incarceration-public health relationship. Overcrowding exacerbates health problems, especially communicable diseases such as flu and other viral infections. In a previous post, I shared how social reform in Russia led to mass incarceration and in turn one of the largest outbreaks of tuberculosis in history. Mental illness  and substance abuse are major problems in jails, and the problem isn’t being addressed adequately. Although over 45% of incarcerated people have a mental illness and over 68% have substance abuse issues, only 15% receive proper treatment.

But that’s not even the  real problem. Our justice system is focused on penalizing, so vulnerable people coming out of prison are unable to receive any assistance because their actions have removed their eligibility. On first glance, the conservative argument would be that felons shouldn’t be privy to housing, medical, and financial assistance. But the whole picture has to be taken into consideration. Families can be easily torn apart by a family member being incarcerated, especially when parents are taken away from children.

Suicides and violence are also common in prisons. In the Vera Institute study it was found that 1/3 of deaths in prisons are due to suicide. Everything considered, mass incarceration is an epidemic and it’s public health ramifications are significant. The justice system in the United States needs to work with public health agencies to improve services, education, and awareness in prisons. The system needs to consider cases of penalizing on an individual by individual basis when evaluating eligibility for financial, housing, and medical assistance.

The inequality of violent death (Part 2)

joe rojas-burke

Injuries and violence kill more young people in the U.S. than any other cause of death. The burden of these deaths varies enormously by race, ethnicity and social class. Deaths by homicide, for instance, are more than eight times more prevalent among blacks than among whites, and homicide deaths are three times more common among American Indians and Alaskan Natives than among whites between the ages of 1 to 30 years old.

The figure below shows age-adjusted suicide and homicide rates in that age bracket by race and ethnic origin in the year 2010. The unit of measure is the number of deaths by suicide or homicide per 100,000 members of each population:

Source: Prevention of injury and violence in the USA, by Tamara M. Haegerich and others, The Lancet (2014)

The unequal burden stands out heart-breakingly clear in life expectancy numbers. Homicide takes two full years off the…

View original post 858 more words

Brutal inequalities in diabetes care: amputation hot spots

joe rojas-burke

Hot spots of diabetic amputation in Los Angeles, where rates vary from less than 1 to more than 10 amputations per 1,000 people age 45 and older with diabetes in 2009.

Surgical amputation of toes, feet or legs is a dreaded outcome of diabetes that can be prevented with good medical care. That can be hard to get if you live in the wrong zip code. People with diabetes in the lowest income neighborhoods of California were 10 times more likely to lose lower extremities to amputation than people with diabetes in the highest income neighborhoods, according to a new paper published in Health Affairs.

Many news outlets covered the story, but none that I read provided much context beyond repeating what the Health Affairs paper had to say, which is a shame because there’s a lot to report. Most didn’t even bother to mention the racial divide and relentless…

View original post 494 more words