Health and Disability

Chicago Police Superintendent Eddie Johnson became wobbly and nearly collapsed during a January news conference held in a police precinct. Several police officers and Chicago Mayor Rahm Emanuel, who also attended the event, rushed to help him. They sat him down and had him drink water. After a few minutes, the superintendent appeared to be fine.

It was later revealed that Superintendent Johnson was on the waiting list for a kidney transplant. A potential life-threatening health event affecting a high-profile person under the glare of television cameras at a news conference has put the spotlight on kidney failure among black men.

Johnson is African-American and African-American men have increased rates of kidney failure because of undiagnosed or uncontrolled high-blood pressure, the leading cause of kidney failure among Black men, reports the National Kidney Foundation.

The headline of an article posted on the Kidney Foundation’s website reported that “Black Men Most at Risk of Kidney, Cardiovascular Disease.”

“Among people diagnosed with kidney disease and high blood pressure, African-American men are least likely to have their blood pressure under control, putting them at risk of life-threatening complications,” according to an article published in the American Journal of Kidney Diseases, the official publication of the National Kidney Foundation, which has its headquarters in New York City.

The study included more than 10,000 people diagnosed with chronic kidney disease (CKD) and high blood pressure, which can worsen CKD.

Patients undergoing shoulder replacement surgery who have Medicaid, Medicare or no health insurance, had higher complication rates as compared to patients who had private insurance.

The findings, which appear in the Journal of Shoulder and Elbow Surgery, demonstrate disparities in acute postoperative outcomes for shoulder replacement surgery based on insurance status.

Shoulder replacements (arthroplasties) are recommended for patients suffering from various conditions, including shoulder arthritis, irreparable rotator cuff tears and fractures. The primary goal of the procedure is pain relief, with a secondary benefit of restoring motion, strength, function and returning patients to an activity level as near to normal as possible.

Using a large, national administrative database (The Healthcare Cost and Utilization Project Nationwide Inpatient Sample), the researchers analyzed more than 100,000 cases (68,578 Medicare; 27,159 private insurance; 3,544 Medicaid/uninsured and 4,009 other) of patients undergoing shoulder arthroplasty (partial or hemi, total, and reverse) procedures. Overall, the perioperative medical and surgical complication rate was 17.2 percent and the mortality rate was 0.20 percent. However, they found that there was a significantly higher rate of medical, surgical and overall complications among Medicare (20.3 percent) and Medicaid/uninsured (16.9 percent) patients compared with privately insured (10.5 percent) patients. When the data was matched and analyzed, the researchers found no differences in the complication rates between Medicaid/uninsured and Medicare patients. However, both the Medicaid/Uninsured and Medicare patients had significantly more medical and surgical complications when compared to the privately insured patients.

According to the researchers, this discrepancy in the complication rates may be the result of a lack of access to both preoperative and postoperative care due to poor socioeconomic status or education level for patients that have government sponsored insurance. Additionally, patients with Medicaid or no insurance may lack access to high volume shoulder surgeons, which may also contribute to the higher complication rates. The authors also found that patients with private insurance are likely to go to higher volume hospitals to have their elective shoulder replacement surgery done.

Patients with Crohn's disease, a type of inflammatory bowel disease (IBD) that causes abdominal pain and diarrhea, can also experience joint pain. In Crohn's disease, which affects about 800,000 Americans, the immune system can attack not only the bowels, but the musculoskeletal system as well, leading to spondyloarthritis, a painful condition that affects the spine and joints. Now new research, published in Science Translational Medicine, helps explain the connection between these seemingly unrelated symptoms, and could help physicians identify Crohn's disease patients who are more likely to develop spondyloarthritis, enabling them to prescribe more effective therapies for both conditions.

New technology helped the researchers identify a type of E. coli bacteria found in people with Crohn's disease that can trigger inflammation associated with spondyloarthritis, according to the study led by principal investigator Dr. Randy Longman and scientists from the Jill Roberts Center for Inflammatory Bowel Disease at NewYork-Presbyterian and Weill Cornell Medicine and the Jill Roberts Institute for Research in Inflammatory Bowel Disease at Weill Cornell Medicine, microbiologists at Cornell University and rheumatologists at Hospital for Special Surgery.

The researchers used fecal samples from patients with IBD to identify bacteria in the gut that were coated with antibodies called immunoglobulin-A (IgA) that fight infection. Using flow cytometry, in which fluorescent probes are used to detect IgA-coated bacterial species, the researchers discovered that IgA-coated E. coli were abundant in fecal samples from patients with both Crohn's disease and spondyloarthritis.

An apparently leaked memorandum has surfaced from Mark Merritt, president and CEO of the Pharmaceutical Care Management Association (PCMA), to the association's board of directors. It outlines PCMA's strategies to mitigate possible reforms of pharmacy benefit managers (PBMs). In response, B. Douglas Hoey, RPh, MBA, National Community Pharmacists Association (NCPA) CEO, issued the following statement:

"More and more scrutiny is being directed towards PBMs, and so, as this purported leaked memo makes clear, they're having to scramble to preserve the status quo, and, as the memo suggests, they've got deep pockets to do it. That's because they've extracted untold profits from patients, drug manufacturers and health plans, and they do it with very little oversight and almost no transparency. PBMs' business model is contributing to the problem of rising drug costs—as well as the resulting medication access and affordability challenges those costs create for patients.

"As evidence, consider their manipulation of pharmacy DIR (direct and indirect remuneration) fees in the Medicare Part D space. NCPA wholeheartedly agrees with Medicare officials that PBM manipulation of pharmacy DIR fees increases costs to the government and raises beneficiary out-of-pocket costs for medications. Those retroactive fees also threaten the viability of some independent pharmacies. The growing PBM share of rebates from drug manufacturers is another example of how PBMs profit right along with higher prices. We need PBM reform in order to help patients and health plan sponsors."

"In this population of older adults on Medicare Part D drug coverage, we noted that while prescriptions of newer line AEDs, in particular levetiracetam, are increasing compared with other studies of older Americans with epilepsy, there remains a substantial proportion receiving older line AEDs, most notably phenytoin," (Dilantin) said Dr. Maria Pisu, senior author of the Epilepsia article. "We cannot assess why this occurs from these data, but the use of newer AEDs with more favorable side effect potential and lower risk for drug-drug interactions is particularly important in an older population with a significant number of co-occurring conditions."

Care homes in B.C. are giving antipsychotic medications to too many seniors who haven’t been diagnosed with psychosis, and that may be responsible for aggression and injuries among the elderly, according to the province’s seniors advocate.

In facilities across the province, an average of 27 per cent of residents are taking antipsychotics without a matching psychiatric diagnosis, according to the newly updated Residential Care Facilities Quick Facts Directory.

The average percentage has declined in recent years, but B.C. Seniors Advocate Isobel Mackenzie says it’s not happening as quickly as it has in other provinces.

“It’s a problem everywhere, but for some reason it is worse in B.C.,” she said.

There are three care homes in B.C. where more than half of residents were taking antipsychotics without a diagnosis of psychosis in 2015-16: Youville Residence (62.6 per cent of residents) and Adanac Park Lodge (52.1 per cent) in Vancouver, and Lynn Valley Care Centre (51.1 per cent) in North Vancouver. 

Mackenzie doesn’t subscribe to the theory that care home staff are using antipsychotics to make their charges easier to control. She believes doctors prescribe these medications because they’re trying to control certain symptoms, but the drugs may do more harm than good. 

“You will find more aggressive behaviours with higher antipsychotic use,” she said. “There was a brilliant study done in Manitoba: You take them off the antipsychotics, the incidents of aggression went down.”

A lot of these drugs aren’t tested on the elderly either, so care home residents may experience side effects in unexpected ways, which could lead to further problems.

“You give somebody an antipsychotic to treat something that you think is an agitation, you exacerbate the delirium and things get worse. They get drowsy, they trip, they fall,” Mackenzie said.

Since 2003, Hearing Loss Association of America (HLAA) has supported legislation that would allow consumers to receive a tax credit for the purchase of hearing aids. The Hearing Aid Assistance Tax Credit Act (Senate bill S.48), reintroduced in the Senate on January 5 by Sen. Dean Heller (R-Nev.), would provide a non-refundable $500 tax credit for the purchase of a single hearing aid, or $1,000 for two, once every five years. In the past, a version of the bill introduced in the U.S. House of Representatives included a $200,000 per year income eligibility cap. A bill has not yet been introduced in the House.

Several iterations of the tax credit bill have been introduced over the span of nearly 14 years, and none have passed. HLAA has therefore decided to focus its efforts and resources on initiatives that we believe will have a more far-reaching impact. Some of these current efforts include:

• Working toward the implementation of the recommendations contained in the National Academies of Sciences, Engineering, and Medicine report, Hearing Health Care for Adults: Priorities for Improving Access and Affordability.
• Supporting legislation that would ensure Medicare coverage for the cost of hearing aids.
• Providing input to the U.S. Food and Drug Administration (FDA), which is currently working on a rulemaking that would consider a new category of over-the-counter (OTC) hearing devices.
• Supporting reintroduction of the Over-the-Counter Hearing Aid Act of 2016, a bill introduced in December 2016 by Senators Elizabeth Warren (D-Mass.) and Chuck Grassley (R-Iowa) to provide for the regulation of OTC hearing aids.

On January 27 President Trump signed an executive order blocking citizens, including doctors, from seven Muslim-majority countries from entering the U.S. for 90 days. This may have a measurable impact on the U.S. health care system. Many doctors may be blocked from returning to the U.S. after leaving the country. According to 2010 data, of approximately 850,000 doctors providing direct patient care in the U.S., 4,180 physicians were Iranian citizens and 3,412 physicians were Syrian citizens.

There are currently 260 people from the seven countries who are applying for residency slots in U.S. hospitals but are now banned from coming to the U.S. Match day, when students learn whether they have been accepted into a program, is on March 17, just over a month away. If the U.S. loses these applicants and cannot find candidates to take their spots, a simple calculation shows that this could affect 400,000 patients over the next year alone (estimated with assumptions that 50% of them successfully match to residency programs, become primary care doctors, and see 3,000 patients over the next year).

In a recent paper published in The BMJ, we found that when Medicare patients were admitted to U.S. hospitals with general medical conditions, their probability of dying within 30 days of admission was 5% lower if they were treated by international medical graduates than if they were treated by U.S. medical graduates. We found no difference in whether patients were more likely to be readmitted to the hospital within 30 days after being discharged. We also saw that the cost of care was somewhat higher with foreign medical graduates than with U.S. medical graduates, though the difference was very small.

Although there is no known cure for multiple sclerosis (MS), there are treatments that can help prevent new attacks and improve function after an attack. However, there are three subtypes of the disease and determining this, as well as the appropriateness and effectiveness of a patient's current treatment, involves an array of expensive, time-consuming tests. Now, after a search lasting 12 years, an international team of researchers has identified a biomarker that would allow MS subtypes to be determined with a simple blood test.

People with fibromyalgia have abnormal levels of the neurotransmitters dopamine, noradrenaline, and serotonin in the brain. Neurotransmitters are chemical messengers that control communication throughout the brain and body.

Research examining serotonin's role in the skin found that abnormal levels of serotonin cause mice to itch. Researchers also found that when serotonin is released in response to pain, certain receptors are activated that cause itchiness.

Scratching the itch causes the release of serotonin as a pain reliever, which activates the receptors again and causes more itching.

Selective serotonin reuptake inhibitors (SSRIs), such as sertraline and fluoxetine, may help to reduce skin itching.

Medications that are used to treat fibromyalgia, including pain relievers, antidepressants, and anti-seizure drugs, can sometimes have side effects of itching in certain people. These medications include:

• Acetaminophen - has a rare side effect of skin, rash, hives, or itching
• Ibuprofen - one of the more common side effects is itching skin
• Naproxen sodium - itching is a common side effect
• Tramadol - itching skin is a common side effect
• Duloxetine and milnacipran - burning, crawling, itching, numbness, prickling, "pins and needles," or tingling feelings are less common side effects
• Pregabalin - itching is a rare side effect

If itching is experienced with fibromyalgia medications, people should check with a doctor to ensure that the symptoms are not an allergic reaction. In some cases of itching, the dosage or medication may need to be altered.