Jan Dyer

In the past decade, medical institutions have begun to check the practice of detailing—pharmaceutical reps promoting medications during sales visits to physicians. This NIH study is one of the first to document the effect of these restrictions. The researchers compared prescribing at 19 academic medical centers (AMCs) that, between 2006 and 2012 instituted policies restricting detailing.

The study compared prescribing by 2,126 physicians at AMCs with that by 24,593 physicians from a pharmacy benefits database. The analysis covered 16.1 million prescriptions in 8 major drug classes: lipid lowering, gastroesophageal reflux disease, diabetes, hypertension, sleep, attention deficit hyperactivity disorder, depression, and antipsychosis.

At the centers with restrictions, physicians prescribed fewer of the promoted drugs and more nonpromoted drugs in the same drug classes. The mean market share of detailed drugs (across all the drug classes) in AMCs before the policy changes was 19.3%. Over the study period, the market share of detailed drugs prescribed by AMC physicians declined by 1.67 percentage point, an 8.7% decrease relative to the prechange level. The comparison group of physicians saw a slight decline over the same period. Although the drop was “modest,” NIH notes, proportionally small changes can represent thousands of prescriptions. The market share of nondetailed drugs increased by a relative 5.6%.

The changes were statistically significant for 6 of the 8 drug classes and for all drugs in the aggregate. The magnitude of changes differed across AMCs, the researchers found. The decline was greatest at centers with the most stringent policies, such as bans on salespeople in patient care areas. In 8 of 11 AMCs with more stringent policies, the changes in prescribing were significant, compared with only 1 of 8 AMCs with more limited measures.

In the past decade, medical institutions have begun to check the practice of detailing—pharmaceutical reps promoting medications during sales visits to physicians. This NIH study is one of the first to document the effect of these restrictions. The researchers compared prescribing at 19 academic medical centers (AMCs) that, between 2006 and 2012 instituted policies restricting detailing.

The study compared prescribing by 2,126 physicians at AMCs with that by 24,593 physicians from a pharmacy benefits database. The analysis covered 16.1 million prescriptions in 8 major drug classes: lipid lowering, gastroesophageal reflux disease, diabetes, hypertension, sleep, attention deficit hyperactivity disorder, depression, and antipsychosis.

At the centers with restrictions, physicians prescribed fewer of the promoted drugs and more nonpromoted drugs in the same drug classes. The mean market share of detailed drugs (across all the drug classes) in AMCs before the policy changes was 19.3%. Over the study period, the market share of detailed drugs prescribed by AMC physicians declined by 1.67 percentage point, an 8.7% decrease relative to the prechange level. The comparison group of physicians saw a slight decline over the same period. Although the drop was “modest,” NIH notes, proportionally small changes can represent thousands of prescriptions. The market share of nondetailed drugs increased by a relative 5.6%.

The changes were statistically significant for 6 of the 8 drug classes and for all drugs in the aggregate. The magnitude of changes differed across AMCs, the researchers found. The decline was greatest at centers with the most stringent policies, such as bans on salespeople in patient care areas. In 8 of 11 AMCs with more stringent policies, the changes in prescribing were significant, compared with only 1 of 8 AMCs with more limited measures.

In the past decade, medical institutions have begun to check the practice of detailing—pharmaceutical reps promoting medications during sales visits to physicians. This NIH study is one of the first to document the effect of these restrictions. The researchers compared prescribing at 19 academic medical centers (AMCs) that, between 2006 and 2012 instituted policies restricting detailing.

The study compared prescribing by 2,126 physicians at AMCs with that by 24,593 physicians from a pharmacy benefits database. The analysis covered 16.1 million prescriptions in 8 major drug classes: lipid lowering, gastroesophageal reflux disease, diabetes, hypertension, sleep, attention deficit hyperactivity disorder, depression, and antipsychosis.

At the centers with restrictions, physicians prescribed fewer of the promoted drugs and more nonpromoted drugs in the same drug classes. The mean market share of detailed drugs (across all the drug classes) in AMCs before the policy changes was 19.3%. Over the study period, the market share of detailed drugs prescribed by AMC physicians declined by 1.67 percentage point, an 8.7% decrease relative to the prechange level. The comparison group of physicians saw a slight decline over the same period. Although the drop was “modest,” NIH notes, proportionally small changes can represent thousands of prescriptions. The market share of nondetailed drugs increased by a relative 5.6%.

The changes were statistically significant for 6 of the 8 drug classes and for all drugs in the aggregate. The magnitude of changes differed across AMCs, the researchers found. The decline was greatest at centers with the most stringent policies, such as bans on salespeople in patient care areas. In 8 of 11 AMCs with more stringent policies, the changes in prescribing were significant, compared with only 1 of 8 AMCs with more limited measures.

Women with severe posttraumatic stress disorder (PTSD) symptoms have a nearly 70% increase in the incidence of cardiovascular disease (CVD), according to a study by researchers from Harvard and Brigham and Women’s Hospital in Boston, Massachusetts, Columbia University in New York, and University of California in San Francisco.

The researchers analyzed data from 49,859 women in the Nurses’ Health Study II. Over 20 years, there were 552 confirmed cases of myocardial infarction or stroke.

Women with 6 to 7 symptoms of trauma and PTSD had the highest risk. Women with trauma but no PTSD symptoms had a 30% higher risk. When women who said illness was their worst trauma were excluded, the risk of CVD doubled among those with trauma and severe PTSD symptoms and increased by 88% in women with trauma and moderate PTSD symptoms.

Strikingly, the researchers also found that when the PTSD symptoms declined so did the CVD risk. The researchers note that CVD risk due to other well-known risk factors, such as smoking, increases with exposure duration declines once the risk factor is eliminated. In this study, for every 5 additional years PTSD symptoms lasted, the odds of CVD were 9% higher.

A “more nuanced understanding” of the role of health behaviors could add insight into how PTSD influences the risk of CVD, the researchers say. They point to studies that have found a link between PTSD and cardiotoxic behaviors such as smoking, drinking, and diet. Physiologic alterations that occur with PTSD symptoms also may play an important role, they suggest, such as changes in neuropeptide Y in response to stress, which might contribute to metabolic syndrome.

Citing “particularly intriguing” findings from a study that found symptoms eventually remitted in 44% of individuals with PTSD, the researchers say providing treatment shortly after PTSD symptoms begin could limit the risk of CVD and, potentially, other disease-related risk.

Source:
Gilsanz P, Winning A, Koenen KC, et al. Psychol Med. 2017;47(8):1370-1378.
doi: 10.1017/S0033291716003378.

Women with severe posttraumatic stress disorder (PTSD) symptoms have a nearly 70% increase in the incidence of cardiovascular disease (CVD), according to a study by researchers from Harvard and Brigham and Women’s Hospital in Boston, Massachusetts, Columbia University in New York, and University of California in San Francisco.

The researchers analyzed data from 49,859 women in the Nurses’ Health Study II. Over 20 years, there were 552 confirmed cases of myocardial infarction or stroke.

Women with 6 to 7 symptoms of trauma and PTSD had the highest risk. Women with trauma but no PTSD symptoms had a 30% higher risk. When women who said illness was their worst trauma were excluded, the risk of CVD doubled among those with trauma and severe PTSD symptoms and increased by 88% in women with trauma and moderate PTSD symptoms.

Strikingly, the researchers also found that when the PTSD symptoms declined so did the CVD risk. The researchers note that CVD risk due to other well-known risk factors, such as smoking, increases with exposure duration declines once the risk factor is eliminated. In this study, for every 5 additional years PTSD symptoms lasted, the odds of CVD were 9% higher.

A “more nuanced understanding” of the role of health behaviors could add insight into how PTSD influences the risk of CVD, the researchers say. They point to studies that have found a link between PTSD and cardiotoxic behaviors such as smoking, drinking, and diet. Physiologic alterations that occur with PTSD symptoms also may play an important role, they suggest, such as changes in neuropeptide Y in response to stress, which might contribute to metabolic syndrome.

Citing “particularly intriguing” findings from a study that found symptoms eventually remitted in 44% of individuals with PTSD, the researchers say providing treatment shortly after PTSD symptoms begin could limit the risk of CVD and, potentially, other disease-related risk.

Source:
Gilsanz P, Winning A, Koenen KC, et al. Psychol Med. 2017;47(8):1370-1378.
doi: 10.1017/S0033291716003378.

Women with severe posttraumatic stress disorder (PTSD) symptoms have a nearly 70% increase in the incidence of cardiovascular disease (CVD), according to a study by researchers from Harvard and Brigham and Women’s Hospital in Boston, Massachusetts, Columbia University in New York, and University of California in San Francisco.

The researchers analyzed data from 49,859 women in the Nurses’ Health Study II. Over 20 years, there were 552 confirmed cases of myocardial infarction or stroke.

Women with 6 to 7 symptoms of trauma and PTSD had the highest risk. Women with trauma but no PTSD symptoms had a 30% higher risk. When women who said illness was their worst trauma were excluded, the risk of CVD doubled among those with trauma and severe PTSD symptoms and increased by 88% in women with trauma and moderate PTSD symptoms.

Strikingly, the researchers also found that when the PTSD symptoms declined so did the CVD risk. The researchers note that CVD risk due to other well-known risk factors, such as smoking, increases with exposure duration declines once the risk factor is eliminated. In this study, for every 5 additional years PTSD symptoms lasted, the odds of CVD were 9% higher.

A “more nuanced understanding” of the role of health behaviors could add insight into how PTSD influences the risk of CVD, the researchers say. They point to studies that have found a link between PTSD and cardiotoxic behaviors such as smoking, drinking, and diet. Physiologic alterations that occur with PTSD symptoms also may play an important role, they suggest, such as changes in neuropeptide Y in response to stress, which might contribute to metabolic syndrome.

Citing “particularly intriguing” findings from a study that found symptoms eventually remitted in 44% of individuals with PTSD, the researchers say providing treatment shortly after PTSD symptoms begin could limit the risk of CVD and, potentially, other disease-related risk.

Source:
Gilsanz P, Winning A, Koenen KC, et al. Psychol Med. 2017;47(8):1370-1378.
doi: 10.1017/S0033291716003378.

When military and VA nurses work side by side—learning from and teaching each other—they benefit and so do their patients. A “unique partnership” between the DoD and VA is proving that at Captain James A. Lovell Federal Health Care Center outside Chicago, Illinois.

The first of its kind facility serves nearly 67,000 active-duty military, military retirees, family members, and veterans. In an article for Health.mil News, U.S. Navy Lt. Nathan Aranas, an active-duty registered nurse (RN) and assistant nurse manager in the emergency department (ED), says, “We learn from local trauma, mental health, and pediatrics and birthing centers, exposing me more to how medicine outside of the military is practiced. It gives me a bigger perspective of how the rest of the country operates as a health care institution.”

Christine Barassi-Jackson, a VA civilian RN, nurse manager in the ED, says “having a combined organization is a great balance that pulls out the best parts of both the Navy and VA.” She leans on Aranas, the article says, to serve as an interpreter with some of the patients. “Knowing more of the Navy culture helps break down walls with the patients and other providers.” Aranas also believes that former active-duty patients may be more at ease with a uniformed nurse “because they understand the lingo.”

Overall, Aranas says, “It’s a great experience for young, active-duty clinicians to have."

When military and VA nurses work side by side—learning from and teaching each other—they benefit and so do their patients. A “unique partnership” between the DoD and VA is proving that at Captain James A. Lovell Federal Health Care Center outside Chicago, Illinois.

The first of its kind facility serves nearly 67,000 active-duty military, military retirees, family members, and veterans. In an article for Health.mil News, U.S. Navy Lt. Nathan Aranas, an active-duty registered nurse (RN) and assistant nurse manager in the emergency department (ED), says, “We learn from local trauma, mental health, and pediatrics and birthing centers, exposing me more to how medicine outside of the military is practiced. It gives me a bigger perspective of how the rest of the country operates as a health care institution.”

Christine Barassi-Jackson, a VA civilian RN, nurse manager in the ED, says “having a combined organization is a great balance that pulls out the best parts of both the Navy and VA.” She leans on Aranas, the article says, to serve as an interpreter with some of the patients. “Knowing more of the Navy culture helps break down walls with the patients and other providers.” Aranas also believes that former active-duty patients may be more at ease with a uniformed nurse “because they understand the lingo.”

Overall, Aranas says, “It’s a great experience for young, active-duty clinicians to have."

When military and VA nurses work side by side—learning from and teaching each other—they benefit and so do their patients. A “unique partnership” between the DoD and VA is proving that at Captain James A. Lovell Federal Health Care Center outside Chicago, Illinois.

The first of its kind facility serves nearly 67,000 active-duty military, military retirees, family members, and veterans. In an article for Health.mil News, U.S. Navy Lt. Nathan Aranas, an active-duty registered nurse (RN) and assistant nurse manager in the emergency department (ED), says, “We learn from local trauma, mental health, and pediatrics and birthing centers, exposing me more to how medicine outside of the military is practiced. It gives me a bigger perspective of how the rest of the country operates as a health care institution.”

Christine Barassi-Jackson, a VA civilian RN, nurse manager in the ED, says “having a combined organization is a great balance that pulls out the best parts of both the Navy and VA.” She leans on Aranas, the article says, to serve as an interpreter with some of the patients. “Knowing more of the Navy culture helps break down walls with the patients and other providers.” Aranas also believes that former active-duty patients may be more at ease with a uniformed nurse “because they understand the lingo.”

Overall, Aranas says, “It’s a great experience for young, active-duty clinicians to have."

A head-to-head comparison of 2 widely used drugs for macular edema due to central retinal vein occlusion—bevacizumab (Avastin) and aflibercept (Eylea)—found that both improved visual acuity (VA) similarly. But Eylea does it for $1,850 per dose, versus $60 per dose for Avastin.

In the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2), National Eye Institute (NEI) researchers randomly assigned 362 patients to either Eylea or Avastin by eye injection every 4 weeks for 6 months. At 6 months, the researchers assessed VA, retinal thickness, and side effects.

On average, VA improved about 4 lines on an eye chart, from 20/100 to 20/40, more than doubling the ability to resolve fine detail, said Frederick Ferris, MD, director of the Division of Epidemiology and Clinical Applications at NEI. “For some patients it restores their ability to drive.”

Both drugs prevent the release of vascular endothelial growth factor, which causes swelling. The researchers found that macular edema declined significantly in both groups. The rates of adverse events, such as elevated intraocular pressure, were low and similar in both groups.

Retinal vein occlusion is associated with diabetes mellitus and hypertension. It is the second most common retinal vascular disease after diabetic retinopathy, according to NIH, and affects more than 16 million adults worldwide.

A head-to-head comparison of 2 widely used drugs for macular edema due to central retinal vein occlusion—bevacizumab (Avastin) and aflibercept (Eylea)—found that both improved visual acuity (VA) similarly. But Eylea does it for $1,850 per dose, versus $60 per dose for Avastin.

In the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2), National Eye Institute (NEI) researchers randomly assigned 362 patients to either Eylea or Avastin by eye injection every 4 weeks for 6 months. At 6 months, the researchers assessed VA, retinal thickness, and side effects.

On average, VA improved about 4 lines on an eye chart, from 20/100 to 20/40, more than doubling the ability to resolve fine detail, said Frederick Ferris, MD, director of the Division of Epidemiology and Clinical Applications at NEI. “For some patients it restores their ability to drive.”

Both drugs prevent the release of vascular endothelial growth factor, which causes swelling. The researchers found that macular edema declined significantly in both groups. The rates of adverse events, such as elevated intraocular pressure, were low and similar in both groups.

Retinal vein occlusion is associated with diabetes mellitus and hypertension. It is the second most common retinal vascular disease after diabetic retinopathy, according to NIH, and affects more than 16 million adults worldwide.

A head-to-head comparison of 2 widely used drugs for macular edema due to central retinal vein occlusion—bevacizumab (Avastin) and aflibercept (Eylea)—found that both improved visual acuity (VA) similarly. But Eylea does it for $1,850 per dose, versus $60 per dose for Avastin.

In the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2), National Eye Institute (NEI) researchers randomly assigned 362 patients to either Eylea or Avastin by eye injection every 4 weeks for 6 months. At 6 months, the researchers assessed VA, retinal thickness, and side effects.

On average, VA improved about 4 lines on an eye chart, from 20/100 to 20/40, more than doubling the ability to resolve fine detail, said Frederick Ferris, MD, director of the Division of Epidemiology and Clinical Applications at NEI. “For some patients it restores their ability to drive.”

Both drugs prevent the release of vascular endothelial growth factor, which causes swelling. The researchers found that macular edema declined significantly in both groups. The rates of adverse events, such as elevated intraocular pressure, were low and similar in both groups.

Retinal vein occlusion is associated with diabetes mellitus and hypertension. It is the second most common retinal vascular disease after diabetic retinopathy, according to NIH, and affects more than 16 million adults worldwide.

The number of new hepatitis C virus (HCV) infections has tripled in just 5 years—to a 15-year high—but the true scale is only now being revealed, according to the CDC.

Limited surveillance resources have led to underreporting, the CDC says. The annual number of reported HCV cases does not reflect the reality of the epidemic. Although 850 cases were reported in 2010 and 2,436 cases in 2015, the CDC estimates 34,000 actual new infections in 2015.

About three-quarters of the 3.5 million Americans with HCV are baby boomers, born between 1945 and 1965. They’re 6 times more likely to be infected with HCV and are at greater risk of death due to HCV. But HCV infections are spreading most rapidly among young adults aged 20 to 29 years, the CDC says, primarily because of injection drug use associated with opioids.

Because of that dual threat of virus spread and the opioid epidemic, HHS-recommended strategies include using comprehensive syringe service programs (SSPs). One CDC study found that 80% of young people with HCV live > 10 miles from an SSP. Another study found that only 3 states have laws that support full access to SSPs and HCV-related treatment and preventive services for people who inject drugs.

The number of new hepatitis C virus (HCV) infections has tripled in just 5 years—to a 15-year high—but the true scale is only now being revealed, according to the CDC.

Limited surveillance resources have led to underreporting, the CDC says. The annual number of reported HCV cases does not reflect the reality of the epidemic. Although 850 cases were reported in 2010 and 2,436 cases in 2015, the CDC estimates 34,000 actual new infections in 2015.

About three-quarters of the 3.5 million Americans with HCV are baby boomers, born between 1945 and 1965. They’re 6 times more likely to be infected with HCV and are at greater risk of death due to HCV. But HCV infections are spreading most rapidly among young adults aged 20 to 29 years, the CDC says, primarily because of injection drug use associated with opioids.

Because of that dual threat of virus spread and the opioid epidemic, HHS-recommended strategies include using comprehensive syringe service programs (SSPs). One CDC study found that 80% of young people with HCV live > 10 miles from an SSP. Another study found that only 3 states have laws that support full access to SSPs and HCV-related treatment and preventive services for people who inject drugs.

The number of new hepatitis C virus (HCV) infections has tripled in just 5 years—to a 15-year high—but the true scale is only now being revealed, according to the CDC.

Limited surveillance resources have led to underreporting, the CDC says. The annual number of reported HCV cases does not reflect the reality of the epidemic. Although 850 cases were reported in 2010 and 2,436 cases in 2015, the CDC estimates 34,000 actual new infections in 2015.

About three-quarters of the 3.5 million Americans with HCV are baby boomers, born between 1945 and 1965. They’re 6 times more likely to be infected with HCV and are at greater risk of death due to HCV. But HCV infections are spreading most rapidly among young adults aged 20 to 29 years, the CDC says, primarily because of injection drug use associated with opioids.

Because of that dual threat of virus spread and the opioid epidemic, HHS-recommended strategies include using comprehensive syringe service programs (SSPs). One CDC study found that 80% of young people with HCV live > 10 miles from an SSP. Another study found that only 3 states have laws that support full access to SSPs and HCV-related treatment and preventive services for people who inject drugs.

The Cherokee Nation has filed a lawsuit against 6 companies, accusing them of “turning a blind eye” to opioids being illegally prescribed to Cherokee adults and children. The lawsuit is the first of its kind filed in the U.S. “As we fight this epidemic in our hospitals, our schools, and our Cherokee homes, we will also use our legal system to make sure the companies, who put profits over people while our society is crippled by this epidemic, are held responsible for their actions,” said Cherokee Nation Principal Chief Bill John Baker.

According to DEA statistics, about 845 mg of opioids were distributed in the 14 counties of the Cherokee Nation in 2015—or between 360 and 720 opioid pills per every prescription. In The Washington Post, one of the lawyers for the Cherokee Nation said the “flood of opioids into Oklahoma has torn apart families and cost the Cherokees hundreds of millions of dollars.” Over the past 3 years, 2,684 opioid-related deaths have been reported in the state, according to Oklahoma Attorney General Mike Hunter.

The lawsuit names McKesson Corporation, Cardinal Health, Inc., and AmerisourceBergen (which together control roughly 85% of prescription drug distribution in the U.S.) as well as CVS, Walgreens, and Walmart. The companies “enabled prescription opioids to fall into illicit distribution channels, failed to alert regulators of extreme volume, and incentivized sales of these drugs with financial bonuses,” said Cherokee Nation Attorney General Todd Hembree. He said the drug distributors and pharmacies knew or should have known that the amount of drugs they were sending and dispensing were suspicious. He charged that the corporations’ profit seeking has unleashed “a plague.”

“Tribal nations have survived disease, removal from our homelands, termination, and other adversities and still we prospered,” said Chief Baker. “However, I fear the opioid epidemic is emerging as the next great challenge of our modern era.”

The full petition is available at www.cherokeecourts.org.

The Cherokee Nation has filed a lawsuit against 6 companies, accusing them of “turning a blind eye” to opioids being illegally prescribed to Cherokee adults and children. The lawsuit is the first of its kind filed in the U.S. “As we fight this epidemic in our hospitals, our schools, and our Cherokee homes, we will also use our legal system to make sure the companies, who put profits over people while our society is crippled by this epidemic, are held responsible for their actions,” said Cherokee Nation Principal Chief Bill John Baker.

According to DEA statistics, about 845 mg of opioids were distributed in the 14 counties of the Cherokee Nation in 2015—or between 360 and 720 opioid pills per every prescription. In The Washington Post, one of the lawyers for the Cherokee Nation said the “flood of opioids into Oklahoma has torn apart families and cost the Cherokees hundreds of millions of dollars.” Over the past 3 years, 2,684 opioid-related deaths have been reported in the state, according to Oklahoma Attorney General Mike Hunter.

The lawsuit names McKesson Corporation, Cardinal Health, Inc., and AmerisourceBergen (which together control roughly 85% of prescription drug distribution in the U.S.) as well as CVS, Walgreens, and Walmart. The companies “enabled prescription opioids to fall into illicit distribution channels, failed to alert regulators of extreme volume, and incentivized sales of these drugs with financial bonuses,” said Cherokee Nation Attorney General Todd Hembree. He said the drug distributors and pharmacies knew or should have known that the amount of drugs they were sending and dispensing were suspicious. He charged that the corporations’ profit seeking has unleashed “a plague.”

“Tribal nations have survived disease, removal from our homelands, termination, and other adversities and still we prospered,” said Chief Baker. “However, I fear the opioid epidemic is emerging as the next great challenge of our modern era.”

The full petition is available at www.cherokeecourts.org.

The Cherokee Nation has filed a lawsuit against 6 companies, accusing them of “turning a blind eye” to opioids being illegally prescribed to Cherokee adults and children. The lawsuit is the first of its kind filed in the U.S. “As we fight this epidemic in our hospitals, our schools, and our Cherokee homes, we will also use our legal system to make sure the companies, who put profits over people while our society is crippled by this epidemic, are held responsible for their actions,” said Cherokee Nation Principal Chief Bill John Baker.

According to DEA statistics, about 845 mg of opioids were distributed in the 14 counties of the Cherokee Nation in 2015—or between 360 and 720 opioid pills per every prescription. In The Washington Post, one of the lawyers for the Cherokee Nation said the “flood of opioids into Oklahoma has torn apart families and cost the Cherokees hundreds of millions of dollars.” Over the past 3 years, 2,684 opioid-related deaths have been reported in the state, according to Oklahoma Attorney General Mike Hunter.

The lawsuit names McKesson Corporation, Cardinal Health, Inc., and AmerisourceBergen (which together control roughly 85% of prescription drug distribution in the U.S.) as well as CVS, Walgreens, and Walmart. The companies “enabled prescription opioids to fall into illicit distribution channels, failed to alert regulators of extreme volume, and incentivized sales of these drugs with financial bonuses,” said Cherokee Nation Attorney General Todd Hembree. He said the drug distributors and pharmacies knew or should have known that the amount of drugs they were sending and dispensing were suspicious. He charged that the corporations’ profit seeking has unleashed “a plague.”

“Tribal nations have survived disease, removal from our homelands, termination, and other adversities and still we prospered,” said Chief Baker. “However, I fear the opioid epidemic is emerging as the next great challenge of our modern era.”

The full petition is available at www.cherokeecourts.org.

What are the long-term clinical effects of wartime traumatic brain injuries (TBIs)? Most are mild, but in general all are incompletely described, say researchers from University of Washington in Seattle and Washington University in St. Louis, Missouri. However, their own study found that service members with even mild concussive TBI often “experienced evolution, not resolution” of symptoms.

The researchers compared the results of 1-year and 5-year clinical evaluations of 50 active-duty U.S. military with acute to subacute concussive blast injury and 44 deployed but uninjured service members. The evaluations included neurobehavioral and neuropsychological performance and mental health burden.

At 5 years, global disability, satisfaction with life, neurobehavioral symptom severity, psychiatric symptom severity, and sleep impairment were significantly worse in patients with concussive blast TBI. Of the patients with concussive blast TBI, 36 (72%) showed decline, compared with only 5 of the combat-deployed group (11%). The researchers also found symptoms of PTSD and depression worsened in the concussive TBI patients. Performance on cognitive measures was no different between the 2 groups. A combination of factors, including neurobehavioral symptom severity, walking ability, and verbal fluency at 1 year after injury, was highly predictive of poor outcomes 5 years later.

“This is one of the first studies to connect the dots from injury to longer term outcomes and it shows that even mild concussions can lead to long-term impairment and continued decline in satisfaction with life,” said lead author Christine L. Mac Donald, PhD. “Most physicians believe that patients will stabilize 6 to 12 months postinjury, but this study challenges that.”

The researchers also found that, although 80% of service members with concussions had sought mental health treatment, only 19% reported that those programs were helpful. The findings advocate for new treatment strategies, the researchers say, to “combat the long-term and extremely costly effect” of these wartime injuries.

What are the long-term clinical effects of wartime traumatic brain injuries (TBIs)? Most are mild, but in general all are incompletely described, say researchers from University of Washington in Seattle and Washington University in St. Louis, Missouri. However, their own study found that service members with even mild concussive TBI often “experienced evolution, not resolution” of symptoms.

The researchers compared the results of 1-year and 5-year clinical evaluations of 50 active-duty U.S. military with acute to subacute concussive blast injury and 44 deployed but uninjured service members. The evaluations included neurobehavioral and neuropsychological performance and mental health burden.

At 5 years, global disability, satisfaction with life, neurobehavioral symptom severity, psychiatric symptom severity, and sleep impairment were significantly worse in patients with concussive blast TBI. Of the patients with concussive blast TBI, 36 (72%) showed decline, compared with only 5 of the combat-deployed group (11%). The researchers also found symptoms of PTSD and depression worsened in the concussive TBI patients. Performance on cognitive measures was no different between the 2 groups. A combination of factors, including neurobehavioral symptom severity, walking ability, and verbal fluency at 1 year after injury, was highly predictive of poor outcomes 5 years later.

“This is one of the first studies to connect the dots from injury to longer term outcomes and it shows that even mild concussions can lead to long-term impairment and continued decline in satisfaction with life,” said lead author Christine L. Mac Donald, PhD. “Most physicians believe that patients will stabilize 6 to 12 months postinjury, but this study challenges that.”

The researchers also found that, although 80% of service members with concussions had sought mental health treatment, only 19% reported that those programs were helpful. The findings advocate for new treatment strategies, the researchers say, to “combat the long-term and extremely costly effect” of these wartime injuries.

What are the long-term clinical effects of wartime traumatic brain injuries (TBIs)? Most are mild, but in general all are incompletely described, say researchers from University of Washington in Seattle and Washington University in St. Louis, Missouri. However, their own study found that service members with even mild concussive TBI often “experienced evolution, not resolution” of symptoms.

The researchers compared the results of 1-year and 5-year clinical evaluations of 50 active-duty U.S. military with acute to subacute concussive blast injury and 44 deployed but uninjured service members. The evaluations included neurobehavioral and neuropsychological performance and mental health burden.

At 5 years, global disability, satisfaction with life, neurobehavioral symptom severity, psychiatric symptom severity, and sleep impairment were significantly worse in patients with concussive blast TBI. Of the patients with concussive blast TBI, 36 (72%) showed decline, compared with only 5 of the combat-deployed group (11%). The researchers also found symptoms of PTSD and depression worsened in the concussive TBI patients. Performance on cognitive measures was no different between the 2 groups. A combination of factors, including neurobehavioral symptom severity, walking ability, and verbal fluency at 1 year after injury, was highly predictive of poor outcomes 5 years later.

“This is one of the first studies to connect the dots from injury to longer term outcomes and it shows that even mild concussions can lead to long-term impairment and continued decline in satisfaction with life,” said lead author Christine L. Mac Donald, PhD. “Most physicians believe that patients will stabilize 6 to 12 months postinjury, but this study challenges that.”

The researchers also found that, although 80% of service members with concussions had sought mental health treatment, only 19% reported that those programs were helpful. The findings advocate for new treatment strategies, the researchers say, to “combat the long-term and extremely costly effect” of these wartime injuries.

Many patients who could benefit from intensive lifestyle interventions to reduce and prevent diabetes may not be getting the opportunity, according to researchers at Montefiore Health System (MHS).

Beginning in 2010, MHS partnered with the YMCA of Greater New York to provide the YMCA’s 1-year Diabetes Prevention Program (DPP) to patients in Bronx-based primary care clinics. During an office visit, eligible patients were told of their risk for developing diabetes and asked whether they were interested in participating. Physicians referred patients who said yes. Schedule and location for 16 core sessions were based on availability of coaches, space for the sessions, and patient demand.

Over the study period, 1,249 patients were referred to the DPP. For up to 1 year after referral, MHS placed patients in 66 core groups. “Placed” meant they were scheduled to attend a session. Patients who attended ≥ 3 sessions were considered “enrolled.” Of MHS patients referred to the YMCA’s DPP, only 34% were placed. Of those, 47% attended ≥ 3 sessions.

More than half (53%) of placed patients were never enrolled. But when they do enroll the study shows patients have good results. One-third of patients lost ≥ 5% of their body weight during their enrollment. The average weight loss was 3.4%.

The study points to some areas for improvement, the researchers say. Reducing the lag time between referral and the start of the sessions, for instance, would maximize the likelihood of enrollment. Patients who started their sessions within 2 months of their referral date were more often enrolled compared with those who had to wait ≥ 4 months (54% vs 22%). The researchers also note that the timing of referrals and sessions are important considerations, and efforts should be made to coordinate them.

Targeting younger patients and Spanish-speaking adults also would help. Attrition among younger participants is of “particular concern,” the researchers say, given that about 26% of adults aged < 60 years have prediabetes. Patients aged 18 to 44 years, the bulk of the patients referred, were least often placed compared with patients aged ≥ 45 years. Patients who preferred sessions in Spanish were less often placed than those who preferred English.

Finally, the researchers point out that health care providers have an important role in placing patients: The number of referrals that a provider made was associated with whether or not the patient was placed.

Many patients who could benefit from intensive lifestyle interventions to reduce and prevent diabetes may not be getting the opportunity, according to researchers at Montefiore Health System (MHS).

Beginning in 2010, MHS partnered with the YMCA of Greater New York to provide the YMCA’s 1-year Diabetes Prevention Program (DPP) to patients in Bronx-based primary care clinics. During an office visit, eligible patients were told of their risk for developing diabetes and asked whether they were interested in participating. Physicians referred patients who said yes. Schedule and location for 16 core sessions were based on availability of coaches, space for the sessions, and patient demand.

Over the study period, 1,249 patients were referred to the DPP. For up to 1 year after referral, MHS placed patients in 66 core groups. “Placed” meant they were scheduled to attend a session. Patients who attended ≥ 3 sessions were considered “enrolled.” Of MHS patients referred to the YMCA’s DPP, only 34% were placed. Of those, 47% attended ≥ 3 sessions.

More than half (53%) of placed patients were never enrolled. But when they do enroll the study shows patients have good results. One-third of patients lost ≥ 5% of their body weight during their enrollment. The average weight loss was 3.4%.

The study points to some areas for improvement, the researchers say. Reducing the lag time between referral and the start of the sessions, for instance, would maximize the likelihood of enrollment. Patients who started their sessions within 2 months of their referral date were more often enrolled compared with those who had to wait ≥ 4 months (54% vs 22%). The researchers also note that the timing of referrals and sessions are important considerations, and efforts should be made to coordinate them.

Targeting younger patients and Spanish-speaking adults also would help. Attrition among younger participants is of “particular concern,” the researchers say, given that about 26% of adults aged < 60 years have prediabetes. Patients aged 18 to 44 years, the bulk of the patients referred, were least often placed compared with patients aged ≥ 45 years. Patients who preferred sessions in Spanish were less often placed than those who preferred English.

Finally, the researchers point out that health care providers have an important role in placing patients: The number of referrals that a provider made was associated with whether or not the patient was placed.

Many patients who could benefit from intensive lifestyle interventions to reduce and prevent diabetes may not be getting the opportunity, according to researchers at Montefiore Health System (MHS).

Beginning in 2010, MHS partnered with the YMCA of Greater New York to provide the YMCA’s 1-year Diabetes Prevention Program (DPP) to patients in Bronx-based primary care clinics. During an office visit, eligible patients were told of their risk for developing diabetes and asked whether they were interested in participating. Physicians referred patients who said yes. Schedule and location for 16 core sessions were based on availability of coaches, space for the sessions, and patient demand.

Over the study period, 1,249 patients were referred to the DPP. For up to 1 year after referral, MHS placed patients in 66 core groups. “Placed” meant they were scheduled to attend a session. Patients who attended ≥ 3 sessions were considered “enrolled.” Of MHS patients referred to the YMCA’s DPP, only 34% were placed. Of those, 47% attended ≥ 3 sessions.

More than half (53%) of placed patients were never enrolled. But when they do enroll the study shows patients have good results. One-third of patients lost ≥ 5% of their body weight during their enrollment. The average weight loss was 3.4%.

The study points to some areas for improvement, the researchers say. Reducing the lag time between referral and the start of the sessions, for instance, would maximize the likelihood of enrollment. Patients who started their sessions within 2 months of their referral date were more often enrolled compared with those who had to wait ≥ 4 months (54% vs 22%). The researchers also note that the timing of referrals and sessions are important considerations, and efforts should be made to coordinate them.

Targeting younger patients and Spanish-speaking adults also would help. Attrition among younger participants is of “particular concern,” the researchers say, given that about 26% of adults aged < 60 years have prediabetes. Patients aged 18 to 44 years, the bulk of the patients referred, were least often placed compared with patients aged ≥ 45 years. Patients who preferred sessions in Spanish were less often placed than those who preferred English.

Finally, the researchers point out that health care providers have an important role in placing patients: The number of referrals that a provider made was associated with whether or not the patient was placed.

“Unprecedented detail” was observed about how a patient’s clinical condition changes in response to Ebola virus disease and treatment. That’s what NIH researchers who analyzed daily gene activation found in a 26-day study of 1 patient.

The patient, who was admitted to the NIH Clinical Center on day 7 of illness, received intensive supportive care, including fluids and electrolytes, but did not receive any experimental Ebola drugs. The researchers took blood samples daily to measure the rise and decline of virus replication and to track the timing, intensity, and duration of expression of numerous immune system genes. They correlated changes in gene expression with subsequent alterations in the patient’s clinical condition, such as development and resolution of blood-clotting dysfunction.

The researchers pinpointed “key transition points” in the response to infection, NIH says. For example, they observed a marked decline in antiviral responses that correlated with clearance of virus from white blood cells. The researchers also found that most host responses shifted rapidly from activating genes involved in cell damage and inflammation toward those linked to promotion of cellular and organ repair—a “pivot” that came before the patient began showing signs of clinical improvement.

Although the study centered on only 1 patient, the researchers say it may help inform the development of treatments designed to boost or accelerate host factors that counter the virus and promote healing.

“Unprecedented detail” was observed about how a patient’s clinical condition changes in response to Ebola virus disease and treatment. That’s what NIH researchers who analyzed daily gene activation found in a 26-day study of 1 patient.

The patient, who was admitted to the NIH Clinical Center on day 7 of illness, received intensive supportive care, including fluids and electrolytes, but did not receive any experimental Ebola drugs. The researchers took blood samples daily to measure the rise and decline of virus replication and to track the timing, intensity, and duration of expression of numerous immune system genes. They correlated changes in gene expression with subsequent alterations in the patient’s clinical condition, such as development and resolution of blood-clotting dysfunction.

The researchers pinpointed “key transition points” in the response to infection, NIH says. For example, they observed a marked decline in antiviral responses that correlated with clearance of virus from white blood cells. The researchers also found that most host responses shifted rapidly from activating genes involved in cell damage and inflammation toward those linked to promotion of cellular and organ repair—a “pivot” that came before the patient began showing signs of clinical improvement.

Although the study centered on only 1 patient, the researchers say it may help inform the development of treatments designed to boost or accelerate host factors that counter the virus and promote healing.

“Unprecedented detail” was observed about how a patient’s clinical condition changes in response to Ebola virus disease and treatment. That’s what NIH researchers who analyzed daily gene activation found in a 26-day study of 1 patient.

The patient, who was admitted to the NIH Clinical Center on day 7 of illness, received intensive supportive care, including fluids and electrolytes, but did not receive any experimental Ebola drugs. The researchers took blood samples daily to measure the rise and decline of virus replication and to track the timing, intensity, and duration of expression of numerous immune system genes. They correlated changes in gene expression with subsequent alterations in the patient’s clinical condition, such as development and resolution of blood-clotting dysfunction.

The researchers pinpointed “key transition points” in the response to infection, NIH says. For example, they observed a marked decline in antiviral responses that correlated with clearance of virus from white blood cells. The researchers also found that most host responses shifted rapidly from activating genes involved in cell damage and inflammation toward those linked to promotion of cellular and organ repair—a “pivot” that came before the patient began showing signs of clinical improvement.

Although the study centered on only 1 patient, the researchers say it may help inform the development of treatments designed to boost or accelerate host factors that counter the virus and promote healing.

The IHS announced the opening of another youth regional treatment center (YRTC) to provide culturally centered, evidence-based substance use disorder services to Native youth.

Desert Sage Youth Wellness Center in Hemet is the first federally owned and operated health care facility in California to serve American Indians and Alaska Natives (AI/AN). Although California has the largest population of AI/AN in the country, IHS says, teens were usually sent out of state to non-IHS or nontribal facilities that do not always meet their “unique cultural needs.”

Desert Sage is 1 of 11 YRTCs funded by IHS across the country. The YRTCs provide comprehensive, holistic care, including mental health assessments, individualized treatment plans, academic education, vocational and life-skills training, and activities to meet the spiritual and cultural needs of Native American youth.

The Desert Sage center, which includes 3 buildings with 32 beds and 5 family suites, will employ 70 full-time employees and treat about 100 tribal youth annually.

Sacred Oaks Healing Center in Davis, the next YRTC planned for California, is expected to be completed in 2019.

The IHS announced the opening of another youth regional treatment center (YRTC) to provide culturally centered, evidence-based substance use disorder services to Native youth.

Desert Sage Youth Wellness Center in Hemet is the first federally owned and operated health care facility in California to serve American Indians and Alaska Natives (AI/AN). Although California has the largest population of AI/AN in the country, IHS says, teens were usually sent out of state to non-IHS or nontribal facilities that do not always meet their “unique cultural needs.”

Desert Sage is 1 of 11 YRTCs funded by IHS across the country. The YRTCs provide comprehensive, holistic care, including mental health assessments, individualized treatment plans, academic education, vocational and life-skills training, and activities to meet the spiritual and cultural needs of Native American youth.

The Desert Sage center, which includes 3 buildings with 32 beds and 5 family suites, will employ 70 full-time employees and treat about 100 tribal youth annually.

Sacred Oaks Healing Center in Davis, the next YRTC planned for California, is expected to be completed in 2019.

The IHS announced the opening of another youth regional treatment center (YRTC) to provide culturally centered, evidence-based substance use disorder services to Native youth.

Desert Sage Youth Wellness Center in Hemet is the first federally owned and operated health care facility in California to serve American Indians and Alaska Natives (AI/AN). Although California has the largest population of AI/AN in the country, IHS says, teens were usually sent out of state to non-IHS or nontribal facilities that do not always meet their “unique cultural needs.”

Desert Sage is 1 of 11 YRTCs funded by IHS across the country. The YRTCs provide comprehensive, holistic care, including mental health assessments, individualized treatment plans, academic education, vocational and life-skills training, and activities to meet the spiritual and cultural needs of Native American youth.

The Desert Sage center, which includes 3 buildings with 32 beds and 5 family suites, will employ 70 full-time employees and treat about 100 tribal youth annually.

Sacred Oaks Healing Center in Davis, the next YRTC planned for California, is expected to be completed in 2019.