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by Amy Norton

Deaths, Hospital Stays and Costs All Down Among U.S. Seniors

Study finds steady improvement among Medicare enrollees from 1999 through 2013
TUESDAY, July 28, 2015 (HealthDay News) -- In a rare piece of good news about the U.S. health care system, a new study finds that deaths, hospital stays and spending are all falling among older Americans.
Between 1999 and 2013, yearly rates of death and hospitalization steadily declined among Americans in the traditional fee-for-service Medicare program. Meanwhile, spending on inpatient care showed the same pattern.
Researchers called the findings striking.
"The declines were steady throughout the study period," said lead researcher Dr. Harlan Krumholz, a professor of medicine at Yale University School of Medicine. "The trends are actually pretty jaw-dropping."
For a public used to hearing how broken the U.S. health care system is, the findings might come as a surprise, Krumholz acknowledged.
"As researchers," he said, "we often focus on finding deficiencies in health care, so we can work on them. And that can lead to a perception that we've got a terrible system."
In this case, Krumholz said, his team wanted to see whether national efforts to improve health care quality -- and public health -- have been paying off.
They focused on the traditional Medicare fee-for-service program, because it has the most data available. In this plan, hospitals and doctors bill Medicare for each individual service -- from a doctor's visit to providing a pain reliever in the hospital, according to the U.S. Government Accountability Office. In 2013, about 71 percent of Medicare beneficiaries were in the traditional fee-for-service program, the study reported.
The rest were enrolled in newer, Medicare Advantage plans, where private insurers approved by Medicare provide coverage. Krumholz's team was also able to analyze death rates among Americans in Medicare Advantage plans. The researchers found a similar decline.
The study can only show what is happening, and not why. "But," Krumholz said, "we have our suspicions."
For one, management of chronic health conditions such as high blood pressure, diabetes and heart disease has improved. Plus, Krumholz said, many Americans have made lifestyle changes for the better: Even though obesity is on the rise, smoking rates are down, and more people are exercising regularly.
The last 15 years have also seen a "big push" to improve health care quality nationally, Krumholz said. That has included measures to cut medical errors and boost hospital safety; public reporting on hospitals' performance, and efforts to improve patients' continuity of care among different providers.
Overall, U.S. spending on health care rose during the study period. But it's not clear if that's why Medicare patients' rates of death and hospitalization have fallen, according to Louise Sheiner, a senior fellow in economic studies at the Brookings Institution, a Washington, D.C.-based think tank.
"We don't know if we would've seen the same changes if we'd spent less on health care," said Sheiner, who was not involved in the study.
But she agreed that the trends, whatever the reasons, are encouraging. "The public is used to hearing that everything is terrible, and we waste too much money," Sheiner said. "But the system is at least increasing people's life expectancy."
In 1999, Medicare beneficiaries' rate of death from any cause was 5.3 percent; by 2013, that figure had declined to 4.5 percent. Death rates dipped both in and out of hospitals.
Meanwhile, hospitalizations fell from more than 35,000 per 100,000 annually, to just under 27,000 per 100,000. Inpatient spending dropped from an average of $3,300 per person in 1999, to $2,800 (adjusted for inflation).
Results of the study were published July 28 in the Journal of the American Medical Association.
"While the study can't pinpoint the reasons for the declines, they are welcome news," said Bowen Garrett, a senior fellow at the Urban Institute's Health Policy Center in Washington, D.C.
"It is good to see signs of improved outcomes during a period in which health care costs increased overall," Garrett said.
Progress is being made, at least for Medicare beneficiaries, Krumholz said. "That should give the public some confidence that we're going in the right direction," he added. "But we shouldn't become complacent, either."
And while some trends are "unequivocally good" -- such as the declining death rate -- some others are tougher to interpret, Krumholz said.
His team looked at what happened to beneficiaries after they were discharged from the hospital, and found changing patterns over time. By 2013, more people were discharged to skilled nursing facilities, long-term care, hospice or home health services. Fewer were sent home without health services.
What's not clear from the study is whether those changes improved people's lives, or were cost-effective, Sheiner said.
As for the positive trends in deaths and hospitalizations, Sheiner said further studies are needed to weed out the specific reasons.
More information
See how hospitals measure up at Medicare's Hospital Compare site ( ).
SOURCES: Harlan Krumholz, M.D., professor, medicine, Yale University School of Medicine, New Haven, Conn.; Louise Sheiner, Ph.D., senior fellow, economic studies, Brookings Institution, Washington, D.C.; Bowen Garrett, Ph.D., senior fellow, Health Policy Center, Urban Institute, Washington, D.C.; July 28, 2015, Journal of the American Medical Association
by Amy Norton

Health Highlights: July 28, 2015

Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:
Cyclosporiasis Outbreak Linked to Human Feces, Toilet Paper in Mexican Cilantro Fields
An outbreak of cyclosporiasis in Texas has been linked to human feces and toilet paper found in cilantro growing fields in Puebla, Mexico, the U.S. Food and Drug Administration says.
As a result, Mexican cilantro is being detained at the border and products from Puebla cannot enter the U.S. without inspections and certification, NBC News reported.
So far, there have been 205 cases of cyclosporiasis in the Texas outbreak. Last year, there were 200 cases of cyclosporiasis in Texas during an outbreak also linked to cilantro from Puebla.
No recall has been issued, but shoppers are being advised to ask their grocer about the origin of cilantro in stores and to thoroughly wash all fresh produce, NBC News reported.
Four Kroger Brand Spices Recalled
Four Kroger brand spices have been recalled by the grocery chain due to possible salmonella contamination.
The recall includes Kroger Ground Cinnamon, Kroger Garlic Powder, Kroger Coarse Ground Black Pepper and Kroger Bac'n Buds, the Cincinnati Enquirer reported.
The four products were made on the same equipment in the same facility. Food and Drug Administration testing detected salmonella in a sample of Kroger Garlic Powder from a store in North Augusta, S.C.
No illnesses have been reported in connection with the recalled products, according to the Enquirer. Consumers who bought the products are being told not to consume them and to return them to a store for a full refund or replacement. For more information, phone Kroger at 800-576-4377.
Selfie With Rattlesnake Leads to Huge Medical Bill
A San Diego man ended up with a $153,000 medical bill after trying to take a selfie with a rattlesnake earlier this month.
The snake bit Todd Fassler, who required two hospitals' stock of the antivenom CroFab, the only drug available to treat people bit by poisonous snakes, CBS News reported.
The bill for the antivenom alone came to more than $83,000.
"The only effective treatment is antivenom," Dr. Keith Boesen, director of the Arizona Poison and Drug Information Center, told CBS News. "There's blood tests we can do to determine the effect of the venom. Hospital bills can always be worked out or negotiated, but you can't really negotiate, other than prosthetics, the loss of part of your hand or your arm."
South Korea MERS Outbreak Over: Prime Minister
The Middle East Respiratory Syndrome (MERS) outbreak in South Korea is over, according to the country's prime minister.
There have been no new infections for 23 days, which means the public "can now be free from worry," Hwang Kyo-ahn said, BBC News reported.
However, the World Health Organization disagrees. It would take 28 days without a new infection -- twice the incubation period of the MERS virus -- to declare the outbreak over in South Korea, a WHO spokeswoman said.
The last MERS case in South Korea was confirmed on July 4, BBC News reported.
So far, 36 people have died in the MERS outbreak in South Korea.
by Amy Norton

Heart Disease, Alzheimer's Linked by Common Risk Factors

Study finds diabetes, smoking and obesity also affect brain areas tied in memory
TUESDAY, July 28, 2015 (HealthDay News) -- Some risk factors for heart disease may also be linked with Alzheimer's and other types of dementia, a new study reports.
"We already know that vascular risk factors damage the brain and can result in cognitive [mental] impairment," study lead author Dr. Kevin King said in a news release from the journal Radiology.
"Our findings give us a more concrete idea about the relationship between specific vascular risk factors and brain health," said King, an assistant professor of radiology at the Keck School of Medicine at the University of Southern California, Los Angeles.
The study was published in the July 28 issue of the journal.
Prior research has linked heart risk factors and mental decline, but this study focused on specific risk factors and three brain structures -- the hippocampus, precuneus and posterior cingulate cortex -- that play a role in memory.
The analysis of data from more than 1,600 adults in the Dallas Heart Study showed that alcohol use and diabetes were associated with smaller total brain volume. Smoking and obesity, meanwhile, were associated with reduced volume in the posterior cingulate cortex, which is involved with memory retrieval, and emotional and social behavior.
Alcohol use and smoking were linked with reduced volume in the hippocampus, and obesity and high fasting blood sugar levels were associated with reduced precuneus size, according to the study.
The findings also suggest that reduced hippocampal and precuneus size may be early indicators for mental decline in people 50 and older, while reduced posterior cingulate size is a better predictor of mental decline in people younger than 50.
"We currently do not have effective treatments for Alzheimer's disease, so the focus is on prevention," King said.
"In the future, we may be able to provide patients with useful and actionable information about the impact different risk factors may be having on their brain health during routine clinical imaging," he explained. "And since no special imaging equipment is needed, there is a great potential to provide this service at many centers."
More information
The U.S. National Institute on Aging has more about Alzheimer's risk factors and prevention ( ).
SOURCE: Radiology, news release, July 28, 2015
by Amy Norton

Millions of Americans Reaping Benefits of Affordable Care Act: Study

Gains seen in how many adults have medical coverage, a doctor and say they are in better health
TUESDAY, July 28, 2015 (HealthDay News) -- Millions more Americans have affordable health insurance, access to a personal doctor and feel they are in better shape following the first two open-enrollment periods of the Affordable Care Act, a new analysis shows.
The survey, which involved more than half a million U.S. adults, found that the Affordable Care Act (ACA), often called Obamacare, has reversed what had been a downward spiral in which health care was becoming more costly and less available to many Americans, said lead researcher Dr. Benjamin Sommers. Sommers is a health economist with Harvard's T.H. Chan School of Public Health and a primary care physician with Brigham and Women's Hospital in Boston.
In particular, minority groups and the chronically ill have made huge strides in gaining health coverage and getting the care they need, the researchers reported.
Close to 16 million more adults have gained health coverage, a reduction of almost 8 percent in those who were previously uninsured, Sommers said.
"Since the passage of the Affordable Care Act five years ago, we've seen the largest reduction in the uninsured rate in four decades," he said.
Sommers said other findings include:
7 million more adults have access to a personal physician, a 3.5 percent improvement. Almost 5 million more adults have easy access to medicines, an improvement of more than 2 percent. 11 million more adults say they can afford the health care their family needs, a 5.5 percent improvement.
In addition, almost 7 million more adults described themselves as being in excellent, very good or good health, rather than fair or poor health, Sommers said. Previous research has shown that people who say they are in fair or poor health have markedly higher death rates, he explained.
The results are published in the July 28 issue of the Journal of the American Medical Association.
"There are no surprises here, because there's no question the ACA has enabled extraordinary progress with respect to improving coverage and access to health care," said Ron Pollack, founding executive director of Families USA, a health care consumer advocacy group. "It's pretty clear that one out of three people who were previously uninsured have gained health care coverage."
Sommers chalked up the improvements to three main factors related to Obamacare: children aged 25 and under remaining on their parents' health plans; the opening of the state-level health insurance marketplaces; and the expansion of Medicaid in 30 states.
"Among the millions of people who have gained coverage through the new marketplaces, almost nine out of 10 of those are receiving subsidies that make coverage affordable for the first time," Pollack said.
Sommers added that people with chronic conditions -- such as diabetes, cancer or heart disease -- have experienced significant improvements in their self-reported health, and a reduction in health-related limitations to their daily activities.
"These results make sense, given that under the Affordable Care Act, insurance companies can no longer discriminate based on pre-existing medical conditions," he said.
Low-income adults in Medicaid expansion states experienced a significant drop in the uninsured rates, and as a result more had gotten their own personal physician and were experiencing easier access to medicine, the study found.
Minority groups also appeared to benefit most under the Affordable Care Act, researchers found. For example, nearly twice as many Hispanics (nearly 12 percent) and blacks (almost 11 percent) reported that they were no longer uninsured, compared with just 6 percent of whites.
These numbers "suggest that the ACA may be associated with reductions in longstanding disparities in access to care," Sommers said.
In the study, Sommers and his colleagues analyzed results of the 2012-2015 Gallup-Healthways Well-Being Index, a daily national telephone survey. The researchers examined changes in coverage and health care access for U.S. adults aged 18 to 64 since the first open-enrollment period began in October 2013, compared with trends prior to the implementation of the Affordable Care Act.
The researchers tried to control for the impact that the economy might have had on people's improving fortunes by including data such as whether a person was working, their household income and their state's annual unemployment rate, Sommers said.
"That gives us pretty good confidence that major changes in the economy aren't driving these results," he said.
More information
For more about the Affordable Care Act, visit the U.S. Department of Health and Human Services ( ).
SOURCES: Benjamin Sommers, M.D., Ph.D., health economist, T.H. Chan School of Public Health, Harvard University, and primary care physician, Brigham and Women's Hospital, both in Boston; Ron Pollack, founding executive director, Families USA; July 28, 2015, Journal of the American Medical Association
by Amy Norton

Psychiatric Woes Often Drive Euthanasia Requests in Belgium

Depression, personality disorders are some reasons people ask to die: study
TUESDAY, July 28, 2015 (HealthDay News) -- Depression and personality disorders are common reasons why psychiatric patients in Belgium request help to die due to unbearable suffering, a new study found.
Euthanasia has been legal in Belgium since 2002, and involves the use of drugs taken by mouth or given intravenously, the researchers explained.
They reviewed requests for help to die made by mentally ill patients in the Dutch-speaking region of Belgium between 2007 and 2011. They were followed through 2012.
Seventy women and 23 men requested euthanasia due to unbearable suffering from mental illness. They were between the ages of 21 and 80, with an average age of 47, the researchers said. Ninety-one had been referred for counseling. Seventy-three had been deemed medically unfit for work. Fifty nine were living alone, the study reported.
Ninety had more than one mental health disorder. Depression (58 patients) and personality disorder (50 patients) were the most common conditions, researchers said.
Forty-eight of the euthanasia requests were approved. Thirty-five were carried out. Eight of the patients cancelled or delayed euthanasia because they said simply having the option gave them enough peace of mind to continue living, researchers explained.
By the end of 2012, 43 of the patients in the study had died, including six who committed suicide.
Among those whose request for euthanasia was approved, 30 died surrounded by family/friends in a calm and peaceful setting, "which would have been impossible to attain in the case of unassisted traumatic suicide," wrote study author Dr. Lieve Thienpont, from University Hospital, Brussels in Belgium, and colleagues.
The findings were published online July 27 in the journal BMJ Open.
In 2010 and 2011, more than 2,000 people died by euthanasia in Belgium. Less than 10 percent of those deaths were in people who weren't terminally ill. Euthanasia accounted for 1 percent of all deaths in Belgium during those two years, the study revealed.
The researchers noted that there is no agreement about the definition of "unbearable suffering" and that there are no guidelines in Belgium on how best to handle mentally ill patients' requests for euthanasia.
"Taking into account the ongoing fierce ethical debates, it is essential to develop such guidelines, and translate them into clear and detailed protocols that can be applied in practice," they concluded.
More information
To learn more about depression, go to the U.S. National Institute of Mental Health ( ).
SOURCE: BMJ Open, news release, July 27, 2015
by Amy Norton

Drug Makers May Delay Reporting Patient Harms to FDA: Study

Analysis found roughly 10 percent of cases were filed after 15-day deadline passed
MONDAY, July 27, 2015 (HealthDay News) -- Drug companies may be endangering the lives of patients by not promptly reporting cases of drug-related illness or death to federal regulators, a new report suggests.
About 10 percent of cases where a drug does serious harm to a person are not reported to the U.S. Food and Drug Administration within the required 15-day period, the new analysis reveals.
Worse, it appears that drug makers are more likely to delay reporting if a patient death is involved, said senior study author Pinar Karaca-Mandic, an associate professor of health policy and management at the University of Minnesota School of Public Health.
"A larger fraction of these serious and unexpected events that involved a patient death were delayed -- about 12 percent of events with patient death, compared to 9 percent of events without patient death," Karaca-Mandic said.
Drug makers delayed filing more than 40,000 reports that involved patient death between 2004 and 2014, researchers found. They also delayed reporting nearly 120,000 events that did not involve a patient death.
The analysis was published online July 27 as a research letter in the journal JAMA Internal Medicine.
"Everyone wants to be sure the drugs we're taking are safe, and it is the FDA's role to make sure the drugs we're taking are safe," said Dr. Rita Redberg, chief editor of the journal and a professor of medicine at the University of California, San Francisco. "If adverse event reports are getting filed late, that means safety warnings are delayed and more people are taking dangerous drugs without knowing it."
For this report, researchers pored through a decade's worth of data from the FDA's Adverse Event Reporting System, eventually reviewing more than 1.6 million reports. About 95 percent of these reports come from drug companies, the authors noted in background information.
They found that drug manufacturers promptly report within the required 15-day period close to 91 percent of cases that do not involve patient deaths, and almost 87 percent of cases that do involve a death.
But the remaining cases were reported late, often by months.
"What was also surprising was that typically these were not delays of just a few days," Karaca-Mandic said. "For example, among events that involved a patient death, about 6 percent were reported within 16 to 90 days, about 3 percent within 91 to 180 days, and about 3 percent were delayed more than 180 days."
Redberg added that it's very likely that the problem is much worse than spelled out in this study.
"Although they reviewed well over 1 million adverse events, it's estimated that only 2 percent of all adverse events ever get reported to the FDA," she said.
A spokesperson for PhRMA, an organization that represents the pharmaceutical industry, said, "Patient safety is the highest priority for biopharmaceutical companies, which diligently submit hundreds of thousands of safety reports to the FDA every year."
"It is important to remember that prior to reporting any adverse event, including serious unexpected adverse events, companies must investigate the reports that they receive from patients and health care professionals," the spokesperson added. "Companies typically verify the accuracy of patient and physician reports, and often contact adverse event reporters to supplement the information that they provide to the FDA."
Karaca-Mandic said the FDA relies on these reports to inform consumers about safety problems that crop up after a drug hits the market, and the agency has the power to revoke a drug's approval or suspend drug sales if the manufacturer fails to promptly report adverse events.
Instead, the agency typically issues warning letters to companies that are dragging their feet, the authors said.
Karaca-Mandic cited a May 26, 2010, letter to Pfizer Inc. in which the FDA rapped the knuckles of the pharmaceutical giant for reporting delays ranging from nine months to more than three years late.
In another letter to Actelion Pharmaceuticals U.S. Inc. on Sept, 14, 2010, the FDA cited the manufacturer's "failure to report approximately 3,500 patient deaths," she added.
The FDA needs to step up its enforcement of reporting requirements, Redberg said in an editorial accompanying the study.
"We need to be able to depend on the FDA to monitor safety of our drugs once they're approved, especially because the FDA is moving toward faster and faster drug approval, which means that we are depending more and more on this post-market reporting," she said.
FDA spokesman Christopher Kelly said the agency had not yet reviewed the study and had no comment on the findings.
Consumers and physicians also can take matters into their own hands and report adverse reports directly to the FDA, rather than going through the drug company, Redberg added.
"Most of the adverse events are getting reported to the manufacturer, and they're supposed to report to the FDA," she said. "As there are these delays, it seems better to have people report directly to the FDA."
More information
For more information on reporting an adverse drug event, visit the U.S. Food and Drug Administration ( ).
SOURCES: Pinar Karaca-Mandic, Ph.D., associate professor, health policy and management, University of Minnesota School of Public Health, Minneapolis, Minn.; Rita Redberg, M.D., M.Sc., chief editor, JAMA Internal Medicine, and professor, medicine, University of California, Christopher Kelly, spokesman, U.S. Food and Drug Administration; San Francisco; July 27, 2015, JAMA Internal Medicine, online
by Amy Norton

Praluent Approved to Treat High Cholesterol

For people at risk of heart attack or stroke
MONDAY, July 27, 2015 (HealthDay News) -- Praluent (alirocumab) injection has been approved by the U.S. Food and Drug Administration to treat people with inherited high cholesterol (heterozygous familial hypercholesterolemia) or people at risk of heart attack or stroke from high cholesterol derived from foods or produced by the liver.
The drug is sanctioned for people who do not benefit enough from improved diet and the use of cholesterol-lowering statins.
Low-density lipoprotein (LDL, the so-called "bad cholesterol") is linked to cardiovascular disease. Heart disease is the leading cause of death among American men and women, killing some 610,000 people every year, the FDA said in a news release.
Praluent is the first-approved drug in a new class of medications called proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors. The drug is an antibody that inhibits the PCSK9 protein, which allows more liver receptors to remove LDL from the blood, lowering "bad" cholesterol.
Praluent was evaluated in clinical studies involving nearly 2,500 people with high cholesterol who were at risk of heart attack or stroke, and were taking the highest tolerated dose of a statin. Participants given Praluent saw a reduction in LDL cholesterol ranging from 36 percent to 59 percent, the FDA said.
The most common side effects of Praluent included itching, swelling, pain or bruising at the injection site, and flu. Serious allergic reactions, some requiring hospitalization, also were reported. Praluent users who develop symptoms of serious allergic reaction should stop using the drug and seek immediate medical attention, the FDA said.
Praluent is marketed by Bridgewater, N.J.-based Sanofi Aventis and Tarrytown, N.Y.-based Regeneron Pharmaceuticals.
More information
The FDA has more about this approval ( ).
by Amy Norton

Expert Panel Recommends Questionnaire to Help Spot Depression

Form could be filled out during visit to family doctor, and patient could be referred for follow-up care
MONDAY, July 27, 2015 (HealthDay News) -- Part of your next visit to your family doctor's office should be spent filling out a questionnaire to assess whether you're suffering from depression, an influential panel of preventive medicine experts recommends.
What's more, people concerned that they might be depressed could download an appropriate questionnaire online, fill it out ahead of time and hand it over to their doctor for evaluation, the panel added.
In an updated recommendation released Monday, the U.S. Preventive Services Task Force urged that family doctors regularly screen patients for depression, using standardized questionnaires that detect warning signs of the mental disorder.
If a patient shows signs of depression, they would be referred to a specialist for a full-fledged diagnosis and treatment using medication, therapy or a combination of the two, according to the recommendation.
These questionnaires can be self-administered in a matter of minutes, with doctors reviewing the results after patients fill out the forms, said Dr. Kirsten Bibbins-Domingo, vice chair of the task force.
"This could be a checklist that patients fill out in the waiting room, or at home prior to the visit," she said. "The good thing is we have many instruments, measures that have been studied for screening for depression."
About 7 percent of adults in the United States currently suffer from depression, but only half have been diagnosed with the condition, said Bibbins-Domingo, who is a professor of medicine, epidemiology and biostatistics at the University of California, San Francisco.
"We know that depression itself is a source of poor health," she said. "It leads people to miss work, to not function as fully as they might, and we know it is linked and associated with other types of chronic diseases."
It makes sense that family doctors perform front-line screening for depression, since they are more likely than a mental health professional to come across a person with undetected symptoms, said Michael Yapko, a clinical psychologist and internationally recognized depression expert based in Fallbrook, Calif.
"Only about 25 percent of depression sufferers seek out professional help, but more than 90 percent will see a physician and present symptoms and signs that could be diagnosed," said Yapko, who is not on the task force.
The panel has recommended regular depression screening for adults since 2002, but their guidelines currently urge doctors to ask two specific questions that provide a quick evaluation of a person's mood. The questions are, "Over the past two weeks, have you felt down, depressed, or hopeless?" and "Over the past two weeks, have you felt little interest or pleasure in doing things?"
The updated recommendation expands doctors' options for depression screening, adding commonly used questionnaires like the Patient Health Questionnaire, or PHQ-9.
The PHQ-9 is a list of 10 questions that focus on problems that a person might have experienced during the past two weeks, including poor appetite, low energy, sleep problems and a lack of interest in doing things.
"These are not instruments that diagnose depression," Bibbins-Domingo noted. "They give clinicians the first indication of something that should be followed up on."
Yapko said that someone who wanted to could lie on the questionnaires and avoid having their symptoms detected, but he added that in his experience it's not a very likely scenario.
"When you have people who are suffering who genuinely want help, they're happy to give you as accurate a portrayal as they can give you," he said. "Generally speaking, the people seeking help want help and they want to do their best in filling these things out. That's what makes the test worthwhile."
The task force is an independent, volunteer panel of national experts that has been issuing recommendations on preventive medicine since 1984.
Yapko and Bibbins-Domingo said depression screening shouldn't eat into a doctor's time, since patients can fill out and score the questionnaires on their own.
Instead of wasting time reading magazines in the waiting room, patients "could be filling out an inventory that is self-administered, self-scored and wouldn't take any physician time at all," Yapko said.
Patients also could download and fill out a depression questionnaire at home and hand it in when they go to the doctor, but Yapko said patients should make sure they're using the form their doctor prefers.
"Which of the many inventories and questionnaires a doctor might wish to use is a matter of personal and professional judgment," he said. "So, a doctor would need to specify which form to obtain online and the patient would then need to remember to bring it in, not always easy when depression negatively affects your memory. Easier to have the form in the office and have them fill it out in the waiting room."
Yapko added that it's important that doctors who screen for depression follow up by referring patients to a mental health professional, rather than trying to diagnose and treat depression themselves.
"When physicians get a diagnosis of depression, their most immediate thing to do is prescribe an antidepressant," Yapko said, noting that more than 70 percent of antidepressants are prescribed by non-psychiatrists. "Only a minority of people walk out of a doctor's office with a referral to a mental health professional, a fact which drives me a little crazy."
More information
Visit the U.S. National Institutes of Health ( ) for more on depression.
SOURCES: Kirsten Bibbins-Domingo, M.D., Ph.D., vice chair, U.S. Preventive Services Task Force, and professor, medicine, epidemiology and biostatistics, University of California, San Francisco; Michael Yapko, Ph.D., clinical psychologist, Fallbrook, Calif.; July 27, 2015, Screening for Depression in Adults: U.S. Preventive Services Task Force Draft Recommendation Statement
by Amy Norton

New Moms Often Get Poor Advice on Baby Care: Study

Tips from family or media can run counter to expert guidelines on vaccines, breast-feeding
MONDAY, July 27, 2015 (HealthDay News) -- New mothers get conflicting advice from medical professionals, family members and the media when it comes to key parenting topics, a recent study found.
And that advice often goes against American Academy of Pediatrics (AAP) recommendations for breast-feeding, vaccines, pacifier use and infant sleep, researchers say.
"In order for parents to make informed decisions about their baby's health and safety, it is important that they get information, and that the information is accurate," said the study's lead author, Dr. Staci Eisenberg, a pediatrician at Boston Medical Center.
"We know from prior studies that advice matters," Eisenberg said. Parents are more likely to follow the recommendations of medical professionals when they "receive appropriate advice from multiple sources, such as family and physicians," she added.
The study was published online July 27 in Pediatrics.
The researchers surveyed more than 1,000 U.S. mothers. Their children were between 2 months and 6 months old. Researchers asked the mothers what advice they had been given on a variety of topics, including vaccines, breast-feeding, pacifiers and infant sleep position and location.
Sleep location included whether babies sleep in their own bed or share a bed with parents, and if they sleep in their own room or their parents' room. Sources of advice included doctors, nurses at the hospital where they gave birth, family members and the media.
Mothers got most of their advice from doctors. But much of that advice contradicted the recommendations of the AAP on these topics.
For example, as much as 15 percent of the advice mothers received from doctors on breast-feeding and on pacifiers didn't match recommendations. Similarly, 26 percent of advice about sleeping positions contradicted recommendations. And nearly 29 percent of mothers got misinformation on where babies should sleep, the study found.
"I don't think too many people will be shocked to learn that medical advice found online or on an episode of Dr. Oz might be very different from the recommendations of pediatric medical experts or even unsupported by legitimate evidence," said Dr. Clay Jones, a pediatrician specializing in newborn medicine at Newton-Wellesley Hospital in Massachusetts. He said inaccurate advice from some family members may be unsurprising, too.
"But I'm not so sure most parents realize how much recommendations differ from doctor to doctor and nurse to nurse, or that many of us give medical information that is just plain wrong," said Jones, who was not involved with the study.
Mothers got advice from family members between 30 percent and 60 percent of the time, depending on the topic. More than 20 percent of the advice about breast-feeding from family members didn't match AAP recommendations.
Similarly, family advice related to pacifiers, where babies sleep and babies' sleep position went against the AAP recommendations two-thirds of the time, the study found.
"Families give inconsistent advice largely because they are not trained medical professionals and are basing their recommendations on personal anecdotal experience," Jones said.
Less than half the women said the media was a source of advice, except when it came to breast-feeding. Seventy percent of mothers said they got advice from the media on breast-feeding, and much of it didn't match recommendations.
In addition, more than a quarter of the mothers who got advice about vaccines from the media received information that was not consistent with AAP recommendations.
"Mothers get inconsistent advice from the media, especially the Internet, because it is the Wild West with no regulation on content at all," Jones said.
The possible consequences of bad advice depends on the topic and the advice, Jones said.
"Not vaccinating your child against potentially life-threatening diseases like measles is an obvious example," he said. "Others may result in less risk of severe illness or injury but may still result in increased stress and anxiety, such as inappropriately demonizing the use of pacifiers while breast-feeding."
Mothers who look for information online should stick to sources such as the AAP, the American Academy of Family Physicians or the U.S. Centers for Disease Control and Prevention, Eisenberg suggested.
Eisenberg and Jones agreed the best source for advice remains the child's doctor.
"While our findings suggest that there is room for improvement, we did find that health care providers were an important source of information, and the information was generally accurate," Eisenberg said. "But I would encourage parents to ask questions if they don't feel like their provider has been entirely clear, or if they have any questions about the recommendations."
More information
For advice recommended by medical experts about these topics, visit the American Academy of Pediatrics ( ).
SOURCES: Staci Eisenberg, M.D., pediatrician, Boston Medical Center, Boston, Mass.; Clay Jones, M.D., pediatrician and neonatal specialist, Newton-Wellesley Hospital, Newton, Mass.; August 2015, Pediatrics
by Amy Norton

Are Hospitals Overusing Neonatal Intensive Care?

Study found newborns admitted to these expensive units were bigger, less premature than in prior years
MONDAY, July 27, 2015 (HealthDay News) -- A new report finds that more babies are being treated in neonatal intensive care units at many U.S. hospitals, and the infants are bigger and less premature.
While they don't know for sure, researchers suggest this is a potential sign that these expensive interventions are being overused.
The report authors analyzed nearly 18 million births from 2007-2012, and found that the number of babies who were treated in neonatal intensive care units grew from 6.4 percent to 7.8 percent.
"An increase of this level over six years raises questions," said study author Wade Harrison, an urban health scholar at Geisel School of Medicine at Dartmouth, in New Hampshire. "Infants admitted to the units are increasingly likely to be of normal birth weight. More than half of all admissions are for normal or high-birth weight newborns. This suggests the need for further study since the units were initially developed to care for the most premature infants."
Neonatal intensive care units, or NICUs, have been used in the United States for more than 50 years. They're designed to provide intensive care to infants with special medical needs, particularly those born prematurely.
But intensive care for babies is expensive and can come with risks of its own, Harrison said. On the medical side, X-rays, antibiotics and IVs can be harmful.
"Costs vary by hospital, but are $3,000 to $5,000 per day for NICU care. In addition, there's billing for treatments rendered, and there may be additional costs if a baby requires surgery or specialized testing," said Dr. Deborah Campbell, chief of the division of neonatology at Children's Hospital at Montefiore, in New York City.
Also, providing unnecessary care can reduce bonding between parents and babies, make breast-feeding more difficult, and cause parental worry and stress, he added.
Meanwhile, Harrison said, there's been a lack of research into neonatal intensive care as a whole because most studies only look at their treatment of babies with very low birth weights. In fact, any baby can undergo treatment in the units, he explained.
In the new study, researchers looked at births from 38 states and Washington D.C., in 2007 through 2012. More than 84 percent of infants with low birth weight were admitted, compared with 4 percent of those with normal birth weights.
But over time, the researchers found, newborns admitted to the units became larger and less premature.
What's going on? The study doesn't pinpoint an answer, but Harrison said possible causes include lower thresholds for admittance. The research didn't indicate that the babies being admitted are sicker, although he acknowledged that the findings may have missed signs of that being the case.
What about fraud aimed at getting higher reimbursements for intensive care? It "was not something we were interested in examining nor could it be answered using the birth certificate data we used in the study," Harrison said.
However, Dr. Robert White, a neonatologist in South Bend, Ind., said there's only one reason for the higher number of very small babies being admitted to the unit: More are being resuscitated after birth and surviving.
As for babies of normal weight, he said there are a variety of reasons. For one, diabetic mothers are having babies with blood sugar problems that often require treatment in an intensive care unit. "Another cause of increased admission of term-infants is narcotic withdrawal," he said, "now often due to prescribed" drugs.
Guidelines regarding the use of the units have also changed, he said. "An infant born at 34 weeks with no medical problems, for example, is now expected to be cared for in a neonatal intensive care unit, whereas that was less likely to be the case in the past."
Still, he said, "we cannot ignore that perverse financial incentives still exist for both physicians and hospitals to provide care in a unit if it can be medically justified, even if it is not medically essential."
What can parents do? If told that a baby needs care in one of these units, they should ask about a private room "where they can comfortably stay for as long as necessary with their baby," White said.
These rooms allow families to stay with their newborn "at a crucial and stressful time and increase the family's opportunity to take an active role in their baby's care and medical decision-making," White said.
More information
For more about premature babies, visit the March of Dimes ( ).
SOURCES: Wade Harrison, M.P.H., urban health scholar, Geisel School of Medicine, Dartmouth, Hanover, N.H.; Robert White, M.D., neonatologist, South Bend, Ind.; Deborah Campbell, M.D., professor, clinical pediatrics, Albert Einstein College of Medicine, and chief, division of neonatology, Children's Hospital at Montefiore, New York City; July 27, 2015, JAMA Pediatrics

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