All Sauce from Weekly Gravy:

Following a cyberattack on the largest health insurer in the United States last month, health care providers continue to scramble as insurance payments and prescription orders continue to be disrupted and physicians lose an estimated $100 million a day. That estimate was generated by First Health Advisory, a cybersecurity firm that specializes in the health industry, according to the American Medical Association (AMA). “This massive breach and its wide-ranging repercussions have hit physician practices across the country, risking patients’ access to their doctors and straining viability of medical practices themselves,” AMA President Dr. Jesse Ehrenfeld said in a news release. “Against the backdrop of persistent Medicare cuts, rising practice costs and spiraling regulatory burdens, this unparalleled cyberattack and disruption threatens the viability of many practices, particularly small practices and those in rural and underserved areas,” he added. “This is an immense crisis demanding immediate attention.” How did the crisis begin? The security breach was first detected on Feb. 21 at Change Healthcare, part of Optum Inc., which is in turn owned by UnitedHealth Group. In a report filed that day with the U.S. Securities and Exchange Commission, UnitedHealth Group told government officials that it had been forced to sever some of Change Healthcare’s vast digital network from its clients. It hasn’t yet been able to restore all of those services. In its latest update on…  read on >  read on >

Nurses who specialize in anesthesia have issued new guidelines to reduce the risk that patients taking weight-loss drugs like Ozempic or Wegovy throw up during surgery. “These medications have exploded in popularity,” said Micah Walden, of the American Association of Nurse Anesthesiology (AANA) Practice Committee. “This means additional preparation for patients, anesthesia providers and the surgical team to help minimize risks of complications during a procedure.” Because general anesthesia can cause nausea, patients are usually asked to fast before surgery. But a study published last week in the journal JAMA Surgery found these weight-loss drugs — called GLP-1 receptor agonists — slow digestion, so it takes longer for food to leave the stomach. That increases a patient’s risk of vomiting or aspiration while under anesthesia. GLP-1 agonists like Ozempic, Wegovy (semaglutide), Saxenda (liraglutide) or Zepbound (tirzepatide) were originally designed to manage type 2 diabetes, but they have become a popular way to lose weight. They make patients feel full sooner, so they eat less. As a precaution, the AANA committee said providers may need to do extra screenings such as an ultrasound of the patient’s stomach before surgery. If the examination indicates that the stomach is not empty or the imaging is inconclusive, the surgical team may consider delaying an elective surgery or proceeding as “full stomach” to reduce the risk of vomiting and aspiration while…  read on >  read on >

Researchers are zeroing in on the reasons why women who battle depression may be more likely than men to develop heart disease. A study published March 12 in the journal JACC: Asia underscores the need to tailor prevention and management strategies according to sex-specific factors, researchers said. This “may help in the development of targeted prevention and treatment strategies” for the heart health risks faced by depressed patients, said corresponding author Dr. Hidehiro Kaneko, an assistant professor of medicine at the University of Tokyo in Japan.  Depression in the third-leading cause of disease worldwide. It has been linked to an increased risk of heart problems including heart attack, angina, stroke and death. Women who are depressed are at a greater risk of heart problems than their male peers with depression, but the reasons have not been understood. For this study, Kaneko’s team evaluated data from nearly 4.2 million people who were listed in a Japanese health claims database between 2005 and 2022. Of those, nearly 2.4 million were men. Researchers looked at participants’ weight, blood pressure and fasting laboratory test results at their initial exam. Those with depression had previously received that diagnosis. Researchers found that women with depression were more likely than men to have one of the heart problems investigated — heart attack, stroke, angina, heart failure and atrial fibrillation.  Researchers suspect women…  read on >  read on >

Baseball season is near, and one orthopedic surgeon is warning young players and their coaches and parents about the very real danger of overuse injuries. Dr. Mark Cohen is a hand, wrist and elbow surgeon at Midwest Orthopaedics at RUSH, in Chicago. He’s also an official team physician for the Chicago White Sox. “I’m a huge baseball fan and have enjoyed treating professional and youth players for many years,” Cohen explained in a RUSH news release. “I love it when we can get a player back on the field. What concerns me is the rate at which Little Leaguers are experiencing big league conditions that may interfere with their body’s normal function as they grow.” Some of these “big league conditions” include simple chronic arm pain, but also torn ulnar collateral ligaments (UCLs) in the elbow, Cohen explained. UCLs often require extensive “Tommy John” surgeries — named after the first major leaguer to get the surgery back in 1974. According to one study of 261 youth and high school pitchers, published in 2023 in the Journal of Shoulder and Elbow Surgery, one in four suffered some kind of injury to their arm over the course of their career. The longer they pitched, the higher their risk for these injuries and the need for surgery, the study found. “Ten years ago, Tommy John surgery was a…  read on >  read on >

People diagnosed with attention-deficit hyperactivity disorder (ADHD) show a marked decline in their two-year risk for death once they start taking medication, new research shows. That was particularly true for deaths due to accidents and drug overdose. People taking ADHD drugs also showed no higher risk of dying from natural causes — suggesting the meds are safe for users’ heart health. Medications like Ritalin, Concerta and others probably lower users’ odds for an early death “by alleviating the core symptoms of ADHD and other psychiatric co-morbidities [illnesses], leading to improved impulse control and decision-making,” concluded a team led by Zheng Chang, of the Karolinska Institute in Stockholm, Sweden. Better impulse control and healthier decisions help people with ADHD avoid tragedies like fatal accidents and drug overdoses, the researchers said. As Chang’s team noted, prior research has shown that people with ADHD face double the odds for deaths from “unnatural causes” — events such as accidents, suicide and unintended drug overdoses.  Many people struggle with the decision to start ADHD medications, however, so the new study wanted to see if the drugs might lower death risks. Chang’s team gathered data from multiple Swedish health registries. In all, they amassed medical histories on almost 149,000 Swedes who’d been diagnosed with ADHD between the ages of 6 and 64. Within three months of their diagnosis, about 57% of…  read on >  read on >

When states let gun owners carry a firearm openly without a permit, death rates soar. Significantly more people died by firearms and suicides in states that have relaxed open carry laws, a nine-year study of death data from all 50 states shows.  “Our analysis suggests that because of the change in the law, which provides easier access to firearms, we saw an increased firearm suicide rate and total suicide rate,” said principal study author Dr. Jose Diaz, a professor of surgery at the University of South Florida in Tampa. His team evaluated annual rates of firearm-related deaths, total suicides and total homicides from 2013 to 2021. Death data came from the U.S. Centers for Disease Control and Prevention. During the study period, 19 states barred open carry or required a permit, and five states switched to open carry laws without a permit. Twenty-six states already allowed open carry without a permit before 2013. Over the study period, firearm deaths jumped 45% nationwide, from 33,636 in 2013 to 48,830 in 2021. Researchers found a significant link between more liberal gun laws and rates of firearm-related deaths. Total suicide rates rose by about 57%, while suicides by firearm rose 18% in states that switched to permitless open carry, the data showed. There was no link between permitless open carry laws and homicides related to firearms. Diaz said…  read on >  read on >

Women who’ve gone through menopause and hope that supplemental vitamin D plus calcium might shield them from disease may be disappointed by new data. A follow-up analysis of data from the landmark Women’s Health Initiative trial found the supplement combo lowered a woman’s long-term odds of dying from cancer by 7%. However, it also raised her odds of fatal heart disease by 6%. The bottom line: there was “no net effect on all-cause mortality” among older women who took the supplement combo, the study authors said. It’s possible “that calcium supplements may increase calcification of coronary arteries, thus increasing cardiovascular disease mortality,” said a team led by Cynthia Thomson, a professor of health promotion sciences at the University of Arizona in Tucson. The findings were published March 11 in the Annals of Internal Medicine. For years, many older women have popped a combination of calcium plus vitamin D to help strengthen their bones. Many may also wonder if the supplements cut their odds for two major killers, heart disease and cancer. The Women’s Health Initiative began enrolling tens of thousands of women as far back as 1991, and has tracked their health outcomes over subsequent decades. In 2006, the first (seven-year) findings on the effects of calcium/vitamin D supplementation on women’s health were announced; the results were “largely null,” Thomson’s group noted. Could that result…  read on >  read on >

Gay and bisexual people, as well as those undergoing gender transition, could face unique dermatological issues, an expert says. Board-certified dermatologist Dr. John Zampella, who runs a clinic in New York City that caters to many LGBTQ+ patients, said the risk for sexually transmitted infections is higher among this group and can sometimes lead to skin complications. “Dermatologists are the experts in the diagnosis and treatment of many sexually transmitted infections like syphilis, HPV and herpes that often have skin-related symptoms,” Zampella explained at the American Academy of Dermatology annual meeting in San Diego. There are recent reports on the emergence of fungal infections, such as ringworm, that could also be sexually transmitted among gay and bisexual men. These typically appear as a spreading rash in the groin or buttocks area, and should be examined by a physician such as a dermatologist, Zampella said. Strains of these infections often prove resistant to traditional antifungal meds and may take longer to treat. The best way to stop many STIs is prevention, of course. As Zampella noted, pre-exposure prophylaxis (PrEP) antivirals are now available as injections that can provide users with two months of protection against HIV. The U.S. Centers for Disease Control and Prevention has also approved the antibiotic doxycycline, taken within 72 hours of having sex, as a preventive measure against syphilis, chlamydia and gonorrhea.…  read on >  read on >

The cost to American families of caring for a child with a mental health condition rose by almost a third between 2017 and 2021, a new report finds, to an average $4,361 per year.  Overall, American families spent an estimated $31 billion in 2021 on child mental health services, which now make up nearly half (about 47%) of all child medical spending, the report found. The findings “underscore the large financial burden associated with pediatric mental health conditions on the U.S. health care system,” said a team led by Theoren Loo. He works for Brightline, a California company focused on virtual mental health care for kids. The findings were published March 11 in the peer-reviewed journal JAMA Network Open. As the study authors noted, “the prevalence of pediatric mental health conditions and the demand for behavioral health services is growing in the U.S.” In 2021, U.S. Surgeon General Dr. Vivek Murthy issued a report outlining “alarming increases in the prevalence of certain mental health challenges” among kids. In the study, Loo’s group tracked 2017-2021 federal data on medical spending from a representative sampling of American households. They found that diagnoses for mental health conditions in kids ages 5 to 17 rose by almost 22% over those five years.   By 2021, about one in every four (25.9%) American children was diagnosed with a mental health…  read on >  read on >

Slicing some fresh limes for that margarita savored in the sun could be a bad combo for some people’s skin, dermatologists warn. Folks can break out in what are nicknamed “margarita rashes” if they are skin-sensitive to certain fruits or vegetables and then get sun exposure soon after. The medical term for these outbreaks is photocontact dermatitis. “Sun sensitivity is a common condition that can negatively impact a person’s quality of life,” said board-certified dermatologist Dr. Brandon Adler, an assistant professor of dermatology at Keck School of Medicine at the University of Southern California in Los Angeles. He spoke about the issue on Friday during the American Academy of Dermatology’s annual meeting. Handling produce such as lime, figs and celery or coming into contact with plants like hogweed and St. John’s wort can set some folks up for photocontact dermatitis. For other people, medicines — taken either by mouth or applied to the skin — can help spur skin reactions, Adler explained. A medicinal cream might only cause a rash where it was applied, but a pill taken by mouth might bring on a rash that breaks out all over the body after sun exposure. Typical photocontact rashes occur in areas most exposed to sun — face, neck, arms or legs, Adler said. “While we will often prescribe anti-inflammatory medications to treat photocontact dermatitis, the…  read on >  read on >