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Mar 12 2014
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Public Health News Roundup: March 12

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Robert Wood Johnson and CDC Foundations Launch New Project on Using Law and Policies to Help People Make Healthier Choices
The Robert Wood Johnson and CDC Foundations have announced the launch of a new project to advance discussion about how laws and policies can assist people in making healthier choices. Subject matter experts will work with federal partners to develop 10 to 15 evidence-based reports during the next three years to highlight laws and policies related to specific topic areas within the U.S. Department of Health and Human Services (HHS) Healthy People 2020 initiative. Healthy People 2020 is a set of goals and objectives with 10-year targets designed to guide national health promotion and disease prevention efforts aimed at improving the health of all people in the United States.

The new project, which will be led by the Office of Disease Prevention and Health Promotion (ODPHP) at HHS, will provide practical information to public health officials and associations; health-related industries; legal practitioners; non-profit organizations; policymakers; and individuals about the use of law and policy to address health factors:

  • ODPHP will provide leadership and support for the development of the reports.
  • CDC will provide technical guidance on the development of specific reports and collaborate with public health partners and communities to promote knowledge and understanding of the reports.
  • RWJF will provide public health law and policy expertise.
  • The CDC Foundation will manage administration and implementation of the project and amplify the results to stakeholders through communications efforts.

“The Robert Wood Johnson Foundation believes that law and policy are important levers for building a culture of health in our nation,” said Risa Lavizzo-Mourey, MD, president and CEO of the Robert Wood Johnson Foundation. “We’re pleased to collaborate with leaders in public health and government to focus attention on policies based on the best science to help achieve the national health goals set out in Healthy People 2020—strategies that all states and communities can use to help people live healthier lives.” Read more on prevention.

FDA Approves Marketing of First Migraine Prevention Device
The U.S. Food and Drug Administration (FDA) has authorized the marketing of the first device designed to stop migraine headaches before they happen. The preventative treatment is a small, portable prescription device that uses an electrical current to stimulate branches of the trigeminal nerve, which has been associated with migraine headaches. An estimated 10 percent of people suffer from migraines, which if untreated can last from four to 72 hours and lead to nausea, vomiting and sensitivity to light and sound. In a release, Christy Foreman, director of the Office of Device Evaluation at the FDA’s Center for Devices and Radiological Health, said Cefaly “may help patients who cannot tolerate current migraine medications for preventing migraines or treating attacks.” Read more on technology.

HHS: 4.2 Million Have Signed Up for Coverage Under the Affordable Care Act
Just a few weeks before the final deadline of March 31, the U.S. Department of Health and Human Services (HHS) has announced that more than 4.2 million people have enrolled in the Health Insurance Marketplace under the Affordable Care Act. Approximately 943,000 enrolled in February. Of the 4,242,300 who have enrolled:

  • 55 percent are female and 45 percent are male;
  • 31 percent are age 34 and under;
  • 25 percent are between the ages of 18 and 34;
  • 63 percent selected a Silver plan (up one percentage point over the prior reporting period), while 18 percent selected a Bronze plan (down one point)
  • 83 percent selected a plan and are eligible to receive Financial Assistance (up one point)

Read more on the Affordable Care Act.

Mar 6 2014
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Concussion Urgent Care Centers for Young Athletes: NewPublicHealth Q&A Robert Graw, MD

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A recent report from the Institute of Medicine found that young athletes in the United States face a "culture of resistance" to reporting when they might have a concussion and to complying with treatment decisions. That culture can result in students heading back to school too quickly—when they should be resting their brains to prevent short- and long-term complications.

"The findings of our report justify the concerns about sports concussions in young people," said Robert Graham, chair of the committee and director of the national program office for Aligning Forces for Quality, at George Washington University, Washington, D.C. (Aligning Forces is a program of the Robert Wood Johnson Foundation.) "However,” says Graham, “there are numerous areas in which we need more and better data. Until we have that information, we urge parents, schools, athletic departments, and the public to examine carefully what we do know, as with any decision regarding risk, so they can make more informed decisions about young athletes playing sports."

Recently, Righttime Medical Care, a chain of urgent care centers in Maryland, opened a number of HeadFirst sports injury and concussion centers in the state, staffed with health professionals who can assess injuries for concussions as well as evaluate students for return to play—in consolation with a team of experts who work with HeadFirst staff. HeadFirst will this year be presenting and publishing data on the more than 10,000 youth it has examined and treated for concussion in just the past two years.

NewPublicHealth recently spoke with Robert Graw, MD, head of Righttime and HeadFirst, about the need for better prevention, evaluation and treatment of concussions to prevent long-term health problems and disability.

NewPublicHealth: Why did Righttime add concussion care to the services provided?

Robert Graw: My son is an orthopedic surgeon and talked to me about the number of injuries he was seeing. We decided a few years ago that we’d learn as much as we could about preventing head injury and the consequences of head injury, and then promote that information through Righttime’s call center and through the visits that people made to our sites.

In the process of learning as much as we could we realized that the knowledge base of how people evaluate and manage concussions had changed drastically in the last five years as people have done more research. So, we then gathered together a group of consultant physicians and neuropsychologists to determine best practices. We met with them frequently, and then had them train our provider staff so that all of them became much more informed about what a concussion really is, the best way to evaluate them and the guidelines for management going forward.

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Feb 21 2014
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Public Health News Roundup: February 21

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HHS, Heart Disease Organizations Join Forces to Vastly Reduce Premature Death Linked to Heart Conditions by 2025
Leaders from the World Heart Federation , the American Heart Association, the U.S. Department of Health and Human Services, and the American College of Cardiology are joining together to help cut premature mortality from cardiovascular disease by at least 25 percent by 2025.
 Key strategies will include secondary prevention efforts for people who have already experienced a heart incident, or have established heart disease, as well as primary prevention strategies in the United States and around the world. “Heart disease can touch anyone, no matter where you live,” said Nancy Brown, chief executive officer of the American Heart Association.  “It will take the collective efforts of everyone from community leaders to healthcare professionals, educators and business leaders to stop this No. 1 killer at the national and global level...” Read more on heart health.

New Guidelines for Stroke Risk, Prevention in Women
The American Heart Association/American Stroke Association has published the first ever set of guidelines dedicated to stroke risk and prevention in women. The 86-page document appears in the journal Stroke and address risk factors distinct to women, including pregnancy, oral contraceptives, menopause and hormone replacement. It also covers factors that affect women more than men, including atrial fibrillation and migraine with aura. “We reviewed a large body of research to be able to summarize our current understanding of stroke risk and stroke prevention in women, information that is critically important for care providers and researchers in the field,” according to Judith Lichtman, MD, associate professor at the Yale School of Public Health and co-author of the study. “The guidelines are also important to empower women and their families to better understand their risk for stroke and be aware of ways they can minimize their likelihood of having a one.” Strokes are the third-leading cause of death among women in the United States. Read more on strokes.

Study: Indicators of Potential Heart Disease as Early as Age 18
Indicators of potential heart disease can be seen as early as age 18, according to a long-term study recently published in the Journal of the American Medical Association. Researchers found that elevated blood pressure at that age, as well as found distinct blood pressure patterns from ages 18-55, indicate people at high risk for calcification of coronary arteries by middle age. “This shows that your blood pressure in young adulthood can impact your risk for heart disease later in life,” said Norrina Allen, PhD, lead study author and assistant professor of Preventive Medicine at Northwestern University Feinberg School of Medicine, in a release. “We can’t wait until middle age to address it. If we can prevent their blood pressure from increasing earlier in life we can reduce their risk of future heart attacks and stroke.” Approximately one in three U.S. adults have hypertension. Read more on prevention.

Feb 11 2014
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Public Health News Roundup: February 11

AHA Releases Stroke Prevention Guidelines for Women
For the first time, the American Heart Association (AHA) has released stroke prevention guidelines for women. The guidelines outline stroke risks unique to women and provide evidence-based recommendations on how best to treat them, including:

  • Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to lower preeclampsia risks.
  • Women who have preeclampsia have twice the risk of stroke and a four-fold risk of high blood pressure later in life. Therefore, preeclampsia should be recognized as a risk factor well after pregnancy, and other risk factors such as smoking, high cholesterol, and obesity in these women should be treated early.
  • Pregnant women with moderately high blood pressure (150-159 mmHg/100-109 mmHg) should be considered for blood pressure medication; expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.
  • Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.
  • Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks.
  • Women over age 75 should be screened for atrial fibrillation risks; a risk factor for stroke.

Read more on prevention.

New Study Predicts Flu Severity
Researchers at St. Jude Children’s Research Hospital in Memphis say flu patients, regardless of age, who have elevated levels of three particular immune system regulators, called cytokines, early in the infection were more likely to develop severe flu symptoms and to be hospitalized than patients with lower levels of the same regulators. Study participants ranged in age from 3 weeks to 71 years.

The study, published in the American Journal of Respiratory and Critical Care Medicine, found that cytokine levels early in the infection were predictive of flu-related complications regardless of patient age, flu strain, the ability of the virus to replicate and other factors. The cytokines studied help to regulate inflammation caused by the body’s immune response to the flu until antibodies and T cells take over. Patients with the elevated cytokines seem to develop airway distress as a reaction to the immune response, a development separate from the effects of the flu virus. “We need to explore targeted therapies to address this problem separately from efforts to clear the virus, says study author Paul Thomas, PhD, an assistant member of the St. Jude Department of Immunology. Read more on flu.

Community Health Worker Model Can Reduce Hospital Readmissions
A new study in JAMA Internal Medicine reports on a community health worker (CHW) program developed at the University of Pennsylvania School of Medicine that hired people from the local community to help discharged patients navigate the health care system and address key health barriers, such as housing instability or food insecurity. The study found that the intervention improved patient experiences and health outcomes and reduced hospital readmissions.

The Penn team tested the model in a randomized trial with 446 hospitalized patients who were either uninsured or on Medicaid, and lived in low-income communities in which more than 30 percent of the population lived below the Federal Poverty Level. More than one-third of all readmissions to the hospitals participating in the study come from a five-zip code region. Patients in the trial received support from CHWs hired for traits such as empathy and active listening. The CHWs connected during a patient's hospital stay and continued after they were discharged to help with issues including scheduling doctor appointments, accessing medications, or finding child care or shelter. The control group received routine hospital care, medication reconciliation, written discharge instructions, and prescriptions from the hospital. The CHW group had a 52 percent greater chance of seeing a primary care physician within two weeks after being discharged from the hospital and scores measuring a patient's confidence in managing their own care in the future more than doubled in the CHW group. While the two groups had similar rates of at least one hospital readmission (15 percent vs 13.6 percent), the CHW group was less likely to have multiple readmissions (2 percent vs 6 percent in the control group). Read more on health disparities.

Sep 12 2013
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Public Health News Roundup: September 12

Study: 60 Percent of Uterine Cancer Cases are Preventable
Approximately 60 percent of U.S. uterine cancer cases are preventable thorough regular physical activity and maintaining a healthy weight, according to a new study from the American Institute for Cancer Research (AICR) and World Cancer Research Fund International. That comes out to nearly 30,000 cases per year; endometrial cancer is the most common cancer of the female reproductive system, ahead of both ovarian cancer and cervical cancer. "Body fat can produce hormones that promote cancer development," said Alice Bender, nutrition communications manager for AICR. "We also know that body fat is linked to chronic inflammation, which produces an environment that encourages cancer development." The study also found various dietary choices that influence cancer risk because of the way they influence hormones such as estrogen and insulin. For example, drinking one cup of coffee a day can reduce the risk of endometrial cancer by 7 percent, while eating sugary items and processed grains can increase it. Read more on cancer.

Overweight, Obese People More Likely to Suffer from Migraines
Migraines can now be added to the long list of medical conditions more likely in people who are overweight or obese, according to a new study in the journal Neurology. Researchers found the painful, often-debilitating headaches were twice as common for obese people as they were for people of normal weight. As many as 15 percent of people suffer from episodic migraines and approximately 32 percent of people with the migraines were obese. "This suggests patients and doctors need to be aware that obesity is associated with an increased risk of episodic migraine and not wait until a patient has chronic migraine to address healthy lifestyle choices, such as diet and exercise, and to choose medications that impact weight with care," said lead researcher Lee Peterlin, MD, from the Johns Hopkins University School of Medicine, according to Reuters. While further research is needed to determine causation, the study results do provide yet one more reason to make healthy lifestyle changes. Read more on obesity.

Anger, Irritability May Be Signs of More Severe, Chronic Depression
Irritability and anger may indicate more complex, chronic and severe forms of major depression, according to a new study in JAMA Psychiatry. Symptoms of irritability and anger during a major depressive episode (MDE) appear to be clinical markers for a significantly more complex, chronic, and severe form of major depressive disorder, a new study indicates. Researchers found that people with MDEs who also exhibit anger and irritability were more likely to have increased severity of their depression, longer bouts of depression, lower impulse control and a more chronic long term course of illness. The findings indicate that people who exhibit these behaviors need closer clinical monitoring that "should include specific strategies to address anger management issues, as well as the frequently associated problems of comorbid anxiety disorder, substance abuse disorder, poor impulse control, and psychosocial impairment when these are present." Read more on mental health.

May 7 2013
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Public Health News Roundup: May 7

RWJF Obesity Report Details Tactics that Could Save Billions in Health Care Costs
The medical costs of the ongoing U.S. obesity epidemic could be as high as $210 billion annually, according to James S. Marks, Senior Vice President for the Robert Wood Johnson Foundation Health Group. The loss of economic productivity likely adds even more billions to the toll. However, increasing the Congressional Budget Office’s time frame for estimating the cost of legislation from 10 years to 75 years would greatly improve the battle against obesity by enabling us to better estimate the true costs—and savings—of health care and public health efforts. The Campaign to End Obesity estimates that over 75 years, obesity screening by physicians would save $44 billion, the S-CHIP childhood obesity demonstration project would save $41 billion, the U.S. Centers for Disease Control and Prevention’s diabetes prevention program would save $18.4 billion and Medicare part D weight-loss drug coverage would save $11.4 billion. Read the full report.

Citing Cancer Risk, FDA Proposes New Rules for Youth and Indoor Tanning
The U.S. Food and Drug Administration (FDA) is proposing that sunlamp products used for tanning be reclassified as a moderate risk device—up from a low risk device—and made to carry recommendations warning against their use by young people. The ultraviolet radiation from indoor tanning increases the risk of melanoma by 75 percent, according to the American Academy of Dermatology. “Using indoor tanning beds can damage your skin and increase your risk of developing skin cancer,” said FDA Commissioner Margaret A. Hamburg, MD. “The FDA’s proposed changes will help address some of the risks associated with sunlamp products and provide consumers with clear and consistent information.” Read more on cancer.

FDA Warns Pregnant Women of Migraine Drug Ingredient’s Risk to Children
Noting the link between the migraine medicine ingredient valproate and lower IQ scores in children, the U.S. Food and Drug Administration (FDA) is warning all pregnant women not to take medication containing the ingredient. "Valproate medications should never be used in pregnant women for the prevention of migraine headaches because we have even more data now that show the risks to the children outweigh any treatment benefits for this use," said Russell Katz, MD, director of the division of neurology products in the FDA's Center for Drug Evaluation and Research. FDA is also warning women who may become pregnant not to use valproate unless it is medically “essential” and that they make sure they are on effective birth control. Read more on maternal and infant health.