Breaking News

TB cases rebound; diabetes screening changes urged; & helping patients overcome language and tech barriers

March 24, 2023
Reporter, Morning Rounds Writer

Good morning. Today we hear about one approach to bridging the telemedicine divide: in-person guides who help patients surmount language and tech barriers when using their phones' health care apps.

public health

TB cases climbing back to pre-pandemic rates

GettyImages-1667722Spencer Platt/Getty Images

New cases of tuberculosis are rebounding to levels not seen since before the Covid-19 pandemic, says a new CDC report that's both grim and worrying. Interim numbers for 2022 estimate TB infections rose to 2.5 cases per every 100,000 Americans, after dropping in 2020 and 2021 when people may have delayed medical care. There were more cases among people newly arrived in the U.S., as well as higher incidence among American Indians or Alaska Natives, Native Hawaiians, and other Pacific Islanders.

The grim part: Incidence was lower among people over 65, possibly because so many had died of Covid. The worrying part: Rates increased among young people aged 15 to 24, and in children aged 4 and younger. Kids fare worse than adults, and it means they caught TB here, as opposed to reactivating an old infection from elsewhere, as happens in adults. STAT'S Helen Branswell has more here, as well as a story on another CDC report about a video alternative to directly observed therapy — when a health professional watches someone take a TB medication.


health

Diabetes screening should be based on age, not weight, study suggests

Guidelines for diabetes screening recommend testing adults from 35 to 70 years old if they are overweight or obese, but those criteria exclude people at risk in certain racial groups, especially Asian people, who tend to develop diabetes at a lower BMI. A new study out today in the American Journal of Preventive Medicine proposes screening all adults age 35 to 70, regardless of weight. 

The current guidelines from the U.S. Preventive Services Task Force, last updated in 2021, lowered the minimum age for screening to 35 from 40 and kept the requirement of a BMI over 25. But the percentage of Asian people with pre-diabetes or diabetes who would be identified is significantly lower than for other racial and ethnic groups. Testing by age leads to more equal percentages of diabetes cases identified across racial and ethnic groups, the researchers concluded. STAT's Elaine Chen has more.


infectious disease

Concerning news — and a learning curve — in Marburg outbreak

Equatorial Guinea, dealing with its first Marburg outbreak, seems to have come to understand that it has a challenge on its hand. The outbreak was first recognized in mid-February, but few details about the West African country's response have been made public. That changed earlier this week when the WHO released an update reporting there have been 29 confirmed and probable cases spread across three provinces that all share borders with Cameroon and Gabon. The WHO rates the risk of cross-border transmission as "very high."

Abdi Mahamud, WHO's director of alert and response coordination, said yesterday that it's not uncommon for countries to have to travel a learning curve: "Some of the experiences when countries are dealing with viral hemorrhagic [fevers] when they haven't dealt with them before is the thinking that it may go away. But with the spread right now, I think it brings a new commitment."



closer Look

How one health system helps patients navigate language barriers — and their smartphones

20230316_131827Ambar Castillo/STAT

Janelle Vargas is used to Hernan Quintero's quips, such as joking about needing to win the lottery to pay his medical bill. In her two years helping him navigate his health care online, she has shown him how to pull up his medical bills on his phone, as well as check on the long list of medications in his records on the Mass General Brigham electronic patient portal. 

Vargas is a "digital access coordinator" at Pentucket Medical, part of the Mass General Brigham system in Lawrence, Mass. The program helps patients prepare for virtual visits, explains video calls, and notes tech- or health-related concerns providers might need to know. "A person, for example, that just came from their country, that doesn't know the language, that maybe has problems using technology, they may not even know that these resources are available to them," Vargas told STAT's Ambar Castillo. Read more.


mental health

Opinion: CDC reports autism numbers are up. It's the need that's rising

Yesterday the CDC reported yet another increase in autims's prevalence among children, based on analyses of 8-year-olds and 4-year-olds. That translates into 1 of every 36 children, up from 1 in 44 in 2018 and far above the 1 in 110 found in 2006. There's an explanation for the jump: Clinicians are getting better at spotting it. No diagnostic test exists, which can mean other problems — attentional issues, obsessive-compulsive disorder, depression, self-harm, eating challenges, anxiety — obscure what's really going on. 

Still, girls and children of color are probably still overlooked, John Elder Robison of the College of William & Mary and Dena Gassner of Towson University say in a STAT First Opinion. Both are autistic adults and parents of autistic adults. "As tools and expertise improve, diagnoses will continue rising," they write. "This is critical, because unsupported autism contributes to homelessness, abuse, self-harm, and other preventable damage. The more autism we recognize, the more people we can help."


coronoavirus

Antiviral in Paxlovid linked to lower risk of long Covid

It doesn't meet the gold standard for medical research, but a cohort study in JAMA Internal Medicine suggests that nirmatrelvir, one of the two pills combined in Paxlovid, could cut the risk of developing long Covid if given within five days of testing positive for Covid-19. The study analyzed VA medical records of more than 35,000 patients who received nirmatrelvir and more than 246,000 patients who didn't. The antiviral is FDA-authorized for people with one or more risk factors for severe Covid, such as being over 60, smoking, having a BMI over 25, or diseases such as cancer or diabetes.

People who took nirmatrelvir, whether vaccinated or not, had a 26% lower risk of long Covid symptoms, a 47% lower risk of death, and a 24% lower risk of hospitalization after their infections. "Until we have better data, the available evidence suggests that nirmatrelvir may prevent [post-Covid condition]," an editor's note says.


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What we're reading

  • It's not just Adderall: The number of drugs in short supply rose by 30% last year, NPR

  • Most trans adults say transitioning made them more satisfied with their lives, Washington Post

  • The surprising biomedical legacy of the Iraq War, STAT
  • Wyoming judge temporarily blocks the state's new abortion ban, New York Times

  • Opinion: I finally got used to practicing telepsychiatry. Now the DEA wants to change everything, STAT

Thanks for reading! More Monday,


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