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MGH Community News |
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MGH Community News |
| July 2015 | Volume 19 • Issue 7 |
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. |
New Assisted Living Regulations Go Into Effect Effective July 1, 2015, Massachusetts assisted living residences (ALRs) are subject to new Executive Office of Elder Affairs (EOEA) regulations. The ALR regulations were last revised in 2006. The new regulations are intended to enhance the safety of the residents in the state's 236 facilities. Changes to the regulations address controlled substances, screening and assessment, training, and incident reporting. Among other things, ALRs are now required to develop detailed safety and evacuation plans to protect residents in the event of a disaster. In an effort to promote residents' right to self-determination, ALRs are now required to document, upon admission, whether residents have advance directives in place for finances and health care. ALRs must also distribute information about a full range of end of life treatment options to residents with serious advancing illness or for whom palliative care would be helpful. These regulations will enhance residents' rights to control their personal finances and health care. They will also ensure that ALR residents have access to a full range of palliative care options. Several of the new requirements apply specifically to so-called memory care units, known as "Special Care Residences," which serve the most vulnerable ALR residents - those with cognitive impairment. For example, providers must provide structured activities for memory impaired residents, address the residents' physical safety needs and provide a secure outdoor space for their residents. The proposed regulations included a provision that prohibited ALRs from allowing residents with "Skilled Nursing Care" needs to age in place. During EOEA's public comment period, the National Academy of Elder Law Attorneys, along with other advocates and consumers, opposed this proposed change. To the extent that it infringed on the rights of ALR residents to contract for services and age in place to the same extent as persons living in private homes, the proposed regulation ran afoul of the state's ALR statute and regulations, as well as the Americans with Disabilities Act. It was deleted from the final regulations. -See the full Margolis & Bloom article.
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Boston Wins Federal OK to Change Senior Housing Formula Reserving More Units for Seniors The Boston Housing Authority has won federal approval to change the way it distributes housing units to senior citizens and disabled adults in the 36 elder-disabled apartment buildings owned by the city of Boston. The approval came from the US Department of Housing and Urban Development (HUD), which must review each city's “Designated Housing Plans." Currently, the BHA is mandated to keep a ratio of 70 percent elderly to 30 percent non-elderly disabled in their developments. The new plan will allow the city of Boston to reserve up to 80 percent of these units in designated buildings for elderly residents. William McGonagle, the BHA’s administrator, has argued that the change is needed to adapt to the city's aging demographics, which have shifted dramatically since the last change in the HUD formula back in 1999. City officials have estimated that 90 percent of new demand for housing in these BHA units will come from elderly residents over the next nine years. Meanwhile, the BHA says that the proportion of non-elderly disabled applicants has declined by 14.5 percent. McGonagle proposed giving Section 8 vouchers to non-elderly-disabled residents to secure private housing. The plan won unanimous support from the Boston City Council earlier this year, but the HUD approval was the only official hurdle that matters. In a statement, McGonagle hailed the HUD decision "The BHA is pleased that HUD has approved our plan to provide additional affordable housing options for Boston's elderly residents. This is a step in the right direction," said McGonagle. "The approval of the new plan will allow us to better attain and preserve the elderly character of these public housing communities." -From The Dorchester Reporter
VA Grants Benefits to Same-Sex Couples Days after the US Supreme Court ruled that the right to marry must be open to gays, the Department of Veterans Affairs extended marital benefits to same-sex couples who were denied them, even in states where other federal retirees received them. The new policy lifts restrictions on veterans’ pensions, VA-backed home loans, burial rights, survivor benefits, and disability compensation for same-sex married couples in every state, a change that advocates estimate could affect hundreds of thousands of veterans. Because of a longstanding federal law that applied only to veterans, gays and lesbians were shut out of many benefits the government extended to same-sex spouses since 2013. That’s when the court invalidated language in the Defense of Marriage Act that had defined a marriage — for federal benefits purposes — as only between a man and a woman. ‘‘We are thrilled that they are acting so quickly,’’ said Chris Rowsee, director of family readiness for the American Military Partners Association, which sued the VA last year on behalf of veterans who were denied spousal benefits. The lawsuit was on hold pending the Supreme Court decision. Other veterans groups praised the policy as a historic shift in a community whose older members were resistant just four years ago to lifting the military’s longstanding ban on gay, bisexual, and transgender troops serving openly. -See the full Boston Globe article.
Temporary Protected Status Announced for Nepal Secretary of Homeland Security Jeh Johnson recently announced his decision to designate Nepal for Temporary Protected Status (TPS) for 18 months based on the conditions resulting from the devastating magnitude 7.8 earthquake that struck Nepal on April 25, 2015, and the subsequent aftershocks. As a result, eligible nationals of Nepal residing in the United States may apply for TPS with U.S. Citizenship and Immigration Services (USCIS). The Federal Register notice published June 26th provides details and procedures for applying for TPS. The TPS designation for Nepal is effective now through December 24, 2016, and the 180-day TPS registration period began June 24, 2015 and runs through December 21, 2015. TPS status allows people to live and work in the U.S., but does not offer a path to permanent citizenship. Generally those with TPS are not considered “qualified” immigrants for federal benefits. TPS status, however, may be sufficient for state benefits and those federal benefits without strict immigration requirements (e.g., WIC). Further information in the Federal Register and at uscis.gov/tps. - Adapted from MIRA Coalition Bulletin, July 02, 2015.
Moments House Moments House is a volunteer-run support community serving Berkshire County residents living with a cancer diagnosis as well as their families and support systems. Patients and families can learn about area services and comfort and support one another through their shared experiences. Services and programs include art therapies, mind and body therapies, dance and music, yoga, touch, workshops, support groups, social activities, and bereavement services. All programs and services are offered free of charge and are open to all – including patient, spouses, caregivers, children, siblings, friends. -Thanks to Mary Zwirner for bringing this program to our attention.
FamilyAid Boston FamilyAid Boston helps families avoid homelessness; access shelter; transition to permanent housing; and regain their stability. They offer a variety of programs, a couple of which are highlighted below. While both programs are currently at capacity, one program advises to check-back periodically and the other is taking names for a waitlist. Homelessness Prevention Applicants for homelessness prevention services must live in the City of Boston, have children under the age of 18 and be at risk of losing their housing. Certain income guidelines apply. While at press time the program closed to new referrals, they suggested to call in future: prevention hotline 617-542-7286 ext. 238. Family Shelter Families must be homeless, from Boston, have children under the age of 18 and be over-income or otherwise ineligible for EA (Emergency Assistance family shelter program). During business hours, call 617-542-7286 x229. Outside of business hours access the program through the Mayor’s Hotline at 617-635-4500. The program is currently running a waitlist. Of note, their advocates are clinical social workers who assist not only with housing, but with employment and mental health concerns. May be helpful to prepare patients that they will be asking about more than just housing issues. FamilyAid Boston also offers additional services, including employment services for their clients. More on their website: http://www.familyaidboston.org/Home.aspx. See especially the referrals section for social service providers: http://www.familyaidboston.org/Referrals.aspx -Thanks to Hannah Godfrey for sharing this resource.
HotelTonight App A patient has been airlifted to the hospital, the family can’t afford a market rate hotel. What do they do? In addition to reviewing our Overnight Accommodations list, they might consider downloading the HotelTonight app from www.hoteltonight.com. Hotels that have unsold rooms may make them available at a discount. The app lets smart-phone users search for these last minute deals. Rooms are available one night at a time and are listed after noon each day. -Thanks to Samantha Ciarocco for sharing this resource.
New Resource Center Helps City Youths Make Career Connections Unemployed youths now have a new resource to help them succeed: the Connection Center, located inside the Ruggles MBTA station and designed to guide young people toward career independence. The center, officially launched this month by Mayor Martin J. Walsh, will refer 20- to 24-year-old high school graduates (or GED holders) to job training, post-secondary school, and employment programs. That demographic is “invisible” to many policy makers, said Neil Sullivan, executive director of the Boston Private Industry Council. “There’s no place for these young men and women to go,” Sullivan said. “The 21st-century labor market is unforgiving to people with only high school diplomas. We have a shrinking workforce and we need as many high school graduates as possible.” More than 9,000 young Bostonians were estimated to be out of school and out of work in the US Census Bureau’s 2011-2013 American Community Surveys. Among them are 4,747 young adults who graduated from high school without entering the labor market or higher education. A project of the Boston Opportunity Youth Collaborative, the center is part of Walsh’s local efforts for fulfilling President Obama’s My Brother’s Keeper Initiative, which focuses on helping youth complete postsecondary education and successfully enter the workforce. The center had a preliminary opening in February. Mentored by “success coaches,” many of whom are former opportunity youths themselves, Connection Center participants will get their needs assessed before being matched with compatible programs. Participating college, vocational, and career readiness programs include College Bound Dorchester, Inquilinos Boricuas en Acción, the Asian American Civic Association, and pharmacy technician training in the Jewish Vocational Service.
Since February, success coaches have placed 12 to 15 youths in college preparatory and training programs, said Kareem Lewis, 36, once an opportunity youth, now works as the center’s lead coach. More information and flyer at: http://bostonopportunityyouth.org/connection-center/ -See the full Boston Globe article.
2015 MassHealth Renewals for People with Disabilities For the next wave of federally required MassHealth renewals, MassHealth will be contacting certain MassHealth members with disabilities. They may need to submit a new application to keep their health care coverage. Members Who Need to Submit a New Application Members need to submit a new MassHealth application if they or a member of their household do not receive a letter in July saying they have been renewed automatically and they are:
MassHealth will send them a letter in August telling them how to apply. They will have 45 days to submit a new MassHealth application from the time they get that letter. Members Who Do NOT Need to Submit a New Application Disabled members do not need to submit a new MassHealth application if they are under age 65 and they:
At the beginning of July, persons described above who met the criteria for a streamlined review were sent letters from MassHealth saying they had been renewed automatically. They do not need to contact MassHealth unless they have any household changes (e.g., income, job loss, etc.) to update.
Important Points Regarding 2015 MassHealth Renewals
-From Updates from MassHealth and the Health Connector - 7/17/15, Mass Health Training Forum.
Connector Electronic Funds Transfer (EFT) Improvements Some improvements were made to the Health Connector's Electronic Funds Transfer (EFT) system this month to help ensure that it accepts payment information only from members who are enrolled. Please note the following changes:
After member information is validated as an existing enrollee known to the premium billing system, the portal will:
Here is a Job Aid that details each step a consumer should take to make an online payment. -Adapted from Updates from MassHealth and the Health Connector - 7/17/15, MA Health Care Training Forum.
Medicare Reminder: Hospital Discharge Appeal Rights People with Medicare can appeal a hospital discharge if they are not ready to leave. The appeal process for a hospital discharge is different from other Medicare appeals, because hospital discharge appeals follow a fast timeline. To appeal, the patient should first consult the Important Message from Medicare notice, which the hospital should provide a patient at least once during their inpatient hospital stay. Among other things, the notice tells patients how to request a review of their case by the Beneficiary and Family-Centered Care Quality Improvement Organization, often called the Quality Improvement Organization (QIO). The QIO is an independent body that reviews hospital discharge appeals for Medicare beneficiaries. Know that while the QIO is reviewing the appeal, the hospital must also provide the patient with a more detailed notice that explains why it thinks she is ready to leave. This is called a Detailed Notice of Discharge. In the meantime, the QIO will review the medical records and contact the patient for her opinion on the discharge. The QIO should make its decision and call the patient within 24 hours of receiving all the information it needs. If the appeal to the QIO is successful, the care will continue to be covered. If the appeal to the QIO is unsuccessful, the patient will not be held responsible for the cost of the 24-hour period while waiting for the QIO to make a decision. If the patient remains in the hospital after that period, she may be responsible for the cost of care if she does not win at a higher level of appeal. Learn more about the higher levels of Medicare appeals for hospital care that is ending. -Adapted from Dear Marci: Can I appeal a hospital discharge?, Medicare Rights Center, July 14, 2015.
New Medicare Guidelines May Encourage More Talks About End-of-Life Care Earlier this month, the federal health program for the elderly proposed to start paying physicians, nurse practitioners, and physician assistants to talk with patients about their end-of-life wishes. Details of the plan are expected later this year, with possible adoption next year. “It’s really an important first step. It shows we value these conversations,” said Dr. Jennifer S. Temel, a Massachusetts General Hospital oncologist, who often treats terminally ill patients. But advocates agree it will take much more than Medicare reimbursements to overcome the obstacles to end-of-life conversations. Both patients and doctors are reluctant to talk about death, and even the willing are unsure when to start. And medical professionals get little training on how to conduct such conversations. Ellen Goodman, a former Globe columnist who founded the Conversation Project to promote end-of-life planning, sees change afoot. The project’s Conversation Starter Kit, which gives tips to patients on talking to loved ones and medical professionals about their wishes, has been downloaded 200,000 times. The proposed Medicare payment is further indication of cultural change, Goodman said. “Let’s be sure,” she cautioned, “that it doesn’t become a quick and dirty checklist, that it becomes a thoughtful conversation.” She predicted that the Medicare rule would lead to new efforts at training. -See the full Boston Globe article.
Medicare to Pilot a Blend of Hospice Care and Treatment Most older Americans close to death have to make a difficult choice: continue with traditional medical treatment or switch to hospice care, which focuses not on a cure but on easing their remaining days. Now, Medicare is testing a third alternative: both. The new pilot program, designed to affect the care of about 150,000 Medicare patients over the next four years, will allow patients with terminal diseases to receive hospice care to manage suffering and counseling to plan for the end of life — but still see doctors and get medical treatments, like chemotherapy or hospitalization, intended to fight their illnesses. The test program is based on research that shows that patients with access to both so-called palliative care and traditional medicine often end up with a better quality of life and less expensive, intense medical treatment. The approach may even offer the patients a longer life span than those treated with traditional medicine alone. The speed with which cancer treatments are changing, for example, can lead to confusion. “It is harder for patients to decide that ‘I don’t want more chemotherapy,’ ” said Dr. Jennifer Temel, an author of a randomized study of patients with lung cancer, and clinical director of thoracic oncology at Massachusetts General Hospital. “I think we need more of a gray zone where patients can get the benefits of hospice care but still receive chemotherapy to help them live longer.” The Medicare pilot program will itself be a kind of randomized trial. So many hospices wanted to participate in the program that Medicare was able to randomly select half to start the program in 2016 and the rest to start two years later. Comparing the outcomes between the two groups, and a third group of hospices that never applied, will allow for a more robust evaluation of whether the policy makes sense for all of Medicare, said Dr. Patrick Conway, the principal deputy administrator and chief medical officer at the Centers for Medicare and Medicaid Services. -See the full The New York Times article.
New Domestic Violence Law Yielding Few Convictions Over a nine-month period in Plymouth County, just 10 out of the 126 cases of strangulation or suffocation of a family member or household member have resulted in convictions. In Bristol County, just 18 defendants out of 159 were convicted of charges under a law that went into effect last summer. And in Norfolk County? Ten defendants were convicted of the charge – out of 83 cases where a defendant was accused of strangulation under the law. Those low conviction rates are from preliminary data, compiled by the state’s 11 district attorneys and spanning the nine months, from Aug. 8 of last year to May 31 after new domestic violence legislation became law. A sweeping overhaul of the state’s domestic violence laws last August included two new charges intended to help domestic violence victims – strangulation and assault and battery on a family or household member. Across the state, the data showed that more than 70 percent of defendants escaped convictions in cases of strangulation and assault and battery on a family or household member that were closed in the nine-month period. “The numbers are the numbers. When you look at the domestic violence cases, they still remain very difficult cases to prosecute,” Plymouth County District Attorney Tim Cruz said. “You’re dealing with a particularly vulnerable group of victims. It’s not unusual for a victim to decline to go forward.” Prosecutors said several of the strangulation cases brought under the new law still are pending in court. But the low conviction rate of accused abusers has one advocate blasting the state and prosecutors for not doing enough to help victims. Domestic violence cases fail, causing incident rates to rise, because Massachusetts has a “disturbing policy of letting victims ‘drop the charges,’” said Wendy Murphy, a nationally recognized expert on sex crimes and a former prosecutor in Middlesex County. “It’s really a way to blame the victim herself if she ends up dead because prosecutors say, ‘I wanted to put the guy in jail but the victim dropped the charge,’” Murphy said. All prosecutors should have “no-drop” policies in place because studies show that they save lives, said Murphy. -See the full Enterprise News article.
Bills Seek More Stable Hours for Low-Paid Workers Unpredictable scheduling is on the rise across the country as the part-time and around-the-clock labor force expands, and there is a growing movement to give employees, most of them low-wage, more control.
A federal bill reintroduced last week and cosponsored by Massachusetts Senator Elizabeth Warren, as well as bills in 10 states, including Massachusetts, would require employers to stabilize schedules, from posting work shifts several weeks in advance to giving additional pay to workers who are on call, or whose shifts are cut or changed on short notice. These schedules — often generated by software that calculates how many workers are needed at certain times, alerting managers when business is slow and they can send people home — are sometimes referred to as “just-in-time” schedules. More employers are using software to manage their increasingly part-time workforces, knowing that workers hungry for higher pay won’t balk at taking shifts at inconvenient times, said Naomi Gerstel, a University of Massachusetts Amherst professor whose book “Unequal Time” addresses unpredictable work schedules in health care. In Massachusetts, business owners are pushing back against the proposed changes, which they say would add to the growing costs and paperwork caused by other recent regulations, such as a mandate for paid sick time and increases in the minimum wage. Adding to the strain are federal efforts to make more workers eligible for overtime and fewer eligible to be independent contractors. Set schedules may actually be beneficial for businesses, said Joan Williams, founding director of the Center for WorkLife Law at the University of California Hastings College of the Law in San Francisco. Williams is about to launch a pilot program with Gap Inc. that will implement stable schedules at some stores and compare their performance with those that continue to give workers less predictable shifts. Research suggests that there is a cost to irregular schedules, she said, including high turnover and absentee rates. -See the full Boston Globe article.
Family Homelessness Surges In Boston, Census Finds The number of homeless families in Boston has jumped by one-quarter in one year, according to the city’s annual point-in-time census. There were 1,543 homeless families on Feb. 25 — the date of the census — a 25 percent increase over the last count: 1,234 families on Dec. 16, 2013. The surge in family homelessness “reflects substantial increased demand for emergency shelter and transitional housing, as rents continue to rise in Boston and the kind of deep rental assistance extremely low-income families need remains scarce,” the Boston Public Health Commission said. Overall, the city’s homeless population increased 5.6 percent, when comparing the February census to the previous count, in late 2013. That’s after hikes of about 4 percent in Boston’s overall homeless population each of the prior two years. Of the overall tally, the city census reported the number of homeless children increased by 18.7 percent this year — from 2,056 to 2,440. Some good news: The number of homeless adults living on the streets in Boston continues to be low when compared with peer cities, the Boston Public Health Commission said in its release. Just 1.7 percent of the total homeless count was unsheltered on the Feb. 25 census date. -See the full WBUR story.
When It Comes to Hospital Shootings, Emergency Color Codes Don’t Work It is hard to think that anything went right at Brigham and Women’s Hospital (BWH) on the morning of January 20, when Stephen Pasceri murdered cardiac surgeon Michael Davidson and then turned the gun on himself. Yet in the midst of the chaos, a lot of things did go right: Police were on the scene within seconds; all 5 million square feet of the hospital were cleared within 16 minutes; and the violence did not spill beyond the exam room. Perhaps one of the most important lessons of this tragedy is contained in a 39-word script that was read aloud over the hospital’s PA system moments after the first shots rang out: “A life-threatening situation now exists at Watkins Clinic B—Shapiro 2. All persons should immediately move away from that location if it is safe to do so. If it is not safe to move away, shelter in place immediately.” Had the horror unfolded at another hospital, there’s a good chance that bystanders would have been met with a vague color-coded emergency warning—Code Silver or Code Green, for instance. Color codes are part of hospital culture. These seemingly benign announcements help staff respond to emergencies without inciting alarm. But this system fails when the emergency at hand threatens visitors, patients, and other individuals who aren’t versed in the spectrum of codes. Given the rise of hospital shootings—they are now a monthly occurrence in the U.S.—should color codes for such emergencies be replaced with straightforward announcements? “It really does not make sense to call a code,” says Robert Chicarello, director of security at BWH. Chicarello says the issue first came to his attention after the 2007 Virginia Tech shooting, which claimed more than 30 lives. As the years went on and massacres piled up across the country, BWH took a close look at its plans for responding to an active-shooter situation. From the outset, Chicarello and his team were keenly aware that approximately 26,000 people walk through the hospital’s doors every day, thousands of whom have no training in hospital codes. Through a series of roundtables and trainings, a team from the hospital decided in late 2013 to replace the code with a scripted announcement. “It needs to be plain English so untrained visitors, patients, anybody who is in the building, can hear it and know what’s happening...It doesn’t have to be what we used, but it needs to be plain English. There’s no downside,” Chicarello says. Still, while the scripted announcement proved effective that deadly winter morning, there’s room for improvement, says Eric Goralnick, medical director of emergency preparedness at BWH. “Our plain language probably isn’t plain enough,” he says, noting that in follow-up interviews after the shooting, several people raised concern with what the term “shelter in place” means. In the wake of Davidson’s murder, Partners HealthCare, the parent organization of BWH, Mass General, and McLean Hospital, among others, has implemented the scripted shooter warning across all of its facilities. Goralnick would like to see other hospitals follow suit. -See the full Enterprise News article.
Beans, Greens, and the Best Foods for the Brain and Mental Health For the past 3 years, the American Psychiatric Association annual meeting has included a session called "Food and Brain”. Drew Ramsey, MD, assistant clinical professor of Psychiatry at Columbia University College of Physicians & Surgeons in New York City, in collaboration with the new International Society for Nutritional Psychiatry, is in the process of developing a standardized "brain food diet." "Food is a very effective and underutilized intervention in mental health," he started off. "We want to help our patients have more resilient brains by using whole foods...by helping get patients off of processed foods, off of white carbohydrates, and off of certain vegetable oils." Though the field is in its infancy, food psychiatry is increasingly being embraced by clinicians and researchers, as a paper published earlier this year in the Lancet Psychiatry attests. "Although the determinants of mental health are complex," the authors wrote, "the emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence of mental disorders suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and gastroenterology." Other recent work found that simply discussing diet with a counselor for just 6 hours over the course of 2 years dropped Beck Depression Inventory scores by 40% in elderly patients with depression. "The data are very promising that we can positively influence mental health through dietary interventions," commented Dr Ramsey. The Best Foods for the Brain So how does Dr Ramsey encourage his patients to eat healthier in the interest of mental health? "You don't have to do some extensive food survey," he says. "I'll just say 'Hey, let's talk about food for a few minutes because it plays a big role in mental health.'" Dr Ramsey will ask his patients what they've had for breakfast, lunch, and dinner over the past few days. "It's not our job to say, 'Eat vegan' or 'Eat paleo'; it's to partner with our patients based on where they are and help them select more nutrient-dense foods," says Dr Ramsey. "Look for allergies, aversions, and even ask about what their childhood dinner table was like—looking for how people eat food and where improvements can be made." He also cautions to be on the lookout for too much beige: pizza, pasta, and rice. "Eat the rainbow," he says, given that bold, bright colors in nature tend to signify valuable vitamins and phytonutrients (the reds, purples, and greens in particular). Dr Ramsey is currently co-developing a brain food manual to provide clinicians with key points about food groups and specific ingredients to help them talk to their patients. Part of the project entails developing a mathematical scale to rank the healthiest brain foods. The list is still in development. -See the full Medscape Psychiatry summery article.
Exercise Provides Cognitive Benefit in Patients With AD In the first study of its kind, Danish researchers have shown that intensive aerobic exercise has a positive cognitive effect in patients with Alzheimer's disease (AD). The single-blinded, randomized, controlled study demonstrated the training intervention was feasible in that few patients dropped out, and it had a dose effect in that the most adherent patients who achieved a high maximum heart rate fared the best, said Gunhild Waldemar, MD, director, Danish Dementia Research Center, and professor, neurology, Copenhagen University Hospital, Denmark. Dr Waldemar presented the new data at the first Congress of the European Academy of Neurology (EAN). To date, some epidemiologic studies have found that midlife physical activity in healthy people lowers later dementia risk, the authors note. Studies in mice have shown that exercise reduces Alzheimer pathology, and other research has demonstrated that moderate physical activity improves cognition in older adults who are at high risk for dementia. But there is little evidence of the effect of physical exercise in people who already have dementia, said Dr Waldemar. "This is the first rigorously conducted study of moderate- to high-intensity aerobic exercise in mild to moderate AD," she said. -See the full Medscape summary article.
Two Antidepressants Linked to Birth Defects The latest study on the risk for birth defects in women taking selective serotonin reuptake inhibitors (SSRIs) early in pregnancy provides "reassuring" evidence for some antidepressants in this class but not others. The study of nearly 28,000 women found no increased risk for birth defects linked to citalopram (Celexa, Forest Laboratories, Inc), escitalopram (Lexapro, Forest Laboratories, Inc), and sertraline (Zoloft, Pfizer Inc) but confirmed two previously reported birth defects associated with fluoxetine (multiple brands) ― heart wall defects and craniosynostosis ― and five previously reported birth defects associated with paroxetine (multiple brands), including heart defects, anencephaly, and abdominal wall defects. Although these birth defects occurred 2 to 3.5 times more frequently among infants of women taking paroxetine or fluoxetine early in pregnancy, the absolute risk is low, the researchers note. The study was published online July 8 in the BMJ. Clinical Guidance "This paper should be helpful to healthcare providers because it combines the knowledge from the literature with data from one of the largest studies able to look at these issues, the National Birth Defects Prevention Study," first author Jennita Reefhuis, PhD, epidemiologist with the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention, told Medscape Medical News. "Early pregnancy is a critical time for a baby's organs to develop, so the best time to discuss the safety of medication use is before pregnancy. If healthcare providers are treating women who are already pregnant, it is important to discuss the risk and benefits of antidepressants as well as the safest options available to treat their mental health condition during pregnancy," Dr Reefhuis said. SSRIs are widely used by women of childbearing age and during pregnancy. Reports of an association between paroxetine and heart defects prompted the US Food and Drug Administration to issue a safety alert in 2005. Continued Scrutiny Warranted Dr Reefhuis and colleagues say that it is "reassuring" that none of the five previously reported associations between sertraline and birth defects were confirmed in this analysis, especially because about 40% of women who reported using an SSRI during early pregnancy used sertraline. The analysis also failed to provide support for nine other previously reported associations between SSRI use during pregnancy and selected birth defects. "This analysis confirms the need to assess the association between specific SSRIs and specific birth defects rather than combining an entire drug class or heterogeneous group of birth defects," the researchers write. "Continued scrutiny of the association between SSRIs and birth defects is warranted, and additional studies of specific SSRI treatments during pregnancy and birth defects are needed to enable women and their healthcare providers to make more informed decisions about treatment," they conclude. "Meanwhile, the current analysis can help guide healthcare providers and women to the safest options for treatment during early pregnancy to minimize the risk of major birth defects, while providing adequate treatment of maternal depression." -See the full Medscape summary article.
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