When Andria Peterson began working as a clinical pharmacist in the pediatric and neonatal intensive care units at St. Rose Dominican Hospital in Henderson, Nevada, in 2009, she witnessed the devastating effects the opioid crisis had on the hospital's youngest patients.

She recalled vividly one baby who stayed in the NICU for 90 days with neonatal abstinence syndrome, a form of withdrawal, because his mother had used substances while pregnant.

The mother came in every day, Peterson said. She took three buses to get to the hospital to see her baby. Peterson watched her sing to him some days and read to him on others.

“I saw in the NICU the love that she had for that baby,” Peterson said. “When it came down to it, she lost custody.”

At the time, Peterson said, she felt more could be done to help people like that mother. That’s why, in 2018, she founded Empowered, a program that provides services for pregnant and postpartum women who have a history of opioid or stimulant use or are currently using drugs.

The program helps about 100 women at any given time, Peterson said. Pregnancy often motivates people to seek treatment for substance use, she said. Yet significant barriers stand in the way of those who want care, even as national rates of fatal drug overdoses during and shortly after pregnancy continue to rise. In addition to the risk of overdose, substance use during pregnancy can result in premature birth, low birth weight, and sudden infant death syndrome.

A federal initiative seeking to combat those overdoses is distributing millions of dollars to states to help fund and expand programs like Empowered. Six states will receive grant funding from the Substance Abuse and Mental Health Services Administration to increase access to treatment during and after pregnancy. The Nevada Health and Human Services Department is distributing the state’s portion of that funding, about $900,000 annually for up to three years, to help the Empowered program expand into northern Nevada, including by establishing an office in Reno and sending mobile staff into nearby rural communities.

Other states are trying to spread the federal funds to maximize reach. State officials in Montana have awarded their state’s latest $900,000 grant to a handful of organizations since first receiving a pool of funding in 2020. Connecticut, Iowa, Maryland, and South Carolina will also receive $900,000 each.

Officials hope the financial boosts will help tamp down the rise in overdoses.

Deaths from drug overdoses hit record highs in 2021, according to the Centers for Disease Control and Prevention. More recent preliminary data shows that the rates of fatal drug overdoses have continued to rise since.

Deaths in pregnant and postpartum people have also increased. Homicides, suicides, and drug overdoses are the leading causes of pregnancy-related death.

Fatal overdoses among pregnant and postpartum people increased by approximately 81% from 2017 to 2020, according to a 2022 study. Of 7,642 reported deaths related to pregnancy during those years, 1,249 were overdoses. Rates of pregnancy-related opioid overdose deaths had already more than doubled from 2007 to 2016.

Meanwhile, mothers and mothers-to-be in rural parts of the country, some of the hardest hit by the opioid crisis, face greater barriers to care because of fewer treatment facilities specializing in pregnant and postpartum people in their communities and fewer providers who can prescribe buprenorphine, a medication used to treat opioid addiction.

Data distinguishing the rates of overdose mortality among pregnant and postpartum people in urban and rural areas is hard to come by, but studies have found higher rates of neonatal opioid withdrawal syndrome in rural parts of the country. Women in rural areas also died at higher rates from drug overdoses in 2020 compared with women in urban areas, while the overall rate and the rate among men were greater in urban areas.

In Nevada, a 2022 maternal mortality and severe maternal morbidity report found that most of the state’s pregnancy-related deaths, 78%, happened in Clark County, home to Las Vegas and two-thirds of the state’s population. However, the state’s rural counties had the highest pregnancy-related death rate — 179.5 per 100,000 live births — while Clark County’s was 123 per 100,000 live births.

During a recent event hosted by Empowered, four mothers recounted their struggles with addiction while pregnant. “It was never my intention to actually have a drug addiction,” said a mother named Amani. “I’ve always wanted to get out of the cycle of relapsing and drug usage.”

Amani, who asked to be identified only by her first name for fear of stigma associated with using drugs while pregnant or after giving birth, said she found the support she needed to treat her addiction in 2021. That’s when she began seeking help at Empowered.

Substance use while pregnant or postpartum is “incredibly stigmatizing,” said Emilie Bruzelius, a postdoctoral fellow in the Department of Epidemiology at Columbia University’s Mailman School of Public Health and author of a study of trends in drug overdose mortality during and after pregnancy. The stigma and fear of interacting with child welfare or law enforcement agencies prevents people from seeking help, she said.

A Rand Corp. study found that states with punitive policies toward mothers with substance use disorders have more cases of neonatal abstinence syndrome. Nevada was among them.

Researchers have found that, in addition to facing fear of punishment, many women don’t have access to treatment during and after pregnancy because few outpatient centers specialize in treating mothers.

Both Nevada and Montana had fewer than one treatment facility with specialized programs for pregnant and postpartum women per 1,000 reproductive-age women with substance use disorders, with Montana ranking in the lowest quintile.

One Health, a community health center covering Montana’s sprawling southeastern plains, is using the newly awarded federal money to train peer support specialists as doulas, professionals specialized in childbirth who can provide support throughout pregnancy and after.

Megkian Doyle, who directs the center’s community-based work, said in one case a survivor of sex trafficking who was drugged by her abusers worked with a recovery doula to prepare for the potential triggers of being exposed to medical workers or needing an IV. In another, a mom in stable recovery from addiction was able to keep her baby when hospital staffers called child protective services because she already had a safety plan with her doula and the agency.

After birth, recovery doulas visit families daily for two weeks, “the window when overdose, relapse, and suicide is happening,” Doyle said. The workers, in their peer support role, can continue helping clients for years.

While doula care, rarely covered by insurance, is unaffordable for many, Medicaid typically covers peer support care. As of late September, 37 states and Washington, D.C., had extended Medicaid benefits to cover care for 12 months postpartum. Montana and Nevada have approved plans to do so. Health centers in similarly rural states have taken note. The program’s latest cohort of recovery doulas includes five peer support specialists from Utah.

With its trauma-informed approach, the Nevada-based Empowered program takes a different tack.

The program focuses on meeting its participants’ most pressing need, which varies depending on the person. Some people need help getting government-issued identification so they can access other social services, including aid from food pantries, said Peterson, the founder and executive director. Others may need safe housing above all.

Empowered is not abstinence-based, meaning its participants do not lose access to services if they relapse or use substances while seeking help. Because some participants may be actively using drugs, the Empowered office is also a distribution site for the overdose reversal medication naloxone and test strips that detect fentanyl, a powerful synthetic opioid that has contributed to jumps in fatal overdose rates in recent years. The program’s staff also provide education about the effects drugs have on an unborn baby during pregnancy.

Being able to be honest with Empowered staff made a difference for Amani.

“I can’t tell you how many times I’ve tripped and fallen but tried to get back up and fallen again,” she said.

The goal is not only to stabilize participants’ lives but to make them resilient — whatever that may look like for each individual. For many, that includes having stable housing, food security, job security, and custody of their children.

To her, Amani said, the Empowered program means love, support, and not being alone.

“I wouldn’t be here, literally, without them,” she said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

PAHO joins forces with Canada to reverse declining immunization against vaccine-preventable diseases in Haiti

Cristina Mitchell

18 Oct 2023

MEDICAL RESEARCH is essential for the advancement of healthcare and the development of new treatments for diseases. It plays a crucial role in improving the lives of people around the world and saving countless lives. One of the main benefits of...

obal Health at the Harvard Global Health Institute, explained.“Despite a decade of this diarrheal disease, we have made no progress on water access,” she said, adding that only

Adults with the same type of so-called ACL injury generally showed no significant increase in such risk, investigators say.

The likely explanation, the researchers say, is that adults are more likely to dial back physical activity and comply with calls for restrictions from a doctor, while children are more likely to continue strenuous sports and other play, and experience further knee damage that may not at first be obvious.

“What we have shown with children is that the longer you wait, the more damage may be done to the knee,” says R. Jay Lee, M.D., senior author of the study and a pediatric sports medicine specialist at the Children’s Center.

In the study, described Oct. 6 in the Orthopaedic Journal of Sports Medicine, the Johns Hopkins investigators worked to establish the risk of tears to the meniscus, a C-shaped pad of cartilage in the knee, in pediatric and adult patients. They did so by comparing the presence of new meniscal tears discovered during arthroscopy-a minimally invasive surgical procedure to repair the knee tissue using a camera-and tears present during an MRI taken around the time of an initial ACL injury.

The researchers say the findings reinforce the need for timely surgical treatment in pediatric patients to prevent ongoing damage to the knee, while older patients’ surgical treatment may be safely delayed.

ACL tears, often experienced as a “popping” sensation in the knee, are especially common in children and adults who play sports that involve sudden, sharp changes in direction, such as football, soccer, lacrosse and basketball. Research estimates that between 100,000 and 200,000 people each year tear their ACL in the United States. Historically, physicians have recommended that ACL reconstruction be delayed in younger patients until the child is finished growing. However, in people of all ages, ACL tears leave the knee unstable and more prone to further injury.

For the new study, Lee and his team searched electronic medical records and identified 542 patients (173 pediatric patients and 369 adult patients) who underwent ACL reconstruction between 2013 and 2022 at Johns Hopkins Medicine.

They found that, overall, most patients (66%), both children and adults in the group studied, had a meniscal tear that was observed arthroscopically, but almost one-third of the tears, 32%, were new injuries not present on an initial MRI. In all, there were 36 new medial meniscus tears (tears on the inside of the knee joint) and 97 new lateral meniscus tears (tears on the outside of the knee). Some 17 patients developed both medial and lateral tears by the time of surgery.

Among those who showed no meniscal tears on their initial MRI, arthroscopy found new medial meniscal tears in 15% of pediatric patients and 16% of adults. But 48% of pediatric patients had new lateral meniscus tears, compared with 34% of adults.

The researchers say adults were more likely than pediatric patients overall to delay ACL reconstruction, but that among adults, the delayed reconstruction was not associated with a higher risk of meniscal tears at the time of injury or at the time of surgery. Researchers believe these findings suggest that delayed ACL reconstruction may be acceptable in adults.

The investigators say their study was limited by the potential for so-called “selection bias,” in which surgeons may have been more likely to operate soon after injury in those with more severe knee injuries. Additionally, the level of a person’s physical activity after ACL injury is likely a major contributor to the development of further knee damage, but its specific contribution is challenging to measure. Lastly, meniscal tears that were missed on the initial MRI could have led to an overestimation of the incidence of “new” meniscal tears in some cases.

However, the researchers say they hope their findings will help inform decisions when adults and caregivers of children who experience ACL injuries are deciding when to have surgery. The researchers will continue their investigation, particularly looking at whether restricting patients’ mobility has an effect on new meniscal tears.

Reference:

Arjun Gupta, Daniel Badin, and R. Jay Lee, Is Delayed Anterior Cruciate Ligament Reconstruction Associated With a Risk of New Meniscal Tears? Reevaluating a Longstanding Paradigm, https://doi.org/10.1177/23259671231203239.

A medical practitioner says the Queen Elizabeth Hospital (QEH) needs to hire additional anesthesiologists to meet the demands that can only be executed by physicians trained in that speciality area.

Speaking to members of the media at a World Anaesthesia Day Symposium in the QEH Auditorium on Monday, consultant anesthesiologist Dr Keisha Thomas-Gibson said more anesthesiologists were required to decrease the heavy workload in the Anaesthesia Department, as she noted that the duties of anesthesiologists go way beyond administering medication to put a patient to sleep before surgery and being there to wake them following the procedure.

Dr Thomas-Gibson, who is the Anesthesia Intensive Care programme coordinator for the University of the West Indies (UWI) undergraduate and postgraduate programmes, said because the anesthesiologist’s role stretches outside the operating theatre, more human resources are necessary to service all the other areas.

“Ninety-nine per cent of patients do not know that the anesthesiologist is with them throughout the surgery. They think that we give an injection and sometimes return to wake you up, or you wake up on your own, and that is absolutely not the case. We are the intraoperative, the surgeon cuts, and we do everything else. 

“So it is a situation where, of course, we need human resources, we need persons, we need staff to be able to execute all of the different roles that we have and the speciality of anaesthesia. Because we are finding ourselves in so many other parts of the hospital, we need staff to be able to service all those areas that we are required to service,” she said.

Adding that an extensive list of highly specialised surgeries is performed in Barbados, Dr Thomas-Gibson said that, at times, anesthesiologists have to push other cases aside to be able to provide the service to that speciality case.

“So the backlogs can’t be addressed by us alone. We are here every single day, and we only do what is presented up until a particular time within here and obvious limitations,” she said.

During her presentation, Dr Thomas-Gibson stressed that the safety record at the hospital is “exceptional”.

She commended the partnership between UWI and the QEH, where doctors are receiving specialised training to become anesthesiologists. (AH)

The post More anesthesiologists needed at QEH appeared first on Barbados Today.

Perez Duran asked President Abinader to pay attention to the growing 0epidemic, about which he indicated the figures do not correspond to reality, so he asked to declare a state of emergency in the country due to increased cases.

“I am making a call to you, Mr. President (…), I understand that within 24 hours you should decree a state of emergency, where a campaign of fumigation, orientation, protocolization of the dengue fever that we have in front of us,” said the doctor.

The doctor’s daughter died on Friday last week after remaining in intensive care and being diagnosed with the disease transmitted by the Aedes Aegypti mosquito after being hospitalized since Wednesday morning.

He explained that the teenager arrived at the hospital “in a critical condition,” so she was immediately referred to the Intensive Care Unit.

“We as parents spared neither resources nor efforts to facilitate everything that was asked of us,” said the grieving father in an interview with Martina Espinal on the program Al Punto.

He indicated that, at first, they thought it was a classic dengue, but after she was intubated early Thursday morning, the infant became brain-dead at 5:00 p.m., indicating to her parents that it was too late.

The girl’s father said that the child’s platelets, which were at 266, reached 11 in just three days.

With a troubled expression, Perez narrated that they took the girl to receive medical attention since the first symptoms appeared on Sunday of that week. However, the pre-adolescent died days later.

“On Friday morning an attempt was made to connect her to a special dialysis machine, when the caveat was made that the girl was clinically dead, it was literally exploding her lungs, heart and kidneys. When she was connected to the machine, the girl died after two minutes, she went into irreversible arrest,” he said.