Suicide rates rise sharply across the United States, new report shows

https://www.washingtonpost.com/news/to-your-health/wp/2018/06/07/u-s-suicide-rates-rise-sharply-across-the-country-new-report-shows/?noredirect=on&utm_term=.2e83fb652ffe

 

Suicide rates rose in all but one state between 1999 and 2016, with increases seen across age, gender, race and ethnicity, according to a report released Thursday by the Centers for Disease Control and Prevention. In more than half of all deaths in 27 states, the people had no known mental health condition when they ended their lives.

In North Dakota, the rate jumped more than 57 percent. In the most recent period studied (2014 to 2016), the rate was highest in Montana, at 29.2 per 100,000 residents, compared with the national average of 13.4 per 100,000.

Only Nevada recorded a decline — of 1 percent — for the overall period, although its rate remained higher than the national average.

Increasingly, suicide is being viewed not only as a mental health problem but a public health one. Nearly 45,000 suicides occurred in the United States in 2016 — more than twice the number of homicides — making it the 10th-leading cause of death. Among people ages 15 to 34, suicide is the second-leading cause of death.

The most common method used across all groups was firearms.

“The data are disturbing,” said Anne Schuchat, the CDC’s principal deputy director. “The widespread nature of the increase, in every state but one, really suggests that this is a national problem hitting most communities.”

It is hitting many places especially hard. In half of the states, suicide among people age 10 and older increased more than 30 percent.Percent change in annual suicide rate* by state, from 1999-2001 to 2014-2016 (Centers for Disease Control and Prevention)

“At what point is it a crisis?” asked Nadine Kaslow, a past president of the American Psychological Association. “Suicide is a public health crisis when you look at the numbers, and they keep going up. It’s up everywhere. And we know that the rates are actually higher than what’s reported. But homicides still get more attention.”

One factor in the rising rate, say mental health professionals as well as economists, sociologists and epidemiologists, is the Great Recession that hit 10 years ago. A 2017 study in the journal Social Science and Medicine showed evidence that a rise in the foreclosure rate during that concussive downturn was associated with an overall, though marginal, increase in suicide rates. The increase was higher for white males than any other race or gender group, however.

“Research for many years and across social and health science fields has demonstrated a strong relationship between economic downturns and an increase in deaths due to suicide,” Sarah Burgard an associate professor of sociology at the University of Michigan, explained in an email on Thursday.

The dramatic rise in opioid addiction also can’t be overlooked, experts say, though untangling accidental from intentional deaths by overdose can be difficult. The CDC has calculated that suicides from opioid overdoses nearly doubled between 1999 and 2014, and data from a 2014 national survey showed that individuals addicted to prescription opioids had a 40 percent to 60 percent higher risk of suicidal ideation. Habitual users of opioids were twice as likely to attempt suicide as people who did not use them.

High suicide numbers in the United States are not a new phenomenon. In 1999, then-Surgeon General David Satcher issued a report on the state of mental health in the country and called suicide “a significant public health problem.” The latest data at that time showed about 30,000 suicides a year.

Kaslow is particularly concerned about what has emerged with suicide among women. The report’s findings came just two days after 55-year-old fashion designer Kate Spade took her own life in New York — action her husband attributed to the severe depression she had been battling.

“Historically, men had higher death rates than women,” Kaslow noted. “That’s equalizing not because men are [committing suicide] less but women are doing it more. That is very, very troublesome.”

National Institute of Mental Health director Joshua A. Gordon explains some of the latest research surrounding suicide rates in the U.S. 

Among the stark numbers in the CDC report was the one signaling a high number of suicides among people with no diagnosed  mental health condition. In the 27 states that use the National Violent Death Reporting System, 54 percent of suicides fell into this category.

But Joshua Gordon, director of the National Institute of Mental Health, said that statistic must be viewed in context.

“When you do a psychological autopsy and go and look carefully at medical records and talk to family members of the victims,” he said, “90 percent will have evidence of a mental health condition.” That indicates a large portion weren’t diagnosed, “which suggests to me that they’re not getting the help they need,” he said.

Cultural attitudes may play a part. Those without a known mental health condition, according to the report, were more likely to be male and belong to a racial or ethnic minority.

“The data supports what we know about that notion,” Gordon said. “Men and Hispanics especially are less likely to seek help.”

The problems most frequently associated with suicide, according to the study, are strained relationships; life stressors, often involving work or finances; substance use problems; physical health conditions; and recent or impending crises. The most important takeaway, mental health professionals say, is that suicide is an issue not only for the mentally ill but for anyone struggling with serious lifestyle problems.

“I think this gets back to what do we need to be teaching people — how to manage breakups, job stresses,” said Christine Moutier, medical director of the American Foundation for Suicide Prevention. “What are we doing as a nation to help people to manage these things? Because anybody can experience those stresses. Anybody.”People without known mental health conditions were more likely to be male and to die by firearm. (CDC)

The rates of suicide for all states and the District of Columbia were calculated using data from the National Vital Statistics System. Information about contributing circumstances for those who died by suicide was obtained via the National Violent Death Reporting System, which is relatively new and in place in only 27 states.

“If you think of [suicide] as other leading causes of death, like AIDS and cancer, with the public health approach, mortality rates decline,” Moutier said. “We know that same approach can work with suicide.”

 

 

‘What The Health?’ Campaign Promises Kept, Plus ‘Nerd Reports’

Podcast: KHN’s ‘What The Health?’ Campaign Promises Kept, Plus ‘Nerd Reports’

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President Donald Trump managed to fulfill — at least in part — two separate campaign promises this week.

To the delight of anti-abortion groups, the administration issued proposed rules that would make it difficult if not impossible for Planned Parenthood to continue to participate in Title X, the federal family-planning program. And Congress cleared for Trump’s signature a “right-to-try” bill aimed at making it easier for patients with terminal illnesses to obtain experimental medications.

Also this week, the National Center for Health Statistics and the Congressional Budget Office issued reports about Americans both with and without health insurance and the cost of subsidizing health insurance to the federal government.

And May’s “Bill of the Month” installment features some very expensive orthopedic screws.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Margot Sanger-Katz of The New York Times, Sarah Kliff of Politico and Alice Ollstein of Talking Points Memo.

Among the takeaways from this week’s podcast:

  • The Trump administration’s proposed rule to cut Title X reproductive health funding for groups that perform abortions was designed to meet demands from the president’s religious supporters, but it could backfire by mobilizing liberal voters.
  • The changes being considered might also open the door for some religious-based groups that don’t support abortion — or perhaps even contraception — to get federal Title X funding.
  • Conservatives’ campaign to get a “right-to-try” bill through Congress has been driven in large part by individual patient stories.
  • New data released by the Centers for Disease Control and Prevention this week shows the uninsured rate did not grow in 2017, despite a number of changes that the Trump administration made to the marketplace and federal promotion of it.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

 

Despite Attacks on Obamacare, the Uninsured Rate Held Steady Last Year

The Uninsured Rate Held Steady

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The numbers suggest a surprising resilience of the health law.

Last year, Trump administration officials declared Obamacare “dead,” pulled enrollment ads offline, distributed social media videos critical of the law and sent signals that the law’s requirement to buy health insurance was no longer in effect.

But the number of Americans with health insurance stayed largely unchanged. The results of a big, government survey on health insurance status were published Tuesday, and they show that the uninsured rate remained basically flat at 9.1 percent in the first year of the Trump presidency.

The numbers suggest a surprising resilience of the health law, and its expansion of insurance coverage, even in the face of efforts that the law’s defenders call “sabotage.”

The new statistics come from the Centers for Disease Control and Prevention, which monitors the number of Americans with and without health insurance every quarter. Some smaller private surveys, from Gallup and the Commonwealth Fund had shown the uninsured rate rising last year. But the C.D.C. research includes a larger sample size, and is generally regarded as a more definitive study. Tuesday’s study contains data from the entire calendar year of 2017.

Among states that expanded their Medicaid programs under the Affordable Care Act, the uninsured rate actually fell last year. Among states that didn’t expand, it rose a little.

Overall, Obamacare has substantially reduced the number of Americans without insurance. According to the report, 19.3 million fewer people were living without health insurance in 2017 compared with 2010, when the Affordable Care Act passed Congress.

New health insurance options aren’t the only thing that has changed since the passage of the Affordable Care Act. A strengthening economy has nudged more Americans into the work force, increasing people’s access to health insurance at work.

Obamacare has shown other signs of hardiness. This year, the Trump administration slashed the program’s advertising budget by 90 percent, and withdrew key subsidies from insurance companies, leading to premium increases for some customers. But every market had at least one insurer that continued to offer plans on the Obamacare marketplaces, and sign-ups dipped only slightly.

That does not mean that the insurance trends will hold forever. There are several reasons the uninsured rate may rise in the future:

  • In the face of rising premiums, it is likely that some who do not qualify for federal subsidies have dropped coverage this year.

  • Several states are trying to set up work or other “community engagement” requirements for some Medicaid beneficiaries. A few will impose such rules this year. States requesting such changes estimate they will result in a declining number of residents covered by Medicaid.

  • The Trump administration is working on regulations to allow more loosely regulated insurance plans into the market. These plans could prove appealing to some people who are currently uninsured. But they could cause prices to rise for insurance plans with all of the Obamacare consumer protections, prompting other people to drop their coverage. According to an estimate from the Urban Institute, about 2.6 million fewer people may have comprehensive coverage next year.

  • The tax penalty for people who decline to obtain insurance will disappear entirely next year. That change alone is likely to cause several million fewer Americans to have insurance. Early filings by insurance carriers suggest the change will cause another round of big price increases. And economists at the Congressional Budget Office estimate that the policy’s disappearance will also cause fewer people eligible for government help from even investigating such options.

The combination of those changes is likely to mean some backsliding. But last year’s data suggest that Obamacare’s policies have helped create options that are appealing to many Americans who would have gone without insurance in the years before its passage.

 

 

 

 

Medical Research, Drug Treatment And Mental Health Are Winners In New Budget Bill

https://www.npr.org/sections/health-shots/2018/03/22/596116779/medical-research-drug-treatment-and-mental-health-are-winners-in-new-budget-bill?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202018-03-23%20Healthcare%20Dive%20%5Bissue:14589%5D&utm_term=Healthcare%20Dive

Sen. Susan Collins, R-Maine (center), is joined on Wednesday by Sen. Lindsey Graham (from left), R-S.C., Sen. Lisa Murkowski, R-Alaska, and Rep. Greg Walden, R-Ore. Collins was pushing for provisions in the budget bill aimed at lowering premiums for people purchasing health insurance in the Affordable Care Act’s marketplaces. That didn’t happen.

 

The big budget deal reached this week in the House doesn’t include a long-sought-after provision to stabilize the Affordable Care Act marketplaces. But the $1.3 billion plan, set to fund the government through September, has lots of new money for medical research, addiction treatment and mental health care.

Here’s the rundown of what’s included in the 2,232-page spending bill, now in the hands of a Senate vote, based on summaries released by the House and Senate appropriations committees.

  • $78 billion in overall funding for the Department of Health and Human Services, a $10 billion increase
  • $3.6 billion to fight the opioid addiction crisis
    • This more than doubles the money allocated in fiscal 2017 and boosts funding for treatment and prevention, as well as helping to find alternatives for people suffering from pain.
  • $3.2 billion for mental health care
    • This is a 17 percent boost from last year and goes to treatment, prevention and research.
  • $37 billion for the National Institutes of Health
    • This is a $3 billion increase over fiscal 2017 and boosts spending on research into Alzheimer’s disease and a universal flu vaccine, among other things.

Lawmakers could not agree on language designed to stabilize the Affordable Care Act insurance markets and lower insurance premiums that Sens. Lamar Alexander, R-Tenn., and Susan Collins, R-Maine, have been fighting for since last fall. That bill would have reinstated the cost-sharing reduction payments, by which the government reimburses insurance companies that give the lowest-income customers a break on their copayments and deductibles.

Last year President Trump announced that the government would stop making the payments, a decision that drove the unsubsidized premiums on insurance policies higher.

Alexander says his proposal would restore those payments and cut premiums as much as 40 percent.

“Nothing is more important to Americans than health care, and nothing is more frightening than the prospect of not being able to afford health insurance, which is the case for a growing number of Americans,” he said at a news conference Wednesday.

But Democrats refused to support the provision because it also included language that would have barred any insurance policy sold on the ACA marketplaces from covering abortion.

 

 

 

Orthopedic Urgent Care Franchising is THE Opportunity of 2018

https://medcitynews.com/?sponsored_content=orthopedic-urgent-care-franchising-opportunity-2018-2&utm_campaign=MCN%20Daily%20Top%20Stories&utm_source=hs_email&utm_medium=email&utm_content=61259603&_hsenc=p2ANqtz-9KZbK2I0aYCjcH-L8_oANZXZSsq2K8jondsl8vHF0rHfcb8_zR65kRtQV-cDsnd_VomLuc-G2in5Y4wJcsFWrR8zgKJg

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Healthcare Executives, Physicians, and Healthpreneurs dealing with hospital spending cuts, reduced insurance reimbursements, and reduced market share are looking for solutions to earnings loss which is giving rise to the innovations in specialized focused urgent care.

The economic pressures coupled with the need for lifestyle balance cause many in the healthcare industry to look for alternatives and franchising is leading this nationwide healthcare overhaul.

With approximately 9,000 urgent care centers in the United States offering generalized care, OrthoNOW is the only franchised care center of its kind in the United States — a unique position to gain market share in this highly fragmented industry.

OrthoNOW’s focus is on sports medicine and the treatment and prevention of the full range of orthopedic injuries, all on a walk-in basis. Services include treatment of injuries to the hand, wrist, foot, ankle, knee, spine and shoulder, as well as preventative consultation and regimens by experts in orthopedics.

Strong interest in the brand is being fueled by CDC estimates that injuries have a $671 billion annual impact on the U.S. economy — orthopedic medicine contributes $48 billion to the GDP and urgent care centers produce an additional $30 billion in revenue. Further, 160 million patients seek out urgent care each year; 48 million of those patients will require orthopedic care who, without access to, are referred to the local emergency room only to be redirected to a specialist following a long and expensive visit.

“OrthoNOW offers an innovative turn-key solution with a comprehensive support system built in. Our corporate staff consists of veteran business, medical and franchise professionals who work closely with our franchisees and provide ongoing support. Thus, our operations are efficient and effective,” says Christine Dura, Chief Development Officer. “We have more than 1,000 territories available, and we are aggressively targeting proven multi-unit operators and Regional Developers who understand the power of scalability.”

Have you ever wondered how owning a proven franchise model in healthcare could change your financial future? OrthoNOW’s power-packed 30 minute webinar is the place to start. Get expert answers to your most pressing questions. Some will watch and miss the opportunity. Some may even try a solution on their own. Regardless, their proven model leads the charge in delivering the healthcare solutions many Americans need NOW.

Answer the call of millions of Americans in need of expert and affordable healthcare. Join OrthoNOW’s webinar on February 28, 2018, which covers the four big questions in franchising:

  • Am I the right fit?
  • What is my investment?
  • How much money can I make?
  • Why OrthoNOW?

As a first step to sensible gun policy, lift congressional brakes on gun-violence research and data-sharing: editorial

http://www.cleveland.com/opinion/index.ssf/2018/02/as_a_first_step_to_sensible_gu.html#incart_2box_opinion

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Knowledge is power. Yet Congress has limited its own access to facts vital to understanding the nation’s gun violence pandemic. That’s because, since 1996,  Congress has effectively prevented the Centers for Disease Control and Prevention from continuing public health research into the consequences of gun violence.

At the same time, while Congress forever proclaims its support of the men and women in blue, lawmakers have fettered law enforcement around the country in understanding gun-crime trends by restricting how the Bureau of Alcohol, Tobacco, Firearms and Explosives can share its gun-trace data.

Assuming Ohio’s congressional delegation doesn’t confuse talk with action, Ohio’s two senators and 16 U.S. House members — three of whom represent portions of Cuyahoga County, thanks to gerrymandering — should work together to eliminate these grotesque and paradoxical restrictions.

They blind congressional decision-making about gun policy – and about the extent and results of illegal gun trafficking.

The United States is awash in weapons, with more guns per 100 residents (89) than any other nation, reports CNN, citing the Swiss-based Small Arms Survey. The next closest is war-torn Yemen, with 55 guns per 100 inhabitants.

With crime guns relatively easy and cheap to obtain, cities like Cleveland are seeing steadily rising rates of gun violence. In Cuyahoga County, gun deaths as a percentage of overall homicides rose more than 14 percent in the last 25 years, according to data from the county medical examiner’s office.

Why would Congress tie the hands of police and policymakers to address this scourge? It makes no sense.

Even the late sponsor of the congressional amendment that precipitated the prohibition on CDC gun research, then-Rep. Jay W. Dickey Jr., an Arkansas Republican, later regretted it publicly.

“I wish we had started the proper research and kept it going all this time,” Dickey, who died last year, told the Huffington Post in 2015, in a story updated last year. “I have regrets.”

Dickey said such gun violence research might have developed safety measures or mechanisms for guns, as highway safety research has made roads safer: “If we had somehow gotten the research going, we could have somehow found a solution to the gun violence without there being any restrictions on the Second Amendment,” he said. “We could have used that all these years to develop the equivalent of that little small [highway barrier] fence.”

It’s not too late to restart this important research effort.

After accomplishing that, Ohio’s delegation should next work to repeal the Tiahrt amendment, named for then-Rep. Todd Tiahrt, a Kansas Republican. As modified, the 2003 amendment has added to the budget a nondisclosure requirement for ATF’s gun-trace efforts.

ATF says this doesn’t bar it from sharing gun-trace data with a law enforcement agency engaged in a “bona fide” criminal investigation, or from doing jurisdictional-specific gun trend investigations, but the amendment limits broadly how ATF can share its gun-trace data. That in turn creates critical knowledge barriers on crime-gun trends for officials in Ohio and every other state.

Repealing the Dickey and Tiahrt amendments wouldn’t crimp the rights of law-abiding gun owners. Instead, unlocking those congressional handcuffs would empower Congress by providing accurate information on which to fashion fair and practical legislation.

That assumes, of course, good faith rather than bombast on the part of Congress and the men and women Ohio sends to the U.S. House and Senate.

Twelve of Ohio’s 16 U.S. representatives, plus Sen. Rob Portman, of suburban Cincinnati, are Republicans, the congressional majority party.

That gives them leverage on eliminating these gun-ignorance amendments. They need to use that leverage. If they don’t, Ohio voters may remind them sooner rather than later that they want their lawmakers armed — with knowledge, not ignorance.

 

At Some California Hospitals, Fewer Than Half Of Workers Get The Flu Shot

At Some California Hospitals, Fewer Than Half Of Workers Get The Flu Shot

How well are doctors, nurses and other workers at your local hospital vaccinated against the flu?

That depends on the hospital.

According to data from the California Department of Public Health, flu vaccination rates among health care staffers at the state’s acute care hospitals range from a low of 37 percent to 100 percent.

Overall, flu vaccination rates among hospital workers climbed significantly in the past several years — from an average of 63 percent during the 2010-11 influenza season to 83 percent during the 2016-17 season, according to the California Department of Public Health. Vaccination rates for the current season won’t be determined until later this year.

But that general increase masks some big variations. Monrovia Memorial Hospital in Los Angeles, Los Robles Hospital and Medical Center, East Campus and Thousand Oaks Surgical Center in Ventura each reported that fewer than 40 percent of their health care workers received the flu vaccine last year. Representatives from those hospitals did not return repeated calls for comment.

On the other end of the spectrum, Rady Children’s Hospital in San Diego reported that every single person working there got the vaccine.

California’s flu vaccination policies for hospital workers, and those of many other states, are far from uniform or ironclad. In various states, health care workers have legally challenged hospital requirements for vaccination on religious and seculargrounds. And some unions in California and elsewhere oppose a legal mandate, partly for civil rights reasons.

Public health officials themselves have different takes on the legal requirements for hospital workers. The Centers for Disease Control and Prevention lists California and Massachusetts among the handful of states where the flu vaccination is mandated for health care workers. But the states’ laws allow health care workers to opt out by signing a form declining the vaccine. For that reason, officials from those two states said they do not actually consider the vaccine mandatory.

Colorado law requires hospital health care workers to provide proof of immunization or a doctor’s note providing for a medical exemption, and requires that non-immunized workers wear masks. Hospitals that achieve a 90 percent or higher flu vaccination rate are exempt from these rules, however.

In California, state law requires that hospitals offer the vaccine free of charge. Many hospitals offer vaccines to personnel in the cafeteria, and during day and night shifts. “The key to getting more people vaccinated is to make it more easily accessible for people,” said Lynn Janssen, chief of the California Department of Public Health’s associated infections branch.

She also said many California counties and hospitals have required health care workers to either get the flu vaccine or wear a mask, which can help prevent spreading illness to others.

Partly as a result, nearly a third of the state’s hospitals now have flu vaccination rates above 90 percent.

Vaccination rates vary significantly among different categories of hospital workers, however. Hospital employees had an average vaccination rate of 87 percent statewide in 2016-17, while licensed independent practitioners — including some physicians, advance practice nurses and physician assistants who do not receive paychecks from the hospital — had a rate of just 67 percent.

The CDC recommends that health workers get one dose of influenza vaccine annually, and cites data showing the vaccine in recent years has been to up 60 percent effective — though it was far less so this year. Dr. Bill Schaffner, an infectious diseases professor at Vanderbilt University School of Medicine in Nashville, Tenn., says there are three principal reasons to get vaccinated: to prevent workers from infecting patients, to keep them healthy in order to care for patients and to spare them a bout with the flu.

A 2017 Canadian study, however, suggests that the benefits of health care worker vaccinations have been overstated.

In any case, just because experts say health care personnel should get the vaccine doesn’t mean they will choose to do so.

“In the studies, and also in our experience, it turns out — to everyone’s great surprise — that health care workers are human beings,” Schaffner said. “Some are too busy, some don’t think the flu vaccine is worth it, some don’t like shots. Some are not convinced they can’t get flu from the flu vaccine.” (Experts say they can’t.)

Because of this, Schaffner said, it’s up to hospital leadership to push staffers to get vaccinated. At Vanderbilt University Medical Center, vaccination rates increased from 70 percent to 90 percent once leaders there effectively made the flu vaccine “mandatory,” he said, requiring noncompliant hospital personnel to present vaccine exemption requests to a hospital committee.

Health officials also encourage patients to ask whether their caregivers are vaccinated.

Jan Emerson-Shea, spokeswoman for the California Hospital Association, said her organization would like the flu vaccine to be mandatory for all health care personnel. Independent physicians have proven an especially challenging group to motivate, she said, since hospitals hold little sway over them.

“I, for the life of me, can’t imagine why a physician wouldn’t want to be vaccinated,” she said. “But they make that choice.”

Yet the California Nurses Association strongly opposes making flu vaccines mandatory, said Gerard Brogan, a registered nurse and spokesman for the union.

He said the union does recommend that providers get the vaccine, but it objects to making vaccination a condition of employment. He said some employees have religious issues or safety concerns about the vaccines and “we think that should be respected as a civil rights issue,” he said.

He also called rules requiring unvaccinated providers to wear a face mask “punitive.”

“It’s almost like the scarlet letter to shame you,” he said.

He said the masks can frighten patients — a contention made by a New York union as well. In any case, he said, wearing the masks is not especially effective in stopping the spread of flu (although some researchers say otherwise). Instead, he said, employees should be encouraged to wash hands and to stay home when they are sick.

Too often, he said, nurses are asked to come in to work when they are ill. He said he was not able to find any nurses willing to discuss their decision not to get the flu shot.