Category Archives: Preventative Medicine

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The CARES Act is the third phase of the federal governments response to the coronavirus following two other laws to support American families and address health sector needs that were approved on March 6, 2020 (Phase I here) and March 18, 2020 (Phase II here).

The CARES Act includes provisions which provide cash payments and other resources to help individuals, small businesses, state and local governments and hospitals/healthcare providers. The CARES Act includes four sections (called Titles) and each title addresses a different topic. This e-update summarizes Title III of the CARES Act titled Supporting Americas Health Care System in the Fight Against the Coronavirus. Title III provides much needed financial assistance to the health care industry, as well as additional guidance and other provisions which provide information on waivers and other benefits to help hospitals and others who are on the front lines of fighting the COVID-19 pandemic. The following is a summary of the major provisions of Title III, organized in order by section numbers under the CARES Act but does not address subtitle B Education Provisions and subtitle C Labor Provisions. We will provide links to summaries of other provisions in the CARES Act prepared by our colleagues throughout the firm as they become available.

TITLE III SUPPORTING AMERICAS HEALTH CARE SYSTEM IN THE FIGHT AGAINST THE CORONAVIRUS

SUBTITLE A HEALTH PROVISIONS

PART I ADDRESSING SUPPLY SHORTAGES

SUBPART A MEDICAL PRODUCT SUPPLIES

Section 3101. National academies report on Americas medical product supply chain security.

Not later than 60 days after the enactment of the CARES Act, the Secretary of Health and Human Services is required to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine to examine and report on the security of the United States medical product supply chain, considering input from various federal agencies and consulting with relevant stakeholders. The report will (1) assess and evaluate the dependence of the United States on critical drugs and devices that are sourced or manufactured outside of the United States; and (2) provide recommendations, which may include a plan to improve the resiliency of the supply chain for critical drugs and devices and to address any supply vulnerabilities or potential disruptions of such products that would significantly affect or pose a threat to public health security or national security.

Section 3102. Requiring the strategic national stockpile to include certain types of medical supplies.

The law adds the following items to the strategic national stockpile that the Secretary of Health and Human Services is required to maintain in the event of a bioterrorist attack or other public health emergency: personal protective equipment, ancillary medical supplies and other applicable supplies required for the administration of drugs, vaccines and other biological products, medical devices, and diagnostic tests.

Section 3103. Treatment of Respiratory Protective Devices as Covered Countermeasures.

The law provides for respiratory protective devices approved by the National Institute for Occupational Safety and Health. The law also states that the Secretary of Health and Human Services determines these devices to be a priority for use during a public health emergency qualify as covered countermeasures under Section 42 U.S. Code Section 247d-6d which provides targeted liability protection for pandemic and epidemic products and security countermeasures.

SUBPART B MITIGATING EMERGENCY DRUG SHORTAGES

Section 3111 Prioritize reviews of drug applications; incentives.

The Secretary is now required to expedite certain new drug applications to prevent drug shortages, when previously, expediting applications was optional.

Section 3112 Additional manufacturer reporting requirements in response to drug shortages.Drugs that are deemed critical during a public health emergency are added to the list of drugs that manufacturers must report to the FDA in the case of discontinuation or interruption. Additionally, this provision expands reporting requirements, including requiring manufacturers of these drugs to develop and implement a redundancy risk management plan that must be submitted to the Secretary of Health and Human Services in the event of an inspection or request.

SUBPART C PREVENTING MEDICAL DEVICE SHORTAGES

Section 3121 Discontinuance or interruption in the production of medical devices.

Manufacturers of life-sustaining devices that are deemed critical to public health during a public health emergency must notify the Secretary of Health and Human Services six months prior to any discontinuance or interruption. If appropriate, the Secretary of Health and Human Services may distribute this information to entities the discontinuance or interruption could affect. The Secretary of Health and Human Services is to maintain a list of drug devices of which there is a shortage.

PART IIACCESS TO HEALTH CARE FOR COVID-19 PATIENTS

SUBPART A COVERAGE OF TESTING AND PREVENTIVE SERVICES

Section 3201 Coverage of diagnostic testing for COVID-19.

The Families First Coronavirus Response Act which was signed into law on March 18, 2020 requires that a group health plan or a health insurance issuer offering group or individual health insurance coverage provide coverage and not impose any cost sharing (including deductibles, copayment and co-insurance) or prior authorization or other medical management requirements for an in vitro diagnostic test for the detection of SARS-CoV-2 or the diagnosis of the virus that causes COVID-19 and the administration of such a test. This section provides more specificity regarding the definition of a COVID-19 diagnostic test under the Families First Coronavirus Response Act by expanding the definition to include an in vitro diagnostic product that

Section 3202 Pricing of diagnostic testing.

A group health plan or a health insurance issuer providing coverage of items and services described in section 6001(a) of division F of the Families First Coronavirus Response Act (which provides for coverage of testing for COVID-19) with respect to an enrollee shall reimburse the provider of the diagnostic testing provider as follows:

During the emergency period described under the Families First Coronavirus Response Act, each provider of a diagnostic test for COVID-10 shall make public the cash price for such test on a public internet website of such provider. The Secretary of Health and Human Services may impose a civil monetary penalty on any provider that is not in compliance and has not completed a corrective action plan to comply in an amount not to exceed $300 per day that the violation is going on.

Section 3203 Rapid coverage of preventive services and vaccines for coronavirus.

The law requires full insurance coverage of yet to be created immunizations and preventive services for COVID-19. Specifically, the Secretary of Health and Human Services, the Secretary of Labor and the Secretary of Treasurer shall require group health plans and health insurance issuers offering group or individual health insurance to cover (without cost-sharing) a qualifying coronavirus preventive service. A qualifying coronavirus preventive service means an item, service or immunization that is intended to prevent or mitigate coronavirus disease 2019 that is:

The requirements shall take effect on the date that is 15 business days after the date on which a recommendation is made relating to the qualifying coronavirus preventive service as described in such paragraph.

SUBPART B SUPPORT FOR HEALTH CARE PROVIDERS

Section 3211 - Supplemental awards for health centers.

$1.32 billion is appropriated for grants to health centers in medically underserved areas working towards the detection of SARS-CoV-2 or the prevention, diagnosis, and treatment of COVID-19.

Section 3212 Telehealth network and telehealth resource centers grant programs.

This provision amends the National Telehealth Strategy and Data Advancement Act to include services for substance use disorders and to serve rural areas in addition to medically underserved areas.

Section 3213 Rural health care services outreach, rural health network development, and small health care provider quality improvement grant programs.

Awards under the National Telehealth Strategy and Data Advancement Act are granted for basic health care services, not only essential health care services.

Sec. 3214 - United States Public Health Service Modernization.

This section amends the Public Health Service Act (42 U.S.C. 204) with respect to Commissioned and Reserve Corps members. The amendments remove references to the Ready Reserve Corps and permit the Regular Corps to be deployed for service in time of a public health emergency, along with other technical amendments.

Section 3215 Limitation on liability for volunteer health care professionals during COVID-19 emergency response.

With limited exceptions, a health care professional shall not be liable under Federal or State law for any harm caused by an act or omission of the professional in the provision of health care services during the public health emergency with respect to COVID-19 if (1) the professional is providing health care services in response to such public health emergency as a volunteer; and (2) the act of omission occurs:

For this purpose, harm includes physical, non-physical, economic and noneconomic losses and health care services means any services provided by a health care professional, or by any individual working under the supervision of a health care professional that relate to (A) the diagnosis, prevention, or treatment of COVID-19; or (B) the assessment or care of the health of a human being related to an actual or suspected case of COVID-19. A volunteer means a health care professional who, with respect to the health care services rendered, does not receive compensation or any other thing of value in lieu of compensation, which compensation (A) includes a payment under any insurance policy or health plan, or any Federal or State health benefits programs; and (B) excludes (i) receipt of items to be used exclusively for rendering health care services in the health care professionals capacity as a volunteer; and (ii) any reimbursement for travel to the site where the volunteer services are rendered and any payments in cash or kind to cover room and board, if the services are being rendered more than 75 miles from the volunteers principal place of residence.

This limitation on liability does not apply if the harm was caused by an act or omission constituting willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious flagrant indifference to the rights or safety of the individual harmed by the health care professional or the health care professional rendered the health care services under the influence (as determined pursuant to applicable State law) of alcohol or an intoxicating drug.

The law clarifies that this section preempts the laws of a State or any political subdivision of a State to the extent that such laws are inconsistent with this section, unless such laws provide greater protection from liability and protections afforded by this section are in addition to those provided by the Volunteer Protection Act of 1997.

This section takes effect upon the date of enactment of the CARES Act and applies to a claim for harm only if the act or omission that caused such harm occurred on or after the date of enactment.

Sec. 3216 - Flexibility for members of National Health Service Corps during emergency period.

This section permits the Secretary of Health and Human Services to assign members of the National Health Service Corps, with voluntary agreement of such corps members, to deploy and provide health services as needed to respond to a public health emergency.

SUBPART C MISCELLANEOUS PROVISIONS

Section 3221 Confidentiality and disclosure of records relating to substance use disorder.

This section revises certain provisions found at 42 U.S.C. 290dd-d concerning confidentiality and disclosure of records relating to substance use disorders. First, outdated references to substance abuse are replaced with the term substance use disorder. Second, the provisions regarding consent and use of the content found in such records was overhauled to explicitly allow use not only specifically consented to by a patient but also as permitted by the HIPAA regulations. The consent and use provisions now also make clear that prior written consent applies for all such future uses or disclosures for purposes of treatment, payment, and health care operations. Third, disclosure of the de-identified record to a public health authority was added to the list of allowable disclosures. Fourth, a list of relevant definitions was added to the statute to be consistent with HIPAA. Fifth, in addition to criminal contexts, administrative and civil contexts were added as situations under which such records may not be disclosed, for example in an application for a warrant. Sixth, general anti-discrimination language was added to protect fair treatment of individuals with such records. Seventh, breach notification language in line with the HITECH Act was added. Finally, this section calls for the Department of Health and Human Services to issue additional regulations to appropriately implement the changes described above and require covered entities to update their notices of privacy practices to account for such records.

Sec. 3222 - Nutrition services.

This section grants the Secretary of Health and Human Services the right to allow state agencies to transfer funds for the provision of nutrition services without the prior approval of the Secretary of Health and Human Services during a public health emergency.

Sec. 3223 - Continuity of service and opportunities for participants in community service activities under title V of the Older Americans Act of 1965.

This section grants the Secretary of Labor the ability to permit participants in community service activities under Title V of the Older Americans Act of 1965 to extend such participation and to increase the average participation cap as set forth therein.

Section 3224 Guidance on protected health information.

No later than 180 days after enactment, the Department of Health and Human Services must issue guidance regarding the sharing of patients protected health information during a public health emergency. The guidance must include information on compliance with regulations promulgated pursuant to HIPAA and applicable policies, including policies that may come into effect during such emergencies.

Section 3225. Reauthorization of healthy start program.

Section 3225 reauthorizes the healthy start program and appropriates $125,500,000 for each of the fiscal years 2021 through 2025. Among other things, the section requires that the Secretary of Health and Human Services ensure that the program is coordinated with other programs and activities related to the reduction of the rate of infant mortality and improved perinatal and infant health outcomes supported by the department.

Section 3226 Importance of the blood supply.

The Secretary of Health and Human Services shall carry out a national campaign to improve awareness of, and support outreach to, the public and healthcare providers about the importance and safety of blood donation and the need for donations for the blood supply during the public health emergency declared by the Secretary of Health and Human Services. The Secretary of Health and Human Services may enter into contracts to establish a national blood donation awareness campaign. The Secretary of Health and Human Services is required to consult with the Commissioner of Food and Drugs, the Assistant Secretary for Health, the Director of the Centers for Disease Control and Prevention, the Director of the National Institutes of Health, and the heads of other relevant Federal agencies, and relevant accrediting bodies and representative organizations. Not later than 2 years after the date of enactment, the Secretary of Health and Human Services shall submit to the Senate and House a report which will include a description of the activities carried out, a description of trends in blood supply donations, and an evaluation of the impact of the public awareness campaign.

PART III INNOVATION

Section 3301. Removing the cap on OTA during public health emergencies.

Section 3301 amends the provisions that govern the Biomedical Advanced Research and Development Authority (BARDA) to remove the cap on other transactions authority (OTA) during a public emergency. Currently, the law authorizes the Secretary of Health and Human Services to enter into other transactions for a project that is expected to cost the Department of Health and Human Services in excess of $100 million only upon the written determination by the Assistant Secretary for Financial Resources that the use of such authority is essential to promoting the success of the project. The amendment removes the foregoing approval for transactions necessary during a public health emergency. Notwithstanding the foregoing, the Secretary of Health and Human Services, to the maximum extent practicable, is required to use competitive procedures when entering into transactions to carry out projects for the purposes of a public health emergency. Any transaction entered into during such public health emergency shall not be terminated solely due to the expiration of the public health emergency if the public health emergency ends before the completion of the terms of such agreement.

Section 3302. Priority zoonotic animal drugs.

Section 3302 amends Chapter V of the Federal Food, Drug, and Cosmetic Act by adding a new section 512A which provides a process for the Secretary of Health and Human Services to expedite the development and review of a new animal drug if preliminary clinical evidence indicates that the new animal drug, alone or in combination with 1 or more other animal drugs, has the potential to prevent or treat a zoonotic disease in animals, including a vector borne-disease, that has the potential to cause serious adverse health consequences for, or serious or life-threatening diseases in, humans.

PART IV HEALTH CARE WORKFORCE

Section 3401 Reauthorization of health professions workforce programs.

Section 3401 makes significant amendments to Title VII of the Public Health Service Act to add additional appropriations of $23,711,000 for each of fiscal years 2021 through 2025 as well as extending funding for various programs.

In addition, under this section, the Secretary of Health and Human Services may award grants or contracts to eligible entities to increase the number of individuals in the public health workforce, to enhance the quality of such workforce, and to enhance the ability of the workforce to meet national, State, and local health care needs. The law authorizes the Secretary of Health and Human Services to give priority to qualified applicants that train residents in rural areas, including for Tribes or Tribal Organizations in such areas.

Section 3402 Health workforce coordination.

Within one year after the date of enactment of the CARES Act, the Secretary of Health and Human Services in consultation with the Advisory Committee on Training in Primary Care Medicine and Dentistry and the Advisory Council on GME, shall develop a comprehensive and coordinated plan with respect to the health care workforce development programs of the Department of Health and Human Services including education and training programs. The plan will include performance measures to determine the extent to which the programs are strengthening the nations health care system, identify any gaps that exist between the outcomes of programs and projected health care workforce needs identified in workforce production reports conducted by the Health Resources and Services Administration, identify actions and barriers and coordinate with other agencies and provide a report to the Senate and House not later than 2 years after the date of enactment of the CARES Act.

Sec. 3403 - Education and training relating to geriatrics.

This section provides that the Secretary of Health and Human Services shall award grants, contracts, or cooperative agreements to certain entities or other health professions schools for the establishment or operation of Geriatrics Workforce Enhancement Programs. These programs are designed to support the training of health professionals in geriatrics, including traineeships and fellowships, with an emphasis on patient and family engagement in an effort to address gaps in health care for older adults. The section sets forth permitted activities, duration of such programs, application requirements, program requirements, and reporting requirements. The section provides the Secretary of Health and Human Services with the authority to grant special consideration and priority to those entities and health professions schools operating in areas with a shortage of geriatric workforce professionals or who can otherwise demonstrate need.

The section further establishes the Geriatric Academic Career Awards program to promote the career development of such individuals as academic geriatricians or other academic geriatric health professionals.

Section 3404 Nursing workforce development.

This section establishes clinics to address national nursing needs including addressing challenges related to the distribution of the nursing workforce and existing or projected nursing workforce shortages in geographic areas that have been identified as having, or that are projected to have, nursing shortage increase access to and the quality of health services, including by supporting the training of professional registered nurses, APRNs, and advanced education nurses within community based settings and in a variety of health delivery system settings or addressing the strategic goals and priorities. No later than September 30, 2020 and biennially thereafter, the Secretary of Health and Human Services will provide a report that contains an assessment of the programs and activities related to enhancing the nursing workforce.

This section also amends Section 296(j) which provides grants to projects that support the enhancement of advanced nursing education and practice to strike the requirements of masters degree program and adding graduate and by inserting clinical nurse leaders after nurse administrators in the list of nurses that qualify for the grants. The law also adds a clinical nurse specialist programs which are education programs that provide registered nurses with full-time clinical nurse specialist education, and have as their objective the education of clinical nurse specialists who will, upon completion of such a program, be qualified to effectively provide care through the wellness and illness continuum to inpatients and outpatients experiencing acute and chronic illness.

In addition, this section expands quality grants to make the quality and retention grants and expanding the high-risk groups to include mental health or substance use disorders in addition to those that are already listed.

Finally, this section adds an additional amount by amending 298(d) to strike $338,000,000 for fiscal years 2011 through 2016 and to insert $137,837,000 for each of the years 2021 through 2025 and to appropriate an additional $117,135,000 for each of the fiscal years 2021 through 2025.

The Comptroller General will conduct an evaluation of the nurse loan repayment program administrated by the Health Resources and Services Administration. The evaluation will focus on the manner in which payments are made under such programs, the existing oversight functions necessary to ensure the proper use of such programs (including payments made as part of such programs), the identification of gaps, if any, in oversight functions and information on the number of nurses assigned to facilities pursuant to such programs (including the type of facility to which nurses are assigned and the impact of modifying the eligibility requirements for programs under the Public Health Services Act). Not later than 18 months after the enactment of the CARES Act, the Comptroller General shall submit a report to the House and Senate on the evaluation which may include recommendations to improve relevant nursing workforce loan repayment program.

SUBTITLE DFINANCING COMMITTEE

Section 3701 Exemption for telehealth services.

This section creates a temporary telehealth-related safe harbor for high deductible health plans. For plan years beginning on or before December 31, 2021, a high deductible health plan does not need to have a deductible for telehealth and other remote care services. In addition, coverage for telehealth and other remote care during such plan years will not be considered in determining whether someone is an eligible individual under a high deductible health plan.

Section 3702 Inclusion of certain over-the-counter medical products as qualifiedmedical expenses.

This section adds the costs of menstrual care products as qualified medical expenses for purposes of health savings accounts, Archer MSAs, health flexible spending arrangements, and health reimbursement arrangements for amounts paid after December 31, 2019.

Section 3703 Increasing Medicare telehealth flexibilities during emergency period.

Federal law at 42 U.S.C. 1320b-5 provides authority to the Secretary of Health and Human Services to waive health care related requirements during a national emergency to ensure that there are sufficient health care items and services to meet patient need and to ensure that health care providers may be reimbursed and may be exempted from sanctions for noncompliance. The CARES Act improves upon Congress recent efforts to enhance the availability of telehealth services for Medicare and Medicaid beneficiaries during this emergency period.

On March 6, 2020, Congress enacted the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, available here, which amended 1320b-5(b) by adding paragraph (b)(8) to permit the Secretary of Health and Human Services to waive certain restrictions on telehealth provided to Medicare, Medicaid and SCHIP beneficiaries starting on March 6, 2020 (the January law). The January law allowed a waiver which would permit payment for telehealth services such as office visits, mental health counseling and preventative health screenings even if a patient was not in a rural area and if the patient was at home. Medicare had historically not paid for telehealth if a patient was at their home when they received the telehealth services, and also did not pay for telehealth for patients in urban areas. The January law, which allowed a waiver to be granted during an emergency period, to permit such payments for Medicare beneficiaries in urban areas and in their homes was a very substantial leap forward for Medicare.

However, the January law still limited the Secretary of Health and Human Services ability to waive certain telehealth payment restrictions. Specifically, the January law did not permit the Secretary of Health and Human Services to waive the limitation on the payment of facility fees, which are only permitted if the patient is located at one of a specific list of originating sites (such as a physician office or a hospital, and notably, NOT at home) and the originating site is located in a rural area.

This new law removes the limitation on the Secretary of Health and Human Services waiver authority for facilities fees related to telehealth. Now, the Secretary of Health and Human Services may determine that during an emergency period, facility fees can be paid for telehealth providers even if the patient is not in a rural area and even if the patient is at home during the telehealth visit.

The January law also included restrictions on the Secretary of Health and Human Services ability to waive requirements for the types of telecommunications services used in telehealth. The Secretary was not permitted to waive telecommunications requirements if the communication did not have both audio and video capabilities. Under this new law, the Secretary now will have the authority to waive all of the requirements regarding the type of telecommunications services that can be used for telehealth.

Further, the January law included a definition of qualified provider which highlighted the fact that telehealth is only allowed for a Medicare or Medicaid beneficiary who is already an established patient of the provider or the providers practice. Despite this continued requirement, the Department of Health and Human Services stated in guidance documents, available here, that it would not conduct audits to ensure that such prior relationship existed for claims submitted during the public health emergency. This new law will go farther than a no audit statement by the Department of Health and Human Services. Instead, this new law will remove the definition of qualified provider, which means that the Secretary of Health and Human Services will have the authority to waive the established patient requirement during the emergency period.

In summary, under this new law the Secretary of Health and Human Services will now have the authority to waive all laws governing payment for telehealth services under Medicare, Medicaid and SCHIP. There are no more limitations to the Secretary of Health and Human Services waiver authority pertaining to payment for telehealth services.

In particular, the Secretary of Health and Human Services now has the authority to waive: (1) the restrictions on the payment of a facility fee even if the patient is at home and not in a rural area during the telehealth visit; (2) all requirements for the type of telecommunications services that can be used- even if the telecommunications service only has audio capabilities; and (3) the requirement that telehealth services can only be provided to a providers established patients.

Section 3704 Enhancing Medicare telehealth services for Federally qualified health centers and rural health clinics during emergency period.

The Act provides that during the currently designated emergency period Medicare shall pay for telehealth services that are furnished via a telecommunications system by a Federally qualified health center (FQHC) or a rural health clinic (RHC) to an eligible telehealth individual who is an enrolled beneficiary notwithstanding that the FQHC or RHC providing the telehealth service is not at the same location as the beneficiary. The Secretary of Health and Human Services shall develop and implement payment methods for such telehealth services, which shall be based on payment rates that are similar to the national average payment rates for comparable telehealth services under the Medicare physician fee schedule. Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement such payment methods through program instruction or otherwise. Costs associated with the telehealth services would not be included in other reimbursement methods for the FQHC and RHC.

Section 3705 - Temporary waiver of requirement for face-to-face visits between home dialysis patients and physicians.

During the currently designated emergency period, the Secretary of Health and Human Services may waive the requirement for face-to-face clinical assessments between home dialysis patients and their physicians. This would allow Medicare beneficiaries determined to have end stage renal disease receiving home dialysis to choose to receive monthly end stage renal disease-related clinical assessments via telehealth.

Section 3706 - Use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care during emergency period.

For purposes of recertifying a Medicare beneficiary for hospice care, during the currently designated emergency period a hospice physician or nurse practitioner may conduct the required face-to-face encounters via telehealth, as determined appropriate by the Secretary of Health and Human Services.

Section 3707 - Encouraging use of telecommunications systems for home health services furnished during emergency period.

The rest is here:
CARES Act Summary of Provisions that Support Americas Health Care System - JD Supra

Expanding primary cares role in the healthcare system has long been viewed as key to reining in healthcare costs and improving outcomes. But patients themselves apparently havent gotten the message.

Medical Economics recently reported on a study of claims data at a large commercial health insurer that found a 25 percent decline in visits to primary care providers between 2008 and 2016. To gain more insight into the studys background and findings. Medical Economics recently spoke with Ishani Ganguli, MD, MPH, one of the studys authors. A transcript of the interview, edited for clarity and brevity, follows.

Medical Economics: What evidence had you seen of a decline in primary care visits that led you and your coauthors to undertake this study?

Ishani Ganguli: We first noticed it when we were studying a different but related topic, the Medicare Annual Wellness Visit, which began in 2011 as part of the Affordable Care Act. Myself and [co-author] Ateev Mehrotra had collaborated on that study and had noticed that primary care visit rates were going down in Medicare. So we started digging more and noticed this pattern was present across different populations.

So we published a paper last year in the Journal of General Internal Medicine demonstrating this decline in Medicare in two national surveys as well as employer data sets and this commercial population. This more recent paper was our opportunity to study in more depth what was happening among these commercially insured adults and to get more clues as to why it was happening.

ME: Annual checkups used to be routine, at least among people with insurance. Is that no longer the case, or would those now be considered preventative visits? And if it is no longer the case, why not?

IG: Let me unpack that a little. Annual Wellness Visits and preventative visits are two terms for what are essentially the same thing, and preventative visits are actually going up. So what we find is a couple of different threads. We know that having a primary care doctor is a good thing and that being in an area with lots of primary care doctors is good for your health.

But going in for an annual checkup is not that useful, particularly if you are a young or healthy person. In fact, when I have young healthy people come to my office I will do a new patient visit but tell them to come back every couple years because theres no benefit to coming in every year if they dont have any new medical needs. So hopefully were being more judicious about when to offer those routine checkups.

The other thing youll see in the data is a story about cost incentives. Thanks to the ACA, these preventative visits became much cheaper, or free to the patient. So part of why we might be seeing a rise in preventative visits as other types of visits in primary care go down is that exact fact.

Patients are savvy and know that [preventative] visit will be paid for and come in for that. If I, as a doctor know a patient is eligible for their next preventative visit they will have to pay less. Whereas the costs to patients for other types of primary care visits have been going up during this period we studied.

ME: Do you think that the way the insurance company whose data you used for the study structured its plans might have contributed to fewer primary care visits by its members?

IG: No. A large national insurer such as this one works with hundreds, maybe thousands of employers and designs plans specifically for each of them, so its virtually impossible to try and categorize these plans in any meaningful way.

Also, its certainly not unique to this insurer. But it may reflect broader trends in, for example, increasing reliance on high-deductible health plans.

ME: What has been the response to the study?

IG: The ACP [American College of Physicians] has been interested because it speaks to the larger challenges of the disconnect in the way we think about healthcare. We increasingly think of primary care as being the solution to a lot of the challenges we face in healthcare. We think about it as a way of saving money and improving the quality of care. And the new primary care models, like accountable care organizations and patient-centered medical homes have primary care at their center. Yet if people arent seeing their primary care doctor as much, that gives you pause. So I think thats why people have been interested, this sort of disconnect between what we want primary care to do for us and what this evidence suggests.

All that being saidand I think we make this point in the papersome of the reasons for the decline are worrisome, like issues of access, such as when theres no primary care doctor who has availability, or the cost barriers.

The good news story, though, is that I think primary care has gotten more efficient and tends to be better than specialist care at using other members of the team, and at doing virtual care through e-mails or telephone calls. So some of the decline might be an appropriate shift to other types of interactions between doctors and patients.

ME: Is it also possible that people just are healthier and thus have less reason to see a doctor?

IG: Yes, I think in certain ways thats probably true. We have better vaccinations, for example. One of my colleagues led a study, using this same data, looking at children in the commercially-insured population and found that vaccines for preventing upper respiratory infections resulted in a huge decline in visits. Weve seen a big drop in visits for more mild conditions like a cold or pink eye where you could go online and figure out what to do, or call your doctor but not come in. The paper we published last year goes into the whole universe of possible reasons [for the decline in primary care visits.]

ME: What are the implications of your findings for primary care doctors and the countrys healthcare system?

IG: To the extent that this is a worrisome story, whether its bigger drops in low-income areas that suggests shortage of primary care doctors and challenges paying for visits, we need to redesign areas of our healthcare system to try and make that better. That could be insurance companies making high-value visits like primary care visits free or low-cost for patients, or changes in our medical education policies to encourage more students to go into primary care, fostering our nurse practitioner and physician assistant colleagues--we included them in the study as primary care practitioners--all those changes are important.

I think theres also education that needs to be done around how patients view primary care. We saw a decline not just among millennials, which is the group we often think of that doesnt feel like they need to see a doctor, but even among folks in the 55-64 age group, the decline was present. To the extent thats telling us either people arent seeing the value in primary care, or getting their needs met in another venue, like an urgent care setting, we need to think more about how we make primary care accessible and attractive to people because of all the current challenges in accessing care.

So Id say, broadly speaking, its changing the way patients pay for primary care, theres how we structure the payment and delivery of primary care to make it easier for primary care docs to meet patients where they need to be, and its educating patients on why its important to have a primary care doctor.

See more here:
Explaining the drop off in primary care visits - Medical Economics

Harvard epidemiologistMarcLipsitchtold The Wall Street Journalthat "it's likely we'll see a global pandemic" of coronavirus, with 40 to 70 percent of the world's population likely to be infected this year.

"What proportion of those will be symptomatic, I can't give a good number," addedLipsitch, who is theDirector of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health.

Two other experts have recently given similar estimates.

Ira Longini, a biostatistician and adviser to the World Health Organization, has predicted that two-thirds of the global populationmay eventually contract COVID-19.

Prof Gabriel Leung, the chair of public health medicine at Hong Kong University, says if the transmission estimate of 2.5 additional people for each infected rate is accurate, that would result inan "attack rate" that wouldaffect 60 to 80 percent of the world's population.

The Centers for Disease Control and Prevention (CDC) has already saidthat it is preparing for the coronavirus to have a greater impact in the U.S. than the 15 confirmed cases currently.

In an interview withCNNon Feb. 13,Robert Redfield, director of the Centers for Disease Control and Prevention (CDC), said,Right now we're in an aggressive containment mode. He addedthat this virus is probably with us beyond this season, beyond this year, and I think eventually the virus will find a foothold and we will get community-based transmission."

Dr. Nancy Messonnier, the director of the CDCs National Center for Immunization and Respiratory Diseases, recentlyconfirmedthat the CDC is taking steps to prepare for the coronavirus to take a foothold in the U.S.

Along with communicating with health care facilities and resources, Messonnier says that the CDC is in constant talks with the medical supplies manufacturers, distributors and other health care partners to ensure there are plenty of preventative devices like masks and gloves available in the U.S. in the event of a larger outbreak.

Some of these partners have reported higher demand for N95 face masks and respirators.

She also took the time to explain the CDCs recommended use of any preventative supplies, especially face masks. Because the virus isnt spreading through the communityin the U.S., Messonnier only advises using face masks if you are sick or under investigation and not hospitalized, before one enters a health care providers office, or when caring for a potential infected patient.

When alone and at home, however, Messonnier says that people do not need to wear a mask.

She also confirmed that 195 people from Wuhan have completed the 14 day quarantine and left the March Air Reserve Base to be self-monitored with the help of state and local health authorities.

Additionally, amid reports of poor treatment of quarantined individuals and the military staff tending to them, Messonnier stated that the individuals discharged pose no health threat to their surrounding communities or the community they will return to.

After the CDC confirmed that a lab error led to the accidental discharge of an infected patient from a San Diego hospital, Messionnier told reporters that the CDC and other health officials are adding additional quality controls to keep patients organized.

Originally posted here:
Harvard professor says global coronavirus pandemic 'likely,' infecting 40-70% of world this year - The Hill

Greek Epidemiology Professor Dr. Dimitrios Paraskevis, the scientist who broke the coronavirus DNA, speaks exclusively to Greek City Times and provides answers on the potential availability of a vaccine against the virus, what we should be mindful of and how the lethal coronavirus started spreading.

By Konstantinos Sarrikostas

What is it actually like running after lethal viruses on a daily basis, 24 hours per day; locating, analyzing and decoding genetic material which leaves a hecatomb of dead people in its wake?

The Father of Medicine Hippocrates became the founder of Orthologic Medicine discouraging his fellow citizens from metaphysical elements, superstitions and even prejudices. Actually, he said that in serious diseases, the most effective method in treatment is absolute accuracy and fastidiousness, which modern doctors, who follow his oath, literally strive for in the healing of their fellow human beings.

Dr. Dimitrios Paraskevis, a modern Hippocrates, is Deputy Professor of Preventive Medicine and Hygienic Epidemiology at the Medical School of the National and Kapodistrian University of Athens. Along with two fellow colleagues, he has managed -in time- to analyse and decode the DNA of the lethal coronavirus which recently broke out in China and has alarmed the international community.

According to Dr. Dimitrios Paraskevis we are in the final stages of discovering a vaccine against the virus, its cause and origin and vital information on how to protect ourselves from it.

As he points out, in a few months time we will have the vaccine against the coronavirus; but what is absolutely essential is the total implementation of hygiene rules and most importantly behave with great composure.

THE INTERVIEW

Professor, the entire planet is discussing the coronavirus and peoples concern is really great. Could you please tell us in simple terms what the coronavirus is and why it has spread so rapidly?

The coronavirus spreads relatively easy for several reasons, the most significant one being that it can be spread by droplets if someone is exposed to them, for instance through sneezing or coughing. Other reasons include the fact that no preventative measures were taken to contain the virus or at the very least limit its spread, especially when it first infected people at the end of November and the beginning of December 2019 a period of prime importance.

This happened because it is an unknown virus and as such there was no awareness amongst the people in China in order that they initiate the necessary control measures. Therefore, when a great number of people have already been infected, you realise that from that point on, it is more difficult to control the infection. Moreover, owing to the fact that universal transfers are really easy nowadays, a disease can easily be spread globally.

From your studies and genetic analysis as the lead scientist of your research team , have you reached a conclusion about how it started? Was it, after all, spread by bats or could it be a lab product: a discussion which exists globally?

The coronavirus belongs to a team which is characterized as B team and its the same team to which the virus which caused the epidemic SARS in 2003 belongs. The genetic material of the virus which has caused this present epidemic, presents a great proportion with the genetic material of the relevant virus infecting bats.

Talking about proportion we mean that it reaches the level of 96%; that is, the possible source of infection is this particular animal, i.e. bats. Of course, we cannot rule out the fact that the infection can be made by another animal, another carrier, another mammal which has been infected by bats and this, in turn, transferred it to humans. This will be hard to find because we have to find the particular animal and locate the truth, the part of the virus which caused the infection. But, on the other hand, it is not of a particular importance either for epidemiology or for research in the creation of vaccines or antivirus drugs.

As to whether the virus has been created in a lab, that is, if it is a product of human intervention, I would like to assure you that such theories exist almost always in every epidemic with every new virus.

There is no possibility scientifically- that something like this has happened. There is no possibility because it was confirmed that this virus exists in animals, the infections from animals to people are very frequent and also all the people from whom it was isolated and characteristically the virus in China during the period of December, had an identical virus, which means that this was the result of infections among diverse people. Therefore, allow me to repeat that human intervention or the possible origin from a lab, should be indisputably ruled out.

The World Health Organization (WHO) has not used the term pandemic yet. Is it, Professor, a pandemic and when does a pandemic exist?

A pandemic, according to WHO, is defined as such when the epidemic has a great spread in, at least, two areas, in two continents. The areas as they are defined by WHO, are not exactly the geographic continents, but they are slightly different. Not to get into many details, the definition of pandemic refers to the geographic spread and not as much to the number of cases.

In Greece, for the time being, there are no certified cases. Do you believe, too, that it is a matter of time before we will be seeing our first case? How well-prepared is our country with the measures that are increasingly updated.

In Greece, there is no certified case. There may be but it is unlikely that there are any. The authorities have taken the appropriate measures, have announced the protection measures to be undertaken by health professionals, by the population and what people who travel should be mindful of.

We are informed about measures in airports and there has been an attempt for a prompt diagnosis of a possible case which is absolutely important to limit further infections.

Is the diagnosis of the specific virus easy and what are the symptoms?

The symptoms are identical to the ones of the flu and the definition of a potential case is related to whether someone has been exposed to other people from areas in which there are cases. That is, a fellow citizen who has not travelled and has flu symptoms, as you realise, does not have this virus.

So, in the first stages and absence of a case in Greece, if someone has symptoms, these symptoms should be accompanied with an exposure to another possible case, obviously and possibly outside Greece so that there may be a realistic possibility that they have been infected. Therefore, our fellow-citizens are more likely to suffer from the flu or another virus rather than the coronavirus.

The documentation of the infection, is feasible at the Paster Institute as well as in other laboratories which can diagnose if an infection is caused by this specific virus.

As far as travelling is concerned and according to WHO, people should not restrict their travels unless they are in areas in which there is a great number of cases. However, they should follow all the instructions which are recommended in reference to the prevention of infection from these viruses. What are some preventative measures?

People should wash their hands with soap for about 20 seconds and especially when they are in congested places such as airports; they should avoid touching their eyes, nose or mouth with their hands. So, when we find ourselves in public places where there are several fellow- citizens, we should bear in mind that we must take great care of our hands hygiene and that they must not touch our face. Also, if we feel symptoms identical to the ones of the flu, we should stay home, so that we dont expose other people to danger; and if symptoms persist, we should ask for medical advice.

Is the mask just some fashion accessory or does it actually contribute to the restriction of the virus spread?

The mask does not constitute the absolute means of protection and it doesnt mean that anyone who wears it is either totally or to a great extent protected from a possible flu infection or coronavirus. The role of the mask is to protect other people from the sufferer who must wear it. If they sneeze while talking, much fewer droplets are exposed, therefore the mask is a way of protection, especially for the protection of others. So, someone wearing a mask should be aware of the fact that they are not totally protected from these viruses.

Professor, why is this virus so lethal? There have have already been 630 deaths and more than 31.400 cases*?

We should clarify the following: The coronavirus is not so lethal in relation to other viruses. The number of deaths concerns a relatively great number of people about whom the coronavirus infection has been documented. Coronavirus as well as flu virus causes, to a great extent, very mild symptoms.

As a result, the number of people who have been infected is much bigger than the number of people whose infection has been documented. So, the denominator, when we estimate death-rate, is much bigger because the real number of the cases is unknown and a lot bigger related to those who have the infection documented.

Until now, the death-rate was considered to be approximately 3% to 4% but it is possibly much less because as I already earlier the real number of the cases is unknown.

Those who are more susceptible to this infection are older people, vulnerable groups and people who suffer from chronic heart diseases, chronic breathing diseases and immunodeficiency. The above categories constitute the percentage of serious symptoms or death.

How far or how close are we for the coronavirus vaccine creation? Can we be optimistic since a relative treatment for very old viruses and lethal diseases has not been found yet?

There are viruses, as you have correctly mentioned, for which it is not easy to develop vaccines. Hopefully, the coronavirus does not have these characteristics.

We consider that the coronavirus vaccine will be available relatively quickly, possibly even in a few months if we also estimate the time required for clinical tests.

Several Institutes and Centres have actively engaged in the creation of the vaccine. It is believed that in some weeks vaccines will be available for clinical tests. In the meantime, protection measures are vital for the restriction of the virus and for our protection.

I would like to point out once more: there are other viruses and diseases that are really dangerous. I realise how worried people are; the coronavirus is something new. However, Greece and the international community have been confronted with similar threats before, over the last 10 years, a fact that fills us with optimism.

We have the experience and the know-how so that we can face this menace effectively. What is really necessary is composure and optimism about the fact that even this disease will be challenged effectively with minimum human cost.

* Data as of the time of interview

This article was researched and written by a GCT team member.

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EXCLUSIVE INTERVIEW: The Greek Professor who 'broke' the coronavirus DNA sees a vaccine coming soon - Greek City Times

CORBIN Baptist Health Corbin in collaboration with the Corbin Public Library held its monthly Noontime Knowledge at the library on Thursday.

In honor of American Heart Month, this months Noontime Knowledge focused on heart health and heart attacks. More specifically, heart attack signs, symptoms and how to react if you or somebody you know is having a heart attack.

Heart attacks are the number one killer of adults here in the United States, said cardiovascular educator at Baptist Health Corbin Tracy Bruck. Over 735,000 Americans have heart attacks every single year. 525,000 people have their first heart attack every year, a lot of people have more than one.

Heart attacks kill 116,000 Americans each year.

Heart attacks are a community problem with a community solution. That community solution is education because if a community knows early symptoms of a heart attack, then you can seek medical treatment early, explained Bruck.

When it comes to symptoms, Bruck said the most common are chest pain and discomfort. Other symptoms include pain in your back, shoulders, arms, neck, throat or jaw; abdominal discomfort; shortness of breath; weakness and fatigue; nausea; and sweating.

According to Bruck, early signs of a heart attack are present in about half of all patients that have suffered one.

Symptoms can suddenly accelerate just before somebody has a heart attack. Most early symptoms happen around 24 hours before someone suffers one. However, some symptoms can occur two to three weeks before someone suffers a heart attack.

Bruck says that men are more likely to suffer heart attacks on their first symptom than women are. Men normally feel pain and numbness on their left arm or side of their chest, while women will typically feel it on their right side.

A womans risk of suffering a heart attack increases four times after going through menopause. Women are also more likely to have what are known as silent heart attacks, which can result in a person having a heart attack and not even realizing it. Women are also more likely to suffer a fatal heart attack.

According to the CDC, heart attacks are more common in men, smokers, people who are obese or overweight, those with family histories of cardiac issues, and people aged 55 or older.

Bruck says knowing your family's personal history with heart disease can help in preventing a heart attack. She also recommends knowing and modifying those things in ones control that can attribute to a higher chance of heart attack.

Those factors one can modify to lower the chance of suffering a heart attack include keeping your blood pressure under control, maintaining an active lifestyle (getting at least 20-30 minutes of physical activity three times a week), stopping the use of tobacco, and keeping an eye on metabolic diseases like diabetes.

If you or someone you know is showing signs of a heart attack, Bruck says its important to seek medical attention right away.

We have a tendency as human beings to delay recognizing and responding to these early symptoms. Were our own worst enemy.

Some of the most common excuses people make are that theyre too busy or that theyre too healthy to be suffering a heart attack. Bruck says some try to pass it off as something else or ignore it all together. This could be dangerous because although the symptoms may subside, theyll come back and thats when it may be too late.

Along with medicine, modifications to lifestyle and preventative measures, the medical community has also created the Life Vest to help those who suffer with a heart related medical condition.

Kim Deering with Zoll Life Vest explained that the vest is a wearable cardioverter defibrillator that can be used to detect sudden cardiac arrest and defibrillate its wearer.

Available to the public since 2003, the vest was designed for those with a compromised heart function, a heart functioning at less than 35% of full capacity.

The Life Vest can be worn under clothing and can be hidden from public view. The vest monitors its wearer the entire time it is worn through the use of four dry electrodes that are placed around ones chest.

The vest senses an arrhythmic beat in its user's heart and activates a vibrating alert. A siren will then sound from the vest and continue to get louder. If the vest were to malfunction or have a bad reading, the wearer can press two buttons simultaneously to cancel the treatment. If the treatment isnt canceled, the vest will perform a treatment shock and release a blue gel.

The blue gel is released in case the wearer were to wake up alone after suffering cardiac arrest and receiving shock treatment. The blue gel would notify them of what had happened and the person could seek medical treatment.

Its saving about three patients a day all across America, said Deering, who added that the vest has a 98% success rate after the first shock.

According to Deering, the Life Vest is meant to be used as bridging tool. If a patient is able to get their heart working above that 35% threshold, then they are no longer at as great of a risk for sudden cardiac arrest, and the device is no longer needed.

The Life Vest is available all over the world, and is accepted by Medicare and all Kentucky Medicaid, as well as most private medical insurances.

The next Noontime Knowledge will be held March 6 at the Corbin Library from noon-1 p.m.

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February's Noontime Knowledge event focuses on heart health - Times Tribune of Corbin

China is facing one of its largest public health crises: the outbreak of the novel coronavirus.

But U.S. healthcare officials are far more concerned about the spread of other viruses, like the flu.

WCBU talked to Lori Grooms, director of infection prevention for OSF HealthCare, about why the flu poses a bigger threat.

Dana Vollmer: Explain why people are more at risk of contracting the flu than coronavirus.

Lori Grooms, director of infection prevention for OSF HealthCare, talks to reporter Dana Vollmer.

Lori Grooms: The flu is something that we see every year and it is commonly circulating. The coronavirus that they're hearing on the news, while there are cases in the United States, the chances of coming in contact with the virus itself are very, very low. The flu virus, it's more common. You could come across somebody at the grocery store, because we all feel like we can wait it out. We have a cough, so I can go to the store and I can get the medicine to take care of it. I can go to work when I'm sick, because I'm just that important that I need to be at work. Unfortunately, because we have the idea that the flu is no big deal and we can go to work with it, we tend to spread it on to others.

DV: Why do people tend to worry about things like coronavirus, but not always think of the flu as potentially deadly?

LG:Because it's new. We're always more scared by the things that we don't know about. Because the flu circulates every year, it's something that we're used to seeing. The coronavirus, we don't know a lot about it and we're being told that we don't know a lot about it. That in itself makes people afraid. Even when you hear things from the Centers for Disease Control and Prevention (CDC) or from the World Health Organization, they're still investigating. They can't tell us exactly everything about this virus because it is so new and there's they're still learning about it. That's what makes people afraid.

DV: What role does social media play in spreading misinformation about virus outbreaks?

LG: Social media, while it's a wonderful thing, it can also be a detriment. Not everything you see on the internet is true. With that, misinformation can spread very easily. What I always try to do is defer back to the experts. If you really want information, CDC has a very good website that anyone in the public can get on to and read the World Health Organization the same way. Those are the organizations that are actually investigating and looking at this virus. They have the most up-to-date and the most current information. The Illinois Department of Public Health also has the most current information. You're not always going to find that with every other website.

DV: The coronavirus is not the first major respiratory virus to pop up in recent years.

LG: It happens every two to three years. I've been in my role in infection prevention for over 15 years. Every two or three years, we're having discussions about a virus that has changed and the transmission is a little bit different. We've seen it with SARS, we've seen it with [MERS] in the more recent years. It's not something that is new to the healthcare profession. We've been planning for things like this. And once something like this comes up, infection prevention at your hospitals, your emergency preparedness we're ready to handle it. We keep current on the information and we just make tweaks to what we're doing on an everyday basis.

DV: Is it inevitable that more viruses like this will surface?

LG: Yes. Viruses are genetic makeup, so anytime you have genes you have the ability for them to change as they reproduce. So you will always see changes in viruses. The thing about the coronavirus that you're hearing on the news the one coming out of Wuhan, China is that this was spread from animals to humans at the start. That always causes concern. Once it is caught by humans, we don't know what's going to happen. You're seeing a lot of cases in China because of that because it's a new strain circulating in humans, but it had been in animals for years.

DV: What do you say to people who are still concerned about contracting coronavirus -- should they postpone their travel plans?

LG: My professional answer is to investigate. Would I travel to China right now? Not unless it was essential. CDC has a travel website that anyone can go to and actually put in the country that they are looking to travel to, and they can see whether or not they recommend traveling to that country. At this point in time, Chinais not recommended to travel for leisure and it is only for, like I said, essential travel. Other countries, if you're traveling there, I would go to the website and I would look it up.

DV: Any other advice for people to protect themselves?

LG: All I would say is that with any infection, with any virus it's the basic preventative measures: if there's a vaccine available, get the vaccine; frequent handwashing; avoid touching your eyes, your nose and your mouth without clean without clean hands; coughing into your elbow, coughing into a tissue and throwing it away; cleaning your hands after you've coughed; staying home if you're sick and avoiding purse other persons who are ill.

People like you value experienced, knowledgeable and award-winning journalism that covers meaningful stories in the Peoria area. To support more stories and interviews like this one,please consider making a contribution.

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Here's Why The Flu Poses A Bigger Risk Than The Coronavirus - Peoria Public Radio

New study highlighting the ability of cannabinoids to fight bacteria in dental plaque opens the door for CBD as an effective oral care product.

In recent years, the craze over CBD cannabidiol one of the more popular and well-known cannabinoids of the cannabis plant, has led to a massive uptick in research into its medical properties. Along with this has come a maelstrom of articles suggesting possible uses outside of what has already been studied, with hopes that upcoming scientific research will uncover even more ways that CBD can be useful, including in dental care.

CBD is now often considered a preferred alternative to pharmaceutical medication when it comes to dealing with sleep issues, anxiety, and depression, and is under intense study for its possible efficacy in treating different forms of cancer. It has been linked to research indicating usefulness in dealing with high cholesterol issues, blood pressure stabilization, and even a possible contender in the fight against Alzheimers disease.

Its pathogenic disease fighting properties have also been studied quite a bit at this point with evidence pointing to it being a strong antimicrobial capable of targeting different kinds of infectious agents. Of course, when it comes to pathogenic diseases, there are about a million different places to look for CBD efficacy.

Pathogenic diseases are infectious diseases that come from pathogens like bacteria, viruses, and fungi. So, anything from the common cold, to bacterial bronchitis, to ringworm are all pathogenic diseases. These, of course, account for a large percentage of the illnesses out there, and particularly the spreadable ones.

Whenever you hear a story about a new coronavirus like whats currently going around now or swine flu, or the plague; its all about pathogenic diseases. There are different ways of fighting pathogenic diseases, and oftentimes in pharmaceutical medicine, what works for one, wont work for another, particularly when looking at the necessary treatment methods for viruses vs bacteria, or even two very different viruses.

As always, its good to remember when dealing with CBD that it is not a pharmaceutical medicine, it is, in fact, a naturopathic medicine relating to plant medicine. Because of this, the chemical structure is significantly more complex than pharmaceutical medications that are based off of plant compounds, but generally in a more simplified way (which is what allows for things like antibiotic resistance as the bacteria are more easily able to replicate the simplified structure).

When dealing with plants, its not uncommon for one plant to be useful in many treatments, think of all the applications CBD is already being touted for. And for this reason, there is constantly new research coming out about new ways of using CBD that hadnt been thought of before.

The World Health Organization (WHO) provides some basic information on worldwide dental health. One of the first things to know about oral diseases is that theyre actually the most common non-communicable diseases (non-contagious) out there. In fact, a study on the Global Burden of Disease found that literally half the worlds population suffers from some sort of oral ailment, with tooth decay coming in at #1.

Unfortunately, dental care is often not very affordable, leaving many people in the world to never receive what they need, which often means living life in pain and discomfort. People that come from lower socio-economic backgrounds, or poorer countries, are way more likely to feel the health inequality gap that exists in dental health. For this reason, having better, and more affordable options for basic dental care and oral disease protection becomes very important.

An interesting new study came out in January of 2020 that investigated the efficiency of CBD vs known oral care products in reducing the amount of bacteria in dental plaque, which is responsible for all kinds of mouth ailments like cavities, bleeding gums, tooth decay, and tooth loss. The sixty test subjects in the study were split into six different categories according to the Dutch periodontal screening index. All participants were 18-45 years old.

The methodology of the study was to take dental plaque from all of the participants and spread each sample across two separate petri dishes, with each petri dish split into four parts, making for eight different places to test each specimen.

The eight things being compared for their ability to fight bacteria in dental plaque were: cannabidiol (CBD), cannabichromene (CBC), cannabinol (CBN), cannabigerol (CBG), cannabigerolic acid (CBGA), Oral B, Colgate, and Cannabite F (a toothpaste made from pomegranate and algae). After being sealed and incubated, the number of bacteria colonies were counted. The results of the study showed cannabinoids to actually be more effective than the well-known oral products like Colgate and Oral B.

When it comes to tooth and mouth care in general, most people shop for their standard drugstore products that theyre used to seeing ads for on TV, and which theyve probably been using for years. Some might even believe that what they use every day is the best option out there. In fact, many products like toothpastes and mouthwashes come with dentist recommended statements, leading to even more trust that these products are the best to use.

A study like this one clearly indicates that this might very well not be true at all, and possibly much better options can be found in non-chemical, more natural forms that have the capacity to do a better job.

Another research study done earlier, in 2012, looked at induced periodontitis (inflammation of the gums) in rats, and the role of endocannabinoid anandamide (AEA). All the rats were exposed to stress, and the results were: corticosterone plasma levels, locomotor activity, adrenal gland weight, and bone loss were all increased, as well as less weight gain.

There was also increased inflammation of the gingival (gum) tissue among other factors. Basically, the rats all responded to the stress by showing different forms of stress-related activity in their bodies. An injection was given locally of AEA to one group, and the results showed a decrease in corticosterone plasma levels and the content of certain cytokines (proteins involved in cell signaling). These AEA-induced inhibitions were mediated by CB1and CB2cannabinoid receptors.

The basic results showed that The endocannabinoid AEA diminishes the inflammatory response in periodontitis even during a stressful situation. The rats, after receiving the injection of AEA showed a reduction in much of their stress responses. This research implies that since CBD interacts with CB1and CB2cannabinoid receptors, it could possibly be useful in treating gingivitis an inflammation of the gums.

While its true that high quality CBD products arent always cheap, the preventative properties (when it comes to many things) may possibly outweigh the costs of dealing with the resulting health issues that come from not practicing good self-care.

Sometimes this is because people dont know what to do, sometimes people simply lack the motivation to do what they should, and others still just dont have the resources available to them to use preventative healthcare methods. If CBD is actually that effective in reducing bacteria and inflammation in the mouth, this could be incredibly useful for people who dont have as much access to dental care, or cant afford it.

If youre interested in chucking your old, standard, well-known toothpaste brand to try out something else, youll find plenty of products containing CBD and other cannabinoids available. Youll also be able to find mouthwashes, and other products for more specific oral ailments will likely pop up soon. Check online for available products.

Were happy to keep you updated on everything CBD, subscribe to the Medical Cannabis Weekly Newsletter.

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CBD Toothpaste Might Be Better Than Your Current Brand, Research Says - CBD Testers

(MENAFN - The Peninsula) More than 800 healthcare professionals gathered in Doha for the Fourth Qatar Diabetes, Endocrinology, and Metabolic Conference (QDEM-4). Hosted by Hamad Medical Corporation's (HMC) Endocrine and Diabetes Division, Department of Medicine, and the Qatar Metabolic Institute (QMI), the conference brought together local and international experts in the fields of endocrinology, obesity, and diabetes to discuss the latest research, treatments, technological advances and preventative measures for these conditions.

Professor Abdul Badi Abou Samra, Chairman of the Department of Internal Medicine at HMC, and QMI Director, said the event provided an important platform for frontline clinicians, scientists, and researchers to discuss strategies and approaches for the management and prevention of diabetes. He said the conference highlighted the work being done in Qatar in the fields of endocrinology and diabetes treatment and management.

'HMC's National Diabetes Centers, located at Hamad General Hospital, Al Wakra Hospital, and the Women's Wellness and Research Center, receive more than 120,000 patient visits annually from around 30,000 patients, said Professor Abou Samra.

'Many of these patients live with other associated complications such as high blood pressure, kidney disease, and vision impairment. It is important for the local and international medical community to meet and discuss trends, best practice, and long-term strategies for the prevention and mitigation of complications related to this disease so we can continue to provide the best care for our patients, added Professor Abou Samra.

Dr Mahmoud Ali Zirie, Senior Consultant and Head of HMC's Endocrinology and Diabetes Division and Chair of the Conference's Organizing Committee, said the conference provided an opportunity to share the work being done here in Qatar and to deliver improvements tailored to the local population. He noted that the event included sessions dedicated to the new World Health Organization (WHO) classification of diabetes and its impact, adrenal disorders, thyroid disorders, cancer, and the latest technology in diabetes management.

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Over 800 healthcare professionals gather for Qatar Diabetes, Endocrinology and Metabolic Conference - MENAFN.COM

Pitt faculty and staff members gathered Wednesday evening to explain more about the novel coronavirus, the microscopic virus that has gained global attention.

Pitts Asian Studies Center hosted a Coronavirus Teach-in in a David Lawrence Hall lecture room nearly filled to capacity. The event featured a five-person panel staffed with experts across a variety of scholarly subjects, moderated by Michael Goodhart, the director of the Global Studies Center.

The presentations included background and contextual information about the outbreak, as well as preventative measures that can be taken to prevent the spread of the virus. The health experts on the panel also discussed the research underway to develop vaccines to treat the virus. The novel coronavirus has claimed the lives of more than 1,100 people globally, with 14 current confirmed cases in the United States.

Professor Amy Hartman, a researcher in the Center for Vaccine Research, highlighted the Wednesday announcement that the University is seeking to obtain samples of the novel coronavirus in an effort to develop an intervention, such as a vaccine.

The lab is a hub for researchers trying to understand pathogenesis, Hartman said. We are the only facility on Pitts campus that has the ability to work with emerging coronaviruses.

In order to provide some background on the virus, Dr. Megan Culler Freeman, a pediatric infectious diseases senior fellow in the School of Medicine, described the family tree of the novel coronavirus.

She said 2019-nCoV is just one strain of the coronavirus family of viruses, a group of RNA viruses that cause illnesses ranging from the common cold to more serious respiratory infections to the current disease under scrutiny. The most common COVID-19 symptoms include fever, shortness of breath and a severe cough.

Freeman mentioned two other coronavirus strains that are cousins to 2019-nCoV, Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome, which have caused outbreaks in the past. Scientists are gathering information about 2019-nCoV, which originated in Wuhan, China, by comparing it to these earlier viruses, but there are still unknown details surrounding how the novel coronavirus has spread to humans.

For SARS and MERS, it was identified that there were intermediate species, Freeman said. Scientists are still working on what might be the intermediary species between the bat and human for the newest strain of the coronavirus.

Another panel member, East Asian history professor Zhaojin Zeng, discussed how the culture and transportation system in China made the initial spread of the virus easier.

Trains make stops and Wuhan is located right in the center of this massive railroad network, Zeng said. This outbreak occurred in December 2019, then came Chinese New Year, people celebrating want to get together and have big family gatherings and dinners.

Although the virus outbreak has been most severe in and around the Wuhan area, history professor Mari Webel cautioned against strictly attributing the virus to a certain geographical region. Weber said while quarantine and isolation are beneficial in preventing the spread of diseases, they can also have consequences when they are implemented for the wrong reasons. Focusing on people or places of origin when thinking about prevention and control of global disease must be done carefully to avoid racializing a disease or stigmatizing a population, Webel said. For example, Asiatic cholera, that tag stuck and served to stigmatize certain traveling populations.

While there is still more research to be done on the novel coronavirus, health experts on the panel said this new strain is not unavoidable.

Dr. Kristen Mertz, a medical epidemiologist for the Allegheny County Health Department, said traditional public health strategies are applicable in minimizing the extent of the virus.

We try to identify and isolate cases so they dont infect other people, Mertz said. We also increase handwashing and use more personal protective equipment, such as gloves and masks and good disinfection techniques.

Freeman said among those who do contract 2019-nCoV, most fatalities arise from older people with other illnesses that already have weakened immune systems, or from overwhelmed health care professionals who are constantly surrounded by infected people.

When you think about how many people these doctors and nurses were already treating on a day-to-day basis, Freeman said, Im sure that everyone is giving it their best effort, but you can imagine the stress to the system.

While each presenter had their own specialty in analyzing 2019-nCoV, individual speakers also all emphasized the dangers of misinformation fueled by social media and sensational reporting.

Webel said it is vital to respect health organizations warnings and preventative strategies in order to avoid misleading information.

Consult CDC recommendations, there is good health journalism to consult, Webel said. There are resources out there that can give us the best information at the present time.

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Ageing should be classified as a disease to provide better treatment of the elderly, says an international group of leading medics and academics.

They are urging the World Health Organisation (WHO) to rethink the way it classifies illnesses so ageing is no longer seen as a natural process but a disease in its own right that leads to frailty, disability and ultimately death.

They say the WHOs current bible which defines and lists all diseases focuses doctors on individual critical conditions rather than the wider range of degenerative changes as people age.

The 30 experts - from Harvard, Stanford and MIT to Cambridge, Imperial and UCL - said their inclusion would encourage doctors to diagnose and prescribe treatments including drugs, diet and exercise that could prevent age-related conditions developing into critical illnesses.

The WHOs health bible - known as the International Classification of Disease (ICD) - determines what doctors around the world diagnose, treat and record.

However, Dr Stuart Calimport, one of the lead authors, cited inconsistencies such as sarcopenia, an age-related muscle-wasting, which was included in the ICD while age-related wearing out of other organs was not.

Critical to ageing is a process known as senescence in which cells throughout the body age, releasing inflammatory factors and enzymes that the immune system can no longer destroy

When senescent cells build up in the skin causing wrinkles it is considered a natural change. Yet when senescent cells build up in the heart and blood vessels, causing blood vessels to calcify, we call it cardiovascular disease, said Dr Calimport, of Liverpool University.

This is an error of logic and categorisation and not due to the intrinsic nature or complexity of pathology or disease.

An ageing disease classified and assessed for the level of severity in one organ can be unclassified in another.

With a lack of classifications and staging, pathological ageing changes may not be logged. This means that treatment needs may be overlooked, such as atrophy, calcification and ageing in organs and tissues where these are not classified or assessed for severity.

Dr Calimport did not believe the classification of more diseases would provide a bonanza for drug firms to develop treatments that would push up the NHS bill.

He said there were already cheap drugs such as Metformin, which was used to treat diabetes and had been shown to be effective in countering age-related conditions.

It would allow for preventative medicine such as social prescribing or the prescribing of exercise. It might not totally prevent ageing but at the moment we are not even recognising ageing in a way that it can be properly recorded and tracked said Dr Calimport.

If you cant track it, how can you prevent it, or slow it down?

The WHO is currently considering submissions for changes to the ICD which will be published next year. There are major updates every decade.

The proposals comes as the number of elderly are expected more than double from 900 million worldwide aged over 60 to two billion by 2050.

By 2030, one in five people in the UK (21.8 per cent) will be aged 65 or over, 6.8 per cent will be aged 75-plus and 3.2 per cent will be aged 85-plus.

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Ageing should be classed as a disease in itself, say leading academics - Telegraph.co.uk