Category: Research Findings

Deaths from Synthetic Opioids outnumbered those from Prescription Opioids for the First Time in 2016

In a research letter published by the Journal of the American Medical Association, researchers noted that overdose deaths from synthetic opioids, such as fentanyl, surpassed prescription opioids and heroin as the leading cause of overdose deaths in the United States. There has been an increasing trend of fentanyl and other synthetic opioids being found in illicit supplies of heroin, cocaine, methamphetamine, and other drugs. Utilizing data from the National Vital Statistics based on death certificates including information on all deaths in the US, Jones et al were able to examine overdose related deaths. While there has been an increasing trend in the number of opioid overdose deaths, previously these have been primarily related to prescription opioids. Of the 42,249 opioid related overdose deaths that occurred in 2016, Jones et al found that 19,413 involved synthetic opioids, while 17,087 involved prescription opioids, and another 15,469 involved heroin. Of the 19,413 deaths related to synthetic opioids, the majority (79.7%) involved another drug or alcohol, with the most common being another opioid. There are some limitations regarding the completeness of data, and the authors suggested that the increase may be due to an increase in testing for synthetic opioids. Still, this data paints a startling picture of the state of the opioid epidemic, showcasing a need to move beyond prescribing habits in order to reduce overdose deaths.

 

Sources –

Jones CM, Einstein EB, Compton WM. Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016. JAMA 2018;319(17):1819-1821. doi:10.1001/jama.2018.2844.

The Duck-Billed Platypus

Antibiotic resistance is an alarming public health threat and who better to help in our fight against Superbugs than the super platypus? Not the platypus we deserve, but the platypus we need.

Part of the monotreme family, the platypus both lays eggs and produces milk to feed their young. Where does this milk come from though? Platypuses (it’s disappointingly not actually “platypi”) don’t have teats. The milk is instead secreted from their belly.

With the milk exposed to the environment before the platypus babies (highly recommend that adorable Google search) drink it, bacteria could pose a problem to the babies. Enter researchers at Australia’s national research agency, the Commonwealth Scientific and Industrial Research Organization (CSIRO), and Deakin University; they sought to examine the unique protein in platypus milk that protected it from becoming contaminated with bacteria. What they found and imaged was aptly named the “Shirley Temple,” a three-dimensional fold in the protein that looks like a ringlet. This newly discovered protein and its structure is only present in monotremes and may prove promising once traditional antibiotics reach their limit. Thanks platypus! Nature is so cool.

Medicaid Expansion and the Opioid Epidemic in the U.S.

As the United States continues to be embattled in an ongoing opioid overdose epidemic, new research is showing the benefits that Medicaid expansion has had under the Patient Protection and Affordable Care Act (ACA). According to a recent study out of the Center on Budget and Policy Priorities, the rate in which patients who were hospitalized due to opioid-related health issues, who were uninsured dropped in states that expanded Medicaid, from 13.4% in 2013 to 2.9% the following year. The same study also showed that Medicaid expansion had not contributed to the ongoing opioid crisis, showing that opioid-related hospitalizations were higher in states that expanded Medicaid three years before expansion occurred, and that the rates had been steady in expansion and non-expansion states. As we can see, Medicaid expansion has had a profound impact in reducing the rate of uninsured, and in the case of the ongoing Opioid epidemic, Medicaid plays a key and vital role in working to help curb the epidemic. For more information on this study from the Center on Budget and Policy Priorities, please check out the link below.

Sources:

Center on Budget and Policy Priorities, Medicaid Expansion Dramatically Increased Covered for People with Opioid-Use Disorders, Latest Data Shows – https://www.cbpp.org/research/health/medicaid-expansion-dramatically-increased-coverage-for-people-with-opioid-use

Just Trust Me (Part I)

Well I’m not trained medically, so I’m taking a lot of what they say on faith.”

This was the response of a 47-year-old man, whose interview was part of a study on patients’ trust in hospitals.

There is no universal definition of trust that will apply to every scenario. Physician training, patient’s racial and cultural background, personalities, and expectations all come into play as their relationship evolves. One recurring theme in the study cited above was “sensing that you are in good hands.” Some mentioned that their trust developed from knowing the sheer amount of training required to be a medical provider. Other patients pointed out that being desperate, or having few other options, accelerates the formation of trust.

The Trust Project at Northwestern emphasizes the role that vulnerability plays in forming trust. Generally, once we come to trust someone, we open up to them; we expose vulnerability. In the healthcare system, it works backwards: being sick, worried, or simply confused by jargon (this is called information asymmetry), the patient often begins her relationship with her provider in a state of vulnerability.

Trust can also vary in different facets of the healthcare system. When we say that a patient has mistrust in the healthcare system, are we referring to his relationship with his provider, institutions like his hospital and insurance company, or the notion of Western medicine to begin with? One study suggests that repeated interactions are a key to building trust, and that patients do not see their providers as interchangeable. These findings suggest that we should enhance continuity, not just access.

Patients with low health literacy may reveal trust in a number of ways. One extreme is blind faith in the expertise of the provider, and another is mistrust and suspicion. One study found that blind trust in physicians was stronger in patients who were older, perceived their prognosis to be uncertain, or sometimes of low SES. Trust in the healthcare system tends to be lower among racial minorities, due to a history of unethical treatment. Could race moderate the relationship between SES and trust? Can these two extremes be reconciled, or even coexist in a single patient?

Read Part II here.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696665/

http://bmjopen.bmj.com/content/2/5/e001389.short

http://www.annfammed.org/content/8/5/440.short

http://www.kellogg.northwestern.edu/trust-project/videos/michelson-ep-2.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518638/

Interactions

Could a lack of communication between older Americans and their healthcare providers increase the likelihood of a bad interaction? And by “bad interaction,” I don’t just mean interpersonally. The University of Michigan conducted a national poll of 1,690 Americans ages 50 to 80 and found that only 35% of those taking multiple medications had discussed possible drug interactions with a health professional in the past two years.

This lack of open-dialogue may be due to the transient nature of where we get our medication. Of the sample, 20% had used more than one pharmacy in the past two years. And even so, only 36% reported that their pharmacist definitely knew of all the medications they were taking. Alcohol, supplements, and certain foods can affect how the body responds to medication as can other medications.

Older adults especially may also be under the care of many different doctors and specialists, with 60% seeing more than one doctor. Addressing medication interactions can be challenging even when all the information is presented but when doctors don’t have the whole picture of which medications are at play, they very well could miss something. Electronic records and medical computer systems may be of assistance in flagging potential interactions, but a complete list of a patient’s medications is still necessary.

Patient-provider communication in recent years has been supplemented with patient portals and electronic paper trails, and I wonder if this older age group is slipping through the gap between interpersonal and electronic communication.

 

Research Spotlight: Dr. Noel Brewer

Last week, Upstream Writers were joined by Noel Brewer, PhD, professor of Health Behavior in the UNC Gillings School of Global Public Health and affiliated scholar with UNC’s Interdisciplinary Health Communication program. Dr. Brewer gave an interesting and informative talk about his recent tobacco research involving the effect of cigarette pack messages. His findings showed that pictorial cigarette pack warnings increased smoking quit attempts and 7-day quitting. Additionally, the pictorial warnings were found to work better than text warnings, as they led to more attention, negative affect, social interactions and thinking about the warnings. Finally, because the study’s findings did not fit existing models of health behavior, Dr. Brewer developed the new Tobacco Warnings Model.

Dr. Brewer received his PhD in psychology from Rutgers University and joined the faculty in the Department of Health Behavior at the University of North Carolina at Chapel Hill in 2004. He studies how people make risky health decisions, and he currently directs the UNC Health Cognition & Behavior Lab where he conducts his research. Furthermore, in addition to Dr. Brewer’s tobacco research involving smoking risk communication, his work also focuses on HPV vaccine communication and increasing HPV vaccine uptake, and he currently serves as Chair of the National HPV Vaccination Roundtable. More information about his research can be found here.

In the spirit of Public Health Thank You Day, thank you, Dr. Brewer, for the work that you do to promote and protect public health! 

An electric dressing to help prevent bacterial infection?

If you read that title and thought I was talking about a sci fi movie, I’d be right there with you. What are these scientists talking about?

They’re talking about a film, alright, but not the cinema. It’s biofilm–when bacteria grow in clumps in a slime-like substance inside an infected cell. When this happens they find it a lot easier to avoid your immune system trying to kill them off, and unfortunately, they’re often resistant to antibiotics as well. This is a huge problem. According to an article published by Contagion, it’s the cause of more than 75% of bacterial infections in the US. However, scientists discovered in the early 90s that they are still sensitive the bio electric environment.

An article published this month in the Annals of Surgery journal discusses the results of a study that tested the efficacy of WED (weak electroceutical dressing) in preventing biofilm from forming on recent wounds. The study tested WED on burn wounds on pigs to observe differences if it was applied 2 hours after infection versus 7 days after infection (or versus a placebo). Good news-the results were promising, for both preventing bioflim development and also in “disturbing” existing biofilm.

While this niche of anti-bacterial therapy is still new, Contagion reports that human clinical trials will be conducted soon.

 

It’s all in the name: Can labels influence eating behavior?

While cruising nutrition-related headlines, I stumbled across “Call a Snack a Meal, and You’re Less Apt to Overeat”. Hmmm, this sounds easy enough and therefore worthy of a click to learn more. The consumer news piece summarized that those participants asked to eat pasta as a snack (eaten standing up from a plastic pot with a plastic fork) ate “much more” during a subsequent taste test than those who had been asked to eat pasta as a meal (eaten seated at a table from a ceramic plate with a metal fork).

The title and content of the article seemed disconnected, so I decided to do a quick review of the peer-reviewed publication. Turns out the seemingly simple advice that caught my eye – prevent overeating by changing how you label a meal or snack – is in fact too good to be true, at least based on the evidence from this study.

The study’s actual intention was to look at the independent and combined effects of labeling the pasta dish (meal or snack) and the location of eating the pasta dish (standing with plasticware or sitting with silverware). There were actually no differences detected in changes in hunger, fullness, or motivation to eat across the four study groups. While there were statistically significant results for increased food intake during the subsequent taste test (sweet and savory snacks), this was limited to those participants who received instructions to eat the snack while standing, not those instructed to eat the snack while sitting. Thus, simply calling something a snack did not prevent overeating.

Another important note is the final quote offered by the study author – “To overcome this, we should call our food a meal and eat it as meal, helping make us more aware of what we are eating so that we don’t overeat later on,” – may have been reported out of context and overly generalized. The study included mostly college students in the United Kingdom who are considered to have a normal body mass index, which does not represent a majority of the population.

Picking apart results of nutrition research and missreporting those results is a disservice to consumers. The bottom line: don’t believe everything you read, and if you have questions or need support for lifestyle changes, seek guidance from trained professionals.

 

Sources:                     

Ogden J, Wood C, Payne E, Fouracre H, Lammyman F. ‘Snack’ versus ‘meal’: The impact of label and place on food intake. Appetite. 2018 Jan 1; 120:666-672. Doi: 10.1016/j.appet.2017.10.026.

Preidt, R. University of Surrey, news release, Oct. 30, 2017. Call a Snack a Meal, and You’re Less Apt to Overeat. HealthDay News. https://consumer.healthday.com/vitamins-and-nutrition-information-27/food-and-nutrition-news-316/call-a-snack-a-meal-and-you-re-less-apt-to-overeat-728047.html

Smoking Disparities among LGBTQ Populations

Recently, I was in a LGTBQ establishment, having a conversation with a friend during a night out, when a tobacco company representative kindly offered us a $2 off coupon for a pack of cigarettes. Needless to say, I accepted the coupon out of curiosity, having had similar experiences in other Queer spaces previously. For those that are not aware, tobacco is fairly engrained in Queer nightlife, most of the people that I know personally who smoke are either LGBTQ identified, or those who live back home in rural Michigan.

According to the Centers for Disease Control and Prevention, about 1 in 6 heterosexually identified adults in the United States are smokers, compared to Lesbian, Gay, and Bisexual adults where the smoking rate is nearly 1 in 4. For transgender individuals, there is little research to know what the smoking prevalence is.

The research on smoking rates among LGBTQ individuals in general has grown more recently, with one study noting the overlap between LGBTQ individuals living in rural Appalachia. Bennett, Ricks, and Howell found that among the LGB individuals, many of them lived with high levels of stress due to their isolated location and living within their identities in those rural areas. Many of those interviewed noted that tobacco smoking is connected to both stress and social structures, though did not seem as aware of how their LGBTQ identity and ability to be “out” as something that may contribute to smoking.

I may be one to have to occasional cigarette, and like my love for sugar, I’m aware of how that makes me appear as a hypocritical public health professional. On the flip side, I think we can all agree that nobody is perfect, and I hope that my owning of my imperfections highlights the level of transparency that I try to bring into my work.

 

Sources:

Centers for Disease Control and Prevention: Lesbian, Gay, Bisexual, and Transgender Persons and Tobacco Use: https://www.cdc.gov/tobacco/disparities/lgbt/index.htm

Bennett, K., Ricks, J. M., & Howell, B. .. (2014). ‘It’s just a way of fitting in:’ Tobacco use and the lived experience of lesbian, gay, and bisexual Appalachians. Journal Of Health Care For The Poor And Underserved25(4), 1646-1666. doi:10.1353/hpu.2014.0186

Do meta-analyses really offer a bottom line?

For any particular health behavior or condition, the number of research studies is ever-growing. The expansive literature makes it nearly impossible for health practitioners, and even researchers, to stay up-to-date.

Meta-analyses are a type of systematic review that allow for the combination of findings from individual studies in a way that increases statistical power and may thus generate evidence-based ‘bottom lines’ for practice. However, a recent viewpoint in the Journal of the American Medical Association, The Misuse of Meta-Analysis in Nutrition Research, leaves us wondering whether meta-analyses do more harm than good.

Some of the most common flaws discussed in this viewpoint include:

  • The people. Individual studies may include a range in demographic characteristics, like age, sex, race, and ethnicity. While it is typically a good thing to include a variety of people in a single study, trying to compare different study populations can make it more challenging to identify real effects. Think: comparing a study that looked at egg consumption and cholesterol levels in men aged 65 and older to a study looking at women aged 20 – 40 years – there are many other factors that could explain the observed effects.
  • The study design. Although studies may be looking at the relationship between saturated fat and heart disease, they may have used different tools to measure saturated fat intake over varying periods or time or different measures related to heart disease. In addition, some trials may have randomly assigned participants to a group while others followed their natural behaviors over time. This is like trying to compare apples and oranges, although they are both fruit, they are in fact different and it may not be appropriate to try and interpret them together.

Results of meta-analyses matter because they can influence health care policy – either by providing an evidence base for decision-making and/or media headlines prompting public conversation that elevates the priority of a specific condition or behavior. Barnard and colleagues suggest the peer-review process should and could be improved by:

  1. Having content expert editors as well as editors with expertise in meta-analysis techniques
  2. Having authors of the review confirm the appropriateness of the representation of the data with authors of the original report
  3. Having transparent methods and data so that others may reproduce the analysis
  4. Pooling original primary data and not published summary data

 

Sources:                     

Meta-Analysis. Study Design 101. https://himmelfarb.gwu.edu/tutorials/studydesign101/metaanalyses.html

Barnard ND, Willett WC, Ding EL. The Misuse of Meta-analysis in Nutrition Research. JAMA. Published online September 18, 2017. doi:10.1001/jama.2017.12083

The Nutrition Source, Harvard T.H. Chan School of Public Health. Meta-analyses in nutrition research: sources of insight or confusion?