Kids were less likely to be diagnosed with autism if their moms took supplements before pregnancy and while they were expecting, according to a study of just over 45,000 Israeli children.
The experimental device uses precisely timed sound and skin stimulation to target nerve activity in the brain.
U.S. officials are investigating whether the outbreak, which has killed two people, is tied to a similar case in Canada.
Teens who engage in risky behaviors are more likely to have unsafe sex -- and that may put them at increased risk for HIV, the AIDS-causing virus, University of Michigan researchers reported.
The science centers around the use of "chimeric antigen receptor" (CAR) genes. In laboratory work with monkeys, these engineered cells have destroyed HIV-infected cells for more than two years, scientists reported.
This year, the publication ranked 40 different diet plans. It based the rankings on input from an expert panel of the country's top nutritionists, dietary consultants and doctors who specialize in heart health, weight loss and diabetes.
Using medications to treat opioid use disorder is a lifesaving cornerstone of treatment — much like insulin for type 1 diabetes. The flawed but widely held view that medications like methadone or buprenorphine are “replacing one addiction for another” prevents many people from getting the treatment they need. In actuality, people successfully treated with these medications carefully follow a prescribed medication regimen, which results in positive health and social consequences — as in patients with many types of chronic medical conditions.
However, even among those who embrace treating opioid use disorder (OUD) with medication, there is a difference of opinion as to which medications are most effective. A new study offers important insight into the advantages and disadvantages of the two medications for OUD that can be prescribed in a doctor’s office (that is, on an outpatient basis). These medications are buprenorphine and extended-release (ER) naltrexone. This study was widely covered in the press, and many of the sound bites and headlines reporting the two treatments to be equally effective were a bit misleading.
Buprenorphine is a partial opioid agonist medication. This medication activates the same receptors in the brain as any opioid, but only partly. Because its effects are long-lasting, it can be taken once a day to relieve cravings, prevent withdrawal, and restore normal functioning in someone with opioid use disorder. Because it is a partial agonist, it has a ceiling effect. This means once all the receptors are occupied by the medication, even if a person takes 20 more tablets she wouldn’t feel any additional effect or be at risk of overdose.
Any doctor who has completed special training (a primary care provider, addiction specialist, OB/GYN, etc.) can prescribe buprenorphine. The advantage is, theoretically, that a person with OUD could receive treatment from any provider he or she might see for a routine health issue. I say theoretically because, despite its availability, only about 4% of physicians have done the necessary training to be able to prescribe it. The research on buprenorphine is robust, with multiple studies showing it reduces the risk of death by more than 50%, helps people stay in treatment, reduces the risk that they will turn to other opioids (like heroin), and improves quality of life in many ways.
Naltrexone is a pure opioid antagonist. It sticks to an opioid receptor, but instead of activating it to relieve craving and withdrawal it acts as a blocker, preventing other opioids from having any effect. The research on naltrexone has been mixed. Naltrexone in pill form is basically no better than placebo because people simply stop taking it. Studies on extended-release naltrexone are more promising and have shown it to be better than no medication at all. However, there has never been a US trial comparing extended-release naltrexone to either methadone or buprenorphine, until this study.
This study enrolled individuals with opioid use disorder who had voluntarily gone to a detoxification program. Researchers then randomly assigned them to either daily buprenorphine or monthly extended-release naltrexone. Both groups were followed for 24 weeks, to see how many people relapsed.
One of the most important things investigators learned is just how hard it was to get participants onto extended-release naltrexone, revealing a potential barrier to its usefulness. Before a person can start taking ER naltrexone, they must be completely off opioids for seven to 10 days. Only 72% of the group assigned to ER naltrexone even got the first dose, and among those who were randomized during the detoxification process, only 53% started the medication. In contrast, 94% of the group assigned to buprenorphine started the medication.
The other important finding was what happened with relapses. The researchers analyzed their data using an “intention to treat analysis.” This means that once a person is randomly assigned to a treatment (or placebo), their data counts even if they don’t stick with the treatment. Here’s why this is important: if you don’t include that data, then you miss other important outcomes that influence how effective a treatment really is. Thanks to this type of analysis, researchers learned that relapse was significantly more likely in the extended-release naltrexone group (65% compared to 57% in the buprenorphine group).
Immediate relapses were even more likely in the naltrexone group due to failures to start the medication — 25% of the naltrexone group had a relapse on day 21, compared to 3% in the buprenorphine group. Overall there were more overdoses in the naltrexone group, but no difference in fatal overdoses between the groups. Most of the overdoses occurred after the study medication was stopped, highlighting the lifesaving importance of getting on, and staying on, treatment. The naltrexone group also had a longer length of stay in inpatient detoxification programs, which may be an important consideration when we think about overall healthcare costs.
So, why did many headlines claim extended-release naltrexone was as effective as buprenorphine? Well, that was the finding of a separate analysis that looked only at people who successfully started each medication. When the data was viewed that way, there was no difference between the two medications, but that’s just part of the picture. If it’s harder to get a person to successfully start and stick with a medication, that should factor in evaluating its “effectiveness.”
This is an incredibly important study. The findings are generally consistent with what I see in my clinical practice. Overall buprenorphine is a more effective treatment for opioid use disorder, in part because it’s easier to get patients started on it and they are more likely to stick with it. Extended-release naltrexone may be as good for people who can successfully complete the detoxification required before starting on it. Both medications have a place, but as with so many conditions and treatments, one size does not fit all.
The post Comparing medications to treat opioid use disorder appeared first on Harvard Health Blog.
Whether you and your family are embracing the pleasures of the winter season with ice skating and snowball fights, or reluctantly venturing outdoors to walk the dog and shovel snow, be aware of the health hazards of this cold snap… like frostbite.
Frostbite can occur even after minutes of exposure to sub-freezing temperatures and wind chill. It develops after exposure to severe cold leads to freezing and injury of tissue with destruction of cells. The inflammation that follows frostbite can cause further tissue damage. The more commonly affected areas are the ears, face, fingers, and toes.
A precursor to frostbite is frostnip, when the cold hasn’t caused any permanent tissue damage. The skin might be red or pale and painful. As early-stage frostbite sets in, the affected areas might feel numb. The skin may feel cold and harder, and become paler or grayish-yellow, and later develop blisters.
Some conditions and situations can increase the risk for frostbite, like dehydration, circulation problems, nicotine and alcohol use, or inadequate shelter and clothing. Also, always be mindful that infants and young children are more vulnerable, and may not be able to recognize these early symptoms and take steps to protect themselves.
If you think you are dealing with frostbite, try to get to warmth as soon as possible. However, don’t try to rewarm the frostbitten areas if there is a chance of refreezing, since that can lead to even more tissue damage. Similarly, avoid walking on frostbitten feet, but if that’s not possible and you must walk to get to a warm environment, do not try to rewarm your feet until out of the cold. Once you are out of the cold, safer ways to rewarm the frostbitten areas are with body heat (e.g., fingers into the armpits) and warm (not hot!) water. Don’t try to warm frostbitten tissue by rubbing or using a heating pad, stove, or the heat of a fire. If symptoms don’t improve, go to the hospital promptly for further medical care.
Though it is important to recognize early signs of frostbite and know how to begin safe home care, here’s where taking steps for prevention for you and your family goes a long way toward a healthier and more delightful winter season.
The post Frozen (the cold will bother you…) appeared first on Harvard Health Blog.
With the flu season in full swing, a new poll shows that almost three-quarters of Americans over the age of 50 think all nursing home employees should get a flu vaccine every year.
