USA Today (10/29, Szabo) reports that the FDA today “gave accelerated approval to a new meningitis vaccine,” called Trumenda, which “protects against type B” meningococcal bacteria. Previously, “vaccines targeted only four of the five major kinds of meningococcal bacteria – types A, C, Y and W.” Meningococcal bacteria are spread via “respiratory or throat secretions, such as through coughing, kissing or sharing drinks,” and can lead to the “sometimes life-threatening inflammation of the lining around the brain and spinal cord,” or “dangerous bloodstream infections.” According to CDC data, “There were 500 cases of meningococcal disease in the USA in 2012,” of which 160 were type B. Trumenda was developed by Wyeth Pharmaceuticals Inc., a subsidiary of Pfizer Inc. of Philadelphia
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People who visited their doctor at least twice a year were 3.2 times more likely to keep their blood pressure under control than those who saw their doctor once a year or less, according to an analysis of 1999–2012 NHANES data on 37,000 adults. Having healthcare insurance and treatment for high cholesterol also increased the likelihood of keeping blood pressure under control. During the period from 1999–2000 to 2011–2012, prevalent hypertension was unchanged (30.1% vs. 30.8%). The findings are published in Circulation
Congressional Quarterly (10/21, Subscription Publication) reports that a top Medicare official suggested on Mondaythat Federal officials are planning a proposed rule to change the way accountable care organizations are paid. CMS Deputy Administrator Sean Cavanaugh said at a Brookings Institution forum that “the new rule will be out shortly” and officials will “hopefully have a final rule early next year.” One concern is that the cost targets ACOs are expected to hit are tied to national increases in Medicare spending. Medicare ACO participants also complain that the healthcare alliances “must save a certain amount of money before they can share in the savings.” Cavanaugh acknowledged the challenges and said, “We need to improve the incentives that the ACOs receive, improve the information and help build the capacity of the ACOs.”
Among 5801 PREDIMED trial participants, those following the Mediterranean diet supplemented with nuts and the Mediterranean diet supplemented with extra-virgin olive oil saw a reduction in blood glucose levels and abdominal obesity. The risk of developing metabolic syndrome over an average follow-up of 4.8 years did not differ between participants on a low-fat diet and on either of the Mediterranean diets, but among the 3392 participants with metabolic syndrome at baseline, participants on either Mediterranean diet were approximately 30% more likely to undergo reversion. They were also more likely to no longer have central obesity, according to the CMAJ study.
A recently developed biomarker of aging—known as an “epigenetic clock”—has revealed a strong correlation between high BMI and the epigenetic, or DNA methylation, age of liver tissue. On average, epigenetic age increased by 3.3 years for each 10 BMI units, and it was not associated with nonalcoholic fatty liver disease activity score. The 279 genes that were underexpressed in older liver samples were highly enriched with nuclear mitochondrial genes that play a role in oxidative phosphorylation and electron transport. The epigenetic age acceleration was not reversible in the short term after rapid weight loss, according to the PNAS study.
Reuters (10/15, Doyle) reports that black Americans are three times more likely to have a leg amputated due to diabetes then other groups, according to a report (PDF) from the Dartmouth Atlas Project. Racial minorities, as well as people living in underserved parts of the country, often receive fewer preventative services. The Project used Medicare claims data to determine the frequency of different preventative services and amputations based on different demographic characteristics.
Bloomberg BusinessWeek (10/14, Tozzi) reports that the study found black patients with diabetes had higher amputation rates in all 306 markets analyzed, the racial disparity was especially profound in southern states. Overall, amputation rates in different areas ranged from “1.2 per 1,000 patients with diabetes and peripheral artery disease... to 6.2.” TIME (10/15, Oaklander) quotes study co-author Philip Goodney, MD: “The resources needed to prevent amputation are currently severely misaligned. While we must look for opportunities to expand education and preventive care for all patients at risk for amputation, it seems clear to us that we can make the greatest gains by focusing on African-American patients in the highest risk regions, typically in the poor rural regions of the Southern United States, where the highest amputation rates remain Health News: New diabetes guidelines: Screen patients aged 45 and older New draft guidelines from the U.S. Preventive Services Task Force recommend screening adults aged 45 and older for prediabetes and type 2 diabetes. The recommendation could mean identifying and treating undiagnosed diabetes in millions more people, preventing complications and improving quality of life. Read more at AMA Wire. The New York Times (10/13, Graham) “The New Old Age” blog reported that a recent study published in the Journal of the American Medical Association weighed the use of “long-acting beta agonists and inhaled corticosteroids” in a population of more than 7,000 adults over the age of 65 who suffered from chronic obstructive pulmonary disease (COPD). Over the study period of approximately 2.5 years, researchers “found that seniors taking both medications had eight percent fewer deaths and hospitalizations...compared with those taking long-acting beta agonists alone.” An accompanying editorial suggested that “patients should be treated with both” medicines.
Nephrology News & Issues (10/13) reported that the US Preventive Services Task Force (USPSTF) has recommended that “primary care physicians should screen all adults over age 45 for diabetes every three years,” but “screening should be done earlier in adults with certain risk factors that include obesity, family history of diabetes, and” hypertension. American Medical Association president Robert M. Wah, MD, said, “For the first time, the USPSTF is recognizing value in screening for prediabetes; consequently, millions more patients at risk could ultimately be identified and helped by diabetes prevention programs recognized by the CDC through its National Diabetes Prevention Program.” Dr. Wah added that the AMA is “pleased that the Task Force is now recommending the use of hemoglobin A1c testing as a primary method for screening at-risk individuals, since this test provides a rapid and accurate means of testing for both prediabetes and diabetes.”
Reuters (10/3, Kennedy) reported that a new study by researchers at University of Otago in New Zealand found that the risk of falls in the home can be reduced by making relatively inexpensive fixes, including installing handrails and edging for stairs, outside lighting, bathroom rails, and slip resistant surfaces. According to the study of 842 New Zealand households with a total of about 1,850 residents, homes in which these changes were made saw a significant reduction in falls.
Kaiser Health News (10/1, Gillespie) reports on an ongoing study that aims to improve the methods used to treat so-called “super utilizers,” patients who frequently show up in emergency departments. Jeffrey Brenner, a MacArthur Fellow and the Executive Director of the Camden Coalition of Healthcare Providers, is leading the randomized controlled trial. Brennar and his team are taking patients with frequent ED visits and randomizing them into either a control group or a treatment group with a coordinated care team. Brennar seeks to show how health systems can improve patient care without increasing costs.
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