Large study determines number needed to be vaccinated to prevent COVID-19 hospitalizations and ED visits

Analysis provides real-world measurement of benefit of vaccination including booster

Peer-Reviewed Publication

REGENSTRIEF INSTITUTE

An analysis of real-world data from more than 1.2 million patients from health systems in four geographically dispersed states -- Indiana, Oregon, Texas and Utah -- conducted by the U.S. Centers for Disease Control and Prevention’s VISION Network, has determined both the number of adults needed to be vaccinated to prevent one COVID-19 associated hospitalization and the number needed to be vaccinated to prevent one COVID-19 associated emergency department (ED) visit.

This study is one of the first, largest and most comprehensive studies to present clear measurement, by age groups, of how widespread vaccination needs to be to provide protection against serious and moderate disease in adults.

Preventing a hospitalization indicates that vaccination provided protection against severe disease. Preventing an ED visit indicates that vaccination provided protection against moderate disease.

“The number needed to be vaccinated or more technically, ‘number needed to vaccinate,’ comes from the related concept of ‘number needed to treat’ -- how many must be treated to avoid one bad outcome. One can think of number needed to treat or vaccinate as similar to how much gas you need, or how hard you need to push on the gas pedal to accelerate,” said study co-author Shaun Grannis, M.D., M.S., Regenstrief Institute Vice President for Data and Analytics and the Regenstrief Professor of Medical Informatics at Indiana University of School of Medicine. “Knowing the number of patients who need to be vaccinated is a way of measuring how effective the vaccine is. The lower the number of patients needed to be vaccinated, the more effective the vaccine. If we can prevent more hospitalizations with fewer vaccinations, that's important to know.  

“Knowing the number of patients needed to be vaccinated helps us plan on the volume of vaccine needed and the type of awareness and education that we want to provide. This number informs decision-making processes by public health officials, vaccine producers, health systems and others.”

The study found that the number of patients needed to be vaccinated to prevent one COVID-19-associated hospitalization was higher than the number needed to vaccinate to prevent one COVID-19 associated ED visit, reflecting differences in outcome severity. These numbers were dependent on patient risk factors as well as local disease incidence.

The number needed to be vaccinated to prevent one COVID-19-associated hospitalization ranged from 44 to 615 (median was 205) individuals and was lower for adults aged 65 years or older and for those with underlying medical conditions. The number needed to be vaccinated decreased as the population became older because older individuals are more susceptible to the adverse effects of the virus and, therefore, the vaccine provides greater protection.

The number of patients needed to be vaccinated to prevent COVID-19-associated ED visits showed a different pattern because vaccines were more effective at preventing ED visits among younger adults than older ones. The median number needed to be vaccinated to prevent one ED visit ranged from 75 to 592 (median was 156) individuals.

Information from patients who had received either two or three mRNA vaccine doses was analyzed. None were immunocompromised. Data was from December 2021- February 2022, a period of Omicron BA.1 variant predominance.

“The reason why the number of patients needed to be vaccinated to prevent a COVID-19 related hospitalization is different from the number needed to prevent an ED (Emergency Department) visit is not fully understood, but it is likely because of how people seek healthcare. Many people, especially younger ones who lack health insurance or Medicare, are more likely to use the ED for primary healthcare. On the other hand, older people usually go to their regular doctor instead of going to the ED,” Dr. Grannis observed.

“Number needed to vaccinate with a COVID-19 booster to prevent a COVID-19-associated hospitalization during SARS-CoV-2 Omicron BA.1 variant predominance, December 2021-February 2022, VISION Network: a retrospective cohort study” is published in The Lancet Regional Health–Americas.

Regenstrief Institute co-authors, in addition to Dr. Grannis, are Interim Director of the Center for Biomedical Informatics Brian Dixon, PhD, MPA; William F. Fadel, PhD and Nimish R. Valvi, DrPH. Peter Embí, M.D., former president of the Regenstrief Institute and current affiliated scientist, is also a co-author.

All authors and affiliations:

Katherine Adams, MPH1; John J. Riddles, M.S.2; Elizabeth A. K. Rowley, DrPH2; Shaun J. Grannis, M.D., M.S.3,4; Manjusha Gaglani, MBBS5,6; Bruce Fireman, M.A.7; Emily Hartmann, MPP8; Allison L. Naleway, PhD9; Edward Stenehjem, M.D., MSc10; Alexandria Hughes, PhD2; Alexandra F. Dalton, PhD1; Karthik Natarajan, PhD11,12; Kristin Dascomb, M.D., PhD10; Chandni Raiyani, BDS, MPH5; Stephanie A. Irving, MHS9; Chantel Sloan-Aagard, PhD8,13; Anupam B. Kharbanda, M.D.14; Malini B. DeSilva, M.D., MPH15; Brian E. Dixon, PhD, MPA3,16; Toan C. Ong, PhD17; Jean Keller, M.S.2; Monica Dickerson, B.S.1; Nancy Grisel, MPP10; Kempapura Murthy, MBBS, MPH5; Juan Nanez, R.N., BSN8; William F. Fadel, PhD3,16; Sarah W. Ball, ScD, MPH2; Palak Patel, MBBS, MPH1; Julie Arndorfer, MPH10; Mufaddal Mamawala, MBBS, MPH5; Nimish R. Valvi, DrPH15; Margaret M. Dunne, MSc2; Eric P. Griggs, MPH1; Peter J. Embi, M.D., M.S.3,18; Mark G. Thompson, PhD1; Ruth Link-Gelles, PhD1; and Mark W. Tenforde, M.D., PhD1.

1Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia; 2Westat, Rockville, Maryland; 3Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana; 4School of Medicine, Indiana University, Indianapolis, Indiana; 5Baylor Scott & White Health, Temple, Texas; 6Texas A&M University College of Medicine, Temple, Texas;7Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland; 8Paso del Norte Health Information Exchange (PHIX), El Paso, Texas; 9Center for Health Research, Kaiser Permanente Center for Health Research, Portland, Oregon; 10Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah; 11Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York; 12New York-Presbyterian Hospital, New York; 13Brigham Young University Department of Public Health, Provo, Utah; 14Children's Minnesota, Minneapolis, Minnesota; 15HealthPartners Institute, Minneapolis, Minnesota; 16Fairbanks School of Public Health, Indiana University, Indianapolis; 17School of Medicine, University of Colorado Anschutz Medical Campus, Aurora; and 18Vanderbilt University Medical Center, Nashville, Tennessee.

About Shaun Grannis, M.D., M.S.
In addition to his role as the vice president for data and analytics at Regenstrief Institute, Shaun Grannis, M.D., M.S., holds the Regenstrief Chair in Medical Informatics and is a professor of family medicine at Indiana University School of Medicine.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe. 

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission. 

About IU School of Medicine
IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

 

---

JOURNAL

The Lancet Regional Health - Americas

DOI

10.1016/j.lana.2023.100530 

ARTICLE TITLE

Number needed to vaccinate with a COVID-19 booster to prevent a COVID-19-associated hospitalization during SARS-CoV-2 Omicron BA.1 variant predominance, December 2021-February 2022, VISION Network: a retrospective cohort study

 

Advancing chemical recycling of waste plastics

New research from the University of Pittsburgh proposes computational approach for predicting product distributions

Peer-Reviewed Publication

UNIVERSITY OF PITTSBURGH

 

IMAGE: COVER ART FOR ACS JCTC VOL. 19 ISS. 12 FEATURING RESEARCH FROM THE LAB OF ASSOCIATE PROFESSOR GIANNIS MPOURMPAKIS. view more 

CREDIT: SUNGIL HONG, HYUNGUK KWON, AND GIANNIS MPOURMPAKIS

It’s lightweight, low-cost, almost endlessly customizable, and concerningly ubiquitous: For all its benefits, plastic—and plastic waste—is a big problem. Unlike glass, which is infinitely recyclable, plastic recycling is challenging and expensive because of the material’s complex molecular structure designed for specific needs.

Globally, an estimated 380 million metric tons of plastic is produced every year. However, only about 9 percent of all plastic waste is recycled, about 12 percent is incinerated, and the rest is discarded in landfills and the natural environment.

New research from the lab of Giannis Mpoumpakis, associate professor of chemical and petroleum engineering at the University of Pittsburgh, focuses on optimizing a promising technology called pyrolysis, which can chemically recycle waste plastics into more valuable chemicals. The paper was published recently and featured on the cover of the American Chemical Society (ACS) Journal of Chemical Theory and Computation.

 

 

“Pyrolysis is relatively low in cost and can generate high-value products, so it presents an appealing, practical solution,” said Mpourmpakis. “It has already been developed on a commercial scale.The main challenge now is finding optimal operating conditions, given the starting and final chemical products, without needing to rely heavily on trial-and-error experimentation.”

To optimize pyrolysis conditions and produce desired products, researchers typically use thermodynamic calculations based on what’s known as the Gibbs free energy minimization approach. However, the lack of thermochemical data can limit the accuracy of these calculations.

While density functional theory (DFT) calculations are commonly used to obtain precise thermochemical data for small molecules, their application becomes challenging and computationally expensive for the large, flexible molecules that make up waste plastics, especially at elevated temperatures of pyrolysis. 

In this study, Mpourmpakis and former postdoc Hyunguk Kwon, who is now a professor at Seoul National University of Science and Technology, developed a computational framework to accurately calculate the temperature-dependent thermochemistry of large and flexible molecules. This framework combines conformational search, DFT calculations, thermochemical corrections, and Boltzmann statistics; the resulting thermochemistry data is used to predict the thermal decomposition profiles of octadecane, a model compound representing polyethylene.

The proposed computational analysis based on first principles offers a significant advancement in predicting temperature-dependent product distributions from plastic pyrolysis. It can guide future experimental efforts in chemical plastic recycling, enabling researchers to optimize pyrolysis conditions and increase the efficiency of converting waste plastics into valuable chemicals. 

“The production of plastics is expected to keep increasing, so it’s essential that we find and perfect ways to recycle and reuse plastics without harming the environment,” said Mpourmpakis. “This work, which has been funded by the National Science Foundation, contributes to the development of sustainable waste management strategies and the reduction of plastic pollution, offering potential benefits for both the environment and society.”

The paper, “Ab Initio Thermochemistry of Highly Flexible Molecules for thermal Decomposition Analysis,” (DOI: 10.1021/acs.jctc.3c00265), was featured on the cover of the June 23, 2023 issue of the Journal of Chemical Theory and Computation.

---

DOI

10.1021/acs.jctc.3c00265 

ARTICLE TITLE

Ab Initio Thermochemistry of Highly Flexible Molecules for thermal Decomposition Analysis

 

Study improves understanding of how bacteria benefit plant growth

UC Riverside-led research aims to improve sustainable agricultural practices

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - RIVERSIDE

 

IMAGE: CO-AUTHORS ARAFAT RAHMAN (SECOND FROM LEFT) AND MAX MANCI (RIGHT) ARE SEEN HERE IN THE FIELD ALONG WITH COLLEAGUES. view more 

CREDIT: SACHS LAB, UC RIVERSIDE.

RIVERSIDE, Calif. -- Plants form alliances with microbes in the soil in which they grow. Legumes, for example, benefit from a symbiotic relationship with microbes that inhabit nodules in their roots and “fix” nitrogen in the atmosphere to make it available to promote the legumes’ growth. But are microbes always beneficial to plants? Or does competition between strains for plant access degrade the service the bacteria ultimately provide?

A team led by scientists at the University of California, Riverside, set up experiments to answer these questions and better understand the competition process. The researchers used a native California plant with nodules, Acmispon strigosus, and a set of eight compatible nitrogen-fixing bacterial strains. They infected some plants with each of the eight strains to directly measure their ability to infect the plants and provide benefits. They then infected other plants with pairs of bacterial strains to assess the competitive ability of each strain and the effect on plant performance.

The researchers found that competition between strains of beneficial bacteria in the soil degrades the service that the bacteria provide to their hosts. 

“More specifically, we found interstrain competition that occurs in the soil before the bacteria infect the plant causes fewer of the bacteria to colonize the plant, resulting in the plant gaining smaller benefits in the end,” said Joel Sachs, a professor of evolution, ecology, and organismal biology, who led the research team. “To understand symbiosis, we often use sterile conditions where one strain of bacteria is ‘inoculated’ or introduced into an otherwise sterile host. Our experiments show that making that system slightly more complex — simply by using two bacterial strains at a time — fundamentally shifts the balance of benefits that the hosts receive, reshaping our understanding of how symbiosis works.”

Study results appear in the journal Current Biology.

Sachs explained that a core challenge in agriculture is leveraging the services that microbes can provide to crops by promoting growth in a sustainable way, without the environmental costs of chemical fertilizers. His lab studies rhizobia — bacteria that promote plant growth. Rhizobial competition is a longstanding problem for sustainable agriculture. Rhizobia form root nodules on legumes, within which the bacteria fix nitrogen for the plant in exchange for carbon from photosynthesis. Growers have long sought to leverage rhizobia to sustainably fertilize staple legume crops such as soybean, peanuts, peas, and green beans. 

“One might think using rhizobia as inoculants should allow growers to minimize the use of chemical nitrogen, which is environmentally damaging,” said Sachs, who chairs the Department of Evolution, Ecology, and Organismal Biology. “But such rhizobial inoculation is rarely successful. When growers inoculate their crops with high-quality rhizobia — strains that fix a lot of nitrogen — these ‘elite’ strains get outcompeted by indigenous rhizobia that are already in the soil and provide little or no benefit to hosts.”

In their experiments, Sachs and his colleagues used bacterial strains whose genomes they had already sequenced. They also characterized the strains, which ranged from highly beneficial to ineffective at nitrogen fixation, to know exactly how beneficial they were to the target plant species. The researchers sequenced the contents of more than 1,100 nodules, each of which was from a plant that was inoculated with one of 28 different strain combinations.

Next, the researchers developed mathematical models to predict how much benefit co-inoculated plants would gain based on expectations from plants that were “clonally infected” (infected with one strain). This allowed the researchers to calculate the growth deficit that was specifically caused by interstrain competition.

“Our models showed that co-inoculated plants got much lower benefits from symbiosis than what could be expected from the clonal infections,” said Arafat Rahman, a former graduate student in Sachs’ lab and the first author of the research paper. “While beneficial bacteria work well in the lab, they get out-competed in the natural environment. Ultimately, we want to find a strain of bacteria — or a set of them — that gives maximum benefit to the host plant and is competitive against bacterial strains that are already in the soil.”

Sachs explained that to discover and develop a bacterial strain that is highly beneficial to plants, scientists need to conduct experiments under very clean conditions. 

“Ultimately, we want to use beneficial bacteria in agriculture,” he said. “To identify these bacteria, we would, typically, add one bacterial strain to a plant in the lab and show that the plant grows much better with the strain than without. In the field, however, that plant is covered in microbes, complicating the story. In our experiments, we advanced from using one strain to a pair of strains to see what impact that has on plant growth. Interestingly, with just two strains, many of our predictions fell apart.”

Rahman stressed that while experiments are needed to ascertain how beneficial a bacterial strain is, experiments that test how competitive the strain is against a panel of other bacterial strains are also needed.

“Both steps are crucial,” he said. “Our work found some of the best strains can be highly beneficial to plant growth but as soon as you pair them with any other strain, that benefit is greatly reduced. Further, it is important to know at which stage the interstrain competition takes place: before the bacteria interact with the plant or after? Our work suggests it’s the former and provides a useful guide to designing future experiments aimed at discovering strains that are better for delivery in crops.”

Sachs said that in a lot of current experimental designs the focus is on the benefit to plants. 

“It’s important, however, to keep in mind that bacteria are shaped by natural selection,” he said. “Some of them may be highly competitive in entering the nodule to infect the plant but not be very beneficial to the plant and that could be a trait that wins out in nature. If we are to leverage microbial communities for the services they can provide to plants and animals, we need to understand interstrain dynamics in these communities.”

According to Sachs and Rahman, sustainable growth practices need to be a critical aspect of new agriculture to feed a growing population on a limited resource base. 

“This will require moving past polluting methods such as adding huge amounts of chemical nitrogen to soil,” Sachs said. “Understanding how to efficiently deliver beneficial microbes to a target host is a central challenge in medicine, agriculture, and livestock science. By revealing that interstrain dynamics can reduce the benefits of symbiosis, our work has opened new avenues of research to improve sustainable agricultural practices.”

Sachs and Rahman were joined in the study by Max Manci, Cassandra Nadon, Ivan A. Perez, Warisha F. Farsamin, Matthew T. Lampe, Tram H. Le, and Lorena Torres Martínez of UCR, and Alexandra J. Weisberg and Jeff H. Chang of Oregon State University. Rahman plans to join Oregon State University as a postdoctoral researcher.

The research was supported by grants from the National Science Foundation and the U.S. Department of Agriculture.

The title of the research paper is “Competitive interference among rhizobia reduces benefits to hosts.”

The University of California, Riverside is a doctoral research university, a living laboratory for groundbreaking exploration of issues critical to Inland Southern California, the state and communities around the world. Reflecting California's diverse culture, UCR's enrollment is more than 26,000 students. The campus opened a medical school in 2013 and has reached the heart of the Coachella Valley by way of the UCR Palm Desert Center. The campus has an annual impact of more than $2.7 billion on the U.S. economy. To learn more, visit www.ucr.edu.

---

JOURNAL

Current Biology

DOI

10.1016/j.cub.2023.06.081 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Competitive interference among rhizobia reduces benefits to hosts

ARTICLE PUBLICATION DATE

24-Jul-2023

 

Consumption of soft drinks and overweight and obesity among adolescents in 107 countries and regions

JAMA Network Open

Peer-Reviewed Publication

JAMA NETWORK

About The Study: The prevalence of daily consumption of soft drinks was associated with the prevalence of overweight and obesity among adolescent students in this study of 107 countries and regions. These results, in conjunction with other evidence, suggest that reducing soft drink consumption should be a priority in combating adolescent overweight and obesity. 

Authors: Huan Hu, Ph.D., of the National Institute of Occupational Safety and Health in Kanagawa, Japan, is the corresponding author. 

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/ 

(doi:10.1001/jamanetworkopen.2023.25158)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

#  #  #

http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.25158?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=072423

About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

---

JOURNAL

JAMA Network Open

 

Community health worker home visiting and birth outcomes among Medicaid recipients

JAMA Pediatrics

Peer-Reviewed Publication

JAMA NETWORK

About The Study: Participation in a home visiting program provided by community health workers working with nurses and social workers, compared with usual care, was associated with reduced risk for adverse birth outcomes, improved prenatal and postnatal care, and reductions in disparities, among birthing individuals with Medicaid. The risk reductions in adverse birth outcomes were greater among Black individuals. 

Authors: Cristian I. Meghea, Ph.D., of Michigan State University in East Lansing, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamapediatrics.2023.2310)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

#  #  #

 https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2023.2310?guestAccessKey=2979eea6-c3d2-4151-a8d4-ad4585abaa9f&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=072423

---

JOURNAL

JAMA Pediatrics

 

Dementia becomes an emergency 1.4 million times a year

Accidents and behavioral disturbances lead the list of reasons for emergency department visits – suggesting need for better caregiver support to prevent crises

Peer-Reviewed Publication

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

A busy, crowded, confusing emergency room is not an ideal place for a person living with dementia.

But 1.4 million times a year, people with Alzheimer’s disease and other forms of dementia end up in emergency care, a new study shows.

Together, they make up nearly 7% of all emergency visits for any reason by people over age 65, according to a University of Michigan team’s findings published in JAMA Neurology.

And compared with their peers who don’t have dementia, these patients have twice the rate of seeking emergency care after an accident or a behavioral or mental health crisis, the researchers show.

With about 6 million Americans currently estimated to have dementia, the study suggests there’s a lot of opportunity to prevent future emergency visits by better supporting dementia caregivers, thereby, the researchers say.

Lead author Lauren B. Gerlach, D.O., M.Sc., says the findings could help inform efforts to support family caregivers and nursing facility staff in reducing patients’ risks of injury, and preventing the agitation, aggression and distressing behaviors that people with dementia can experience.

“While dementia is thought of as a cognitive or memory disorder, it is the behavioral aspects of the disease such as anxiety, agitation and sleep disturbances that can cause the most stress for caregivers and patients alike”, said Gerlach, a geriatric psychiatrist at Michigan Medicine, U-M’s academic medical center. “Emergency departments are often not the right place to manage these behaviors,” she added. “We really need to do better to support caregivers so there are options other than seeking emergency care.”

Once a person with dementia is in the emergency department, it can be a very disorienting experience, Gerlach explains. “This is especially true in the context of a busy ED where visits can last many hours and patients may have difficulty understanding what is occurring or communicating their needs,” she said. “Even routine blood draws from unfamiliar staff can be a very scary experience for a patient with advanced dementia.”

To make matters worse, behavioral symptoms common in this group can lead to treatment with potentially dangerous sedative medications.

Emergency department patients with dementia received antipsychotic medications at more than twice the rate as other emergency patients over age 65 during their visit, the study shows. Such drugs, often used to sedate people with dementia and calm their behavioral symptoms, can carry major risks if used long-term – including increasing the risk of fall accidents and death as highlighted in warnings from the U.S. Food & Drug Administration. Long after the emergency has ended, the concern is that these newly started antipsychotic and sedative medications in could then continue to be prescribed long-term, putting patients with dementia at further risk, said Gerlach.

The study also adds evidence that older adults with dementia may be treated differently in the emergency department. People with dementia were much more likely than those without to receive a urine test or a CT scan of their head.

“Difficulty in the ability of patients with dementia to communicate their symptoms verbally can make it challenging to distinguish what is causing their symptoms,” Gerlach explains. “Is it related to a change in their environment, difficulty between the patient and their caregiver, or an underlying medical issue?”

For instance, urinary tract infections can cause pain that can lead to agitation or aggression in a person with dementia, who may not be able to express what they’re feeling. However, these challenges can sometimes lead to indiscriminate laboratory testing and imaging, Gerlach adds.

The data for the study came from the National Hospital Ambulatory Medical Care Survey conducted by the Centers for Disease Control and Prevention, and include information on people over 65 no matter what form of health care coverage they had.  

Gerlach and Matthew A. Davis, Ph.D., an associate professor in the U-M School of Nursing and Michigan Medicine’s Department of Learning Health Sciences, note that there has not been much research on emergency care for people with dementia, despite the fact that clinicians and caregivers who care for such patients know from experience that emergencies can be common.

Helping caregivers prevent and respond to dementia-related crises

Caregiver stress and burnout from a lack of respite or support may play a role in the need for seeking emergency care in people with dementia, noted Gerlach, who is an assistant professor in the U-M Department of Psychiatry.

She sees promise in a new proposed Medicare rule that would allow health care teams to get reimbursed for sessions that educate family caregivers – including on how to prevent or soothe behavioral symptoms among their loved ones.

One approach to this, called DICE, was co-developed at Michigan Medicine’s geriatric psychiatry division and is now available online to dementia caregivers anywhere. Gerlach also recommends the caregiver support programs and information offered by the Alzheimer’s Association, and videos from UCLA Health, available in multiple languages, to her patients’ caregivers to help manage these behaviors.

Those who live with people who have dementia should also consider safety upgrades in the home to reduce fall risks and the chance of other injuries. “It’s important to match the home environment to their needs and ability, which could reduce the risk of emergency care being needed,” Gerlach said.

The rise of geriatric-focused emergency departments or areas within larger emergency departments may also help, Gerlach noted, but they are not available in all areas.

It’s also important for families to be realistic about when it’s time to seek emergency services for their loved one with dementia.

If physical aggression or falling risk gets to be too much for a family caregiver to handle, the safety of the patient and the caregiver must outweigh the desire to keep them at home, Gerlach says. “But before that, there is a lot we can do in the outpatient setting to help prevent crisis and the need for emergency care,” she said.

The study was funded by the National institute on Aging, part of the National Institutes of Health (AG066864, AG066582) including the grant that funds the U-M Center to Accelerate Population Research in Alzheimer’s, headed by co-author and geriatrician Julie Bynum, M.D., M.P.H.

Gerlach, Davis and Bynum are members of the U-M Institute for Healthcare Policy and Innovation. U-M data analyst Jonathan Martindale, MHI, is also an author on the paper.

Citation: Characteristics of Emergency Department Visits Among Older Adults With Dementia, JAMA Neurology, DOI:10.1001/jamaneurol.2023.2244

 

---

JOURNAL

JAMA Neurology

DOI

10.1001/jamaneurol.2023.2244 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Characteristics of Emergency Department Visits Among Older Adults With Dementia

ARTICLE PUBLICATION DATE

24-Jul-2023

US Supreme Court asked to set aside ruling that blocks construction on Mountain Valley Pipeline

AP• Yesterday 


CHARLESTON, W.Va. (AP) — The fate of a controversial natural gas pipeline in West Virginia may rest with the U.S. Supreme Court, as the state appealed a lower court's ruling that temporarily blocked construction despite a Congressional order clearing the way for the project.

West Virginia Attorney General Patrick Morrisey argued that the 4th Circuit Court of Appeals in Richmond, Virginia, lacked jurisdiction to block the Mountain Valley Pipeline. In a statement Monday, he said any challenges to Congress' action must be heard by a federal appeals court in Washington, D.C.

Morrisey asked the U.S. Supreme Court to take up the case.

“The Mountain Valley Pipeline is vital to the survival of American energy independence and affects thousands of jobs in West Virginia — its completion is also critical to our national security, the urgent need is for it to be completed as soon as possible,” Morrisey said.

Related video: Appeals court blocks construction on Mountain Valley Pipeline even after Congress says it can't (WTVR Richmond, VA)   Duration 1:20   View on Watch

Congress passed legislation last month ordering all necessary permits be issued for the pipeline, which crosses rugged mountainsides in Virginia and West Virginia. Environmentalists say the construction plan will cause erosion that will ruin soil and water quality.

The legislation addressing the pipeline was part of a bipartisan bill to raise the debt ceiling. It stripped the 4th Circuit Court from jurisdiction over the case. Environmentalists have argued that Congress overstepped its authority by enacting the law, saying it violates the separation of powers outlined in the Constitution.

The appeals court issued a stay July 10 focusing on a 3-mile (5-kilometer) pipeline section that cuts through the Jefferson National Forest. On July 11, the court issued a similar stay in connection with parallel litigation alleging the pipeline would violate the Endangered Species Act. Environmentalists made similar constitutional arguments in that case.

The pipeline's operators say the project is already substantially complete and that only 3 acres (one hectare) of trees need to be cleared, compared to more than 4,400 acres (1,700 hectares) that have been already cleared.

The $6.6 billion, 300-mile (500-kilometer) pipeline is designed to meet growing energy demands in the South and Mid-Atlantic by transporting gas from the Marcellus and Utica fields in Pennsylvania and Ohio.

John Raby, The Associated Press

 

Study: Inflation Reduction Act’s cap on insulin out-of-pocket costs boosts prescription fills

Published in JAMA, the findings from USC and University of Wisconsin–Madison researchers suggest the policy cut the number of Medicare enrollees who weren’t filling insulin because of cost

Peer-Reviewed Publication

UNIVERSITY OF SOUTHERN CALIFORNIA

LOS ANGELES – The Inflation Reduction Act’s policy capping out-of-pocket costs for insulin to $35 for a month’s supply led to increases in the total number of insulin fills for Medicare beneficiaries, according to a new study from the USC Schaeffer Center for Health Policy & Economics and University of Wisconsin–Madison.

Following the cap’s enactment in January 2023, the number of insulin fills among Medicare Part D enrollees increased from 519,588 to 523,564 per month. In contrast, the number of insulin fills decreased among older adults without Medicare during the same period. The study was published today in the Journal of the American Medical Association.

The amount spent out-of-pocket for insulin has skyrocketed for Medicare enrollees, from $236 million in 2007 to more than $1 billion in 2020. As a result, many patients with diabetes ration the life-saving drug, increasing the risk of poor health outcomes. In January, the Inflation Reduction Act (IRA) capped all Part D beneficiaries’ out-of-pocket costs for insulin at $35 for a month’s supply. The study’s findings suggest the cap is encouraging patients to fill their insulin prescriptions. 

Study analyzed 14 million insulin fills from a national prescription database

To examine the cap’s effectiveness, researchers used data from IQVIA’s National Prescription Audit, which includes 92% of retail pharmacies and 70% of mail-order and long-term care facility pharmacies. The study sample included 14 million insulin fills.

Researchers compared changes in insulin fills for Medicare Part D enrollees aged 65 to 74 with changes among 60- to 64-year-olds without Medicare insurance. The researchers compared outcomes before (September through December 2022) and after (January through April 2023) the IRA cap took effect.

While insulin fills increased among Medicare Part D enrollees after the cap, the number of fills for those without Medicare dropped from 344,719 to 330,229 per month during the same period.

Additionally, the average number of monthly fills with out-of-pocket expenses of $35 or less grew from 340,509 to 366,928 for Medicare enrollees. For those without Medicare, those less expensive fills fell from 242,733 to 220,867, the study found.

After adjusting for differences in the study sample, the analysis suggests that Medicare beneficiaries filled about 50,000 more insulin prescriptions per month that were $35 or less, and about 20,000 of these fills would not have taken place if not for the policy.

Quotes:

“Many Americans are concerned with the cost of insulin because people with diabetes are at great risk of serious health problems, including nerve damage, heart attack and stroke. This new policy has the potential to do two things: save money for people who are taking insulin, and help people afford insulin to begin with,” said study co-author John A. Romley, associate professor at the USC Sol Price School of Public Policy and Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences and a senior fellow at the USC Schaeffer Center.

“Our analysis suggests that this policy meaningfully reduced the number of Medicare beneficiaries who were not filling their insulin because of the cost – which would have potentially put their health at risk,” said lead author Rebecca Myerson, assistant professor of population health sciences at the University of Wisconsin School of Medicine and Public Health and a nonresident senior fellow at the USC Schaeffer Center.

“Ensuring access to affordable insulin is critical for promoting health equity given that Black and Latinx individuals, including among Medicare populations, are more likely to suffer from diabetes and experience barriers in accessing diabetes medications, including insulins,” said co-author Dima Mazen Qato, Hygeia Centennial Chair and associate professor in the Titus Family Department of Clinical Pharmacy at the USC Mann School. She is also a senior fellow with the USC Schaeffer Center.

Dana Goldman, dean and C. Erwin and Ione L. Piper chair of the USC Price School and the co-director of the USC Schaeffer Center, was also a co-author of the study. The research was partially funded by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK107552).

About

Established in 2009, the USC Leonard D. Schaeffer Center for Health Policy & Economics measurably improves value in health through evidence-based policy solutions, research excellence, and private and public-sector engagement. The USC Schaeffer Center combines the rigor and independence of academic research with communication and management resources more typically found in non-academic settings to advance research in health policy. A collaboration between the USC Mann School of Pharmacy and Pharmaceutical Sciences and the USC Sol Price School of Public Policy, the Schaeffer Center has approximately 60 affiliated faculty, including three recipients of the Nobel Prize in Economics, and 40 staff.

The University of Wisconsin School of Medicine and Public Health is recognized as a leading institution in health sciences education, research, and service. Founded in 1907 as the medical school of the University of Wisconsin–Madison, we transformed into the nation’s first School of Medicine and Public Health in 2005 to integrate medical and public health approaches throughout our missions. Powered by more than 5,400 faculty and staff, our impact spans the state of Wisconsin and beyond. With deep commitment to a vision of healthy people and healthy communities, we translate discovery into application and foster interconnections between clinical care, education, and research. We are consistently ranked among the nation’s top medical schools, with more than 2,700 students and trainees enrolled in our high-performance academic programs. Annual research funding awards to our scientists averages nearly $450 million. Our 27 departments count some of the nation’s leading researchers, educators, and clinicians among the faculty, including several National Medal of Science recipients and National Academy of Science honorees. Together, we are advancing health and health equity through remarkable service to patients and communities, outstanding education, and innovative research.

---

JOURNAL

JAMA

DOI

10.1001/jama.2023.12951 

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Insulin Fills by Medicare Enrollees Before and After the Inflation Reduction Act Caps on Out-of-Pocket Costs

ARTICLE PUBLICATION DATE

24-Jul-2023