Young Adolescents as Likely to Die From Suicide as From Traffic Accidents

November 11, 2016

WASHINGTON — It is now just as likely for middle school students to die from suicide as from traffic accidents.

That grim fact was published on Thursday by the Centers for Disease Control and Prevention. They found that in 2014, the most recent year for which data is available, the suicide rate for children ages 10 to 14 had caught up to their death rate for traffic accidents.

The number is an extreme data point in an accumulating body of evidence that young adolescents are suffering from a range of health problems associated with the country’s rapidly changing culture. The pervasiveness of social networking means that entire schools can witness someone’s shame, instead of a gaggle of girls on a school bus. And with continual access to such networks, those pressures do not end when a child comes home in the afternoon.

“It’s clear to me that the question of suicidal thoughts and behavior in this age group has certainly come up far more frequently in the last decade than it had in the previous decade,” said Dr. Marsha Levy-Warren, a clinical psychologist in New York who works with adolescents. “Cultural norms have changed tremendously from 20 years ago.”

Death is a rare event for adolescents. But the unprecedented rise in suicide among children at such young ages, however small the number, was troubling and federal researchers decided to track it. In all, 425 children ages 10 to 14 killed themselves in 2014. In contrast, 384 children of that age died in car accidents.

“This graph is really surprising,” said Sally Curtin, an expert at the National Center for Health Statistics who analyzed the data. “We think of traffic accidents as so commonplace.”

The crossing-over point was reached in part because suicide had spiked, but also because fatal traffic accidents had declined.

In 1999, the death rate for children ages 10 to 14 from traffic accidents — about 4.5 deaths per 100,000 — was quadruple the rate for suicide. But by 2014, the death rate from car crashes had been cut in half, part of a broader trend across the entire population. The suicide rate, however, had nearly doubled, with most of the increase happening since 2007. In 2014, the suicide death rate was 2.1 per 100,000.

Far more boys than girls killed themselves in 2014 — 275 boys to 150 girls — in line with adults in the general population. American men kill themselves at far higher rates than women. But the increase for girls was much sharper — a tripling, compared with a rise of about a third for boys.

The reasons for suicide are complex. No single factor causes it. But social media tends to exacerbate the challenges and insecurities girls are already wrestling with at that age, possibly heightening risks, adolescent health experts said. (The data published Thursday did not include methods, but an earlier report gave those details.)

“Social media is girl town,” said Rachel Simmons, the author of “Odd Girl Out: The Hidden Culture of Aggression in Girls.” “They are all over it in ways that boys are not.”

Statistically, girls dominate visual platforms like Facebook and Instagram where they receive instant validation from their peers, she said. It also is a way to quantify popularity, and take things that used to be private and intangible and make them public and tangible, Ms. Simmons added.

“It used to be that you didn’t know how many friends someone had, or what they were doing after school,” she said. “Social media assigns numbers to those things. For the most vulnerable girls, that can be very destabilizing.”

The public aspect can be particularly painful, Dr. Levy-Warren said. Social media exponentially amplifies humiliation, and an unformed, vulnerable child who is humiliated is at much higher risk of suicide than she would otherwise have been.

“If something gets said that’s hurtful or humiliating, it’s not just the kid who said it who knows, it’s the entire school or class,” she said. “In the past, if you made a misstep, it was a limited number of people who would know about it.”

Another profound change has been that girls are going through puberty at earlier ages. Today girls get their first period at age 12 and a half on average, compared with about 16 at the turn of the 20th century, according to “The New Puberty,” a 2014 book that describes the phenomenon. That means girls are becoming young women at an age when they are less equipped to deal with the issues that raises — sex and gender identity, peer relationships, more independence from family. Girls experience depression at twice the rate of boys in adolescence, Ms. Simmons said, a pattern that continues into adulthood.

What is more, they live in a culture of fast answers and immediate change. That compounds the pressure.

“For a young girl who starts to develop breasts, hips, body hair — it’s a long haul before you land,” Dr. Levy-Warren said. “You don’t really know how you’re going to look for a number of years, and a lot of kids don’t know how to wait anymore. It’s just so painful.”

She added, “There’s this collision of emotional need, social circumstances and a sense of needing an immediate answer.”

Depression is being diagnosed more often these days, and adolescents are taking more medication than ever before, but Dr. Levy-Warren cautioned that it was not clear whether that is because more people are actually depressed, or because it is simply being identified more than before.

Suicide is just the tip of a broader iceberg of emotional trouble, experts warn. One recent study of millions of injuries in American emergency departments found that rates of self-harm, including cutting, had more than tripled among 10- to 14-year-olds. “This is particularly concerning as this type of injury often heralds suicidal behavior,” the researchers wrote.

CDC: Many Factors Affect IBD’s (Inflammatory Bowel Disease) Population Prevalance

October 28, 2016
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CDC: Many Factors Affect IBD’s Population Prevalence

Federal survey data yield several surprises

  • by Alexandria Bachert
    Staff Writer, MedPage TodayOctober 27, 2016

A new report identifying population subgroups with greater prevalence of inflammatory bowel disease (IBD) might lead to a better understanding of the disease and the populations most affected, CDC researchers said.

Data from the 2015 National Health Interview Survey indicated that nearly 3.1 million (1.3%) U.S. adults reported receiving a diagnosis of IBD in 2015, with the prevalence distribution varying with certain sociodemographic factors including age, education, ethnicity, income, and employment status.

This estimate was nearly three times the number of adults previously reported to have IBD based on administrative data sources and limited geographic coverage, said James M. Dahlhamer, PhD, and colleagues in the analysis published Thursday in the CDC’s Morbidity and Mortality Weekly Report.

Dahlhamer and colleagues analyzed 33,672 adults, ages 18 and older, from the Sample Adult Core component of NHIS, as well as sociodemographic characteristics from the Household Module and Family Core sections of the survey. Using these data, they estimated the number of IBD cases and prevalence of IBD for the overall U.S. adult population, as well as by various sociodemographic characteristics.

Similar to previous reports, a higher prevalence of IBD was seen among adults ages 45 and older (3.2%), as well as among non-Hispanic whites (1.4%).

But Dahlhamer and colleagues also found variations in certain subgroups that had not been previously reported.

Adults with less than a high school level of education had a higher prevalence of IBD (1.7%) compared with those who had a bachelor’s degree or higher (1.1%). Additionally, 1.6% of unemployed adults, compared with 1.2% of adults who were currently employed, reported ever receiving a diagnosis of IBD.

Adults living in poverty (family incomes <100% of the federal poverty level) had a higher prevalence of IBD (1.8%) than adults from families with incomes ≥400% of the federal poverty level (1.1%).

Regionally, adults living outside the central city of a metropolitan statistical area (MSA) had a higher prevalence of IBD (1.4%) than did adults living in the central or principal city of an MSA (1.0%). Individuals born in the U.S. were more likely to have been diagnosed with IBD (1.4%) than those who were born elsewhere (0.8%).

Also, the data contradicted findings from some earlier reports, including regional and sex differences in prevalence.

However, Dahlhamer and colleagues noted several limitations to the analysis — data were self-reported and excluded adults in long-term care facilities, active duty military personnel, and incarcerated people. Additionally, only diagnosed cases of Crohn’s disease and ulcerative colitis were included.

CMS Awards $347 Million for Patient Safety Initiative

October 2, 2016

Money will go toward reducing inpatient harm, readmissions.

By Joyce Frieden/News Editor/MedPage Today/September 30, 2016

WASHINGTON — The Centers for Medicare & Medicaid Services (CMS) is awarding $347 million to healthcare organizations in an effort to reduce patient harm and decrease readmissions, the agency announced Thursday.

The money will go to 16 different groups, including hospital associations, quality improvement organizations, and health systems as part of an effort to reduce hospital-acquired conditions and readmissions among Medicare beneficiaries.

We made significant and successful progress in keeping patients safe over the last few years,” CMS chief medical officer Patrick Conway, MD, said on a conference call with reporters. “Since 2010, we have seen an unprecedented reduction in preventable patient harm in hospitals across the U.S., resulting in 2.1 million fewer people harmed, 87,000 lives saved and $20 billion in costs saved.”

Now CMS wants to continue these efforts and set additional goals, Conway explained, noting that these improvements would not have been possible without the Affordable Care Act and the work of CMS’s innovation center.

A Minnesota Doctor Is Trying Get a $50 EpiPen Alternative to Market

September 18, 2016

By   SEPTEMBER 15, 2016, 1:31 PM EDT, Fortune

To provide an option other than Mylan’s pricey device.

A Minnesota doctor wants to make fighting deadly allergies cheaper—a lot cheaper.

Douglas McMahon of the Allergy and Asthma Center of Minnesota in Eagan has created what he says is a more convenient epinephrine-delivering device for treating anaphylaxis—a severe allergic reaction which can cause difficulty breathing and other dangerous symptoms—that would be available at about a tenth of the price of Mylan’s MYL 0.67% brand name EpiPen, according to a local CBS affiliate.

“By chance I came to realize how inexpensive the parts were, including the medicine, and I realized we can sell it to patients for a very reasonable cost,” McMahon told the network in an interview.

Mylan has been under intense scrutiny since reports emerged that the pharma giant had raised the price of the EpiPen from less than $100 for a one-year, two-pack supply to about $600 over the course of a decade. The firm scrambled to bolster price-lowering coupons for patients after its share value nosedived and has pledged to release a generic competitor to its own product that will be about half the cost of the branded one.

But McMahon says his alternative device, dubbed theAllergyStop, would cost as little as $50. And he believes the technology itself is superior to Mylan’s since it is far more compact and easier to carry—particularly important since most Americans who die from anaphylaxis do not have their epinephrine with them. The device can also be customized to provide different dosages for different body types.Still, there are some big hurdles that need to be cleared before the AllergyStop can reach the market. For one, McMahon needs to conduct the thorough, expensive safety and clinical trials necessary for Food and Drug Administration (FDA) clearance. Such testing can easily cost upwards of $1 million, which is why McMahon is currently trying to raise money through an Indiegogo campaign.

There’s also the question of how realistically the physician can stick to his low target price. If he opens up the product to outside investors, they may press him to raise its tab, he admits.

In the meantime, Mylan is still facing tough questions (and an investigation by New York’s Attorney General) about its decision to hike the EpiPen’s price. CEO Heather Bresch is slated to testify in front of the U.S. House Committee on Government and Oversight in a September 21 congressional hearing.

Aetna to Quit Most Obamacare Markets, Joining Major Insurers

August 18, 2016

By Zackery Tracer/Bloomberg/August 16, 2016

Health insurer Aetna Inc. will stop selling individual Obamacare plans next year in 11 of the 15 states where it had been participating in the program, joining other major insurers that have pulled out of the government-run markets in the face of mounting losses.

Aetna will exit markets including North Carolina, Pennsylvania and Florida, and keep selling plans on state exchanges only in Iowa, Delaware, Nebraska and Virginia, according to a statement Monday evening. In most areas it’s exiting, Aetna will offer individual coverage outside of the program’s exchanges.

State of the union: Overworked nurses, docs organize nationwide

August 4, 2016

by Zack Budryk |Aug 4, 2016 10:47am – Fierce Healthcare

Union activity is on the rise in hospitals across the nation as frustrated doctors and nurses say hospitals value profits over patients and encourage a culture of overwork to make up for inadequate staffing.

For example, nurses at Einstein Medical Center in Philadelphia voted to form a union in April, to protest unsafe conditions and inadequate staffing, according to The Nation.

Meanwhile, in January, nurses at Hahnemann University Hospital in Philadelphia, owned by the for-profit Tenet chain, voted by a wide margin to join the Pennsylvania Association of Staff Nurses & Allied Professionals (PASNAP), The Nation reports. St. Christopher’s Hospital for Children in Philadelphia joined shortly after.

Even doctors are fed up, according to the article. After years of tension within the workplace, three doctors in Minnesota joined a professional unit of Steelworkers Local 9460, which finalized its first contract at Lake Superior Community Health Center in Duluth.

Lack of adequate staffing is frequently cited as the reason for such organizing efforts, according to the article. A March PASNAP survey of recently organized nurses found that 70 percent say they’ve never worked in an organization that had sufficient staffing. Yet, research shows that in addition to improving workplace conditions, increased staffing levels leads to better patient outcomes, while inadequate staffing is a major driver of mortality.

Established healthcare unions also report recent successes. Just this week, the 1199 SEIU United Healthcare Workers East, which represents 5,000 workers at Boston’s Steward Health Care System, signed a contract with the system to maintain health benefits while agreeing on a 5.5 percent raise over three years for its technicians and non-clinical staff, according to The Boston Globe.

In West Virginia, the 4th Circuit Court of Appeals has ordered Bluefield Regional Medical Center and Greenbrier Valley Medical Center to recognize nurses’ right to organize and join them at the collective bargaining table, according to the Register-Herald.

Nurses and doctors who serve on the frontline of care are ideally poised to lead on labor issues, PASNAP President Patty Eakin told The Nation. “One of the biggest things we’re going to get out of [a union],” she said, “is a legal voice, and a way to raise our voices up together and say, ‘This has to change.’”

Freestanding ERs May Freeze Out Poor, Minorities

July 17, 2016

Fierce Healthcare/By Zack Budryk/July 14, 2016

The freestanding emergency room mode is taking healthcare delivery by storm, but concerns linger about their effect on care access, according to a new study published in theAnnals of Emergency Medicine.

These stand-alone facilities are physicially separate from acute care hospitals but are available 24/7 for emergency care, and offer many of the same services as traditional emergency departments, including on-site advanced diagnostic imaging and laboratory testing.

Researchers from Boston’s Brigham and Women’s Hospital assembled a national database of freestanding ERs, determining that 360 existed across 30 states as of spring 2015, up from 222 in 2009. They found growth of the ERs is concentrated in high-income areas with growing populations, more traditional ERs, a higher proportion of privately insured patients and a lower proportion of Medicaid beneficiaries.

Ohio, Texas and Colorado led the other states for number of freestanding ERs, and in Texas and Ohio specifically, freestanding ERs were concentrated in ZIP codes with more privately-insured patients, according to the research. Texas’ freestanding ERs are more likely to be in ZIP codes with fewer Hispanics and higher annual spending.

Therefore, researchers concluded that although the model is on the rise, the facilities grow in areas that need the least help with care access.

“In the states with the most freestanding EDs, it seems less likely that they will expand access to underserved populations,” corresponding author Jeremiah Schuur, M.D., vice chair, Clinical Affairs, Department of Emergency Medicine, Brigham and Women’s Hospital, said in astatement, “as they are preferentially located in areas where people had more available health services, higher rates of private health insurance, lower rates of Medicaid and higher median incomes.”

The findings echo concerns voiced last year by the Medicare Payment Advisory Commission (MedPAC), which noted that two-thirds of Houston’s for-profit freestanding ERs are in ZIP codes with an average income higher than $53,000, FierceHealthcare previously reported.

Battlefield lessons for trauma care: National system could save 200K lives

June 21, 2016

Fierce Healthcare – by Zack Budryk |Jun 20, 2016 10:10am

Improved trauma care could prevent 20 percent of deaths from injuries such as gunshots or car accidents, according to a new report from the National Academies of Sciences, Engineering and Medicine.

The report, co-authored by Donald Berwick, M.D., former administrator for the Centers for Medicare & Medicaid Services, calls for healthcare leaders to set a national goal of zero preventable deaths from injury. As a model for such a strategy, the report cites the U.S. Army’s 75th Ranger Regiment, which managed to nearly eliminate preventable deaths.

Between 2001 and 2011, if all trauma centers nationwide had achieved outcomes on the level of the top-performing centers, 200,000 fewer patients would have died, according to the report. As it stands, however, research shows all trauma providers are not created equal, withtrauma centers serving a predominantly minority population seeing higher mortality rates.

To properly address trauma care, the authors write, healthcare needs a nationwide trauma care system that provides education across the entire continuum of trauma care, from the actual injury scene to rehabilitation and post-rehabilitation. Currently, “we do not have a cogent or well-designed research strategy on trauma care,” Berwick said in a public briefing on the report last week, according to Kaiser Health News.

Trauma care also needs a bigger research budget, according to the report; while trauma is the top cause of death for civilian Americans under 46, its research budget was less than 1 percent of the National Institutes of Health’s 2015 biomedical research budget.

In the wake of mass casualty events such as this month’s mass shooting in Orlando, Florida, which killed 49 people, the presence nearby of emergency personnel with battlefield experience provides a clear advantage.

“The tragedy is that a lot of this likely could be helped by that hard-won knowledge gained on the battlefield,” John B. Holcomb, a retired colonel and chairman of surgery at the University of Texas Health Science Center, who served on the committee, told Stars & Stripes. “No one knows where the next Orlando is going to happen.”

Psoriasis Linked to AAA – —Shared inflammatory mechanisms may explain the association

April 17, 2016

by Nancy Walsh, Senior Staff Writer, MedPage Today

Patients with psoriasis — whether mild or severe — are at increased risk of abdominal aortic aneurysms (AAA), a Danish nationwide cohort study found.

“These findings add importantly to current evidence of psoriasis as a clinically relevant risk factor for cardiovascular disease and may require increased focus on heightened risk of AAA in patients with psoriasis,” the researchers wrote in Atherosclerosis, Thrombosis, and Vascular Biology.

Systemic inflammatory markers such as C-reactive protein and tumor necrosis factor (TNF)-α also are elevated in patients with AAA and in those with psoriasis.

Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner.

Blood Test For Concussion

April 1, 2016

Researchers at Orlando Health detected evidence of concussions in patients up to 7 days after their injury using a simple blood test, according to a new study published in JAMA Neurology. The discovery could greatly expand the window for diagnosing concussions, especially in patients who experience a delayed onset of symptoms.

Science Daily, March 28, 2016.