MONDAY, Aug. 24, 2020 (HealthDay News) — One in five U.S. nursing homes reports a severe shortage of personal protective equipment (PPE) and any shortage of staff during the COVID-19 pandemic, according to a report published online Aug. 20 in Health Affairs.
Brian E. McGarry, Ph.D., from the University of Rochester in New York, and colleagues examined the state of nursing homes with respect to adequate PPE and staffing using a new national database containing data from 98 percent of U.S. nursing homes.
The researchers found that a severe shortage of PPE and any shortage of staff were reported by more than one in five nursing homes (20.7 and 20.8 percent, respectively). Shortages of N95 masks and gowns were most common, at 13.4 and 12.6 percent of nursing homes, respectively. From May to July of 2020, there was no meaningful improvement in the rates of both staff and PPE shortages; N95 masks and gowns continued to be the most common types of PPE shortages (14.4 and 10.9 percent). The likelihood of reporting shortages was increased for facilities with COVID-19 cases among residents and staff and for those serving more Medicaid recipients and with lower quality scores.
“Many nursing homes in the United States are poorly prepared to prevent and manage COVID-19 outbreaks given a lack of essential PPE and staff,” the authors write. “Unless these shortages are prioritized by policymakers, long-term care residents will continue to be at a great disadvantage in the pandemic.”
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MONDAY, Aug. 24, 2020 (HealthDay News) — Large areas of rural America are experiencing shortages of emergency physicians, according to a study published online July 31 in the Annals of Emergency Medicine.
Christopher L. Bennett, M.D., from Massachusetts General Hospital in Boston, and colleagues used the 2020 American Medical Association Physician Masterfile data set and the 2018 Census Bureau estimates to characterize the current U.S. emergency physician workforce and to calculate emergency physician population density.
The researchers found that there were 48,835 clinically active emergency physicians (median age, 50 years; 28 percent women) in 2020. The overall density of emergency physicians was 14.9 per 100,000 population, with most emergency physicians located in urban areas (92 percent). Only 6 percent were located in large rural areas and 2 percent in small rural areas. Compared with those in rural areas, urban emergency physicians were younger (median age, 50 years versus 58 years in large rural areas and 62 years in small rural areas). Additionally, urban emergency physicians were more likely to be women (29 percent urban versus 20 percent and 19 percent in large and small rural areas, respectively). The total number of clinically active emergency physicians increased; however, emergency physician density decreased per 100,000 U.S. population in both large rural (0.4) and small rural (3.7) areas compared with 2008.
“Given the ongoing demand for physicians in all U.S. emergency departments, this analysis provides essential information for understanding the current emergency physician workforce and the challenges ahead,” the authors write.
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MONDAY, Aug. 24, 2020 (HealthDay News) — Patients with moderate COVID-19 receiving a five-day course of remdesivir have a statistically significant difference in clinical status compared with usual care, according to a study published online Aug. 21 in the Journal of the American Medical Association.
Christoph D. Spinner, M.D., from the Technical University of Munich, and colleagues determined the efficacy of five or 10 days of remdesivir treatment versus standard care on clinical status on day 11 after treatment initiation. Hospitalized patients with moderate COVID-19 pneumonia were enrolled and randomly assigned to receive a 10-day course of remdesivir, a five-day course of remdesivir, or standard care (197, 199, and 200 patients, respectively).
The researchers found that the odds of a better clinical distribution on day 11 were increased for patients in the five-day remdesivir group compared with those receiving standard care (odds ratio, 1.65; 95 percent confidence interval, 1.09 to 2.48; P = 0.02). On day 11, the clinical status distribution was not significantly different between the 10-day remdesivir and standard-care groups (P = 0.18). Nine patients had died by day 28: 1, 2, and 2 percent in the five-day remdesivir, 10-day remdesivir, and standard-care groups, respectively. Compared with standard care, remdesivir-treated patients more frequently had nausea, hypokalemia, and headache.
“In aggregate, important questions remain regarding the efficacy of remdesivir,” write the authors of an accompanying editorial. “It therefore seems prudent to urgently conduct further evaluations of remdesivir in large-scale randomized clinical trials designed to address the residual uncertainties and inform optimal use.”
Several authors disclosed financial ties to biopharmaceutical companies, including Gilead Sciences, which manufactures remdesivir and funded the study.
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MONDAY, Aug. 24, 2020 (HealthDay News) — Pediatric and young adult cancer survivors, frail versus robust survivors, and newly diagnosed pediatric patients after cancer therapy have increased expression of p16INK4a, corresponding with age acceleration, according to a study published online Aug. 24 in Cancer.
Andrew B. Smitherman, M.D., from the University of North California at Chapel Hill, and colleagues conducted a cross-sectional cohort study involving 60 young adult cancer survivors and 29 age-matched, cancer-free controls who were assessed for p16INK4a expression and frailty. Before and after cancer therapy, nine newly diagnosed pediatric patients underwent prospective measurements for p16INK4a expression.
The researchers found that compared with controls, survivors had higher expression of p16INK4a, representing a 25-year age acceleration in survivors. Among newly diagnosed patients, there was an increase in p16INK4a expression from matched pretreatment to posttreatment samples. Compared with robust survivors, frail survivors had higher p16INK4a expression, representing a 35-year age acceleration.
“We report that childhood, adolescent, and young adult cancer survivors exhibit evidence of increased cellular senescence and accelerated molecular aging equivalent to more than two decades of advanced chronological age,” the authors write.
Several authors disclosed financial ties to the biopharmaceutical industry.
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MONDAY, Aug. 24, 2020 (HealthDay News) — Pediatric and young adult cancer survivors, frail versus robust survivors, and newly diagnosed pediatric patients after cancer therapy have increased expression of p16INK4a, corresponding with age acceleration, according to a study published online Aug. 24 in Cancer.
Andrew B. Smitherman, M.D., from the University of North California at Chapel Hill, and colleagues conducted a cross-sectional cohort study involving 60 young adult cancer survivors and 29 age-matched, cancer-free controls who were assessed for p16INK4a expression and frailty. Before and after cancer therapy, nine newly diagnosed pediatric patients underwent prospective measurements for p16INK4a expression.
The researchers found that compared with controls, survivors had higher expression of p16INK4a, representing a 25-year age acceleration in survivors. Among newly diagnosed patients, there was an increase in p16INK4a expression from matched pretreatment to posttreatment samples. Compared with robust survivors, frail survivors had higher p16INK4a expression, representing a 35-year age acceleration.
“We report that childhood, adolescent, and young adult cancer survivors exhibit evidence of increased cellular senescence and accelerated molecular aging equivalent to more than two decades of advanced chronological age,” the authors write.
Several authors disclosed financial ties to the biopharmaceutical industry.
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MONDAY, Aug. 24, 2020 (HealthDay News) — Renin-angiotensin-aldosterone system (RAAS) inhibitors are beneficial for hypertensive patients with COVID-19, according to a study published online Aug. 24 in Current Atherosclerosis Reports.
Ranu Baral, from Norfolk and Norwich University Hospital in the United Kingdom, and colleagues examined the impact of RAAS inhibitors on hypertensive patients with COVID-19. Data were included for 28,872 patients.
The researchers observed a trend to lower risk for death/critical events with use of any RAAS inhibition for any condition (odds ratio [OR], 0.671; 95 percent confidence interval [CI], 0.435 to 1.034; P = 0.071). Among patients with hypertension, a significantly lower risk was seen for deaths (OR, 0.664; 95 percent CI, 0.458 to 0.964; P = 0.031) or the combination of death/critical outcomes (OR, 0.670; 95 percent CI, 0.495 to 0.908; P = 0.010). No significant association of death/critical outcomes was seen for angiotensin-converting enzyme inhibitor use versus non-angiotensin-converting enzyme inhibitor use (OR, 1.008; 95 percent CI, 0.822 to 1.235; P = 0.941) or for angiotensin receptor blocker versus non-angiotensin receptor blocker use (OR, 0.946; 95 percent CI, 0.735 to 1.218; P = 0.668).
“The really important thing that we showed was that there is no evidence that these medications might increase the severity of COVID-19 or risk of death,” a coauthor said in a statement. “On the contrary, we found that there was a significantly lower risk of death and critical outcomes, so they might in fact have a protective role — particularly in patients with hypertension.”
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MONDAY, Aug. 24, 2020 (HealthDay News) — For patients with early-stage oropharyngeal cancer, transoral robotic surgery is associated with improved surgical outcomes and survival, according to a study published online Aug. 20 in JAMA Oncology.
Anthony T. Nguyen, M.D., Ph.D., from the Cedars-Sinai Medical Center in Los Angeles, and colleagues compared long-term outcomes of transoral robotic surgery to those of nonrobotic surgery for patients with early-stage oropharyngeal cancer in a retrospective cohort comparative effectiveness analysis. Data were included for 9,745 patients, of whom 27.6 percent underwent transoral robotic surgery.
The researchers found that from 2010 through 2015, use of robotic surgery increased significantly from 18.3 to 35.5 percent of all surgical procedures for T1 and T2 oropharyngeal cancers. There was an association seen for robotic surgery with reduced rates of positive surgical margins (12.5 versus 20.3 percent) and lower adjuvant chemoradiotherapy use (28.6 versus 35.7 percent). Compared with nonrobotic surgery, robotic surgery correlated with improved overall survival among 4,071 patients with known human papillomavirus status (hazard ratio, 0.74). In propensity score-matched cohorts, the five-year overall survival was 84.8 and 80.3 percent among patients undergoing robotic versus nonrobotic surgery. In contrast, no evidence was seen for robotic surgery improving survival in other cancers such as prostate, endometrial, or cervical cancer.
“These results are hypothesis generating,” the authors write. “The association between robotic surgery and improved survival was unique to oropharyngeal squamous cell carcinoma, and was not observed in prostate, endometrial, or cervical cancers.”
One author disclosed financial ties to biopharmaceutical companies.
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MONDAY, Aug. 24, 2020 (HealthDay News) — Nine individual antihypertensive agents from the classes of angiotensin agents, calcium antagonists, and β-blockers are associated with reduced rates of depression, according to a study published online Aug. 24 in Hypertension.
Lars Vedel Kessing, M.D., from Rigshospitalet in Copenhagen, Denmark, and colleagues examined whether the 41 most commonly used individual antihypertensive drugs were associated with an altered risk for incident depression using Danish population-based registers. Participants were included in the study in January 2005 and were followed to December 2015.
The researchers found significantly reduced rates of depression with continued use of angiotensin agents, calcium antagonists, and β-blockers, but not with diuretic use. Individual drugs associated with reduced rates of depression included enalapril and ramipril; amlodipine, verapamil, and verapamil combinations; and propranolol, atenolol, bisoprolol, and carvedilol. None of the drugs were associated with an elevated depression risk.
“Our study’s findings could help guide prescriptions for patients with high blood pressure who are at risk of developing depression, those with prior depression or anxiety, and patients with a family history of depression,” Kessing said in a statement. “If depression develops, a medication switch may be considered to one of the nine antihypertensive medications that lowered depression risk.”
Several authors disclosed financial ties to the pharmaceutical industry.
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MONDAY, Aug. 24, 2020 (HealthDay News) — The historically higher lung cancer incidence in young Black people compared with White people has disappeared and reversed in men and women, respectively, in the United States, according to a study published online Aug. 20 in JNCI Cancer Spectrum.
Ahmedin Jemal, D.V.M., Ph.D., from the American Cancer Society in Atlanta, and colleagues examined the five-year age-specific lung cancer incidence in Black and White people younger than 55 years of age and calculated the Black-to-White incidence rate ratios (IRRs) using incidence data from 1997 to 2016.
The researchers found that in successive Black and White men born since circa 1947 and women born since circa 1957, the five-year age-specific incidence decreased, with steeper decreases seen in Blacks than Whites. In men born 1967 to 1972, the Black-to-White IRRs became unity and the IRRs reversed in women born since circa 1967. The historically higher sex-specific smoking prevalence in Blacks compared with Whites disappeared in men, while in women born since circa 1965, this prevalence reversed. The exception to these patterns was the higher incidence in Black compared with White men born circa 1977 to 1982.
“Although these patterns herald progress in reducing racial disparities in lung cancer occurrence and the success of tobacco control in the Black community, the increasing lung cancer incidence rates in Black men born circa 1977 to 1982 is concerning and underscores the need for targeted tobacco prevention interventions,” the authors write.
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MONDAY, Aug. 24, 2020 (HealthDay News) — Diagnosis of African American children with autism spectrum disorder (ASD) occurs at an average of 64.9 months, many months after parents’ first concerns about their child’s development, according to a study published online Aug. 24 in Pediatrics.
John N. Constantino, M.D., from the School of Medicine at Washington University in St. Louis, and colleagues analyzed data on African American children with ASD and examined delays in diagnosis and obstacles to service access. Parents of 584 African American children with autism completed event history calendar interviews for their children. These data were assessed relative to developmental outcomes for children with autism and their siblings.
The researchers found that ASD was diagnosed at an average age of 64.9 months, which was 42.3 months after parents’ first concerns about their children’s development on average. There was a complex relationship observed between the timing of diagnosis and ASD severity. Intellectual disability comorbidity was not predicted in a direct way by familial factors that are linked to cognitive variation within the general population.
“We highlight a pressing need to determine whether broad implementation of timely diagnosis, when coupled with high-quality early intervention, would reduce the proportion of African American children with autism and comorbid intellectual disability,” the authors write. “An immediate public health and research priority is to explore the extent to which resolution of health disparities that compromise timely access to effective intervention can reduce deleterious effects on cognition that disproportionately accompany autism among African American youth.”
Two authors disclosed financial ties to the pharmaceutical industry.
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