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Doctors push to include dialysis machines in emergency stockpile

August 7, 2023
Reporter, Morning Rounds Writer

Good morning and welcome to the working week. Better get to it, but be sure to catch up on the ProMed saga we told you about last week. Helen Branswell has an update on moves by the early-warning disease network to change to a subscription model. 

emergency preparedness

National stockpile should keep dialysis in mind, doctors and patients say

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Michael Starghill for STAT

Kidney failure is like drowning from the inside, as excess fluid and toxins build up. Dialysis three times a week was keeping Ariel Brigham (above) alive, but Hurricane Harvey left her stranded in her flooded Houston apartment. The region's dialysis clinics shut down and travel to emergency rooms was impossible. After seven days without dialysis, her potassium levels were so high her heart had slowed dangerously. "I was dying," she said.

If a dialysis technician hadn't spoken up, Brigham, then 26, would have been sent home after finally getting just one treatment at a hospital. Her case illustrates the vulnerability of people on dialysis who are often overlooked in official emergency plans. "We need to have some kind of reserve of machines that can be quickly accessed and used in time of need. It's public health," Jose Arrascue, a nephrologist in southern Florida, told STAT contributor Carrie Arnold. Read how that might happen.


mental health

FDA approves fast-acting pill for postpartum depression, but not wider use

Hailed as a historic recognition of postpartum depression, the FDA on Friday approved the first oral drug specifically developed to treat the maternal mental health disorder. But in a blow to drugmaker Sage Therapeutics, the agency denied the go-ahead it sought to also use the medication to treat depression more broadly. The drug, to be marketed as Zurzuvae, is a pill patients take for 14 days. Clinical trials have shown depressive symptoms can improve in just a few days and last for four weeks after treatment.

About 1 in 8 women experience symptoms of postpartum depression following childbirth, including feelings of sadness, guilt, and worthlessness, and in severe cases, thoughts of harming themselves or their newborns. Sage had previously won FDA approval for Zulresso to treat postpartum depression, but that was an intravenous drug requiring 60 hours as a hospital inpatient. The new drug does have sedative side effects, noted in a boxed warning on its label. STAT's Brittany Trang has more.


Health

Late-stage cancer diagnoses rose in 2020, with some groups affected more than others

It's a familiar pandemic story by now: In March 2020 and for months after, people didn't get their regular cancer screenings or visit their primary care doctors, either because of Covid lockdowns or fear of infection in the pre-vaccine era. How many cancers were missed has been a burning question. Researchers report in the Lancet Oncology that while cancer diagnoses returned to nearly prepandemic levels by the end of 2020, stage 4 cancer diagnoses were 7% more likely that year than in 2019. 

Certain people were particularly hard hit: Hispanic and Asian American and Pacific Islander groups, uninsured people, Medicare-insured individuals under 65, and people living in socioeconomically deprived areas. The authors say  "ongoing monitoring of the lasting effects of the pandemic on cancer survival, mortality, and economic burden is warranted, as well as increased efforts to mitigate the disparities in these outcomes." STAT's Simar Bajaj has more.



Closer Look

Community health workers, experts in the 'in between,' seek recognition beyond Covid

B3A3476Sarah Stacke for STAT

In the U.S., people may have heard about community health workers for the first time when they were enlisted to encourage people to get vaccinated against Covid. These human bridges between the health care system and  patients have a long tradition in other countries, including the "accompaniment" model enlisted by Partners In Health, for example. Montefiore Comprehensive Health Care Center in the Bronx, N.Y., is unusual in seamlessly depending on these frontline public health workers to use their life experience and deep knowledge of communities to help patients.

For Hawa Abraham (above), the role means helping patients with social needs that are health needs, too. "I want to be that person on the front line to help the less privileged navigate the system," she said. With Covid fading from the general public's attention, Abraham's counterparts elsewhere may be left behind. STAT's Ambar Castillo explains.


global health

Opinion: Drugs along can't stop tuberculosis

In a win for advocates, the latest tuberculosis news involves a patent decision that makes TB pills more available in low- and middle-income countries with high rates of disease. That's not nearly enough, STAT's Abdullahi Tsanni writes in a First Opinion. And he would know. After earning an undergraduate degree in biochemistry, he volunteered for a year in a northern Nigerian hospital's TB DOT center, WHO's shorthand for "directly observed therapy," where active tuberculosis cases are managed.

He watched people swallow dozens of pills a day in regimens lasting months, weathering such side effects as nausea, headaches, and depression. And those were the people with the means to get there. "I tried to help, when I could, but on my own I couldn't transport everyone to and from the DOT," he writes. "The drugs alone aren't enough; they need social and economic support." Read more on how people are trying to help.


children's health

School program promoting water over sweet drinks linked to less growth in overweight prevalence

The name of the campaign says it all: Water First. In an effort to prevent unhealthy weight gain in children, researchers tested whether encouraging fourth-graders to drink water instead of sugar-sweetened milks and juices available at school or at home would help. Eighteen low-income, ethnically diverse elementary schools in the San Francisco Bay area and their more than 1,200 students were split into two groups: schools that promoted water and schools that didn't, serving as the control group. 

After seven months, there was no difference in overweight or obesity prevalence between the groups, but after 15 months, there was a smaller (0.5% vs. 3.7%) increase in overweight prevalence in the Water First schools compared to the control schools. If that seems small, the authors note in their Pediatrics study published today that the Healthy People 2030 goal for reducing obesity prevalence in children is 2.3%.


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What we're reading

  • Doctors suddenly got way better at treating eczema, The Atlantic
  • Want to live longer? Play with your grandkids. It's good for them, too, Washington Post

  • Veterans see historic expansion of benefits for toxic exposure as new law nears anniversary, Associated Press
  • Is good posture overrated? Back to first principles on back pain, The Guardian

Thanks for reading! More tomorrow,


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