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Caring for the caregivers, smartphone TB detection, & why one psychiatrist stopped taking insurance

January 4, 2024
Reporter, Morning Rounds Writer
Good morning: JPM is coming. That's the J.P. Morgan Healthcare Conference, starting Jan. 8 in San Francisco. STAT will be there in force, bringing you updates from the worlds of pharma, biotech, and, of course, health care. Leading up to the big JPM 2024 event, STAT's team shares their burning questions.

health

Caring for the caregivers after transplant patients come homeglenda and ira copperman

Jessica Rinaldi/Boston Globe

"Caregiver" doesn't begin to cover the roles that someone plays when their loved one has received a life-changing organ transplant. "Nurse," "case manager," and "financial planner" start to encompass some of the responsibilities assumed by family members who lack support through the long process of recovering and adjusting to the complexities of managing post-transplant health. There are checkups, medications, and medical equipment to manage, from IV drips to dressing changes to vital signs monitoring. 

"Transplantation is not the end story. You don't stop what you do as caregiver or care partners the day after a transplant," said Ira Copperman, whose wife, Glenda (above), received a double organ transplant in 1999. "It is a lifelong journey." Advocates, doctors, and patients are trying to change a framework for support that now ends one year post-transplant, adding training and counseling and turning to the Family Medical Leave Act for financial assistance. STAT's Annalisa Merelli has more.


mental health

How online racial bias may be connected to adolescents' suicidal thinking

With suicide rates rising among Black adolescents over the past 20 years, researchers have been looking into possible causes. A new study in JAMA Psychiatry asked whether there was a connection between online racial discrimination and suicidal thinking. The researchers point out that cyberbullying has already been linked to increased suicidal ideation, and Black adolescents have an average of five racially discriminatory experiences daily, most online.

After analyzing data from the first wave of the National Survey of Critical Digital Literacy, the researchers concluded there was a connection, but contrary to their expectations, it was indirect. Offline racial discrimination has been directly associated with suicidal thinking, but among the 525 Black adolescents in the new study, there was a link between individual online racial discrimination and PTSD symptoms, and then between PTSD symptoms and suicidal ideation. Still, they urge online platforms to "create safer spaces for Black adolescents by proactively monitoring and reducing hate speech."


global health

Smartphone tool shows promise for detecting TB

Tuberculosis has been on the wane for years, but in 2021 cases started mounting again, making it the second-most common cause of death from an infectious disease. Diagnosing someone with TB as opposed to other respiratory illnesses such as asthma, pneumonia, or Covid can be challenging, especially where molecular tests on cultures of saliva and mucus are not accessible. Now researchers writing in Science Advances report on their success with a tool that uses smartphone recordings to detect coughs specific to TB. 

The audio framework, called TBscreen, was trained in Nairobi, Kenya, on 33,000 natural coughs and 1,200 forced coughs and tested on 149 patients who had pulmonary TB and 46 patients with other respiratory conditions. The test's sensitivity was about 70% when used on recordings from a Google Pixel 2 smartphone (the best performer). The scientists hope their tool can become a point-of-care cough-based TB screen. 



first opinion

For this psychiatrist, insurance ≠ access

Psychiatrist Andrew Popper has had to tell prospective patients many times over his 15 years in solo private practice that he can't take on new patients. He eventually realized he was spending more time dealing with insurance denials than he was seeing patients, limiting the number of people he could help. Writing in a STAT First Opinion, he compares filling out insurance forms to defusing a bomb: Both require extreme care and both are uncertain to succeed. 

Then he stopped taking insurance. "I've had more time to see patients. I've seen more new patients in the past six months than I did in the previous three years," he says. "While my practice revenues fell 10% (not counting inflation) in 2023, I am serving more patients in total. But asking clinicians to see more patients for less money is not a sustainable path to improving access to mental health care." Read how he made the change, including how patients paid.


health

Children at risk for drug interactions

As rates of chronic illnesses rise among children, so do the rates of dangerous interactions between drugs prescribed to treat those conditions. A study out in Pediatrics today estimates that 1 in 5 U.S. children who take prescription drugs will experience a serious problem from a drug-drug interaction over a year of treatment, with the risk higher among adolescents, children with more medical and mental health complexity, and those who take more than two drugs. 

To reach this conclusion, the researchers analyzed 2019 data for more than 781,000 children insured by Medicaid who were prescribed drugs as outpatients. The drugs most often involved are clonidine, antipsychotic drugs, asthma and allergy drugs, and ADHD drugs. Clonidine, a drug for high blood pressure as well as ADHD, was the most frequently implicated drug. Major drug-drug interactions can affect children's cardiovascular and central nervous systems, as well as change the concentration of the drugs they need.


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What we're reading

  • Should patients be allowed to die from anorexia? New York Times
  • New York closed psych beds for youth in crisis. Now, foster care programs and host towns are being pushed to the limit, ProPublica

  • A potent antibiotic has emerged in the battle against deadly, drug-resistant superbugs, Los Angeles Times
  • Novo Nordisk enlists two Flagship biotechs to develop obesity, MASH drugs, STAT
  • Health tech's 2024 hiring outlook: Balance tips toward employers, STAT

Thanks for reading! More tomorrow,


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