20 May 2022

Nonfatal Firearm Injury Costs

Welcome back. If you follow or occasionally visit this blog, you may be aware that I’ve written about firearms--four times to pitch the need for gun research, not gun control.

As I described in the first of my four posts (see Gun Research), Congress essentially shut down gun research funding by the Centers for Disease Control and Prevention in 1996 and later by the National Institutes of Health. Although research continued without federal support, it was estimated that gun violence research funding and publications were less than 5% of what would have expected based on the statistics for other leading causes of death.

I am happy to note that, in December 2019, Congress changed its collective mind. After more than 20 years, Congress approved funding of $25 million for fiscal 2022 to be split between the CDC and NIH to examine gun violence from a public health perspective. While experts concede the amount is small in comparison to the scope of the issue, they celebrated.

Congress approved fiscal year 2022 funding for the CDC and NIH to examine gun violence (graphic from abcnews.go.com/Politics/decades-long-gap-gun-violence-research-funding-lasting/story?id=80646946).
Which brings me to an example of the gun research that NIH funded.

Long-Term, Often Hidden Costs of Firearm Injuries
Some 45,000 people are killed in the U.S. by firearms each year; more than twice as many sustain firearm injuries and survive.

A team of researchers set out to measure the first year’s changes in clinical and economic outcomes for survivors and their family members after nonfatal firearm injury. These typically include worse mental health, substance use disorders and higher health care spending.

The researchers were affiliated with Harvard Medical School, Massachusetts General Hospital, Harvard T.H. Chan School of Public Health, Harvard University, Michigan University and Boston Health Care for the Homeless Program.

Data for Analysis
The researchers analyzed 10 years of data, 2008-2018, from IBM MarketScan commercial and Medicare claims databases--nationwide samples of employer-sponsored commercial insurance enrollees and Medicare beneficiaries with employer-sponsored Medicare supplemental coverage. The databases contain detailed claims data for more than 40 million persons annually.

They identified two cohorts: survivors of firearm injury and the survivors’ family members, all of whom had been enrolled in the insurance coverage for at least 1 year before through 1 year after the firearm injury. For control, each cohort member was matched to five unexposed participants.

The final dataset comprised 6,498 survivors and 32,490 matched control participants, along with 12,489 family members and 62,445 matched control participants.

About 71% of nonfatal firearm injuries were unintentional; 21% were assaults and 4% self-harm.

Characteristics of firearm injury survivors and their matched control participants. DxCG – Diagnostic Cost Groups risk score is a measure of health status or expected spending; larger values denote greater expected spending. Consumer directed health plans -- preferred-provider organization plans with health reimbursement funded by employer (from Table 1 of www.acpjournals.org/doi/10.7326/M21-2812).
Study Findings
In the first year after injury, the survivors’ medical spending increased 402% per person per month and cost sharing (co-pays and deductibles) increased 176% per person per month over the control participants’ spending. The increase was driven by the first month’s spending of 4,122%  and 1,917% in cost sharing per survivor.

The cost of all categories of the survivors’ health care increased relative to the control participants--40% increase in pain diagnoses, 51% increase in psychiatric disorders and 85% increase in substance-use disorders, in addition to increased pain and psychiatric medications. Family members had a 12% increase in psychiatric disorders relative to their control participants.

These clinical and economic changes were driven by intentional and more severe firearm injuries.

Changes in study outcomes for 1 year after unintentional and intentional nonfatal firearm injuries; intentional firearm injuries include assault, self-harm and law-enforcement shootings (from Table 3 of www.acpjournals.org/doi/10.7326/M21-2812).
Wrap Up
Nonfatal firearm injuries cause survivors, their families, employers, insurers and society to spend thousands of dollars more each month on healthcare. Considering the annual number of gunshot survivors in the U.S., the researchers estimate direct health care spending to be well over $2 billion for just the first year.

The researchers suggest that it might be wise for doctors to screen gunshot survivors and their family members for signs of mental health problems and to be mindful of an increased risk of substance use disorders when treating pain in the wake of a shooting.

Interesting stuff when Congress allows gun research. Thanks for stopping by.

CDC tally of firearm deaths: www.cdc.gov/nchs/fastats/injury.htm
Congressional turnabout on funding CDC and NIH gun violence research:
Study of nonfatal firearm injury outcomes in Annals of Internal Medicine journal: www.acpjournals.org/doi/10.7326/M21-2812
Article on study on EurekAlert! website: www.eurekalert.org/news-releases/948335

13 May 2022

Food as Medicine

Welcome back. There’s a new report you may have missed that I’d like to tell you about. You can download the entire document at no cost, so I’ll just point and hit the highlights.

To bridge the gap between traditional medicine and the use of food in preventing and treating disease, the Center for Food as Medicine and the Hunter College New York City Food Policy Center have produced a major narrative review: Food as Medicine: How Food and Diet Impact the Treatment of Disease and Disease Management.

Cover of Food as Medicine report (foodmedcenter.org/wp-content/uploads/foodasmedicine.pdf).
The 335-page report, with more than 2500 citations, has five parts.

Part 1: Brief history of food as medicine
Humans were cultivating food crops for medicinal purposes as early as 300 BCE. The authors review how food as medicine was practiced across ancient cultures, including traditional Chinese medicine, ancient Greece, Ayurvedic medicine in India, as well as in the New World.

Although food has remained an integral component of many Eastern healing practices, Western cultures broke away. Nevertheless, its popularity has risen in modern society, popular culture and on social media.

Among items spotlighted are garlic and mushrooms as medicine and deciphering online health information.

Part 2: Challenges to food as medicine
The use and acceptance of food as medicine encounters modern challenges. The report begins with the impact and influences of dietary guidelines--America’s, the World Health Organization’s and those of multiple countries. Governmental diet regulations are severely politicized and criticized because of their ties to corporate interest.

Other topics addressed include food insecurity, food as medicine interventions, primary care physicians and nutrition counseling, attempts to define healthy and unhealthy, and a big, broad problem, the effects of marketing, legalized health claims and industry-funded research.

Part 3: Food as medicine Interventions, programs, policies and practices
The epidemic of diet-related diseases has led to the increased use of food to treat these illnesses and avoid costly healthcare.

A variety of food interventions are reviewed, including medically tailored meals designed and prepared for specific medical conditions and food prescriptions (mostly fruits and vegetables) assigned like a pharmaceutical by a health care professional. Incorporating these solutions directly into programs such as Medicare and Medicaid has proven affordable and effective, improving health outcomes and reducing healthcare costs.

A related topic is culinary medicine, which blends the art of food and cooking with the science of medicine in an effort to improve patients’ conditions by analyzing how food can play a role in preventing or treating a particular disease.

Dietary supplements, nutraceuticals and functional foods that are ingested with the intention of providing a physiological or medicinal effect are also discussed, as is health insurance to cover food interventions and food as medicine programs.

Part 4: Food for specific diseases
Dietary interventions have been studied for specific conditions and diseases. The report covers: Alzheimer’s, Arthritis (Rheumatoid and Non-Rheumatoid), Autism, Cancer, Chronic Kidney Disease, Cirrhosis and Ascites, Diabetes, Inflammatory Bowel Diseases, HIV/AIDS, Hypertension, Mental Health Conditions and Illnesses, Multiple Sclerosis and Sleep.

Part 5: Recommendations
A series of recommendations are offered for healthcare professionals, insurance companies, policymakers, community organizations and other key stakeholders to consider when designing food as medicine interventions, programming, policies and research.

Wrap Up
I’ll close with a selection of some of the report’s key findings:

- Many medical schools do not require basic nutrition courses, leaving physicians unprepared to interact with patients about food to manage disease.
- Social media has facilitated the hijacking of food as medicine, co-opting it into a pseudoscientific alternative medicine.
- Websites with evidence-based content coexist with those containing inaccurate, incomplete or misleading information, making it difficult to decipher information about food as medicine.
- The increased popularity of dietary supplements paired with a lack of regulation has caused confusion among consumers and patients.
- Marketing and health claims printed on packaged food can muddy consumers’ understanding of the impact of food and diet on disease.
- Research funded by the food industry has skewed public understanding of the impacts of certain foods on health.

Happy reading, and thanks for stopping by.

End graphic from Food as Medicine report (foodmedcenter.org/wp-content/uploads/foodasmedicine.pdf).
Food as Medicine report: foodmedcenter.org/wp-content/uploads/foodasmedicine.pdf
Article on report on EurekAlert! website: www.eurekalert.org/news-releases/948063
Center for Food as Medicine: foodmedcenter.org
Hunter College NYC Food Policy Center: nycfoodpolicy.org

06 May 2022

Big Oil's Words vs Actions

Welcome back. As you may have heard, we’ve got a climate problem. To keep the lid on global warming to 1.5°C or even 2°C, net worldwide emissions of carbon dioxide must reach zero no later than 2050.

There is strong international agreement across the climate community that net worldwide emissions of carbon dioxide should reach zero by 2050 to hold global climate warming to 2°C (from www.sustainabilitymatters.net.au/content/sustainability/article/net-zero-carbon-neutral-carbon-negative-what-do-they-mean-exactly--1597925690).

Pray tell, what are the fossil fuel producers going to do? It’s estimated that just four of the energy giants alone--Chevron, Exxon, BP and Shell--are responsible for more than 10% of global carbon emissions since 1965. Clearly, decarbonizing the global economy by mid-century won’t happen with their current fossil fuel-based business models.

On the bright side, several oil and gas majors have increasingly discussed clean energy and climate change, pledged decarbonization strategies and invested in renewables and low-carbon technology. Some claim they are transforming into clean energy companies.

Is Big Oil Coming Clean?
Well, I’m impressed, aren’t you? Oh wait. These are the same companies that, for years, have spread misinformation and aggressively obstructed progress toward climate action. They have spent millions lobbying to delay or weaken climate policy.

So, maybe we should look closer at the extent to which oil majors are truly divesting from fossil fuels and transitioning toward clean energy.

And that’s what researchers with Japan’s Tohoku and Kyoto universities did. They dug into the clean energy claims of the four energy giants, examining 12 years of publicly available data (2009-2020) from three perspectives: discourse, strategies and investments.

Big Oils’ Discourse, Strategies and Investments

Discourse: The frequency of 39 keywords in the companies’ annual reports, categorized as climate change, transition, emissions and clean energy, showed amplified discourse about mitigating emissions and increasing clean energy businesses.

Frequency of 39 keyword mentions in 4 categories in annual reports, normalized by each report’s total word count (from journals.plos.org/plosone/article?id=10.1371/journal.pone.0263596).

Strategies: Indicators of the status of strategies that reflect a transition toward clean energy were categorized as climate-change cognition, business model, emissions reduction and clean energy investment.

For all companies, in most years, the volume of pledges was considerably greater than concrete actions, with scarce acknowledgment of the need to shift away from or reduce dependence on all types of non-sequestered fossil fuels.

Total annual scores for pledges (top) and actions (bottom), 2009-2020, show all companies score considerably higher for pledges than actions (from journals.plos.org/plosone/article?id=10.1371/journal.pone.0263596).
Investments: Analysis of financial data from annual reports indicated that oil and gas exploration and production remain the primary business for all majors and that fossil fuels are still the primary cash engine.

Moreover, third-party data on trends in renewables and clean energy investment showed no evidence to suggest a shift from fossil fuels.

Wrap Up
The researchers found that the two European energy giants, BP and Shell, are a step ahead of the U.S. companies, Chevron and ExxonMobil, but that none of the four is comprehensively transitioning its core business model from fossil fuels to clean energy.

Everything could change, of course. Let's hope so. Thanks for stopping by.

Study of clean energy claims of BP, Chevron, ExxonMobil and Shell in PLOS journal: journals.plos.org/plosone/article?id=10.1371/journal.pone.0263596
Article on study on EurekAlert! website: www.eurekalert.org/news-releases/942905

29 April 2022

Youths Happier During Lockdown

Welcome back. Among the interesting studies published during my hiatus was one from researchers with Cambridge and Oxford universities. They found the self-reported mental health and wellbeing of 1 in 3 youths improved during England’s first COVID-19 lockdown. 

Self-reported change in mental wellbeing of 16,940 youths during England’s first COVID-19 lockdown (from link.springer.com/article/10.1007/s00787-021-01934-z).
Improved? Wait. That’s not what I’ve been hearing and reading. Has the media overstated the issue? Here’s what the U.S. Surgeon General wrote on 7 December 2021:

Before the COVID-19 pandemic, mental health challenges were the leading cause of disability and poor life outcomes in young people, with up to 1 in 5 children ages 3 to 17 in the U.S. having a mental, emotional, developmental, or behavioral disorder…

The pandemic added to the pre-existing challenges that America’s youth faced…This Fall, a coalition of the nation’s leading experts in pediatric health declared a national emergency in child and adolescent mental health.

The UK study doesn’t detract from the crisis, it simply adds perspective: not every youth got worse. Determining why one-third fared better might provide insight for promoting youth mental health and wellbeing going forward.

Data for Analysis

The researchers used data from the OxWell Student Survey, a recurring, cross-sectional, self-report survey relating to mental health and wellbeing. The school-base survey of England’s students, aged 8 to 18, contains questions repeated in each iteration as well as new questions added in response to social and environmental events and emerging research.

For the current study, 16,940 students were surveyed June-July 2020 at the tail end of England’s first national lockdown. They answered questions about their experiences with the pandemic, school, home, lifestyle, relationships and more.

Examining the Data
The study was limited to a descriptive analysis of data, which is probably sufficient to highlight major differences without resorting to statistical testing. Descriptive analysis is also the simplest way for me to summarize key findings from the reported results.

Toward that end, I’ve prepared a table relating the youths’ self-reported changes during the lockdown to the number of those whose mental wellbeing got better, worse or remained the same. I’ve listed 14 items derived from a table the researchers reported with over 100 items. This is not to say the reported detail wasn’t significant; only that it’s well beyond the scope of what I needed to capture some core findings. I encourage you to review the paper to pursue the topic in greater depth. 

Relationships of selected variables with self-reported change in mental wellbeing of 16,940 youths during England’s first COVID-19 lockdown (modified from Table 2 of link.springer.com/article/10.1007/s00787-021-01934-z).
Overall, the mental wellbeing of surveyed males and younger students tended to improve during the lockdown while surveyed females and older students tended to get worse.

The students whose mental wellbeing improved during the lockdown self-reported that they were able to get all the academic help they needed at home, managed school tasks better, were bullied a little less, had better relationships with friends and family, felt less left out and less lonely, and exercised as well as slept more.

Wrap Up
As the researchers point out, the survey showed that students who reported improved mental health and wellbeing were more likely than their peers to report improvement across the full range of school, relational and lifestyle factors.

The impact of lockdown was dependent on a number of factors, such as gender, pre-pandemic mental health, social relationships, school connectedness, online learning experience, family composition and family financial situation.

While the crisis is real, many students did indeed experience improved mental health and wellbeing. Thanks for stopping by.

Study of UK students during lockdown in European Child & Adolescent Psychiatry journal: link.springer.com/article/10.1007/s00787-021-01934-z
Article on study on EurekAlert! website: www.eurekalert.org/news-releases/944267
U.S. Surgeon General’s advisory: www.hhs.gov/about/news/2021/12/07/us-surgeon-general-issues-advisory-on-youth-mental-health-crisis-further-exposed-by-covid-19-pandemic.html
Oxwell Student Survey and information for parents:

25 April 2022

Coming Back


I’m sorry, I’m sorry, I’m sorry. I expected my Time Out would be for about one month, not five. Yes, I needed a break, but the real purpose was a family writing project that took much longer than expected. Then came all sorts of unrelated items, capped by taxes.

Although I stopped blogging, I didn’t stop monitoring the daily research summaries. So, I’ll be back very soon. I hope you will, too.