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MGH Community News |
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MGH Community News |
| October 2013 | Volume 17 • Issue 9 |
Highlights
Sections
Social Service staff may direct resource questions to the Community Resource Center, Lindsey Streahle, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
This article is based on a presentation given at the Social Service Department staff meeting on October 24, 2013. Background Federal law requires the screening of patients with serious mental illness and/or developmental disabilities before admission to a skilled nursing facility to prevent them being inappropriately warehoused in nursing homes. The law and process, commonly known as OBRAPASRR (Preadmission Screen and Resident Review), also seeks to ensure appropriate services are provided for these populations in nursing homes. These are preadmission screens, i.e., they must be completed before transfer to SNF. For Massachusetts residents the developmental/intellectual disabilities screen must be completed by Department of Developmental Services (DDS) staff. We are “delegated hospital” which means we are able to complete serious mental illness screens for inpatients rather than waiting for an outside agency to come in and complete the screen The New Form The OBRA indicators and exemptions have NOT changed. The new form is available now on our website. We’ve been informed that though there is not a specific final date beyond which they will not accept the old form, that they’d like us to start using them by October 28, 2013. There are a number of minor, self-explanatory changes to the form. But understanding the key change requires some background. The Olmstead Decision The Olmstead Decision refers to a 1999 U.S. Supreme Court case that requires states to eliminate unnecessary segregation of persons with disabilities and to ensure that persons with disabilities receive services in the most integrated setting appropriate to their needs. In other words, to deinstitutionalize when possible. The Massachusetts efforts to comply are called, as a group, “Community First”. There are several components, but the significant ones for the purposes of this article are:
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The Community First Check-Off As part of these Community First efforts, the new OBRA form has a new check-off item: “Recommend Further Evaluation for Placement in Setting Other Than Nursing Facility.” This is our opportunity to help flag patients we think have potential to return to the community after a period of time and with appropriate services in place. Checking this box does not mean that we think SNF placement is inappropriate at this time. The check-off is designed to be a trigger for SNF discharge planners and ASAP screening nurses to consider Community First programs, such as Money Follows the Person, at a later date.
New Summary Sheet The new form has a new last page which is a summary sheet. The summary sheet asks you to repeat the determination (the individual is or is not in need of “specialized services”- i.e., acute psychiatric hospitalization), the recommended services and community referrals, and the Community First check-off. After we submit the OBRA form to Lahey Behavioral Health they will detach the summary sheet and send it, with the determination letter, to the SNF for inclusion in the patient’s medical record. If the Community First check-off is checked-off, the hope is that this will then trigger a closer review and consideration of community alternatives Additional New Materials At the training for the new form, DMH staff also distributed a couple of new additional handouts. First is an updated flow-chart that gives an abbreviated “at-a-glance” reference for the OBRA indicators and exemptions. DMH staff also distributed a new Community Based Services Resource List. They encourage us to distribute this list to patients and families as part of the OBRA preadmission screening process. It also can be a staff reference to long-term care alternatives in the state. The list includes a description of and contacts for Long-Term Care Options Counseling. These are specially trained Elder Service or Centers for Independent Living staff who work with individuals to identify supports and options for community placement alternatives. These programs also have the potential to be a resource or partners for us in exploring these alternatives. The list also references Adult Foster Care, Group Adult Foster Care, PCA program, the PACE program and mental health-specific resources. More Information Not sure if screen is indicated or do you have other OBRA questions? Call the Lahey Health Behavioral Services OBRA office at 978-524-7100 x7813. Lahey Health Behavioral Services is the new name for Health and Education Services (HES) the long-time DMH OBRA contractor. While this is a new name, the same staff remain at the same address and phone number. Fuel Assistance Season is Here and the Winter Moratorium is Coming Soon Heating season is upon us! Fuel Assistance, formally known as the Low Income Home Energy Assistance Program or LIHEAP, offers assistance between November 1 and April 30 annually. Financial eligibility is 60% of Estimated State Median Income (see last column of chart). Even renters whose utilities are included in their rent or with housing subsidies may qualify (see our website for details). The annually updated Cold Relief Brochure lists where to apply by town. The Winter Moratorium In Massachusetts utilities are prohibited from shutting-off heat-related utilities between November 15 and March 15 each year (commonly extended a few weeks on an annual basis) for those with documented “financial hardship”. This protection applies only to gas and electric utilities, and not to “deliverables” such as oil, propane, and wood. It does apply to electricity in homes that heat with gas if electricity is required to operate the heating system. To qualify, one must document “financial hardship” by completing a utility-specific form and supplying required additional documentation. While the winter moratorium provides protection from shut-off during this time period, it does not erase the debt. Utilities are free to, and will, proceed with shut-off at the end of the moratorium unless arrangements are made to address overdue bills. See Managing Arrearages for advocacy tips to address overdue bills, including utility discounts and Arrearage Management programs.
Section 12- New Form and Rules The DMH form used to involuntarily commit patients to an acute psychiatric facility, known as Section 12 or a “Pink Paper” has been revised. The new version of the, “APPLICATION FOR AN AUTHORIZATION OF TEMPORARY INVOLUNTARY HOSPITALIZATION M.G.L. Chapter 123, Sections 12 (a) and 12 (b)” is called Form AA-5. The new form contains a clarification requested by Emergency Medical Services that the signer of a form is also authorizing the use of restraint during transport, but only if necessary for the safety of the person being transported or of others who are likely to come into contact with him or her. The other change incorporates a change in Massachusetts law relating to the signature authority of Nurse Practitioners (NP). In consultation with the Board of Registration in Nursing, DMH has concluded that with the passage of this statute, NPs are authorized to sign Section 12s on behalf of patients whom they have examined within the scope of their practice as Nurse Practitioners. -Thanks to Matt Silvia-Perkins and Melanie Cohn-Hopwood for updating us about these changes. DPH Guide to Nursing Home Care is Revised One of the most significant and trying times in the life of any family is the decision to admit a loved one into a nursing home. Patients and loved ones are bound to have questions on everything from how to manage day-to-day routines to how to continue participating in life-long interests and activities. Even in the best of cases, issues may come up that can sometimes be difficult for residents, families, and nursing home staff to anticipate and address. For some years now, the Department of Public Health has made available an online, downloadable guidebook to help patients, caregivers, and their families address these concerns with prospective and current long-term care providers. The guide has been recently rewritten and redesigned. A Guide to Nursing Home Care: Important Questions That Residents and Families Often Ask provides answers to a wide range of important, commonly asked questions including “Who can receive information and make decisions about me?” and “Who is allowed to see my medical records?” What’s more, the brochure contains an easy-to-use Consumer Checklist which contains each of the documents and regulations which you should be aware of – whether you’re a nursing home resident or a family member – such as a Resident Rights Brochure, your Family Council Rights and a Health Care Proxy Form. The newly redesigned brochure was developed by DPH in partnership with the Massachusetts Executive Office of Elder Affairs, the Massachusetts Senior Care Association, Leading Age Massachusetts, nursing home resident advocates, and legislators. The guide is available on the DPH website in English, Spanish, Portuguese, Chinese, Vietnamese, and Haitian Creole. Nursing Home Residents' Rights for the LGBT Community- New Fact Sheet The National Consumer Voice for Quality Long-Term Care recently released a new consumer fact sheet Residents' Rights and the LGBT Community: Know Your Rights as a Nursing Home Resident , produced by the National Long-Term Care Ombudsman Resource Center (NORC) in collaboration with the National Resource Center on LGBT Aging (NRC) and Lambda Legal . This fact sheet highlights residents' rights and nursing home requirements that may be of particular importance to lesbian, gay, bisexual or transgender (LGBT) residents and provides options for complaint resolution, information for reporting abuse and resources regarding long-term care and LGBT advocacy. -Adapted from : News from Margolis & Bloom, LLP - October 29, 2013,Margolis & Bloom, LLP (see the archive). New Rules Make it Harder for Loan Services to Foreclose The state’s Division of Banks has filed new regulations that prevent third-party loan servicers from foreclosing on a property if a loan modification is in process. The regulations, which took effect on October 11, 2013, are part of a broader effort by Governor Deval Patrick’s administration to curb unnecessary bank foreclosures. This past summer, the state adopted similar regulations for mortgage lenders. -See the full Boston Globe article... Using an Annuity to Keep the Spouse of a Medicaid Applicant from Becoming Impoverished When one spouse qualifies for Medicaid to pay for a nursing home stay, Medicaid has rules to prevent community spouses from impoverishment, but the protections aren’t always enough. There are steps that one can take to increase the community spouse's income, and an annuity may be a good option. To qualify for Medicaid coverage, in general, the community spouse may keep one-half of the couple's total "countable" assets up to a maximum of $115,920 (in 2013). Called the "community spouse resource allowance," this is the most that a state may allow a community spouse to retain without a hearing or a court order. One way to ensure that the community spouse has enough money to live on is for the community spouse to purchase an annuity. By purchasing an annuity, the spouse turns a countable resource into an income stream, which should not be counted by Medicaid. The annuity must meet certain qualifications in order to not be considered an asset transfer, including be irrevocable and name the state as a remainder beneficiary. (More on annuities and Medicaid planning.) Some states have improperly denied Medicaid benefits to an applicant whose spouse has purchased an annuity, but a recent decision by a U.S. Court of Appeals makes clear that community spouses can purchase annuities under current federal law. Before purchasing an annuity or applying for Medicaid, one should consult with an attorney who can advise about the best way to protect the community spouse. -See the full ElderLawAnswers.com article ... -Cited in/Linked from News from Margolis & Bloom, LLP - October 15, 2013. Medical Loans Can Add to the Pain In dentists’ and doctors’ offices, hearing aid centers and pain clinics, US health care is forging a lucrative alliance with US finance. A growing number of health care professionals are urging patients to pay for treatment not covered by their insurance plans with credit cards and lines of credit that can be arranged quickly in the provider’s office. Many of these cards charge no interest for a promotional period, typically six to 18 months. But if the debt is not paid in full when that time is up, costly rates — usually 25 to 30 percent — kick in. If payments are late, patients face additional fees and, in most cases, their rates increase automatically. The higher rates are often retroactive, meaning that they are applied to patients’ original balances, rather than to the amount they still owe. The American Medical Association and the American Dental Association have no formal policy on the cards, but some practitioners refuse to use them, saying they threaten to exploit the traditional relationship between provider and patient. Doctors, dentists, and others have a financial incentive to recommend the financing because it encourages patients to opt for procedures and products they might otherwise forgo. It also ensures that providers get paid upfront — a fact that financial services companies promote. State authorities and care advocates in California, Florida, Illinois, Michigan, and elsewhere say older people — many of them grappling with dwindling savings and mounting debt — are running into trouble with medical credit cards and loans. Minnesota’s attorney general, Lori Swanson, is investigating the use of medical credit cards, which she said could come with “hidden tripwires and other perils.” -See the full Boston Globe article ...
Newborns Exposed to Substances: Support and Therapy (NESST) Project NESST (Newborns Exposed to Substances: Support and Therapy) is a new pilot program from Jewish Family & Children’s Services (JF&CS) that offers support for substance-exposed newborns and their families. While some programs focus on the medical needs of infants who were exposed to opiates, cocaine, prescription medications, or other substances, this program is one of the first to address the emotional and psychological challenges of being the parent of a substance-exposed newborn. The program will offer individualized services to each client from pregnancy through the early years of parenting. Staff will include both clinicians to provide infant-parent mental health treatment and Mentoring Moms to offer peer support and connections to community resources. In the process of developing NESST over the past year, JF&CS Center for Early Relationship Support (CERS) staff spoke with providers and policy experts who have been involved with this population and learned of a gap in understanding the experience and needs of the women themselves. In collaboration with NESST’s evaluation team at the BU School of Social Work, staff began to interview mothers about their experience of pregnancy, labor and delivery, and parenting a substance-exposed newborn. The interviews revealed the pain, isolation, and judgment these women feel. One woman commented, “You need somebody there who isn’t judging you and understands. I always felt like if I was to tell a doctor that I’d be so judged for having a newborn and having a drug addiction.” Another said, “You feel so guilty and want to do the right thing but don’t have the resources, the help, or therapy.” Another added, “Your program needs to offer advocacy for the mothers because no one listens to us.” For more information, call 781-647-JFCS (5327) or email your questions via their contact us page. -See the full JF&CS blog announcement ...
MassHealth Basic and Essential Now Cover Hospice A version of the following was e-mailed to Oncology and Palliative care social workers in September. As of July 1, 2013 MassHealth Basic and Essential now offer hospice coverage. Specifically, MassHealth Basic and MassHealth Essential benefit packages include: routine home care; continuous home care; inpatient respite care; and general inpatient care. See the Provider Bulletin ( Hospice Bulletin 10, August 2013) for definitions of these terms. Hospice services are not covered in nursing facilities for MassHealth Basic and Essential members. One social worker reported that some hospices have not been aware of this change. The Provider Bulletin may be shared with hospices as an educational and advocacy tool. This change is preparatory to MassHealth Basic and Essential being rolled in to a new type of MassHealth coverage beginning January 1, 2013 as part of Affordable Care Act implementation. -Thanks to Mary Zwirner for her contributions to this article. Affordable Care Act (ACA) Implementation Update and Review Reminder : Kim Simonian, MPH, Associate Director for Public Payer Patient Access with Partners HealthCare - Community Health, will be the featured speaker at a joint Social Service and Case Management training on Affordable Care Act implementation on December 5, 10:00 – 11:30 a.m. in the O’Keeffe Auditorium. The Affordable Care Act (ACA- also known as Obamacare) has 10 titles, and understanding these titles helps to see just how expansive it is:
On coverage, a host of early reforms were implemented in 2010-2011, including continued coverage for young adults up to age 26 years on their parents' insurance, elimination of lifetime and annual benefit caps, several billion dollars in insurance rebates to employers and consumers whose policies spend less than 80%-85% on pure medical costs, the closing of the Medicare Part D prescription drug "doughnut hole," and much more. On delivery reform, a host of innovations involving Accountable Care Organizations (ACOs), patient-centered medical homes, hospital penalties for excessive readmissions and healthcare-acquired infections, comparative effectiveness research, and more are taking hold. When the ACA was signed, many observers dismissed the role of ACOs, none of which existed in March 2010; today, more than 250 of them are forming within Medicare. The movement toward accountable care and away from fee-for-service is proceeding. What's Coming Nationally? The fundamental structural components of Title 1 take full effect on January 1, 2014. These include:
What's Coming in Massachusetts? As a result of Massachusetts’ 2006 health reforms we have a relatively small number of uninsured in this state. These reforms became the model for the Affordable Care Act, so most Massachusetts residents will not see major changes as a result of ACA implementation. One of the main ACA changes currently getting a lot of press is the health care “exchanges” or online marketplaces. The Massachusetts Health Connector (MAhealthconnector.org) is the Massachusetts exchange which has been operational for some time (it administers Commonwealth Care and Commonwealth Choice). But it will now be offering new Qualified Health Plans (QHPs) to those who need to purchase their own insurance. Generally those who already have health coverage through an employer or Medicare do not need to visit the Connector website to purchase insurance as they are already covered. Massachusetts Residents with Health Coverage Who Should Re-Apply
All people who need to re-apply for health insurance should get information in the mail explaining the steps they need to take. Those who need to re-apply will have to choose a new plan, but the state has tried to ensure that the coverage is similar and that people who received financial assistance previously should not pay more under the ACA.
New Methodology for Counting Income – MAGI For most applicants, income eligibility for MassHealth and Qualified Health Plan credits/subsidies will be based on an income counting method called MAGI (Modified Adjusted Gross Income). MAGI is used in federal income tax calculations. Using MAGI, there will be changes in the way some types of income, such as child support, earnings of a child, alimony, and business losses, will be counted. Household composition rules will also change with the switch to MAGI. Some groups, including people age 65 and older, are exempt from MAGI rules. The new rules are also not likely to affect people who receive TAFDC, EAEDC, or SSI who automatically qualify for MassHealth. For people who qualify for MassHealth based on disability, Massachusetts proposes to use some MAGI income counting rules combined with current household composition rules. One important change that will affect many MassHealth applicants is the MAGI standard income disregard. The MAGI income disregard equals 5% of the Federal Poverty Guidelines based on household size. For many MassHealth applicants, the income disregard, in effect, raises the income limit from 133% FPL to 138% FPL. This change is expected, for the most part, to allow more people to qualify for assistance. However it makes it more complicated to quickly estimate eligibility.
What Form Will Subsidies Take? Subsidies under the ACA will primarily take the form of a premium tax credit. A premium tax credit is money that the federal government generally pays directly to the insurance company every month to provide lower monthly premiums for those who qualify. Or those who qualify for premium tax credits can instead opt to claim them at the end of the tax year similar to other tax credits Assistance is available to those with incomes up to 400% of the federal poverty level or FPL (the current Commonwealth Care income eligibility limit is 300% of FPL). Cost sharing assistance for deductibles, co-insurance and co-pays is available for those up to 250% of FPL under the ACA, with Massachusetts extending this assistance up to 300% FPL. Open Enrollment and the Individual Mandate Enrollment in the Qualified Health Plans available for purchase through the health exchanges is limited to an annual Open Enrollment period. For this first year, this enrollment period will run through March 31, 2014. One must enroll by the 15 th of the month for coverage to start at the beginning of the following month. So for coverage starting January 1, 2014, one must enroll by December 15. Those who do not have insurance, who can afford insurance, and who do not enroll may be subject to a tax penalty. This requirement and penalty is commonly known as the “individual mandate”. Due to the government shutdown and the difficulties experienced by the national ACA website (HealthCare.gov), the Obama administration has extended the deadline to avoid penalty through the end of open enrollment. Types of Plans Available on the Exchanges (Nationally and in MA) Each plan’s co-pays and benefits may be slightly different. The new plans are grouped in metallic levels designed to make it easy to compare:
More Information and Outreach Materials (MA)
Also see accompanying story below: Dental Insurance Offered as Part of Affordable Care Act. Dental Insurance Offered as Part of Affordable Care Act As part of the roll-out of the Affordable Care Act (often called “Obamacare”), Massachusetts residents can now apply for dental insurance. Dental plans will now be available for adults, children, and families through the Health Connector (MAhealthconnector.org) . Members may be able to get premium tax credits to help pay for dental insurance. Open enrollment began on October 1, 2013 and runs through March 31, 2014. Apply online at MAhealthconnector.org. The public can also get help with an application from a Navigator or Certified Application Counselor. Go to MAhealthconnector.org or call 1-877 MA ENROLL (1-877-623-6765) or TTY 1-877-623-7773 for a list of local Navigators or Certified Application Counselors. Health Connector Customer Service is open Monday to Friday, 7:00 a.m. to 7:00 p.m. and Saturdays, 9:00 a.m. to 3:00 p.m. Educational/Outreach Materials
- From: Open Enrollment for NEW Health and Dental Insurance Plans Begins Today October 1, 2013!, e-mail from MA Health Care Training Forum, October 01, 2013. Medicare Members Should NOT Enroll in ACA Plans - Watch for Scams As you are no doubt aware, on October 1, the U.S. Department of Health and Human Services (HHS) launched the Health Insurance Marketplaces, as part of implementing the Affordable Care Act (ACA). (See accompanying story above for more on the ACA.) The Health Insurance Marketplaces created by the ACA are only for people who do not already have insurance. People with Medicare should not enroll in the insurance plans offered in the Marketplaces. In fact, it is illegal for insurers to sell a Marketplace policy to anyone on Medicare. In addition, Medicare Advantage plans, Medigap supplemental policies and stand-alone Part D plans will not be sold through the Marketplaces. People with Medicare will be able to make changes to their coverage during the Medicare Fall Open Enrollment Period, which runs from October 15 to December 7 of each year. Additional caveats (added 2/14): Keep in mind that there are some consequences that may occur if you drop your Medicare coverage and somehow mistakenly sign up for a health insurance plan in the Marketplace. If you drop your Medicare coverage, you will most likely have to pay a premium penalty if you enroll in Medicare again in the future. In addition, you will likely have to wait until a specific enrollment period to sign up for Medicare and may therefore, experience gaps in health coverage. Making changes to Medicare coverage is no different than last year—simply go to www.medicare.gov or call 1-800-Medicare. Learn more about Medicare and the Marketplaces from the Medicare Rights Center. Watch for Scams Medicare Rights Center President Joe Baker was quoted in a recent Reuters article on seniors and marketing fraud. With the launch of the Health Insurance Marketplaces, Medicare beneficiaries are at increased risk of identity theft related to scams targeting seniors with Medicare. According to the Reuters article, consumer protection advocates worry that scammers will falsely tell seniors that they need to renew their Medicare coverage or sign up in the new Marketplaces in order to get them to divulge critical personal information on application forms. Advocates have also received reports of fake websites purporting to offer Affordable Care Act (ACA) insurance policies, also known as Qualified Health Plans (QHP). Seniors are also having to distinguish between two different enrollment periods and marketing messages—one for the Health Insurance Marketplaces, which began enrollment on October 1, and another for Medicare’s Fall Open Enrollment, which runs from October 15 to December 7. According to the Reuters article, the challenge for seniors will be sorting out scams from the massive, legitimate outreach now under way to promote the new law. More information on Medicare and the Marketplaces (such as what to do if enrolled in a QHP when you become Medicare eligible) at Medicare Interactive (a service of the Medicare Rights Center). -Adapted from Medicare Watch, Volume 4, Issue 39 , The Medicare Rights Center, October 03, 2013.
Opinion: Annals of Health Reform Chutzpah (by John E. McDonough) Now that the shutdown/debt ceiling crisis is over, critics are going after the Obama Administration for the problems plaguing the federal health insurance exchange website. One of the most persistent critics has been the Washington Post's Ezra Klein , otherwise an ardent supporter of the ACA. Recently, though, Ezra took the gloves off with the anti-ACA crowd who are crying crocodile tears about the inability of federal Exchange website applicants to get their insurance coverage applications through the process. All I can say is -- wish I had written that:
And there's more... People can kick the Obama Administration all they want over the website. I just can't ignore which side really wants health insurance coverage for all Americans and which side doesn't. I give the Administration the benefit of the doubt as they work to get it fixed. -See the full Boston.com Health Stew blog post...
Flu Shot Linked to Lower Heart Attack, Stroke Risk A recent study published in the Journal of the American Medical Association finds that getting the influenza vaccine lowers a person’s odds of a having heart attack, stroke, heart failure, or other major cardiac event—including death—by about a third over the following year. What’s the connection between flu and cardiovascular problems? “When you get the flu, your body mounts an impressive immune response, which causes a lot of inflammation. As a result, the plaque inside your blood vessels can become unstable, which can lead to blockage and a possible heart attack or stroke,” says study leader Jacob Udell, MD, a cardiologist at Women’s College Hospital in Toronto and a clinician-scientist at the University of Toronto. Changes in the lungs wrought by the flu virus can lower blood oxygen levels, which makes the heart work harder. The virus can also directly injure heart muscle cells, leading to heart failure or making it worse. Udell and colleagues pooled data from six clinical trials involving more than 6,700 people. Their average age was 67. About one-third had heart disease; the rest did not. Overall, those who had been vaccinated against the flu had a 36% lower risk of a having major cardiac event during the following year. And for those who had recently had a heart attack, a flu shot cut the risk of heart attack or stroke even further. Dr. Udell cautions that the safety and effectiveness of an influenza vaccine to lower the risk of heart attack or stroke still needs to be confirmed with a large clinic trial, which he’s currently planning. If the findings hold true, “we may be able to tell patients that by getting your flu shot, it might save your life—what a simple and significant way to reduce deaths and the burden on our healthcare system,” says Dr. Udell. -See the full Harvard Health Blog story...
Electronic cigarettes -- e-cigs -- look like cigarettes in size and shape, but they are nonflammable, so you don't smoke them. Instead, you "vape" them, and vaping seems to be catching on. The Centers for Disease Control and Prevention (CDC) says their use is growing rapidly. Already about 1 in 5 cigarette smokers in the United States have tried them, and they are available everywhere -- in retail outlets, on the Internet -- but experts disagree on whether vaping is safe. The US Food and Drug Administration (FDA) says that analyses of at least 2 brands of e-cigs revealed detectable levels of known carcinogens and toxic chemicals, such as diethylene glycol, an ingredient in antifreeze, as well as small amounts of tobacco-specific nitrosamines. The new study in Tobacco Control analyzed vapors from a dozen brands and also found some toxic substances, but at levels 9 to 450 times lower than in regular cigarette smoke, implying that vaping may be safer than smoking. Still, the impact of e-cigs on long-term health needs further study. The CDC also says it is not clear whether e-cigs help people quit smoking. Many e-cigs also deliver nicotine, so the gadget still keeps some people addicted. It is not clear whether e-cigs will help smokers decrease or increase their use of traditional cigarettes. There is also concern that electronic cigarettes could entice young people to try them, who would then get hooked on the nicotine. More research is needed. For now buyer beware. -See the full Medscape article... Electronic Cigarettes as Good as Patch for Quitting Smoking Electronic cigarettes are as effective as the patch when it comes to helping smokers overcome the cravings of nicotine addiction, suggests the first randomized study of its kind. The work, presented at the European Respiratory Society (ERS) 2013 Annual Congress, and simultaneously published online in the Lancet , demonstrates that smokers using e-cigarettes and those using the patch are able to abstain from smoking in equal proportions after 6 months. Chris Bullen, MD, director of the National Institute for Health Innovation at the University of Auckland in New Zealand, and his team compared 3 approaches to smoking cessation in 657 smokers. Participants actively trying to quit were randomly assigned to active e-cigarettes that contained 16 mg of nicotine, placebo e-cigarettes with no nicotine, or patches that contained 21 mg of nicotine. After randomization, study participants were instructed to use the assigned method for 1 week prior to their quit date, and for 12 weeks thereafter. During the study period, all participants were offered behavioral support. The researchers assessed sustained abstinence from cigarettes 6 months after the quit date. Overall 5.7% of participants remained cigarette-free at 6 months. When the researchers analyzed cigarette consumption and evaluated the benefit of cutting down instead of However, the success seen with the active e-cigarette did come with some interesting caveats. "At 6 months, more than a third of the people in that group who had quit smoking were still using the e-cigarettes," Dr. Bullen reported. “ For those in the e-cigarette cohort who didn't manage to quit, about 30% now use both. This is certainly a concern, and more research is needed in the area of dual use." He said. -See the full Medscape summary article and commentary...
Necrosing Narcotic 'Krokodil' - First US Reports The flesh-eating street narcotic known as "Krokodil" in Russia, where it has been used extensively by addicts since 2003, may have made its way to the United States, according to a report from an Arizona poison control center. This version of the opioid desomorphine was nicknamed Krokodil and pronounced crocodile because it causes a users' skin to turn scaly and green, eventually leading the skin to rot and even drop off. Although the New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) estimates that as many as 1 million people in Russia have used this drug, what is thought to be the first 2 cases of use in the United States were reported recently in Arizona. Use has been reported in other European countries, such as Germany. As reported recently by Medscape Medical News, Krokodil is known as "the drug that eats junkies," and for many users leads to having exposed bones and rotting sores all over their bodies. It can also cause a rupture of blood vessels, and complications can include thrombophlebitis and gangrene. The survival rate after first use of this designer drug is usually only 2 to 3 years. Frank LoVecchio, DO, a medical toxicologist and co–medical director at the Banner Good Samaritan Poison and Drug Information Center in Phoenix, Arizona, told Medscape Medical News that "I don't want to oversensationalize it, but I am worried. And I hope the use of this drug just stops and doesn't go any further. So my goal is to tell physicians to just be on the lookout and to be aware from a public health standpoint," Dr. LoVecchio said. -See the full Medscape article ...
Oxytocin Dysfunction Seen in Both Depressed Moms and Kids A dysfunctional oxytocin system may underpin the long-term harmful effects of maternal depression on child development, suggesting a potential for oxytocin-based interventions, researchers say. "Infants of depressed mothers have long-lasting difficulties both in general and specifically in social and emotional outcomes, such as social engagement with others, the capacity for empathy, which underpin the capacity for intimacy," Ruth Feldman, PhD, psychology professor at Ban-Ilan University, Ramat Gan, Israel, who worked on the study, told Medscape Medical News. "As we found that the oxytocin production of mothers and children is dysfunctional, interventions for infants that are known to induce oxytocin release may be implemented, such as touch therapies, massage, teaching mothers to engage in social-reciprocal interactions, the use of gaze synchrony, and how to answer the infant's social gaze, etc," she said. But intervening early is "critical, as the oxytocin system is built during the first year of life on the basis of social experiences with the parent," she said. The study is published in the October issue of the American Journal of Psychiatry. -See the full Medscape summary article... Some Psych Disorders Previously Linked to Preterm Birth May Not Be Only some psychiatric disorders that have been previously linked to preterm birth are actually caused by early birth, whereas others appear to be related to genetics, new research suggests. In the largest study of its kind to date, researchers confirmed the strong link between preterm birth and the risk for autism and attention-deficit/hyperactivity disorder (ADHD). However, they also found that other problems that have previously been closely linked to preterm birth, including severe mental illness, learning problems, suicide, and economic woes, may instead be more closely related to other conditions that family members share. "Interventions and preventative efforts aimed at lowering the prevalence of preterm birth are essential. But our results also suggest that families where one child is born preterm need wraparound services because all of the offspring in such families need assistance," Brian D'Onofrio, PhD, associate professor in the Department of Psychological and Brain Sciences at Indiana University Bloomington, told Medscape Medical News. The study was published online September 25 in JAMA Psychiatry. -See the full Medscape summary article… |