Tag: USA

Categories : Environmental Effects Substance UseTags :

Pharmaceutical and Illicit Drugs Contaminating New York’s Rivers

On By ModernMedia
Photo by Bill Oxford on Unsplash

In research published in Environmental Toxicology & Chemistry, investigators sampled water from 19 locations across the Hudson and East Rivers in 2021 and 2022 to identify and quantify the prescribed pharmaceuticals and drugs of abuse that are making their way into New York City’s rivers and to determine the source of these pollutants.

Metoprolol and atenolol (blood pressure medications), benzoylecgonine (the main metabolite of cocaine), methamphetamine (a stimulant), and methadone (an opioid) were the most prevalent drugs, present in more than 60% of water samples.

More drugs and higher concentrations were detected in water contaminated by Enterococci (bacteria that live in the intestinal tract) and after rainfall, indicating an impact from sewer overflow. However, the presence of drugs in clean water and during periods of dry weather indicated that wastewater treatment plant discharge may also contribute to the presence of drugs in rivers.

“This study shows how pharmaceuticals and drugs of abuse enter the New York City aquatic environment, highlighting the necessity of improving the current water management system,” said corresponding author Marta Concheiro-Guisan, PharmD, PhD, of the John Jay College of Criminal Justice.

Source: Wiley

Categories : General InterestTags :

US Doctor Gives His Life Stopping Church Shooting

On By ModernMedia
Candle-lit vigil
Photo by Thays Orrico on Unsplash

A US doctor has been hailed as a hero after he gave his life to stop a gunman firing upon a church congregation.

The Orange County Sherriff’s Department hailed the doctor’s ultimate sacrifice following the tragic shooting, which took place at a the Geneva Presbyterian Church in Laguna Woods, California, on Sunday afternoon.

John Cheng, MD, 52, was attending a church lunch with his mother when 68-year-old David Chou chained the doors shut and opened fire on a group of elderly parishioners.

Acting without hesitation, Dr Cheng, a prominent sports medicine physician, quickly tackled the suspect, allowing church members to restrain him, according to a statement from the Orange County Sheriff’s Department.

When he leapt to the defence, Dr Cheng sustained multiple gunshot wounds and succumbed to his injuries. He leaves behind his wife and two children, as well as devastated colleagues at his practice, who referred to him as a protector, ABC 7 reported.

“Officials said that were it not for the actions of Dr Cheng, there most certainly would have been many more lives lost,” said the California Medical Association in a statement released a day after the shooting.

“Our nation continues to be plagued by an epidemic of gun violence,” they wrote. “Physicians as healers are often on the front lines of these tragic events, treating the wounds of the victims of gun violence.”

Five other victims sustained gunshot wounds and were taken to local hospitals for treatment. The suspected shooter, who is in custody and being charged with murder and attempted murder, allegedly drove from Las Vegas to attack the church, at which members of the Taiwanese Presbyterian Church have had a space since 2009. He knew no-one at the church but spent about an hour mingling with them to gain their trust, NPR reported.

The shooting is being investigated as a hate crime, since the suspect was reportedly upset about political tensions involving China and Taiwan, the sheriff’s department noted.

At a media briefing, Orange County District Attorney Todd Spitzer praised Dr Cheng’s actions.

Dr Cheng knew that there were many parishioners at risk, Spitzer said. He charged across the room, and did everything he possibly could to disable the assailant. “He sacrificed himself so that others could live,” he added.

Don Barnes, the Orange County Sheriff-Coroner, was in agreement, saying that “there is no doubt that Dr. Cheng’s actions that day saved the lives of many other church members. He is a hero and will be remembered by this community as such.”

Source: MedPage Today

Categories : Healthcare Politics and RegulationsTags :

US Stands Poised to Rescind Abortion Rights

On By ModernMedia
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The US Supreme Court has voted to strike down the landmark Roe v Wade decision which constitutionally protects abortion rights, according to an initial draft majority opinion leaked by news outlet POLITICO. This comes at a time when abortion rights are being challenged in a number of US states, and such a ruling would cause abortion to become immediately illegal in 22 US states.

In 2019, there were 630 000 reported abortions in the US in 2019, according to the US Centers for Disease Control, an 18% decrease compared with 2010. Women in their 20s accounted for 57% of abortions in 2019. Abortions are highest among black American women, with a rate of 27 per 1000 for ages 15–44.

The Roe v Wade decision in 1973 gave women in the US an absolute right to an abortion in the first three months of pregnancy, and limited rights in the second trimester.

In 1992, in Planned Parenthood v Casey, it was ruled that states could not place an “undue burden” on women seeking abortions before a foetus could survive outside the womb, at about 24 weeks.

The draft opinion written by Justice Samuel Alito completely refutes the 1973 decision which guaranteed constitutional protections of abortion rights in the US, and also a subsequent 1992 decision – Planned Parenthood v. Casey – that largely maintained the right. “Roe was egregiously wrong from the start,” Justice Alito wrote.

“We hold that Roe and Casey must be overruled,” he writes in the document, labelled as the “Opinion of the Court.” “It is time to heed the Constitution and return the issue of abortion to the people’s elected representatives.”

In the past, deliberations on controversial cases have been fluid, with justices occasionally changing their votes as draft opinions circulate. This represents a rare breach of Supreme Court secrecy and tradition around its deliberations. The final, binding decision, is expected to be published in two months. Currently, five Republican appointees including Justice Alito have voted in favour of repealing Roe and Casey, while the three Democrat appointees are dissenting. It is not known how the last member, Chief Justice John Roberts, will vote.

The ruling as it currently stands would end the 49 year old US constitutional protection of abortion rights, instead allowing each US state to restrict or ban abortions outright.

POLITICO notes that public disclosure of a draft decision is unprecedented in the court’s modern history. Some observers had predicted that the conservative majority would have chipped away at abortion rights without overturning it.

The draft shows that the court is seeking to reject Roe’s logic and legal protections. “The inescapable conclusion is that a right to abortion is not deeply rooted in the Nation’s history and traditions,” Justice Alito wrote, declaring that one Roe’s central tenets, the “viability” distinction between foetuses not capable of surviving outside the uterus and those which can, “makes no sense.”

Justice Alito also described doctors and nurses who terminate pregnancies as “abortionists”, instead of the more neutral term “abortion providers” used by Chief Justice Roberts.

Source: Politico

Categories : COVID Healthcare Politics and RegulationsTags : 1 Comment

Political Factors Drove Hydroxychloroquine and Ivermectin COVID Prescriptions

On By ModernMedia
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Hydroxychloroquine and ivermectin, two COVID treatments that have been shown to be ineffective for those purposes, were more heavily prescribed in the second half of 2020 in parts of the US that voted for the Republican party, according to a new research letter published in JAMA Internal Medicine.

“We’d all like to think of the health care system as basically non-partisan, but the COVID pandemic may have started to chip away at this assumption,” said lead author Michael Barnett, assistant professor of health policy and management.

The study compared prescription rates for hydroxychloroquine and ivermectin with rates for two control medications, methotrexate sodium and albendazole, which are similar drugs but have not been proposed as COVID treatments. Comparing different US counties, researchers looked at deidentified medical claims data from January 2019 through December 2020 from roughly 18.5 million adults as well as census and voting data.

Overall, hydroxychloroquine prescribing volume from June through December 2020 was roughly double what it had been in the previous year, while the volume of ivermectin prescriptions was seven-fold higher in December 2020 than the previous year. In 2019, prescribing of hydroxychloroquine and ivermectin did not differ according to county Republican vote share. However, that changed in 2020.

After June 2020 – coinciding with when the US Food and Drug Administration revoked emergency use authorisation for hydroxychloroquine – prescribing volume for the drug was significantly higher in counties with the highest Republican vote share as compared to counties with the lowest vote share.

As for ivermectin, prescribing volume was significantly higher in the highest versus lowest Republican vote share counties in December 2020 a 964% increase on the overall prescribing volume in 2019. The spike lined up with with a number of key events, such as the mid-November 2020 release of a now-retracted manuscript claiming that the drug was highly effective against COVID, and a widely publicised US Senate hearing in early December that included testimony from a doctor promoting ivermectin as a COVID treatment.

Neither of the control drugs had differences in overall prescribing volume or in prescribing by county Republican vote share.

The authors concluded that the prescribing of hydroxychloroquine and ivermectin may have been influenced by physician or patient political affiliation. “This is the first evidence, to our knowledge, of such a political divide for a basic clinical decision like infection treatment or prevention,” said Barnett.

Source: Harvard T.H. Chan School of Public Health

Categories : Cardiovascular DiseaseTags :

US Sees Surge in Hypertension Hospitalisations

On By ModernMedia
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The number of people hospitalised for a hypertensive crisis in the US more than doubled from 2002 to 2014, according to researchers from Cedars-Sinai Medical Center. Possible causes included socioeconomic factors such as reduced access to healthcare.

A hypertensive crisis is an acute, marked elevation in blood pressure that is associated with signs of target-organ damage. This increase in hypertensive crises happened at a time when some studies reported overall progress in blood pressure control and a decline in related cardiovascular events in the US. The findings are published in the Journal of the American Heart Association.

“Although more people have been able to manage their blood pressure over the last few years, we’re not seeing this improvement translate into fewer hospitalisations for hypertensive crisis,” said first author Joseph E. Ebinger, MD, a clinical cardiologist and director of clinical analytics at the Smidt Heart Institute

Dr Ebinger said there could be a number of explanations for the incrrease. More people may be unable to afford hypertension medications or are taking inadequate doses of these drugs. Socioeconomic factors may also make it difficult for people to avoid unhealthy behaviours that can contribute to hypertension, such as smoking, as well as having limited access to health care and other concerns.

“We need more research to understand why this is happening and how clinicians can help patients stay out of the hospital,” Dr Ebinger said.

For their study, the investigators used data from the National Inpatient Sample, which is a publicly available database. The data include a subset of all hospitalisations across the US, providing a picture of nationwide trends. They found that annual hospitalisations for hypertensive crises more than doubled over a 13-year period. Hospitalisations related to hypertensive crises accounted for 0.17% of all admissions for men in 2002 but 0.39% in 2014, and represented 0.16% of all admissions for women in 2002 but 0.34% in 2014.

The mortality risk for hypertensive crisis, however, did decrease slightly overall during the studied time period. Women died at the same rate as men, even though they had fewer health issues than men who also were hospitalised for a hypertensive crisis.

“These findings raise the question: Are there sex-specific biologic mechanisms that place women at greater risk for dying during a hypertensive crisis?” said senior study author Susan Cheng, MD, MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute. “By understanding these processes, we could prevent more deaths among women,” she added.

Source: Cedars-Sinai Medical Center

Categories : COVID HospitalsTags :

Omicron Not ‘Mild’ for US, Experts Say

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In stark contrast to South Africa’s approach to COVID and the country’s experts characterising Omicron as “mild”, US experts have said that calling it “mild” ignores the harsh situation their country faces: record hospitalisations, sick children, other conditions being worsened by COVID, and staff shortages.

While Omicron’s odds of causing a person’s hospitalisation or death are lower, US numbers suggest that Omicron is, in fact, serious on a population level.

“What’s mild about hospitals at or near the breaking point? What’s mild about hundreds of healthcare workers per hospital out ill with COVID? What’s mild about 1.3 million cases in the U.S. just yesterday? What’s mild about the rising titer of burnout? What’s mild about an unprecedented number of children now ill and hospitalised with COVID?” Clyde Yancy, MD, chief of cardiology at Northwestern University’s Feinberg School of Medicine in Chicago, wrote in an email to MedPage Today.

“I think prudence would suggest that we reframe ‘mild’ and think more about ‘self-limited,'” he added. “We are likely at or near a plateau but how long will it last and how much more agony awaits?”

Americans were hospitalised in record numbers last week. “When there are many more people sick in large numbers – in millions – even if it’s a smaller percentage that’s going to be severely sick, that is going to result in large numbers in the hospitals,” said Biykem Bozkurt, MD, PhD, a cardiologist at Baylor College of Medicine in Houston.

While Omicron is still a threat for those unvaccinated or without previous infection, its high breakthrough rate is a cause for concern, especially in vulnerable people.

“Individuals who have breakthroughs after being vaccinated, including the elderly who have comorbid heart disease, are now flooding our emergency departments with decompensated cardiovascular diagnoses and a positive coronavirus test,” said cardiologist Jim Januzzi, MD, of Massachusetts General Hospital and Harvard Medical School in Boston.

As well as buckling healthcare systems, vulnerable and overlooked populations are being affected by Omicron even more.

Paediatric hospitalisations in the US reached a new peak in mid-January, with 20% of the entire pandemic’s hospitalisations of children happening in just two weeks in January. Over 1000 children have died from COVID by the CDC’s numbers, including 359 under five.

Moreover, patients on immunosuppressive medications may be less protected by the vaccines. “The labelling of the Omicron infection as ‘mild’ overlooks the important features and the messaging to the public,” rheumatologist Vaidehi Chowdhary, MBBS, MD, DM, of Yale School of Medicine in New Haven, Connecticut, wrote in an email to MedPage Today.

“Some patients who are on strong immunosuppressive medications do not have adequate vaccine titers and remain vulnerable,” she said, pointing out that there’s a shortage of monoclonal antibodies and antivirals, which means that this group must take extra precautions to ensure they aren’t infected in the first place.

Omicron’s impact on those who are immunosuppressed or have long COVID is not yet known, Dr Chowdhary noted. “For immunosuppressed patients, to minimise infections, many in-person appointments have been converted to telehealth or elective procedures deferred. The impact of these practices and their impact on overall patient health are not known.”

People living with disabilities and chronic illnesses continue to be faced with worsened infections, delaying consultations and difficulty accessing healthcare.

Then there are those whose infection has exacerbated their condition, whatever it may be. Omicron could be the thing that tips them over the edge, or that keeps them in the hospital for longer, experts have said. Examples seen include patients with blood clots having those clots exacerbated by COVID, and COVID-positive trauma patients having complications and longer recovery times.

Healthcare workers falling ill due to Omicron has seriously stressed US healthcare, with staff shortages have been reported in almost 20% of the country’s hospitals, leaving their already overworked colleagues to work extra.

Dr Januzzi’s hospital has been “completely full, with a huge number of individuals with COVID. So, we’re really at a breaking point where staff are getting sick. Patients and physicians alike are exhausted … the hope would be that we can get through this time and get to the other side of this.”

Source: MedPage Today

Categories : Mental HealthTags :

Politics Makes People Sick – Literally

On By ModernMedia
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According to a new US study, all the political jockeying is harmful to our health, has been for some time, and even a change in party power didn’t help.

Political scientist Kevin Smith followed up a landmark 2017 survey study where he measured the effects of the political climate on Americans’ physical, social, mental and emotional health. Smith repeated the same 32-question survey twice in 2020 – two weeks prior to the election, and two weeks after. The 2020 findings mirrored the 2017 results, and again found that a large proportion of American adults blame politics for causing them stress, loss of sleep, fractured relationships and more.

Similar to the 2017 findings, the results of the 2020 surveys, published in PLOS One, showed that an estimated 40% of Americans identified politics as a significant source of stress. Between a fifth and a third of US adults also blamed politics for causing fatigue, feelings of anger, loss of temper and triggering compulsive behaviours. About a quarter of adults reported they’d given serious consideration to moving because of politics.

That the results remained mostly stable after nearly four years is cause for alarm, Smith said.

“This second round of surveys pretty conclusively demonstrates that the first survey was not out of left field – that what we found in that first survey really is indicative of what many Americans are experiencing,” Smith, chair and professor of political science, said. “It’s also unpleasant to think that in that span of time, nothing changed. A huge chunk of American adults genuinely perceive politics is exacting a serious toll on their social, their psychological and even their physical health.”

Smith repeated the survey with the same group of people both before and after the election to see if the election’s outcome would recast people’s perceptions.

“We wondered if a change in presidency, which indeed was the case, would shift attitudes, and the short answer is no,” Smith said. “If anything, the costs that people perceive politics is exacting on their health increased a little bit after the election.”

Smioth was most surprised at the repeated finding that 5% of Americans blame politics for having suicidal thoughts.

“One in 20 adults has contemplated suicide because of politics,” Smith said. “That showed up in the first survey in 2017, and we wondered if it was a statistical artifact. But in the two surveys since, we found exactly the same thing, so millions of American adults have contemplated suicide because of politics. That’s a serious health problem.”

Those most likely to be negatively affected by politics were younger, more often Democratic-leaning, more interested in politics and more politically engaged.

“If there’s a profile of a person who is more likely to experience these effects from politics, it’s people with those traits,” Smith said.

This could mean problems for democracy if this trend continued. Smith suggested investigating whether civic education had a positive effect, as those who were more knowledgeable about politics seemed to be less affected.

Source: University of Nebraska

Categories : COVIDTags :

Sharply Increased Fatality Rate Estimated for Iota Variant

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A study available on the medRxiv preprint server has estimated the increases of the SARS-CoV-2 Iota (B.1.526) variant for transmissibility, immune escape ability, and infection fatality rate in New York.

The study findings revealed that the Iota variant has considerably higher transmissibility and immune escape potential than previously circulating variants and that it can increase the infection fatality rate by 62%-82% among older adults.

Iota variant emerges in New York
The lota variant, was first identified in New York City in November 2020 and then spread across the US and to 27 countries.

According to one lab study, the Iota variant modestly resists neutralisation by therapeutic monoclonal antibodies and vaccine/infection-induced antibodies. Fortunately however, evidence indicates that the variant does not increase the risk of breakthrough infections in vaccinated or previously infected individuals.

Study design
For the study, the scientists analysed multiple epidemiological and population datasets collected in New York City and, with mathematical modeling, estimated the transmission rate, immune evasion ability, and infection fatality risk of the Iota variant.

The prevalence of SARS-CoV-2 was estimated at 16.6% at the end of the first wave, and 41.7% at the end of the second wave. Infections in all age groups were seen with the second wave, compared to mostly older age groups in the first.

Transmissibility and breakthrough
A rapid increase in Iota-infected cases was observed during the second pandemic wave. Before the variant was first discovered in a neighbourhood in early November 2020, a rise in cases was seen in that same neighborhood, which remained higher than other neighbourhoods until Iota became prevalent and raised the baseline.

The researchers estimated that Iota is 15–25% more transmissible than previously circulating variants, with breakthrough infections in 0–10% of the population. These increases made the Iota variant become dominant in New York City from November 2020 to March 2021. Afterward, with the surge of more infectious variant B.1.1.7 (Alpha), Iota prevalence fell.

Despite a reduction in mortality rate following mass vaccination, infection fatality rate was seen to increase in New York City during the second pandemic wave. The researchers estimated that the Iota variant increases the infection fatality rates by 46% for 45–64 year olds, 82% (65–74), and 62% (75+). Compared to previously circulating variants, the Iota variant, overall, caused a 60% increase in infection fatality rate, comparable to that estimated for the Alpha variant.

Source: News-Medical.Net

Categories : COVID PaediatricsTags :

Infant with COVID Airlifted Out as Texas Hospitals Fill Up

On By ModernMedia
Photo by Fas Khan on Unsplash
Photo by Fas Khan on Unsplash

An 11-month-old girl in Houston, Texas, had to be airlifted to a hospital in a different city because no paediatric hospitals in Houston would accept her as a transfer patient.

“She needed to be intubated immediately because she was having seizures,” said Patricia Darnauer, the administrator for LBJ Hospital. “We looked at all five major paediatric hospital groups and none [had beds] available.”

The little girl will be receiving treatment at Baylor Scott & White McLane Children’s Medical Center some 220 kilometres away.

The situation is sad but not surprising for Dr Christina Propst, who is one of the most outspoken pediatricians in Houston. Ever since the pandemic began in the US, Dr Propst has encouraged masking, social distancing, and being cautious to anyone who would listen.

“The emergency rooms at the major children’s hospitals here in Houston, the largest medical center in the world, are extremely crowded,” said Dr Propst. “They are filling, if not full, as are the hospitals and intensive care units.”

Delta variant infecting more children
Dr Propst and other clinicians ascribed the scarcity of paediatric beds, to the delta variant of COVID noticeably affecting more children, as well as being more transmissible. Texas Children’s Hospital has 30 children and adolescents hospitalised with COVID, compared to their January peak of 40.

However, the problem is worsened by widespread cases of Respiratory Syncytial Virus (RSV) in children. This is all taking place during the summer break for US schools, where doctors are used to injuries from playing outdoors.

Darnauer spoke of high numbers of patients at her hospital. “We are back beyond our pre-pandemic volumes at LBJ.”

Dr Propst advises mask wearing for those children not old enough for the vaccine, and she would also like to see Texas once again allow public schools to mandate masks. Unlike many other countries, COVID health regulations are largely up to individual states.

“If children are not masking in schools, it will be a major problem,” said Dr Propst.

She added that, even in normal times, the start of the school year generally causes a lot of germs to spread.

“It is typical that two weeks after school we see a great surge of strep and other sources of infection. We are bracing ourselves, not a question of when, it will be bad,” she said.

Source: ABC13

Categories : COVID General InterestTags :

Trump Encouraged to Urge Followers to Take Vaccine

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As US polls show that half of Republicans voters are reluctant to get a COVID vaccine, two former senior Trump administration officials have said that former US President Donald Trump is being encouraged to urge his followers to get the jab. 

The officials stressed that herd immunity could be threatened by Republican vaccine hesitancy, and that Trump’s followers will listen to him and him alone.

“Vaccines are widely regarded as one of Trump’s greatest accomplishments, and Trump understands that this legacy is at risk because half of his supporters are not taking the vaccine,” one of the officials told CNN. “It’s just not clear yet if he understands that he’s the only one who can fix this.”

The other official concurred. “In Trump country, if you want to call it that, there are still significant numbers of people who aren’t sure [COVID] is a real thing, despite folks getting sick, and there are lots of suspicions about the vaccine,” the source said. “They have literally said to me, ‘I want to hear from the president about this.’ I don’t think they’re going to listen to anyone else.”

Trump told Fox News last week that he would make a “commercial” about the vaccine, but did not make a firm commitment.
However, a person close to Trump disagreed he should take this approach. “He shouldn’t be pushing these vaccines. His posse isn’t exactly vaccine-approving and it could backfire,” the person said.

All the living former presidents save for Trump, and their wives, appeared in an ad campaign started last month encouraging vaccination – though Trump’s team denied he was approached to participate. This was because the team that organised the PSA did not think it was likely he would participate, according to a source close to that project.

In the Fox interview, Trump said, “I encourage them to take it. I do,” referring to his supporters, but has only spoken out a few times about vaccination.

Fifty-four percent of Republicans are either hesitant about or opposed to getting a COVID vaccine, according to a March survey by the Kaiser Family Foundation, and 29% said they would not get a vaccine under any circumstances.

The number of people 18 and over with at least one vaccine dose, the top 10 states are all states President Joe Biden won last November. Trump won 9 out of the bottom 10 states for vaccination.

A third former Trump official confided that as early as last summer, there were already concerns over Republican vaccine refusal.

“On Facebook I saw a ton of hesitancy for that group — just insane amounts of hesitancy already and we knew it was just going to get worse,” the official said.

That official said Trump ally Michael Caputo briefly mentioned to Trump last fall that it would be good for the president to do a vaccine PSA after the election.

One of the other former officials noted that recently, Caputo “in particular has been active in discussing” the possibility of doing a PSA with the Trump team.

“Michael takes this very seriously and sees this as a big public health problem,” said the source. “His stepping out, because he’s so connected to the president, is really going to be forceful and incredibly helpful.”

Mr Caputo served as assistant secretary for public affairs at the US Department of Health and Human Services, leaving after being diagnosed with throat cancer and a rant at heath scientists saying they were undermining Trump.

Mr Caputo confirmed to CNN that he met with Trump and the two men “spoke about vaccine hesitancy and what can be done about it.”

Trump’s final year in office will define his legacy, according to historians, which was marred by the failure to contain COVID and his incitement of a mob that stormed the US Capitol.

The former  officials said they don’t want to see the vaccine development that Trump pushed undone by vaccine hesitancy, including among his own supporters.

“I see Operation Warp Speed tipping towards failure, and it really concerns me,” one of the senior officials warned. “If we don’t move half those people into the vaccinated column, we’re most likely not going to reach community immunity, and if we don’t reach it, then the president’s vaccine legacy is dead.”

The other senior official said Trump supporters would respond positively to the former president “taking ownership of Operation Warp Speed” and mentioning that he and his wife were both vaccinated.

“He could talk about how [vaccine uptake] is the way to get the country back to where it needs to be economically and socially, using his language that he uses with his supporters. I think that would be really powerful,” said the source.

Source: CNN