Biologics improve productivity and reduce missed workdays in rheumatic disease

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The results of a systematic review of published studies showed that biologics improve both absenteeism (not showing up for work) and presenteeism (being at work but not functioning fully) in patients with chronic inflammatory arthritides. Rheumatic conditions are the most frequently cited reason for absence from work, and these findings suggest that biologics could significantly reduce the economic burden of these diseases.

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Traveling abroad? Check health coverage off your to-do list first!

If you’re planning a vacation abroad, you already know that there’s a lot to do before you leave. There are suitcases to pack, an itinerary to plan, and perhaps a passport to renew. We want you to have a fun, relaxing trip – so don’t forget to include health coverage on your to-do list.

If you have Original Medicare, your health care services and supplies are covered when you’re in the U.S., which includes Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

But, if you plan to travel overseas or outside the U.S. (including to Canada or Mexico), it’s important to know that in most cases, Medicare won’t pay for health care services or supplies you get outside the U.S. (except in these rare cases).

That doesn’t mean you have to travel without coverage. There are several ways you can get health coverage outside the U.S.:

  1. If you have a Medigap policy, check your policy to see if it includes coverage outside the U.S.
  2. If you get your health care from another Medicare health plan (rather than Original Medicare), check with your plan to see if they offer coverage outside the U.S.
  3. Purchase a travel insurance policy that includes health coverage.

In all 3 cases, check with your policy or plan before traveling and make sure you understand what is covered outside the U.S. For information on other foreign travel situations (like a cruise, dialysis, or prescription drugs) you can watch this video.

Taking the time to plan out your health coverage before you travel abroad will help you to have an enjoyable and relaxing trip. For more information on how to stay healthy abroad, visit the Centers for Disease Control’s Traveler’s Health page.

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Study shows 28% decline in prostate cancer diagnoses following USPSTF recommendation against PSA testing

A new study led by Vanderbilt University Medical Center investigators found new diagnoses of prostate cancer in the U.S. declined 28 percent in the year following the draft recommendation from the United States Preventive Services Task Force (USPSTF) against routine PSA screening for men. The new research, led by first author Daniel Barocas, M.D., MPH, assistant professor of urological surgery and medicine, was posted online in the June 15 issue of The Journal of Urology in advance of publication.

In October 2011, the USPSTF issued a draft guideline discouraging the use of prostate-specific antigen (PSA)-based screenings for prostate cancer after concluding the harms outweigh potential benefits. Harmful side effects of treatment may include incontinence, erectile dysfunction and radiation cystitis.

However, the ‘grade D’ recommendation was considered controversial because of uncertainty about the risk-benefit ratio of screening since prostate cancer is the second leading cause of cancer death among men in the U.S., with nearly 30,000 deaths annually, and some studies show that screening saves lives.

To assess the effects of this recommendation, the investigators identified new cancers diagnosed between January 2010 and December 2012 in the National Cancer Database. They studied the trend of prostate cancers diagnosed each month before and after the draft guideline, compared with new colon cancer cases.

The research revealed that 12 months after the draft USPSTF guidelines were published diagnoses of new low-risk cancers had fallen by 37.9 percent while colon cancer cases remained stable.

New prostate cancer diagnoses also declined by 23 to 29.3 percent among men over age 70 and 26 percent among men considered infirm. The authors note these are populations who are unlikely to live long enough to benefit from early detection and are at risk of harms of treatment.

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However, the investigators suggest that withholding screening may also result in failure to detect higher-risk cancers during the window of curability. Timely treatment of intermediate and high-risk localized disease is associated with superior overall survival, disease-specific survival and decreased spread of the disease to other locations in the body.

The study identified a drop of 28.1 percent in diagnoses of intermediate-risk disease and 23.1 percent in high-risk prostate cancer one year after the draft guideline. The decline did not vary across age or comorbidity features.

‘These findings suggest that reduced screening may result in missed opportunities to spare these men from progressive disease and cancer death,’ said Barocas.

While the observation period was too limited to determine the impact on the diagnosis of metastatic prostate cancer, which is associated with a high treatment burden, decrease in quality of life and increased mortality, the authors did observe a small upward trend in diagnoses of non-localized disease.

‘The results raise concern that if this trend continues more men may be diagnosed at a point when their disease is advanced. Younger, healthier men with intermediate or high-risk disease would normally be candidates for aggressive local therapy and they may not be receiving a timely diagnosis under this policy,’ said Barocas.

The authors suggest that future research should focus on screening regimens that minimize harms and maximize potential benefits of screening, while also considering patient preferences.


Vanderbilt University Medical Center

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'Make work healthier' bosses told

Bosses must make work happier and healthier, health chiefs say

By Smitha Mundasad
Health reporter, BBC News
  • 24 June 2015
  • From the section Health
Work related stress

Managers across England must “raise their game” to create happy, healthy workplaces, England’s chief health advisers have warned.

Guidelines from the health watchdog, NICE, urge employers to make sure their staff work reasonable hours and take regular breaks.

NICE says healthier workplaces will not only benefit staff, but also increase the productivity of businesses.

Figures indicate work-related illnesses cost society about £13bn a year.

‘Lack of control’

The estimates, for England, Scotland and Wales, suggest about 27 million working days were lost to illnesses, including stress and back pain, in 2012-13.

The National Institute of Health and Care Excellence’s (NICE) guidelines, designed to address this, are intended for employers, managers and employees.

The document suggests bosses must take responsibility to ensure staff are appreciated for the work they do.

And employers should allow their workers opportunities to be more creative and explore new possibilities.

Managers are also urged to add flexibility to rotas where possible, so staff can have more control over their own time.

Prof Gillian Leng, NICE’s deputy chief executive, said: “Employers and managers need to recognise the value and benefits of a healthy workplace and what a difference it can make, not only to their employees, but to the productivity of their business.

“Each year more than a million working people in the UK experience a work-related illness.

“It is not only the physical hazards of work – long, irregular hours, lack of activity or repetitive injuries – that damage people’s health.

“Other factors such as a lack of control over work, conflicts, and discriminatory practices can also have an effect.”

Responding to the guidelines, Simon Stevens, NHS England chief executive, said: “Health-promoting workplaces are obviously good for millions of employees and ultimately for taxpayers too, so the time is right for all employers – including the NHS – to raise our game.”

The Department of Health said it should not be hard for workplaces to put the new guidelines in place.

Meanwhile the Confederation of British Industry acknowledged the importance of employee wellbeing and said most businesses recognise this.

Neil Carberry, director for employment and skills at the confederation, suggested offices designed to deliver different working environments, or encourage flexible practices could help retain staff and enhance productivity.

But the potential for flexible rotas and other measures would vary from company to company and decisions would need to be taken by individual companies, he said.

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Ebola crisis 'harming malaria fight'

Ebola crisis in Guinea ‘has set back malaria fight’

  • 24 June 2015
  • From the section Health
Bed nets can help prevent malaria (picture taken in Kenya)

Most malaria deaths occur among children living in Africa

The continuing Ebola epidemic in Guinea has set back the country’s fight against malaria, say experts.

They estimate 74,000 cases of malaria went untreated in 2014 because clinics were either closed or patients were too scared to seek help.

They warn that malaria deaths since the Ebola outbreak began will far exceed the number of Ebola deaths in the country – which now stand at 2,444.

Their report is in the Lancet Infectious Diseases journal.

Both Ebola and malaria cause fever. The authors of the Lancet report say fear surrounding the Ebola virus may have stopped patients in Guinea going to see a doctor to get this symptom checked.

‘Extra burden’

Dr Mateusz Plucinski and colleagues analysed how many patients clinics in Guinea were seeing before and during the Ebola epidemic that emerged there in early 2014.

They sampled 60 health facilities in the most Ebola-affected districts and 60 in districts unaffected by Ebola.

And they looked at malaria prescriptions dispensed before and during the epidemic.

There has been a big Ebola public health campaign across West Africa

Once Ebola hit, outpatient attendances fell dramatically – by nearly half in certain age groups in the worst-affected areas. And the number of treated malaria cases dropped by up to 69%.

At the same time, the rate of “just in case” or presumptive treatment of fever cases with antimalarial drugs in health facilities and by community health workers decreased or did not change.

The US experts warn that malaria deaths will have risen as a result. Meanwhile, Ebola seems to be abating.

According to the World Health Organization (WHO), in the most recent week for which there is data, there were 10 reported cases of Ebola in Guinea. In early 2015, cases were in the hundreds.

But malaria has been a long-standing problem in the region – particularly in the young. WHO estimates suggest it led to around 584,000 deaths globally in 2013. Most occurred among children in Africa.

Dr Franco Pagnoni, from the WHO’s Global Malaria Programme, said untreated malaria cases had placed an additional burden on an already overburdened health system in the Ebola-affected countries.

He said it was important to ensure that Ebola containment and prevention activities were accompanied by efforts to detect, treat and prevent malaria in order to save more lives.

Towards the end of 2014, the World Health Organization recommended mass treatment of malaria irrespective of symptoms in areas heavily affected by Ebola. This happened in Liberia and Sierra Leone, but not Guinea.

Dr Plucinski said: “Malaria control efforts and care delivery must be kept on track during an Ebola epidemic so that progress made in malaria control is not jeopardised and Ebola outbreak response is not impeded.”

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Vancouver votes to regulate booming marijuana dispensary industry

Vancouver city councillors on Wednesday voted in favor of new rules for licensing marijuana dispensaries, despite objections from the federal government, becoming the first Canada city to regulate retailers selling the drug.

The bylaw, part of an effort to slow the thriving but so-far unlicensed industry in Vancouver, comes as the number of shops selling everything from joints to marijuana-infused lollipops has jumped from about 10 five years ago to roughly 100.

Under the new rules, the city will charge dispensaries a C$30,000 ($24,197) annual licensing fee, restrict where shops can be located, and impose criminal record checks for staff.

Marijuana technically remains illegal in Canada, with the exception of medical marijuana, which is used to manage chronic pain and to treat conditions like arthritis.

Vancouver dispensaries say they sell marijuana for medical purposes, but they operate outside of the federally regulated system, which provides the drug to some 40,000 licensed users through a mail order service.

“Storefronts selling marijuana are illegal and, under this Conservative government, will remain illegal,” said Canada’s health minister Rona Ambrose in a House debate earlier this month. “We expect the police to enforce the law.”

The Vancouver Police Department has said it will not crack down on dispensaries, so long as they do not sell to minors and are not selling other illicit drugs.

Vancouver Councillor Geoff Meggs, speaking in favor of the proposed legislation, called the federal government’s position “backwards and destructive.”

“Wake up, you are completely out of touch with the realities on the ground,” he said.

Vancouver councillors voted 8-3 in favor of the new rules, which were amended after public hearings to create a two-tier licensing system, allowing so-called “Compassion Clubs” to pay a licensing fee of C$1,000. The clubs are non-profit societies that also offer subsidized health services to screened clients.

($1 = 1.2398 Canadian dollars)

(Reporting by Julie Gordon; Editing by Lisa Shumaker)

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U.S. CDC updates recommendation for new meningitis B vaccines

The U.S. Centers for Disease Control and Prevention on Wednesday recommended that decisions to use new meningitis B vaccines from Pfizer and GlaxoSmithKline in people aged 16 to 23 be made on an individual patient basis by physicians, the companies said, potentially paving the way for wider access to the drugs.

The CDC stopped short of broadly recommending Pfizer’s Trumenba and Glaxo’s Bexsero, but did expand the target group.

The CDC’s February recommendation had listed people aged 10 to 25, but only those deemed to be at high risk of contracting the deadly disease.

A broad category A recommendation by the CDD would advise use for all persons in a certain age or risk factor group. The category B recommendation that the CDC did make leaves the decision to vaccinate up to individual doctors along with patients or their parents.

Still, the new CDC recommendation, which makes no mention of risk factor and cites 16 through 18 as the preferred age of vaccination, should help make the vaccines more readily available in clinics and more likely to gain reimbursement from health insurers for a wider group of people.

Pfizer and Novartis, which sold the rights to Bexsero to Glaxo in March, had argued that the previous CDC recommendation was too narrow in scope. It had defined high risk largely as those with specified pre-existing medical conditions or who have professional exposure to the bacterium.

Meningitis can be treated with antibiotics, but 10 percent to 15 percent of patients die and up to 19 percent of survivors have long-term disabilities, including brain damage and limb amputations. Vaccination is deemed the best way to prevent the disease.

The U.S. Food and Drug Administration estimates serogroup B causes about 160 meningitis infections annually in the United States.

(Reporting by Bill Berkrot; Editing by Leslie Adler)

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