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Health Updates 17 July 2012

  • Gastric bypass may not cut healthcare costs: “Among obese veterans, bariatric surgery — predominantly gastric bypass — was not associated with lower healthcare expenditures in the 3 years after the operation, researchers found.  For outpatient, inpatient and total healthcare spending, there was a spike in the surgical group around the time of the operation followed by a convergence to the levels seen in the nonsurgical group, according to Matthew Maciejewski, PhD, of the Durham VA Medical Center in North Carolina, and colleagues.  The findings contrast with previous observational analyses conducted primarily in younger, predominantly female cohorts that have shown lower healthcare expenditures in the 2 to 5 years following bariatric surgery, the researchers reported in the July issue of Archives of Surgery.  ‘Although bariatric surgery was not associated with reduced expenditures in this cohort of older, predominantly male patients, many patients may still choose to undergo bariatric surgery given the strong evidence of significant reductions in body weight and comorbidities and improved quality of life,’ they wrote.”  Jumps in spending around the time of surgery were expected, as were extra expenditures related to presurgical workups and evaluations.   However, “the failure to see expenditures in the surgical group dip below those in the nonmedical group after the operation was unexpected”.   This could be attributed to the higher proportion of males in the study, their higher-than-average ages, and the fact that the surgical patients ultimately lived longer than the nonsurgical patients and consumed more resources during the six years studied. (Todd Neale, MedPage Today)
  • Faltering steps may indicate oncoming dementia: “Three new studies suggest that a person’s walking ability or type of gait may give hints about oncoming Alzheimer’s disease.  The studies, presented this week in Vancouver at the annual meeting of the Alzheimer’s Association, highlight changes in walking patterns as a potential sign that mental decline is underway.  In one four-year study, a Swiss team led by Dr. Stephanie Bridenbaugh of the Basel Mobility Center tracked the walking ability of nearly 1,200 elderly memory clinic outpatients and compared the results to the walking ability of healthy people.  Tests revealed that a slowing of pace and a change in gait was linked to progression of mental decline, whether the mental state known as mild cognitive impairment (MCI) or full-blown Alzheimer’s disease.  ‘Those with Alzheimer’s dementia walked  slower than those with MCI, who in turn walked slower than those who were cognitively healthy’, Bridenbaugh explained in a news release issued by the conference.  In a second trial, researchers at the Mayo Clinic Study of Aging,  led by Dr. Rodolfo Savica, also looked at walking patterns among more than 1,300 patients….The result: Declines in mental skills, including losses in memory and executive function, were associated with a slowed walking pace and shortening of the patient’s stride.  ‘These results support a possible role of gait changes as an early predictor of cognitive impairment,’ Savica said in a news release.  Lastly, a Japanese team from Tohoku University Graduate School of Medicine in Sendai, led by Kenichi Meguro, focused on 525 men and women aged 75 and older.  The reserachers conducted neurological, psychological and physical tests to assess the potential of a connection between gait and dementia.  Their results mirrored both the Swiss and American studies — as walking abilities declined, so too did the patients’ mental skills. ‘Gait velocity was significantly decreased as the severity of dementia  symptoms increased,’ Meguro noted in a news release.  The bottom line, he said: ‘Gait should no longer be considered a simple, automatic motor activity that is independent of cognition.  They are linked’.”  (HealthDay)
  • Drug approved to fight HIV infection“The Food and Drug Administration on Monday approved the first drug shown to reduce the risk of HIV infection, a milestone in the 30-year battle against the virus that causes AIDS.  The agency approved Truvada, a pill made by Gilead Sciences, as a preventive measure for people who are at high risk of acquiring HIV through sexual activity, like those whose partners are infected.  Public health advocates say the approval could help slow the spread of HIV, which has held steady at about 50,000 new infections per year for the last 15 years.  An estimated 1.2 million Americans have HIV, which develops into AIDS unless treated with antiviral drugs.  Gilead Sciences has marketed Truvada since 2004 as a treatment for people who are already infected with the virus, but starting in 2010, studies showed that the drug could prevent people from contracting HIV.  A three-year study found that daily doses cut the risk of infection in healthy gay and bisexual men by 42 percent when accompanied by condoms and counseling.  Last year, another study found that Truvada reduced infection by 75 percent in heterosexual couples in which one partner was infected.” (NY Times)
  • Child abuse rises when economy sags: “The housing crisis that has left so many people without a permanent home may have worsened another serious problem: child abuse.  As mortgage delinquencies and foreclosures loom, the rates of child abuse leading to hospitalization also increased, according to new research. Between 2000 and 2009, the rate of child abuse requiring hospital admission increased by 3 percent a year for every 1 percent increase in the 90-day mortgage-delinquency rate.  The rate of traumatic brain injury suspected to be caused by child abuse increased 5 percent a year for every 1 percent increase in the mortgage-delinquency rate, according to the study.  ‘On a community level, we need to recognize that losing a home is very stressful, and we need to let families know that it’s OK to ask for help,’ said the study’s lead author, Dr. Joanne Wood, assistant professor of pediatrics at Children’s Hospital of Philadelphia.  ‘We need to provide them links to resources where they can get help’.  Results of the study will be published in the August issue of the journal Pediatrics.  The study was released online July 16.  During the late 1990s and early 2000s, rates of child abuse declined dramatically, according to background information in the study.  Some theorized that the decrease was likely due to a thriving economy….Wood said she initiated the [present] study because she heard concerning reports from her colleagues that they were seeing an increase in children being admitted to the hospital due to abuse….When the researchers compared the [hospital] admission rates with local economic data, a clear trend emerged.  In families whose housing situation was insecure — either because they were behind on their mortgage or had lost their home to foreclosure — child abuse was far more likely.”  (womenshealth.gov)
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