Aaron E. Carroll's Blog, page 8

What Kind of Exercise Is Best for Depression?

We already know exercise is good for us, including our mental health, but we still have some questions. Like, what kind of exercise is best? And at what intensity?

 



The post What Kind of Exercise Is Best for Depression? first appeared on The Incidental Economist.

A Call for Responsible Antibiotic Use in the Era of Telehealth

Telehealth has revolutionized health care by making it more accessible and convenient. Although antibiotics have saved millions of lives, the growth of telehealth since the COVID-19 pandemic may be contributing to a concerning new issue: antibiotic overuse.

On The Health Care Blog, I write about how telehealth may inadvertently increase the risk of antibiotic overuse, contributing to antimicrobial resistance. Studies show higher antibiotic prescription rates during virtual consultations than during in-person visits, raising concerns about the quality of diagnoses and the influence of patient satisfaction on prescribing rates. This is a call for insurers, providers, and patients to work together to ensure antibiotics are prescribed and used responsibly.

Read my full piece here.

The post A Call for Responsible Antibiotic Use in the Era of Telehealth first appeared on The Incidental Economist.

Oil pulling: promises so sweet, what’s it doing to my teeth?

The ancient practice of oil pulling is being repackaged for the digital age. Are the lies about it getting resold as well?

Oil pulling – swishing an unrefined oil in your mouth for 10-20 minutes to “pull” bacteria from the mouth has recently gained popularity on TikTok. It’s not a new concept though. Articles report that oil pulling first showed up in Ayurvedic medicine thousands of years ago.

Ayurvedic medicine is a traditional medicine practice that focuses on balance and natural remedies. It’s still practiced around the world, but the evidence for it is scattered and inconclusive. This is in part because many Ayurvedic practices claim to unilaterally cure dozens of ailments. Oil pulling, for instance, is said to cure 30 diseases.

Regardless of effectiveness, oil pulling has enjoyed cyclical popularity in modern times.

Anecdotally, oil pulling was first re-popularized in the 1990s during a presentation by Dr. Fedor Karach, although no record of him or the presentation can be found despite still being regularly cited. Oil pulling made its rounds again in the mid-2010s, popularized by celebrities like Gwyneth Paltrow and Shailene Woodley. At the time, how-to’s usually focused on swishing unspecific oils for arbitrary amounts of time.

Today, on TikTok, oil pulling is a commercial endeavor and Guru Nanda’s branded mouthwashes are the leading attraction. As opposed to ten years ago, the general sense now is that it’s better to buy a pre-made product. To date, just one internet storefront has sold over 1.7 million bottles of Guru Nanda’s oil pulling mouthwashes.

Just as in the past, modern claims of what oil pulling achieves are all over the place. Guru Nanda’s CEO has made an effort to clarify what their mouthwashes can do, but the company still benefits from the many misconceptions. TikTok sellers make claims of teeth strengthening and whitening and body “detoxification.” Plus, pitches for Guru Nanda products often show grotesque recreations of what was “pulled” from the person’s gums after use.

This is all likely an overrepresentation of what oil pulling actually does. But what is that exactly?

It’s hard to tell.

A lot of the research on oil pulling is low quality and hard to reproduce. Very small sample sizes plague existing studies, and large meta-analyses have a hard time determining statistical significance of any result. No articles demonstrate that oil pulling strengthens, whitens, or detoxifies teeth or the body.

At best, some studies show oil pulling may be associated with a decrease in counts of certain bacteria related to tooth decay. It’s also possible that some oils like coconut or sesame are more effective than others.

But even if oil pulling does something, it’s not very user friendly. For one, users must swish for 10-20 minutes; this can lead to jaw strain and is quite time-consuming. Plus, users must spit the oil out in the trash rather than the sink – oil clogs drains.

To make matters worse, oil pulling research doesn’t stand against research on traditional antiseptic, teeth whitening, or fluoride-based mouthwashes.

In a review of 28 systematic reviews and 18 meta-analyses on mouthwash, all found it inhibited and reduced plaque and gingivitis. There was no consensus on what mouthwash was best, but some did have distinct benefits over others, like strengthening teeth (fluoride) or eliminating more microorganisms (antiseptic and prescription).

Regarding usability, standard mouthwashes only need to be swished for 30-60 seconds to be effective, and they can be spit right into the sink. Plus, standard mouthwashes are the same no matter where you buy them. (The number of counterfeit Guru Nanda products have soared, creating a potentially dangerous market for consumers.)

Consumers want what’s best for their health, and sellers on TikTok are ready to take advantage of that. All that we know and don’t know about oil pulling tells us that rinsing with standard mouthwash takes less effort, costs less, and is more effective. Regardless of the product, all consumers deserve concrete evidence that it actually works, and oil pulling just doesn’t meet the mark.

The post Oil pulling: promises so sweet, what’s it doing to my teeth? first appeared on The Incidental Economist.

Medicare’s fiscal cliff

The recent good news is that the bankruptcy date for Medicare’s hospital care coverage fund was pushed back a few years to 2036. The bad news is that this temporary reprieve is just that, plus it doesn’t even address the financial situation of the rest of Medicare. I wrote about this for the Boston Globe today:

There are 67 million Americans currently on Medicare. Ninety percent of them are over 65 and the country’s population is aging quickly. By 2040, it’s estimated that 80 million Americans will be over 65. That’s an extra 13 million people on Medicare’s rolls.

It’s simple math: More recipients means more spending. But the catch is Medicare is already spending a lot of money and how fast it’s spending is alarming.

Read the whole piece here.

Research for this article was supported by Arnold Ventures.

The post Medicare’s fiscal cliff first appeared on The Incidental Economist.

Recent Research: Aging, Dementia, and the Risk of Becoming Homebound

As more Americans cross into older age, the risk of dementia increases and so, too, does the risk of becoming homebound.

This presents an access to care problem not only for aging adults and their families, but also for our health care system to successfully serve those patients. While there are home-based primary care and community programs that reach homebound individuals with dementia, the demand for them far outstrips supply.

There’s incentive, then, to better understand what factors contribute to becoming homebound for people living with dementia beyond well-established contributors like age or socioeconomic status.

Recent Study

Collaborators from the Icahn School of Medicine at Mount Sinai, Johns Hopkins University School of Medicine, Johns Hopkins University School of Nursing, and Boston University School of Public Health published a study investigating factors that contribute to someone newly diagnosed with dementia becoming homebound.

Authors followed a cohort of 939 individuals aged 65 or older newly diagnosed with dementia in the National Health and Aging Trends Study (NHATS) from 2011 to 2018. Participants were classified as either homebound (never or rarely leaving home) or nonhomebound based on self and proxy reporting.

Investigators performed two different analyses to examine factors contributing to becoming homebound in individuals with dementia. First, they used chi-square and Student t tests to investigate differences between those who were homebound and nonhomebound when initially diagnosed with dementia. Those participants were followed for a median of four years after initial participation to identify changes in homebound status over time.

Authors also used a Fine-Gray subdistribution hazard model to identify factors contributing to becoming homebound over time among those who were nonhomebound when they initially received their dementia diagnosis.

Findings

Authors found that about 20 percent of this nationally representative sample were homebound at the time of dementia diagnosis. Additionally, these homebound individuals were more likely to be Hispanic, have Medicaid and lower income, and have more chronic conditions and depression than nonhomebound individuals.

Those who were homebound from the start were also more likely to need more assistance with activities of daily living (e.g., eating, dressing) and receive more hours of care from a caregiver per week. This group was more likely than nonhomebound individuals to receive paid help, live in an assisted living facility, and live in a metropolitan area.

When looking at the individuals who were nonhomebound at the time of dementia diagnosis, between eight to 11 percent became homebound in any given year of follow-up between 2011 to 2018. Authors found that individuals living in an assisted living facility and Hispanic ethnicity were more likely to become homebound.

Conclusion

Investigators acknowledged several limitations of this study. First, homebound status can be fluid, and annual, brief assessments may fail to capture that fluidity. Additionally, the National Health and Aging Trends Study definition of dementia is not equivalent to a clinical assessment, so some cohort participants may instead have had more transient cognitive impairment.

The study’s findings demonstrate that most individuals newly diagnosed with dementia are nonhomebound but may become homebound over time, and this risk is elevated among those residing in an assisted living facility or being of Hispanic descent. These findings underscore the need to examine if and how assisted living facilities meet the needs of those who are newly diagnosed with dementia. Additionally, further research is needed to identify the preferences of different groups and their options for culturally sensitive care.

In general, identifying contributing factors to becoming homebound for individuals newly diagnosed with dementia is an important first step for preventing or reducing this phenomenon.

The post Recent Research: Aging, Dementia, and the Risk of Becoming Homebound first appeared on The Incidental Economist.

Is Acetaminophen Safe for Pregnant People?

We’ve got new and improved data on the relationship between acetaminophen use during pregnancy and diagnoses of Autism, ADHD, and Intellectual Disability in offspring. Have we been right or wrong to recommend it during pregnancy?

 



The post Is Acetaminophen Safe for Pregnant People? first appeared on The Incidental Economist.

Reminder: HSR Call for Abstracts on the Role of Health Services Research in Advances in Cancer Prevention and Control

Cross-posted from the Health Services Research website.

Sponsored by: Department of Public Health Sciences, University of Virginia School of Medicine
Submission deadline for abstracts: Monday 17 June 2024

Health Services Research (HSR) and the Department of Public Health Sciences, University of Virginia School of Medicine are partnering to publish a Special Issue on The Role of Health Services Research in Cancer Prevention and Control. The special issue will be edited by Kevin Schulman, MD, Roger Anderson, PhD, Xin Hu, PhD, and Asal Pilehvari, PhD.

Paradigm shifts in cancer screening such as mammography, colonoscopy, and Pap smears have been pivotal in detecting cancers at earlier and more treatable stages. Treatments including targeted therapies, immunotherapies, and precision medicine have prolonged disease-free intervals, improved overall survival, and enhanced quality of life for survivors. Interventions in the delivery and quality of palliative care and hospice utilization have improved the end-of-life experience. Health services research has contributed significantly to evaluating the effectiveness, accessibility, and implementation strategies of these screening programs, treatments, and interventions, guiding their integration into clinical practice.

Nonetheless, challenges persist in ensuring equitable access to high-quality cancer care for all. Disparities in cancer outcomes based on factors including socioeconomic status, sex, gender identification, race, ethnicity, disability, comoribidities, care delivery system, health policy, and geographical location remain a concern. Addressing these disparities and further improving cancer prevention and control strategies requires a comprehensive application of health services research.

Health services research can contribute to understanding how integrating innovative approaches of technology such as artificial intelligence (AI), predictive analytics, big data analytics, and evidence synthesis methodologies can improve informed decision-making across the cancer care continuum. Health services research can also inform policy innovations that promote access to care, and patient-centered care approaches. All present opportunities to further enhance cancer prevention and control and improve patient outcomes.

This special issue will include empirical studies that illuminate the application of health services research throughout the cancer care continuum, from prevention and early detection to treatment, survivorship, and end-of-life care. Examples of topic areas of interest include but are not limited to:

Evaluation of cancer care quality indicators, cancer care utilization and economic outcomes, and/or organizational structures or designs associated with efficiency and effectiveness of cancer care delivery.Evaluation of the use of cutting-edge technologies, including AI and machine learning:to evaluate and/or quantify cancer care quality, utilization, and outcomes; oras a clinical application to improve personalized treatment decision, cancer care quality and utilization in real-world-applications, such as risk stratification, pattern recognition, or improved diagnostic accuracy.Generation of data-driven recommendations to address the access, cost or quality of cancer care for key stakeholders across the cancer control continuum, from prevention to end-of-life care, including but not limited to insurance companies, professional societies, health care providers, governments, patients and caregivers.

HSR is issuing a call for abstracts to invite paper submissions for this special issue. The deadline for initial submission of abstracts is 17 June 2024.  Abstracts may not exceed 300 words and must be formatted as indicated in the HSR Author Instructions (Section 2.4.2.2, keywords not necessary).

Abstracts will be evaluated by a multidisciplinary review panel. Evaluation criteria include:

Quality, rigor, and originalityRelevance to the special issue themeClarity of writing and presentation.

Authors of abstracts that most closely match the criteria will be invited in August to submit full manuscripts in November 2024.

Invited manuscripts must follow the Author Instructions and undergo the same HSR peer review process as regular issue manuscripts. However, due to the strict timeline for publishing the special issue, the review and revision process will follow an expedited timeline. Authors must be prompt in returning revisions. Invited articles will be published online on acceptance. Some accepted articles might not be selected for the special issue but will be published in a regular issue.

The expected publication date for the special issue is March 2026.

To submit an abstract for consideration, please email it with the corresponding author’s contact information to hsr@aha.org. Include “Special Issue HSR in Cancer” in the email subject line.

Key dates for authors

Submission deadline for abstracts: 17 June 2024

Full manuscript invitation: 1 August 2024

Full manuscript deadline: 1 November 2024

Special issue publication date: March 2026

Questions? Please email Kelly Teagle at hsr@aha.org.

The post Reminder: HSR Call for Abstracts on the Role of Health Services Research in Advances in Cancer Prevention and Control first appeared on The Incidental Economist.

Stopping ‘Brain Waste’ for Foreign-born Workers in the US

Immigration is top-of-mind for voters heading into the 2024 presidential election and so, too, is the economy and our workforce. For highly educated, highly skilled immigrants, entering the workforce and obtaining high-wage work can feel impossible. Brain waste is to blame. I have a new piece out in the Worcester Telegram & Gazette looking at this phenomenon and ways we can better match skilled immigrants with high-wage jobs.

In 2020, over 260,000 immigrants with undergraduate health care degrees such as nursing were underemployed. How might this untapped group of health professionals have buoyed the workforce during the COVID-19 pandemic if they’d been licensed in the U.S.?

Read the whole piece here.

Research for this article was supported by Arnold Ventures.

The post Stopping ‘Brain Waste’ for Foreign-born Workers in the US first appeared on The Incidental Economist.

Qualitative Brief: Better Understanding VA Urgent Care Delivery

Rates of urgent care and emergency department usage have fluctuated over the years, largely increasing. However, as usage has increased, so have costs, and there is significant ongoing research on how to mitigate this trend. This is true within the Veterans Health Administration (VHA) as well. For VHA, understanding how Veterans are referred into urgent care services and emergency departments will help policymakers better understand bottlenecks in non-emergency care services, hopefully reducing costs and improving Veteran access to high quality care.

The Partnered Evidence-based Policy Resource Center (PEPReC) published a policy brief on the qualitative research of one of PEPReC’s doctoral students, examining the roles of and relationship between VHA urgent care clinics and VHA emergency departments. Read the full brief here.

PEPReC, within the Veterans Health Administration and funded in large part by the Quality Enhancement Research Initiative (QUERI), is a team of health economists, health services and public health researchers, statistical programmers, and policy analysts who engage policymakers to improve Veterans’ lives through evidence-driven innovations using advanced quantitative methods.

The post Qualitative Brief: Better Understanding VA Urgent Care Delivery first appeared on The Incidental Economist.

Does Intermittent Fasting Increase Heart Attack Risk by 91%?

Sigh. Nutrition research is often bad, and how we talk about it is even worse. If you believe the hype from the past several years, intermittent fasting doesn’t only help you lose weight, it may go so far as to prolong your life. So what do we do with new data suggesting it significantly increases your risk for cardiovascular disease?

 



The post Does Intermittent Fasting Increase Heart Attack Risk by 91%? first appeared on The Incidental Economist.