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Use of St. John’s Wort in Potentially Dangerous Combinations

July 22, 2014 Comments off

Use of St. John’s Wort in Potentially Dangerous Combinations
Source: Journal of Alternative and Complementary Medicine

Objectives:
The objective of this study was to assess how often St. John’s wort (SJW) is prescribed with medications that may interact dangerously with it.

Design:
The study design was a retrospective analysis of nationally representative data from the National Ambulatory Medical Care Survey.

Settings:
The study setting was U.S. nonfederal outpatient physician offices.

Subjects:
Those prescribed SJW between 1993 and 2010 were the subjects.

Outcome Measures:
The outcome measures were medications co-prescribed with SJW.

Results: Twenty-eight percent (28%) of SJW visits involved a drug that has potentially dangerous interaction with SJW. These included selective serotonin reuptake inhibitors, benzodiazepines, warfarin, statins, verapamil, digoxin, and oral contraceptives.

Conclusions:
SJW is frequently used in potentially dangerous combinations. Physicians should be aware of these common interactions and warn patients appropriately.

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A Practitioner’s Toolkit for Managing the Menopause

July 22, 2014 Comments off

A Practitioner’s Toolkit for Managing the Menopause
Source: Climacteric

Objective
A number of learned societies, including the International Menopause Society, have produced position statements pertaining to the use of postmenopausal hormone therapy. These documents are highly informative but are not designed for use by primary-care physicians and nurse practitioners during routine consultations. Our aim was to produce a toolkit for practitioners that could be used during office consultations to assist them in the assessment and management of the menopause.

Methods
We used clinical experience in primary care, combined with published diagnostic algorithms, positions statements from learned medical societies and relevant peer-reviewed literature to develop assessment and management algorithms relevant to the primary care of women age 40 years and older.

Results
The resultant ‘Practitioner’s Toolkit for Managing the Menopause’ comprises algorithms for the reasons why a woman might present, determination of menopausal status, key information that should be ascertained, issues that may influence treatment decision-making, hormonal and non-hormonal treatment options, symptom management and patient review, and a brief supporting document.

Conclusions
We believe these algorithms and supporting document provide an accessible desktop tool for health-care practitioners caring for women at midlife. The toolkit has been endorsed by the International Menopause Society for global use.

Chart Book: Social Security Disability Insurance

July 22, 2014 Comments off

Chart Book: Social Security Disability Insurance
Source: Center on Budget and Policy Priorities

Disability Insurance (DI) is an integral part of Social Security. It provides modest but vital benefits to workers who can no longer support themselves on account of a serious and long-lasting medical impairment. The Social Security Administration (SSA) administers the DI program.

In December 2013, 8.9 million people received disabled-worker benefits from Social Security. Payments also went to some of their family members: 160,000 spouses and 1.9 million children.

DI benefits are financed primarily by a portion of the Social Security payroll tax and totaled about $140 billion in 2013. That’s 4 percent of the federal budget and less than 1 percent of the gross domestic product (GDP). Employers and employees each pay a DI tax of 0.9 percent on earnings up to a specified amount, currently $117,000. Financial transactions are handled through a DI trust fund, which receives payroll tax revenues and pays out benefits and which is legally separate from the much larger Social Security retirement fund. Under current projections, the DI trust fund will need replenishment in 2016.

Association between Class III Obesity (BMI of 40–59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies

July 22, 2014 Comments off

Association between Class III Obesity (BMI of 40–59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies
Source: PLoS Medicine

Background
The prevalence of class III obesity (body mass index [BMI]≥40 kg/m2) has increased dramatically in several countries and currently affects 6% of adults in the US, with uncertain impact on the risks of illness and death. Using data from a large pooled study, we evaluated the risk of death, overall and due to a wide range of causes, and years of life expectancy lost associated with class III obesity.

Methods and Findings
In a pooled analysis of 20 prospective studies from the United States, Sweden, and Australia, we estimated sex- and age-adjusted total and cause-specific mortality rates (deaths per 100,000 persons per year) and multivariable-adjusted hazard ratios for adults, aged 19–83 y at baseline, classified as obese class III (BMI 40.0–59.9 kg/m2) compared with those classified as normal weight (BMI 18.5–24.9 kg/m2). Participants reporting ever smoking cigarettes or a history of chronic disease (heart disease, cancer, stroke, or emphysema) on baseline questionnaires were excluded. Among 9,564 class III obesity participants, mortality rates were 856.0 in men and 663.0 in women during the study period (1976–2009). Among 304,011 normal-weight participants, rates were 346.7 and 280.5 in men and women, respectively. Deaths from heart disease contributed largely to the excess rates in the class III obesity group (rate differences = 238.9 and 132.8 in men and women, respectively), followed by deaths from cancer (rate differences = 36.7 and 62.3 in men and women, respectively) and diabetes (rate differences = 51.2 and 29.2 in men and women, respectively). Within the class III obesity range, multivariable-adjusted hazard ratios for total deaths and deaths due to heart disease, cancer, diabetes, nephritis/nephrotic syndrome/nephrosis, chronic lower respiratory disease, and influenza/pneumonia increased with increasing BMI. Compared with normal-weight BMI, a BMI of 40–44.9, 45–49.9, 50–54.9, and 55–59.9 kg/m2 was associated with an estimated 6.5 (95% CI: 5.7–7.3), 8.9 (95% CI: 7.4–10.4), 9.8 (95% CI: 7.4–12.2), and 13.7 (95% CI: 10.5–16.9) y of life lost. A limitation was that BMI was mainly ascertained by self-report.

Conclusions
Class III obesity is associated with substantially elevated rates of total mortality, with most of the excess deaths due to heart disease, cancer, and diabetes, and major reductions in life expectancy compared with normal weight.

Categories: death, obesity, PLoS Medicine

Census Bureau Updates Interactive HIV/AIDS Database; New Prevalence Estimates from More Than 100 Countries

July 22, 2014 Comments off

Census Bureau Updates Interactive HIV/AIDS Database; New Prevalence Estimates from More Than 100 Countries
Source: U.S. Census Bureau

The U.S. Census Bureau today released its annually updated interactive global resource on the prevalence of HIV infection and AIDS cases and deaths. First developed in 1987, the database now holds more than 164,000 statistics, an increase of approximately 5,900 new estimates in the last year, and is the most comprehensive resource of its kind in the world.

The Census Bureau database is maintained with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID).

The tool consists of a library of statistics from more than 14,900 sources in international scientific and medical journals, individual countries’ annual HIV/AIDS surveillance reports, and papers and posters presented at international conferences. China represents 28 percent of the new records in the database, the largest increase by a single country.

The menu-driven access tool enables users to search for statistical information in countries and territories across the world, as well as by subpopulation, geographic subarea (such as urban and rural), age, sex and year from the 1960s to 2013.

67 Law Enforcement Officer Fatalities Nationwide in First Half of 2014

July 22, 2014 Comments off

67 Law Enforcement Officer Fatalities Nationwide in First Half of 2014
Source: National Law Enforcement Officers Memorial Fund

Today the National Law Enforcement Officers Memorial Fund issued a new report stating that 67 officers have been killed in the line of duty during the first half of 2014—a 31 percent increase over the same period last year.

Of these 67 officers, 26 were killed in traffic-related incidents; 25 were killed by gunfire; and 16 died due to job-related illnesses and other causes.

Key Facts

  • Traffic-related incidents were once again the leading cause of officer fatalities, with 26 officers killed in the first half of 2014—a 37 percent increase over the same period last year.
  • Firearms-related fatalities spiked to 25 in the first half of this year—a 56 percent increase over the first six months of 2013. Investigating suspicious persons or situations was the leading circumstance of fatal shootings, with six officer fatalities; followed by ambushes, with five officer fatalities.
  • Sixteen officers died due to other causes in the first half of 2014, the same as the number reported during the same time last year. Job-related illnesses, such as heart attacks, increased 62 percent in the first half of 2014, with 13 officer fatalities compared to eight during the same period last year.
  • California led all states with eight officer fatalities; followed by Florida, New York, Texas and Virginia each with four peace officer fatalities.

VA OIG — Administrative Investigation, Prohibited Personnel Practice and Preferential Treatment, National Cemetery Administration, VA Central Office

July 22, 2014 Comments off

Administrative Investigation, Prohibited Personnel Practice and Preferential Treatment, National Cemetery Administration, VA Central Office (PDF)
Source: U.S. Department of Veterans Affairs, Office of Inspector General

The former Under Secretary for Memorial Affairs engaged in a prohibited personnel practice when he created a position and preselected an employee for that position. He also engaged in preferential treatment of an NCA contractor when he developed a less-than-arm’s-length relationship with the contractor. Further, NCA improperly gave the contractor sole-source contracts to provide one-to-one services to select NCA employees.

Marine mammals trace anthropogenic structures at sea

July 22, 2014 Comments off

Marine mammals trace anthropogenic structures at sea
Source: Current Biology

On land, species from all trophic levels have adapted to fill vacant niches in environments heavily modified by humans (e.g. [1] ). In the marine environment, ocean infrastructure has led to artificial reefs, resulting in localized increases in fish and crustacean density [2] . Whether marine apex predators exhibit behavioural adaptations to utilise such a scattered potential resource is unknown. Using high resolution GPS data we show how infrastructure, including wind turbines and pipelines, shapes the movements of individuals from two seal species (Phoca vitulina and Halichoerus grypus). Using state-space models, we infer that these animals are using structures to forage. We highlight the ecological consequences of such behaviour, at a time of unprecedented developments in marine infrastructure.

See: Seals Are Drawn to Offshore Wind Farms (The Atlantic)

Continuity of Care and the Cost of Treating Chronic Disease

July 21, 2014 Comments off

Continuity of Care and the Cost of Treating Chronic Disease
Source: RAND Corporation

Strengthening coordination of care in the U.S. health care system is a priority for policymakers and the medical community. Poor coordination of care can drive up costs and harm patient health, especially for patients with chronic illnesses who see many different providers across many different settings. Some new models of care, such as the patient-centered medical home, focus on improving coordination as a way to provide affordable, high-quality care. Are these new models having the desired effect?

To answer this question, RAND researchers studied one important aspect of care coordination: continuity of care — the extent to which a patient’s care visits occur with the same provider. Researchers reviewed insurance claims data to gauge the association between continuity of care, costs, and patient outcomes during episodes of care for Medicare patients with one or more of three chronic diseases: congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and type 2 diabetes mellitus (DM).

Researchers used a continuity of care (COC) index to measure the number of providers and/or practices involved in a patient’s care during a 365-day episode of care. The index ranges from 0 (each visit involved a unique provider) to 1 (all visits were billed by a single provider). An increase in the COC index reflects either fewer providers involved in a patient’s care or a concentration of visits among fewer providers.

Findings from this study show that modest improvements in continuity of care correlate with sizable reductions in service use, complications, and costs:

  • Higher levels of care continuity for CHF, COPD, and DM patients were consistently associated with lower rates of hospitalizations, emergency room visits, and complications.
  • An 0.1-unit increase in the COC index (which ranges from 0 to 1) was associated with episode-of-care costs for CHF, COPD, and DM patients that were on average 5 percent lower.

NSCAW Child Well-Being Spotlight: Teenage Girls in the Child Welfare System Report High Rates of Risky Sexual Activity and Pregnancy

July 21, 2014 Comments off

NSCAW Child Well-Being Spotlight: Teenage Girls in the Child Welfare System Report High Rates of Risky Sexual Activity and Pregnancy
Source: U.S. Department of Health and Human Services (Administration for Children & Families)

This National Survey of Child and Adolescent Well-Being (NSCAW) spotlight describes the high rates of risky sexual activity and pregnancy among teenage girls in the second cohort of NSCAW (NSCAW II). According to data from the National Survey of Child and Adolescent Well-Being (NSCAW), 16.8% of girls ages 14-17, and 45.1% of girls ages 18-20, had experienced at least one pregnancy.

New From the GAO

July 21, 2014 Comments off

New GAO Reports
Source: Government Accountability Office

1. Consumer Finance: Credit Cards Designed for Medical Services Not Covered by Insurance. GAO-14-570, June 19.
http://www.gao.gov/products/GAO-14-570
Highlights - http://www.gao.gov/assets/670/664256.pdf
Podcast - http://www.gao.gov/multimedia/podcasts/664738

2. State Department: Implementation of Grants Policies Needs Better Oversight. GAO-14-635, July 21.
http://www.gao.gov/products/GAO-14-635
Highlights - http://www.gao.gov/assets/670/664905.pdf

3. African Growth and Opportunity Act: Observations on Competitiveness and Diversification of U.S. Imports from Beneficiary Countries. GAO-14-722R, July 21.
http://www.gao.gov/products/GAO-14-722R

CRS — Unaccompanied Alien Children: Potential Factors Contributing to Recent Immigration

July 21, 2014 Comments off

Unaccompanied Alien Children: Potential Factors Contributing to Recent Immigration (PDF)
Source: Congressional Research Service (via U.S. State Department Foreign Press Center)

Since FY2008, the growth in the number of unaccompanied alien children (UAC) from Mexico, El Salvador, Guatemala, and Honduras seeking to enter the United States has increased substantially. Total unaccompanied child apprehensions increased from about 8,000 in FY2008 to 52,000 in the first 8 ½ months of FY2014. Since 2012, children from El Salvador, Guatemala, and Honduras (Central America’s “northern triangle”) account for almost all of this increase. Apprehension trends for these three countries are similar and diverge sharply from those for Mexican children. Unaccompanied child migrants’ motives for migrating to the United States are often multifaceted and difficult to measure analytically.

Four recent out-migration-related factors distinguishing northern triangle Central American countries are high violent crime rates, poor economic conditions fueled by relatively low economic growth rates, high rates of poverty, and the presence of transnational gangs.

Impact of San Francisco’s Toy Ordinance on Restaurants and Children’s Food Purchases, 2011–2012

July 21, 2014 Comments off

Impact of San Francisco’s Toy Ordinance on Restaurants and Children’s Food Purchases, 2011–2012
Source: Preventing Chronic Disease (CDC)

Introduction
In 2011, San Francisco passed the first citywide ordinance to improve the nutritional standards of children’s meals sold at restaurants by preventing the giving away of free toys or other incentives with meals unless nutritional criteria were met. This study examined the impact of the Healthy Food Incentives Ordinance at ordinance-affected restaurants on restaurant response (eg, toy-distribution practices, change in children’s menus), and the energy and nutrient content of all orders and children’s-meal–only orders purchased for children aged 0 through 12 years.

Methods
Restaurant responses were examined from January 2010 through March 2012. Parent–caregiver/child dyads (n = 762) who were restaurant customers were surveyed at 2 points before and 1 seasonally matched point after ordinance enactment at Chain A and B restaurants (n = 30) in 2011 and 2012.

Results
Both restaurant chains responded to the ordinance by selling toys separately from children’s meals, but neither changed their menus to meet ordinance-specified nutrition criteria. Among children for whom children’s meals were purchased, significant decreases in kilocalories, sodium, and fat per order were likely due to changes in children’s side dishes and beverages at Chain A.

Conclusion
Although the changes at Chain A did not appear to be directly in response to the ordinance, the transition to a more healthful beverage and default side dish was consistent with the intent of the ordinance. Study results underscore the importance of policy wording, support the concept that more healthful defaults may be a powerful approach for improving dietary intake, and suggest that public policies may contribute to positive restaurant changes.

Halbig v Burwell: Potential Implications for ACA Coverage and Subsidies

July 18, 2014 Comments off

Halbig v Burwell: Potential Implications for ACA Coverage and Subsidies
Source: Robert Wood Johnson Foundation

A new report quantifies what’s at stake—in terms of health coverage and dollars—in the Halbig v. Burwell decision expected soon. Urban Institute researchers estimate that 7.3 million people, or about 62 percent of the 11.8 million people expected to enroll in federally facilitated marketplaces by 2016, could lose out on $36.1 billion in subsidies. Residents in Texas and Florida would lose the most, $5.6 billion and $4.8 billion respectively in subsidies at risk in this court decision.

NCPDP Recommendations and Guidance for Standardizing the Dosing Designations on Prescription Container Labels of Oral Liquid Medications

July 18, 2014 Comments off

NCPDP Recommendations and Guidance for Standardizing the Dosing Designations on Prescription Container Labels of Oral Liquid Medications (PDF)
Source: National Council for Prescription Drug Programs

This paper provides the healthcare industry, in particular the pharmacy sector, with historical and background information on the patient risks associated with the dosing of liquid medications and recommendations to mitigate those risks through best practices in prescription orders, prescription labeling and the provision of dosing devices.

DOD — The Education Directory for Children With Special Needs

July 18, 2014 Comments off

The Education Directory for Children With Special Needs
Source: U.S. Department of Defense

The Education Directory for Children With Special Needs provides military families with children with special needs the information they need to make informed assignment decisions and easier transitions.

The directory consists of two components:

  • The Early Intervention Directory focusing on early intervention services for children birth through 3 years old
  • The School-Age Directory focusing on education services for children with special needs, 3 through 21 years old

Both provide tools and resources to help with the transition to a new location. The Early Intervention Directory summarizes national and state level early intervention trends and includes descriptions of local early intervention service providers. The School-Age Directory summarizes national and state level trends for special education and includes descriptions of individual school districts.

Note: Not just for military families. Lots of good info here.

Selection and Costs for Employer-Sponsored Health Insurance in the Private Sector, 2013 versus 2012

July 18, 2014 Comments off

Selection and Costs for Employer-Sponsored Health Insurance in the Private Sector, 2013 versus 2012
Source: Agency for Healthcare Research and Quality (Medical Expenditure Panel Survey)

Highlights

  • In 2013, 51.3 percent of private-sector employees enrolled in employer-sponsored health insurance chose single coverage, rather than employee-plus-one or family coverage. This percentage did not differ from that for 2012.
  • Average annual total premiums across all three coverage types were up in 2013 compared to 2012. Single premiums rose 3.5 percent, employee-plus-one premiums rose 3.5 percent, and family premiums rose 3.6 percent.
  • The average annual dollar amount that employees contributed toward the premium also rose for all three types of coverage in 2013 versus 2012.

What does the Research Tell us about Services for Children in Therapeutic/Treatment Foster Care with Behavioral Health Issues?

July 18, 2014 Comments off

What does the Research Tell us about Services for Children in Therapeutic/Treatment Foster Care with Behavioral Health Issues?
Source: Substance Abuse and Mental Health Services Administration

Reports on a technical expert panel convened to assess the research about services for foster care children in therapeutic or treatment care. Reviews the scientific evidence and expert panel input to identify actions to be taken and further research needs.

The Cost of Abortion, When Providers Offer Services, and Harassment of Abortion Providers All Remained Stable Between 2008 And 2012

July 18, 2014 Comments off

The Cost of Abortion, When Providers Offer Services, and Harassment of Abortion Providers All Remained Stable Between 2008 And 2012
Source: Guttmacher Institute

Access to abortion services is affected by a variety of factors, including the cost of the procedure, the gestational age limits at which providers offer services and antiabortion harassment. According to “Secondary Measures of Access to Abortion Services in the U.S., 2011-2012: Gestational Age Limits, Cost and Harassment,” by Jenna Jerman and Rachel Jones of the Guttmacher Institute, there was relatively little change in any of these measures between 2008 and 2011–2012. The new analysis relies on data from the Institute’s 16th census of all known abortion providers in the United States.

In 2011–2012, the median cost of a surgical abortion at 10 weeks’ gestation was $495, and an early medication abortion cost $500. By comparison, the inflation-adjusted charge in 2009 for the same procedures was $503 and $524, respectively. The cost varied by facility size: facilities with the largest caseloads charged the least ($450), while those that performed fewer than 30 procedures per year charged the most ($650). Because women were more likely to obtain abortions at facilities that charged less, on average, women paid $480 for a surgical procedure at 10 weeks in 2011–2012, compared with $483 in 2009 (adjusted for inflation).

Using Dietary Supplements Wisely

July 18, 2014 Comments off

Using Dietary Supplements Wisely
Source: National Center for Complementary and Alternative Medicine

Like many Americans, you may take dietary supplements in an effort to stay healthy. With so many dietary supplements available and so many claims made about their health benefits, how can you decide whether a supplement is safe or useful? This fact sheet provides a general overview of dietary supplements, discusses safety considerations, and suggests sources for additional information.

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