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Patients with opioid use disorder die at a rate similar to heart attacks

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Hospital patients with an opioid use disorder died at a rate comparable to those who had a heart attack within a year of hospital discharge, according to a new study from Oregon Health & Science University.

The study, published in the Journal of Addiction Medicine, found that nearly 8% of patients with an opioid use disorder died within 12 months of their discharge. The authors say their results underscore the need for hospital addiction care and generally improving health systems for those with substance use disorders who also have other conditions.

“We need systems that meet the broad needs of people with substance use disorders and serious medical illnesses,” said Senior Author Honora Englander, MD, Associate Professor of Medicine (Hospital Medicine) at the OHSU School of Medicine. “That means trauma-informed systems that destigmatize addiction in order to make health systems more trustworthy and effective for our patients.”

Researchers entered the study knowing that people with opioid use disorder are seven times more likely to be hospitalized than the general population, but the new study is the first to characterize the rate at which these patients are one year after they are discharged died from the hospital.

The researchers reviewed the data from a total of 6,654 Medicaid patients treated at 62 Oregon hospitals between April 2015 and December 2017.

Of the 522 people who died within a year of hospital discharge, 58% were due to drug-related deaths, including overdoses. The other deaths were attributed to causes other than drugs, including diseases of the circulatory, respiratory and endocrine systems.

“Much of the research has focused on overdose deaths,” said lead author Caroline King, Ph.D., MPH, an MD / Ph.D. Student at the OHSU School of Medicine. “We found that overdoses are just the tip of the iceberg for these patients, accounting for 13% of deaths in the year after discharge.”

The death rate is striking and surprising, she said.

An 8% mortality rate after one year is comparable to conditions such as acute myocardial infarction or heart attack.

“For heart attacks, hospital systems in the US have universally accepted standards, metrics and quality reports that improve performance,” said Englander. “The same should be true for opioid use disorders, where mortality rates are similar.”

King said it is clear that health systems need to better integrate and de-stigmatize the medical care these patients need, starting with facilitating access to proven drug addiction drugs like methadone and buprenorphine.

“Methadone should be easier to access than heroin,” said Englander. “Right now that’s not the case – systems are such that people have to work so hard just to get life-saving treatment.”

According to research, treatment for opioid use disorder in hospitals is rare

More information:
Caroline King et al., Causes of Death in the 12 Months After Hospital Discharge in Patients with Opioid Use Disorder, Journal of Addiction Medicine (2021). DOI: 10.1097 / ADM.0000000000000915 Provided by Oregon Health & Science University

Quote: Patients with an opioid use disorder die at a rate similar to heart attacks (2021, September 14), accessed September 14, 2021 from https://medicalxpress.com/news/2021-09-patients-opioid-disorder-die-similar .html

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She fought to save her child from an eating disorder. Now, she combats the misconceptions.

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Nine years ago, JD Ouellette almost lost her then 17-year-old daughter Kinsey to an almost fatal anorexia nervosa. Kinsey has since recovered, but her mother is still in the trenches helping other parents and children in San Diego teach the tools and strategies they need to win their own battle against eating disorders.

According to the National Eating Disorders Association, EDs will affect approximately 20 million women and 10 million men in America during their lifetime. These conditions include anorexia and bulimia nervosa, as well as binge eating and eating disorders that restrict avoidance. They can affect people of any age, ethnicity, and socio-economic group. They can occur in children as early as 7 years of age and are particularly common in women between the ages of 15 and 24. Unfortunately, only about 10 percent of people with eating disorders are ever treated.

Ouellette, a 57-year-old mother of four from Scripps Ranch, said parents may not be able to spot the signs due to widespread myth and outdated information online. New research over the past 20 years has dramatically changed scientists’ knowledge of these diseases and their treatments, Ouellette said that sharing this new information with families can save lives.

“What I’m telling parents is to trust their Spidey sense,” Ouellette said, referring to Spider-Man’s oversensitivity to danger. “If you feel like something is wrong, especially after reading it in the Union-Tribune, get a review right away.”

JD Oullette stands outside the UC San Diego Health Eating Disorders Center in La Jolla.

(Ariana Drehsler / The San Diego Union-Tribune)

In 2012, Kinsey Ouellette underwent treatment at the UC San Diego Eating Disorders Center for Treatment and Research in La Jolla, widely recognized as one of the leading eating disorder research organizations in the country. JD Ouellette said she was so grateful for her daughter’s recovery that she volunteered to look after other parents of children starting treatment. When the university where she worked as an administrative specialist was closed in 2018, she devoted herself entirely to her new calling.

Today she runs her own coaching service for parents and patients with eating disorders; serves as a parenting mentor on the University of California Center’s Parents Advisory Board at San Diego; is the mentor for EQUIP, a 2-year program for the treatment of fully virtual eating disorders in San Diego; is a co-founder of the International Eating Disorders Family Support Network and the World Eating Disorders Action Day; and is a former board member for Families Empowered and Supporting Treatment of Eating Disorders (FEAST).

Ouellette said that most Americans, and a surprising number of pediatricians, fail to realize that eating disorders is not a personal “choice” but an inherited, genetic, neurobiological disorder. Although they can be triggered by social or environmental factors (such as bodyshaming or the media promotion of thin body types), they should be understood as complex medical and psychiatric diseases.

“One of the greatest things I’ve learned is that everything I thought I knew about EDs was just plain wrong,” she said. “I was a teacher with a master’s degree and was wrong.”

Decades ago, traditional treatment for young people with severe eating disorders was removing them – or a “parental ectomy,” as Ouellette calls it – because parents were seen as the cause of the problem. Now, according to Ouellette, research has shown that the most effective method is called family-based treatment, where a patient’s family is part of the trained “team” that guides the patient to physical and emotional health at home.

“No family causes an eating disorder, but every family needs to change to fight an eating disorder,” said Ouellette. “Think of it this way: your family’s operating software does not have an ED control patch, so you need to update your software to the version that combats ED.”

Ouellette said teens with these disorders share temperamental traits in common. They are often great students and high performing athletes and artists who work hard, are internally motivated, and used to practicing perfectly.

“These are very valuable skills, but once you develop ED, the same discipline applies. There is a light and a dark side to these skills, ”she said.

That was the case with Kinsey, who was a top student and high school athlete. After graduation, she and a few friends decided to “re-model” a “healthy diet” to avoid the “new 15” pounds that students often put on in their freshman year of college, but within two months of starting the makeover, Kinseys became Health so precarious that her family urged her to seek treatment at UC San Diego.

“Some people burn slowly, but it was a long way from the cliff. It was amazing, ”said Ouellette. “She has said many times in the years since that if we hadn’t intervened, she would have been dead within a few months.”

“Think about your disorder as a person. If your child screams, yells, throws objects, refuses to eat, negotiates meals, whatever it is, you are not witnessing or interacting with your actual child. You are face to face with the personification of their disorder. “

Kinsey, the daughter of JD Oullette, as she wrote in an essay about her eating disorder

Ouellette said family-based treatment works, but it’s not easy. Marriages can break up and parent-child relationships can be permanently broken without the support of a comprehensive treatment program like the one at UC San Diego, Rady Children’s Hospital in San Diego, or EQUIP.

“If a plate of food is like a plate of snakes and spiders for a child, they will behave appropriately, and that’s hard for anyone,” Ouellette said. “It’s really easy for parents to feel like you are against their child, but in reality, it is you against the eating disorder your child is controlling.”

In an essay, Kinsey wrote about her battle with anorexia for FEAST, she said that children affected by an eating disorder will say and do almost anything if they believe their parents are in the way of their weight goal.

“Think about your disorder as a person,” wrote Kinsey. “If your child is screaming, yelling, throwing objects, refusing to eat, negotiating meals, whatever it is, you are not experiencing or dealing with your actual child. They face the personification of their disorder. That hatred comes from a losing eating disorder. So remember that the more hate you feel, the better you work. “

Treatment and recovery outcomes vary, but Ouellette said that in most cases, aggressive treatment can resolve the disorder in three to four months, but it can take one to three years to achieve full recovery. Relapses are common. Some studies show a relapse rate of 36 percent in anorexic patients and 35 percent in bulimic patients.

Ouellette said she advises parents who are having difficulty treating their child to focus on the end goal and stay on track.

“It is important that you approach this with compassion, consistency, and with the knowledge that whatever you do is protection, even if it feels like punishment or seems filtered,” she said. “Feeding our children and monitoring exercise and other behaviors in order to achieve and maintain their optimal physical and mental health is our right and responsibility as parents.”

Common warning signs of an eating disorder

  • Sudden weight loss or weight gain
  • Eating disorders, such as skipping breakfast or lunch habitually
  • Take part in fasting challenges or keep track of everything you eat in a day
  • Sudden change in mood or socializing habits
  • Self-esteem problems related to body image
  • Decision for vegans or vegetarians
  • Anxiety or depression
  • Exercise compulsion
  • Eating rituals (such as over-chewing or not touching food)
  • Girls experience irregular menstruation or a break in menstruation
  • Boys with focus on bodybuilding and body fat
  • Dizziness or fainting
  • Stomach cramps or acid reflux
  • Sleep disorder
  • Cuts and calluses on the top of the finger joints (from vomiting)
  • Yellow skin (eaten from too many carrots)
  • Difficulty concentrating
  • Dry skin and hair

– Source: National Association for Eating Disorders

Self-care tips for parents of a child with an eating disorder

  • Learn psychoeducation, which is a therapeutic intervention for patients and family members to understand and manage illness.
  • Work with providers to equip them with the same skills that you are teaching your child.
  • In order to avoid conflict, both parents should remain on the same side when treating their child.
  • Divide up the responsibilities in your family, ideally so that the father can take on a more active role.
  • Engage in bonding activities with your child in treatment.
  • Do guided meditation for at least five minutes a day.
  • Learn to play a musical instrument.
  • Go outside and take a walk.
  • Avoid activities that cause stress.

– Source: JD Ouellette

Resources:

National Association for Eating Disorders – nationaleatingdisorders.org
Families supports and supports the treatment of eating disorders (FEAST): fest-ed.org
UC San Diego Center for Treatment and Research for Eating Disorders – eatdisorders.ucsd.edu
Rady Children’s Hospital-San Diego Eating Disorders Treatment Unit – rchsd.org
EQUIP virtual family-based treatment program – equip.health
Parent and patient coaching by JD Ouellette: jdouellette.com

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How insulin resistance can lead to depression

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Stanford Medicine scientists have found that insulin resistance can increase the risk of developing major depressive disorder. The results of the study were published in the American Journal of Psychiatry. “If you are insulin resistant, your risk of developing major depressive disorder is twice that of someone who is not insulin resistant, even if you’ve never experienced depression before,” said Natalie Rasgon, MD, PhD, Professor of Psychiatry and Behavioral Sciences.

The WHO estimates that almost 5% of adults suffer from depression. Symptoms include incessant sadness, despair, sluggishness, trouble sleeping, and loss of appetite.

Also read: How I recognized OCD and what impact it had on my life

Some factors that contribute to this deeply debilitating disease – such as childhood trauma, the loss of a loved one, or the stress of the COVID-19 pandemic – we cannot prevent. But insulin resistance is preventable: it can be reduced or eliminated through diet, exercise and, if necessary, medication.

Rasgon shares lead authorship of the study with Brenda Penninx, MD, PhD, Professor of Psychiatric Epidemiology at the Medical Center of the University of Amsterdam. The study’s lead author is Kathleen Watson, PhD, a postdoctoral fellow in Rasgon’s group.

Studies have confirmed that at least 1 in 3 of us walk around with insulin resistance – often without knowing it. The condition is not caused by an inadequate ability of the pancreas to secrete insulin into the bloodstream, as is the case with type 1 diabetes, but rather by the decreased ability of cells throughout the body to obey this hormone’s command.

The job of insulin is to tell our cells that it is time for them to process the glucose that floods our blood from our food intake, its production in our liver, or both. Every cell in the body uses glucose as fuel, and each of these cells has receptors on their surface that, when bound to insulin, signal the cell to take in the precious source of energy.

But an increasing proportion of the world’s population is insulin resistant for a variety of reasons, including their insulin receptors that don’t bind properly to insulin, excessive caloric intake, sedentary lifestyle, stress, and lack of sleep. Eventually, their blood sugar levels become chronically high.

Once these levels stay above a certain threshold, the diagnosis is type 2 diabetes, a treatable but incurable disease that can lead to cardiovascular and cerebrovascular disease, neuropathy, kidney disease, limb amputation, and other unhealthy outcomes.

Associations between insulin resistance and several mental disorders have already been established. For example, about 40 percent of patients who suffer from mood disorders have been shown to be insulin resistant, Rasgon said. But these assessments are based on cross-sectional studies – snapshots of populations at a single point in time.

The question of whether one event was the cause or the result of the other – or whether both were the results of a different causal factor – is best clarified by longitudinal studies that people can typically track over years or even decades to determine which event occurred first.

Also Read: How Reflection Can Accelerate Growth

As part of a cross-institutional collaboration within the Rasgon research network, founded in 2015, the scientists received data from an ongoing longitudinal study in which more than 3,000 participants were closely observed in order to get to know the causes and consequences of depression: the Dutch study on depression and anxiety.

Rasgon is Stanford’s lead investigator and Penninx is the lead investigator. “The Dutch study, with its meticulous monitoring of a large test population for nine years and still growing, presented us with a great opportunity,” said Watson.

The Stanford team analyzed data from 601 men and women who served as controls for the Dutch study. At the time of their enrollment, they had never suffered from depression or anxiety. Their median age was 41 years. The team measured three proxies of insulin resistance: fasting blood sugar levels, waist circumference, and the ratio of circulating triglyceride levels to that of circulating high-density lipoprotein – or HDL, known as “good” cholesterol.

They examined the data to see if those who were diagnosed with insulin resistance were at an increased nine-year risk of developing major depressive disorder. The answer to all three measures was yes: they found that a moderate increase in insulin resistance, as measured by the triglyceride-to-HDL ratio, was associated with an 89 percent increase in new cases of major depressive disorders.

Similarly, every two-inch increase in belly fat was associated with an 11 percent higher rate of depression, and an increase in fasting plasma glucose of 18 milligrams per deciliter of blood was associated with a 37 percent higher rate of depression. “Some subjects were already insulin resistant at the start of the study – there was no way of knowing when they first became insulin resistant,” said Watson. “We wanted to be more specific about how quickly the connection started,” added Watson.

The researchers therefore limited the next phase of their analysis to the approximately 400 test subjects who not only had never experienced significant depression, but also showed no signs of insulin resistance at the start of the study. However, within the first two years of the study, nearly 100 of these participants became insulin resistant. The researchers compared the likelihood of this group of developing major depressive disorder within the next seven years with that of participants who had not become insulin resistant after two years.

Also read: Pressure is a privilege, believes soccer player Ashutosh Mehta

While the number of participants was too small to determine statistical significance for waist circumference and triglyceride-to-HDL ratio, the fasting glucose results were not only statistically significant – meaning they were not incidental – but Also clinically meaningful – that is, important enough to worry: Those who developed prediabetes within the first two years of the study were at 2.66 times the risk of major depression after the nine-year follow-up up compared to those who received normal fasting glucose test results. had the two year point.

Bottom line: Insulin resistance is a strong risk factor for serious problems, including not only type 2 diabetes but also depression. “It is time providers took into account the metabolic status of patients with mood disorders and vice versa by assessing mood in patients with metabolic disorders such as obesity and high blood pressure,” said Rasgon. “To prevent depression, doctors should check their patients’ insulin sensitivity. These tests are readily available in laboratories around the world and they are inexpensive. In the end, we can curb the development of lifelong debilitating diseases, ”concluded Rasgon.

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Curious about keeping diseases at bay? This expert advice is all you need to know

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Today we live in an epidemic of diseases of civilization. Be it diabetes, high blood pressure, arthritis, fatty liver, thyroid, cholesterol, obesity, or even cancer, all of these have skyrocketed over the past 25-30 years. The interesting observation, however, is that none of these diseases occur overnight. We don’t wake up one morning with any of these lifestyle diseases. Our unhealthy habits are responsible for these diseases.

In the last six years of my practice, I have observed that health or illness is just a by-product of our habits. It’s years of people’s habits – a combination of eating, inactivity, poor sleep habits, and stress – that led them to their current state of health. Epigenetics – a science that teaches us that what we do can change our genes – explains that whatever gets into our bodies makes our cells either healthier or more inflamed. And there are only the following things that can get into our bodies – food, thoughts and emotions. Hence, we should be aware that every day as we take care of our food and our thoughts, we have the opportunity to heal ourselves and become healthier than what we were yesterday.

The first step to beginning healing is to stop the disease from developing. I’m going to share four simple lifestyle changes that can make sure you are healthy.

Replace non-real food with real food – There are either foods or food-like substances. So cookies, chips, packaged items, fried foods, and maida are not real food. It is food-like substances that can trigger more inflammation and thus more diseases in us. So if we want to stop causing disease, we should stop consuming it and eat real foods. Natural plant-based foods – like fruits and vegetables – have fiber, antioxidants, live enzymes, and loads of disease-reversing properties.

Swap an hour at the gym to be more active throughout the day – The culture of sitting for five to six hours at a time creates insulin resistance at the cellular level. And insulin resistance plays an important role in aging, obesity, diabetes, heart disease and cancer. Many people feel that it is okay for them to work out in the gym for an hour a day. However, there is a difference between exercising for an hour and sitting all day versus doing all day activity.

Sleep on time – An important factor in poor health is impaired sleep. Getting a good night’s sleep and sleeping on time are critical to cleansing the system and stopping disease from growing. It is just as important for our cells to clean themselves and remove debris. And most of the cleansing happens while we sleep. When people have trouble sleeping, their bodies don’t purify themselves the way they should be, which leads to more illness and poor health.

Live in gratitude and happiness all day long – Like poor sleep, stress is another major reason for the increase in lifestyle diseases. As humans, we have 70-80,000 thoughts in a single day. And every thought has an emotion. We only have two options. We either live in hormones of stress, fear, anxiety or love, happiness and gratitude. And when we live in gratitude, our genes are expressed healthier, while in stressful situations, our genes express more proteins that cause disease.

What really matters in the end are our habits and the way we live our lives every day. It’s a choice we have to make.

(The author is an India-based expert on disease reversal. He is the founder and CEO of Reverse Factor. To find out more, call 8100550660 or visit www.reversefactor.in)

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Posted on: Saturday September 25, 2021 7:00 AM IST

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