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Examining the News Affecting Pharmacy & Clinics
May 2015, Vol 3, No 5 - The Vitals

In This Article




Potassium May Lower Blood Pressure In Teens

Including more potassium as part of a healthy diet during childhood may help lower blood pressure in adolescents, according to a study published in JAMA Pediatrics.

“The beneficial effects of dietary potassium on both systolic and diastolic blood pressures suggest that consuming more potassium-rich foods during childhood may help suppress the adolescent increase in blood pressure,” Justin R. Buendia, BS, Department of Medicine, Boston University School of Medicine, Boston, MA, and colleagues found.

In the prospective, National Heart, Lung, and Blood Institute’s Growth and Health Study, investigators sought to evaluate the effect of dietary sodium, potassium, and the potassium-to-sodium ratio on blood pressure in adolescents. Overall, 2185 black and white girls who were aged 9 to 10 years at the beginning of the study received follow-ups for ≤10 years. The study participants had complete data for early-adolescent to midadolescent diet and blood pressure. The primary end points were mean systolic and diastolic blood pressures throughout adolescence and at the end of the study.

The authors found no evidence that higher sodium intakes had an adverse effect on the blood pressures of the study participants. However, mixed models indicated that adolescents consuming ≥3500 mg/d had generally lower diastolic blood pressure, compared with individuals consuming <2500 mg/d. Higher potassium intake inversely correlated with blood pressure change throughout adolescence and at the end of the study.

Source: Buendia JR, Bradlee ML, Daniels SR, et al. Longitudinal effects of dietary sodium and potassium on blood pressure in adolescent girls. JAMA Pediatr. 2015 Apr 27 [Online ahead of print].

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Healthcare Spending On The Rise For Children With Diabetes

Data from the Health Care Cost Institute (HCCI) indicate that healthcare spending for privately insured children with diabetes rose almost 4% in 2013, and was almost $10,700 higher than for patients without diabetes.

“Diabetes is a costly chronic condition in the United States, medical costs and productivity loss attributable to diabetes were estimated to be $245 billion in 2012,” the report explained. The HCCI report compares the per capita spending for children diagnosed with diabetes, and looks at health spending for individuals with diabetes by age and gender.

The data set includes almost 40 million individuals from all 50 states and the District of Columbia, who are aged <65 years and have employer-sponsored insurance. The study population included 5.3% of patients with type 1 or type 2 diabetes in 2013. Diabetes diagnosis was determined using the Dictionary of Disease Management Terminology methodology for identifying healthcare activity associated with diabetes.

Overall, healthcare spending for children with diabetes increased between 2011 and 2013, with the dollar amount increase in per capita spending for children between 2012 and 2013 almost double the increase for young adults aged 19 to 25 years ($1361 and $753, respectively). This rise in spending for children with diabetes was associated with higher spending on insulin.

Per capita healthcare spending was also significantly higher in patients with diabetes ($14,999) compared with patients without diabetes ($4305). Out-of-pocket costs were also more than double in patients with diabetes ($1922) compared with patients without diabetes ($738).

The report also indicated that insured women with diabetes between the ages of 19 and 54 years had higher per capita spending than men with diabetes. Pre-Medicare adults with diabetes between the ages of 55 and 64 years had the highest per capita spending for any age-group.

Source: Health Care Cost Institute. Per Capita Health Care Spending on Diabetes: 2009-2013. www.healthcostinstitute.org/files/HCCI%20Diabetes%20Issue%20Brief%205-7-15.pdf. Published May 2015. Accessed May 7, 2015.

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Oropharyngeal Exercises Help Snoring

Healthcare professionals may be able to recommend a noninvasive treatment option for their patients who snore.

“Snoring is extremely common in the general population, and may indicate obstructive sleep apnea,” Vanessa Ieto, PhD, Sleep Laboratory, Pulmonary Division, Heart Institute, University of Sao Paulo Medical School, Brazil, and colleagues explained in a study published online first in Chest. “However, snoring is not objectively measured during polysomnography, and no

standard treatment is available for primary snoring, or when snoring is associated with mild forms of obstructive sleep apnea.”

As part of the study, investigators randomized patients for 3 months of treatment with daily oropharyngeal exercises, or nasal dilator strips with respiratory exercises (control). Oropharyngeal exercises included pushing the tip of the tongue against the roof of the mouth and sliding the tongue backward; sucking the tongue upward against the roof of the mouth, and pressing the entire tongue against the roof of the mouth; forcing the back of the tongue against the floor of the mouth while keeping the tip of the tongue in contact with the bottom front teeth; and elevating the back of the roof of the mouth and uvula while pronouncing the vowel “A.”

Thirty-nine patients were included in the study. The mean age of the patient population was 46 years, body mass index was 28.2 kg/m2, Apnea-Hypopnea Index was 15.3 events per hour, and the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index scores were 9.2 and 6.4, respectively. Twenty patients were included in the control. Patients in the study group and the control group were similar at the start of the study. Treatment with oropharyngeal exercises led to a significant decrease in the Snore Index and Total Snore Index. In particular, snoring frequency was decreased by 36%, and total snoring power was reduced by 59%.

Source: Ieto V, Kayamori F, Montes MI, et al. Effects of oropharyngeal exercises on snoring: a randomized trial. Chest. 2015 May 7 [Online ahead of print].

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Outbreak of HIV In Indiana Linked to Oxymorphone Injection

The Indiana State Department of Health started an ongoing investigation of an outbreak of the human immunodeficiency virus (HIV) in January following 11 confirmed cases in a rural county of southeastern Indiana. The cases occurred among residents in the same community, and were linked to syringe-sharing of opioid oxymorphone injections. Overall, 135 patients were diagnosed with HIV as of late April in a community of 4200 people.

“The outbreak highlights the vulnerability of many rural, resource-poor populations to drug use, misuse, and addiction, in the context of a high prevalence of unaddressed cormorbid conditions,” Caitlin Conrad, from the Indiana State Department of Health, Indianapolis, and colleagues stated in the May 1 issue Morbidity and Mortality Weekly Report. “The outbreak also demonstrates the importance of timely HIV and hepatitis C surveillance activities, and rapid response to interrupt disease transmission.”

Patients diagnosed with HIV had a mean age of 35 years, and 54.8% were men. In addition, data indicate that 80% of the patients reported injection drug use, 3% did not report injection drug use, and 17% were not interviewed to determine injection drug use. In addition, 84.4% of the patients were coinfected with hepatitis C.

Trends in the community indicated that injection drug use is a multi-generational activity, with as many as 3 generations of a family and multiple community members injecting together. The daily numbers of injections ranged from 4 to 15, with the number of injection partners ranging from 1 to 6 per injection event.

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Healthcare Policy

5 Facts About HB 2041

  1. The Massachusetts bill was sponsored by Rep Angelo J. Puppolo, Jr, and seeks to recognize pharmacists as healthcare providers.
  2. It would amend the definition of “health care provider” in their General Laws to include registered pharmacists.
  3. The bill includes coverage for patients diagnosed with ≥1 chronic disease, for drug therapy management services from a registered pharmacist, and pharmacists to be paid for these services as part of a collaborative drug therapy management agreement with a physician.
  4. It promotes collaboration between physicians and pharmacists in the management of certain diseases, including asthma, chronic obstructive pulmonary disease, diabetes, hypertension, hyperlipidemia, congestive heart failure, human immunodeficiency virus or AIDS, and osteoporosis.
  5. The bill would also allow registered pharmacists to administer medication prescribed by a supervising physician, including drugs and biological products.

Sources

  1. The General Court. Bill H.2041. https://malegislature.gov/Bills/189/House/H2041. Accessed May 7, 2015.
  2. Yap D; American Pharmacist’s Association. Massachusetts bill would recognize pharmacists as health care providers. www.pharmacist.com/massachusetts-bill-would-recognize-pharmacists-health-care-providers. Published April 28, 2015. Accessed May 7, 2015.
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Last modified: June 18, 2015
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