[News release] Quarantine yes/no?

From the 24 March 2015 EurkAlert!

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The authors discuss how the use of quarantine can unintentionally introduce secondary and tertiary effects. If individuals show symptoms but are not isolated immediately, they will contaminate the quarantine group, and if individuals without symptoms are cohorted with a group already symptomatic, the risk of transmission will increase. The other unintended consequence is to patients admitted to hospitals for other medical reasons, e.g., heart attacks, strokes, trauma, and cancer.

The issue of psychological stress during quarantine is also addressed. These include fear of the disease and possible confinement, and the effects on family, friends and colleagues.

Before civil liberties are suspended, decision-makers must use evidence-based data to support their decisions. Public health officials and political figures should avoid taking unnecessary harsh precautions in their effort to appear on top of the situation. Per Dr. Barbisch, Major General, US Army (ret): “Quarantine should only be used if the inherent restrictions will effectively reduce the spread of the disease.”

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[News release] George Washington University to hold national conference on integrating health and legal care

From the 25 March 2015 EurkAlert!

he National Center for Medical-Legal Partnership, part of Milken Institute School of Public Health at the George Washington University, will host its tenth annual conference on April 9-10, 2015, in McLean, Virginia to discuss how to better address the social and legal problems negatively impacting the health of 50 million low-income Americans. Leaders from law, health care, public health and government in 38 states will present research and strategies aimed at effectively integrating health and legal care.

With featured remarks from Lauren Taylor, co-author of The American Health Care Paradox, Jeffrey Levi, executive director of Trust for America’s Health, and Phillip Alberti, senior director for health equity research & policy at the Association of American Medical Colleges, participants will explore topics including:

• The intersection of health and legal problems for veterans, children and chronically ill individuals;
• The ways that providing integrated legal care for patients can help meet community benefit requirements for public hospitals; and
• The ability of legal care to strengthen population health interventions.

A full agenda is available at: http://www.medical-legalpartnership.org/join-movement/summit/

[News release] Medicaid Is a Very Good Investment Even If It Does Not Lower Cholesterol, Blood Pressure, or Blood Sugar

Centers for Medicare and Medicaid Services (Medicaid administrator) logo (Photo credit: Wikipedia)

From the 25 March 2015 Columbia University news release

Quality-Life Year Gains Average $62,000

March 26, 2015 — Researchers atColumbia University’s Mailman School of Public Health analyzed the results of the Oregon Health Experiment, where eligible uninsured individuals were randomly assigned Medicaid or to stay with their current care. Considered controversial because the experiment found no measurable gains for physical health it did reveal benefits for mental health, financial wellbeing, and preventive screening. In terms of quality-adjusted life years, the researchers showed that Medicaid is an excellent value—a $62,000 gain in quality-adjusted life years. Study findings are online in the American Journal of Public Health. 
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Related articles

• NY expands mental health safety net for released inmates

[News release] An International Team of Researchers Discover Strong Association Between Lifestyles of Indigenous Communities and Gut Microbial Ecologies

From the 25 March 2015 University of Oklahoma news release

…the team presents an in-depth analysis of the gut microbiome of the Matses, an Amazonian hunter-gatherer community, which is compared with that of the village of Tunapunco, who are highland small-scale farmers, as well as with urban city-dwellers in Norman, Okla.

In comparing the three groups to previously published studies in Africa and South America, the team observed a striking trend.  Human gut microbiota cluster together based on subsistence strategy more than geographic proximity.  Thus, hunter-gatherers in South America and Africa are more similar to each other than either are to rural agriculturalists or to urban-industrialists, even from neighboring populations.

It is now well accepted that human gut microbiomes are actively involved in health and that changes in our gut microbes from living more sanitized, industrialized lifestyles, has led to susceptibility to certain autoimmune disorders like asthma and allergies.

Also, it has become clear that industrialization has led to a decrease in gut microbiome diversity.  Moreover, in the gut of industrialized peoples, one particular bacteria genus is conspicuously absent, Treponema.  These bacteria have co-existed with humans and other primates for millions of years, so their absence in industrialized people is disconcerting.

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[News release] Emergency medicine physicians urge colleagues to help prevent gun violence

From the 25 March 2015 UC Davis news release

In an editorial posted online today in the Annals of Emergency Medicine, two practicing emergency medicine physicians from the University of California, Davis, and Brown University — both thought leaders at the forefront of finding solutions to the public health crisis of gun violence — urge their colleagues to take direct action to protect the health and safety of patients and communities.

Their editorial follows the Feb. 24 call to action by eight health professional organizations, including the American College of Emergency Physicians, and the American Bar Association, to reduce firearm injuries and deaths in the U.S. — unprecedented support that suggests mobilization to prevent firearm violence may be underway.

“Firearm violence causes nearly as many deaths as motor vehicle crashes,” said Garen J. Wintemute, an emergency medicine professor at UC Davis and a national authority on evidence-based strategies to prevent firearm violence. “Firearms are involved in most homicides and suicides, and the number of suicides by firearm is increasing — especially among older white men.

“Emergency medicine physicians have limited opportunities to prevent a death once a shooting has occurred, because most people who die from their wounds do so where they are shot. Gun ownership or having a gun in the household is a well-documented risk factor for a violent death. For that reason, we believe physicians should also work to help prevent shootings,” he said.

The authors describe how America successfully reduced motor-vehicle-related deaths by better vehicle and roadway design and public policies that make driving under the influence a crime. Yet no comparable public-health campaign focused on reducing gun violence has been launched.

The authors particularly emphasize the need for a national policy requiring background checks on all transfers of firearms to help prevent access to firearms by those who are prohibited from having them. They recommend adding two other high-risk groups to the list of individuals who are prohibited from purchasing firearms. These include persons with a history of violent misdemeanor convictions, such as assault and battery and domestic violence, as well as those with a documented history of addiction and alcohol abuse.

“Controlled studies of felons, those who have committed violent misdemeanors and persons prohibited for mental-health reasons have all shown reductions in risk for future violence of 25 percent or more when these individuals are denied firearm purchases,” said Megan Ranney, an emergency medicine physician and director of the Emergency Digital Health Innovation program at Rhode Island Hospital and the Warren Alpert Medical School of Brown University.

The authors also address mental illness and gun violence. While they agree with recommendations that focus on behavior and expanded access to treatment, they emphasize that serious mental illness directly accounts for only 4 percent of interpersonal violence. In contrast, mental illness is associated with between 47 and 74 percent of suicides. The risk of firearm injury increases when mental illness coexists with alcohol abuse, drug abuse and a history of prior violence.

“Physicians need to include questions about firearms when assessing risk of violence in their patients, and need to act on the information, especially when patients are expressing thoughts of dangerousness to themselves or others, are intoxicated or are in the emergency department for a violence-related injury,” Ranney said.

At a time when civilian fatalities from gunshot wounds for 2004 to 2013 have outnumbered combat fatalities from World War II, the authors welcome the unprecedented support from leading organizations of health and legal professionals for policy recommendations to reduce gun violence.

“Physicians can take direct action to protect the health and safety of patients and communities,” Wintemute said. “While we may not all agree on all the specifics, enough of us will agree on enough of them to make a difference for the better.”

The Violence Prevention Research Program is an organized research program of the University of California, Davis, that conducts leading-edge research to further America’s efforts to understand and prevent violence. Since its founding over 30 years ago, the program has produced a uniquely rich and informative body of research on the causes, nature and prevention of violence, especially firearm violence. Current areas of emphasis include the prediction of criminal behavior, the effectiveness of waiting period and background-check programs for prospective purchasers of firearms, and the determinants of firearm violence. For more information, visit www.ucdmc.ucdavis.edu/vprp

Founded in 1863, Rhode Island Hospital in Providence, R.I., is a private, not-for-profit hospital and is the principal teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Last year, Rhode Island Hospital received more than $55 million in external research funding. It is also home to Hasbro Children’s Hospital, the state’s only facility dedicated to pediatric care. For more information on Rhode Island Hospital, visitwww.rhodeislandhospital.org, follow us on Twitter @RIHospital or like us on Facebook http://www.facebook.com/rhodeislandhospitalpage.

 

Related article

Texas bill would prohibit doctors from asking about guns

While legislation expanding how and where Texans can carry weapons is dominating the Legislature this week, one state lawmaker is targeting the doctor’s office as a place to keep the federal government from learning who owns guns.

Over the objections of the medical community, state Rep. Stuart Spitzer, R-Kaufman, has filed a bill that would prohibit doctors from asking patients whether they own a firearm and makes the Texas Medical Board, which licenses physicians, responsible for doling out punishment.

 

Penn Medicine Study: In Debated Surgical Procedure, Technique Trumps Technology

From the 26 March 2015 news release

Improved Decision-Making in How to Use New Technology May be Key to Decrease in Complications Associated with Fracture Healing Procedures

A team of orthopedic surgeons from the Perelman School of Medicine at the University of Pennsylvania has found that modern technology for healing distal femur fractures is as safe and effective as its more established alternative, without a potential shortfall of the older approach. The team found that when done correctly, there are no significant differences between the two approaches – “locked plating” and “non-locked plating” – in terms of healing rates, need for corrective surgery, or hardware failure. The findings are being presented on Thursday, March 26, 2015, at the American Academy of Orthopaedic Surgeons Annual Meeting in Las Vegas.

he team examined medical records of 95 patients who underwent surgery to repair distal femoral fractures. Though relatively uncommon in the general population, an increase in the number of these fractures is expected as the population ages. For 80 percent of the patients studied, the fracture healed within 3.5 months of surgery, while 20 percent needed corrective surgery. The researchers found that patients whose surgeons used locked plating – which historically required a second revision surgery roughly 40 percent of the time – had no more setbacks than patients whose providers used non-locked plating.

The two methods differ by virtue of their use of locking and non-locking screws, respectively, to attach metal plates to fractured bone in order to provide stability and promote healing. While locked plating virtually eliminates the possibility of the plate moving, it has been associated with pronounced stiffness and rigidity around the healing bone, which can prevent the broken bone from healing.

“Plates used in distal femur surgery come in various sizes, and have as many as 16 to 20 apertures, or screw holes,” explained the study’s senior author Samir Mehta, MD, chief of the division of Orthopaedic Trauma at the Perelman School of Medicine at the University of Pennsylvania. “In the early days of locked plating, some surgeons used screws in every one of these apertures, which we think lead to stiffness, rigidity and pain for patients. Today, surgeons are more judicious, using far fewer screws and picking and choosing which holes to insert the screws in based on factors in the case at hand. This improved decision-making on the part of surgeons is what we believe has resulted in the significant decrease in techincal problems associated with locked plating.”

According to the researchers, the one factor that had a significant impact on fracture healing was if the fracture was open. Additionally, two factors increased the risk of poor healing for the participant population, but did not reach statistical significance: diabetes and non-weight bearing status postoperatively. The latter finding points the way toward early weight-bearing by patients, typically within a few days of surgery, rather than remaining in bed.

“As surgeons become more adept at application of both established and developing implant technologies, outcomes will continue to improve,” said lead investigator Ryan M. Taylor, MD, a fifth-year resident in the department of Orthopaedic Surgery at the Perelman School of Medicine at the University of Pennsylvania. “However, we must remain cognizant of patient specific variables such as age, weight, and pre-existing comorbidities, which can affect overall care strategies and management.”

[News release] Research aims to reduce health care disparities

From ScienceDaily

Date:March 26, 2015

Source:H. Lee Moffitt Cancer Center & Research Institute

Summary:The lesbian, gay, bisexual, transgender/transsexual, queer/questioning and intersex (LGBTQI) population has been largely understudied by the medical community. Researchers found that the LGBTQI community experience health disparities due to reduced access to health care and health insurance, coupled with being at an elevated risk for multiple types of cancer when compared to non-LGBTQI populations.

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The study highlights that LGBTQI populations face barriers to health insurance such as when partnerships and marriages are not legally recognized; concerns about disclosure in a health care setting, discrimination, misconceptions, legal and financial barriers and the disenfranchised stress and distress of caregiving same-sex partners.

Additionally, there are higher rates of smoking and substance abuse and low screening rates resulting in poor patient outcomes and survival rates for LGBTQI populations. Her review, The Importance of disclosure: Lesbian, gay, bisexual, transgendered, queer/questioning, and intersex individuals and the cancer continuum, was published in the American Cancer Society’s journal, Cancer.

Researchers identified that the real or perceived limited access to care due to fear of discrimination and lack of sensitivity and knowledge of LGBTQI issues stood as roadblocks to patient care. In a study of family physicians only 1 in 80 reported routinely asking patients about sexual orientation, while the majority reported rarely or never asking. The National Institutes of Health and the Institute of Medicine now recognize gender identify and sexual orientation as vital aspects of a health history and the need for improved research in this population.

“For many years, physicians did not ask patients about their sexual orientation. The importance of recognizing gender identity and sexual orientation is critical to ensuring the best quality and evidence-based care is available to patients,” explained Quinn.

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[Reblog] Can Buttered Coffee Give You a Better Body?

From the March 2015 blog item by  Laura Jeffers, MEd, RD, LD at Clevelandclinic.org

Heart-healthy fats are good, but not in coffee

There’s a lot of hype lately about the most recent coffee trend. Take your morning cup-of-joe, add two tablespoons of butter and some oil, and call it Bulletproof Coffee. No doubt it’s an interesting flavor, but it’s the claims of increased energy and weight loss that seem to be giving this morning jolt traction.

It’s not just any butter and coffee. Those supporting this idea say it has to be unsalted, grass-fed butter and medium-chain triglyceride oil (MCT) added to low-toxicity coffee beans. But can a mixture like that really live up to what proponents are saying?

What happens to butter in your body

There’s no real research into whether butter-spiked coffee is good for you, but we do know some things about how butter affects your digestion.

According to existing research, fat in butter contains glycosphingolipids, fatty acids that ward off gastrointestinal tract infections, especially in very young children and older adults.

Its omega-3 and omega-6 fats also slow down your body’s metabolism of caffeine, so you hold on to energy longer and avoid the crash that comes when the stimulant wears off.

More about MCT

MCT, most commonly found in coconut oil, is also good for our bodies and brains. When it comes to our bodies, we don’t store MCT in our adipose tissue, the fat around and inside our muscles, like the other dietary fats we eat.

Most of those fats are long-chain triglycerides, but MCTs are shorter. They travel directly to the liver where they’re processed into powerful energy particles called ketone bodies.

In addition, if your brain loses the ability to break down its primary fuel source, glucose, due to cognitive impairment or some other disorder, it can use ketone bodies as an excellent, alternative source. Researchshows that people with cognitive impairment who ingest MCT experience an almost immediate improvement in mental function.

My verdict

So, do the health benefits of butter and MCT mean you should add them to your morning coffee? To begin with, if you don’t already drink coffee, I don’t recommend you start. If you do, though, I still don’t endorse your adding butter and oil to it, and I have no plans to do it either.

Healthy fats and oils do have a place in our daily diets, but I’m not convinced that enhancing our coffee with them is the best way to incorporate them.