TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, take a look at the top medical stories of the week. A transcript of the podcast is below the summary.
This week’s topics consist of COVID and pregnancy, self-perceived versus objective assessments of hearing loss, behavioral intervention for obesity in low earnings individuals, and how flu vaccine behavior can inform COVID vaccination.
Program notes:
0: 43 Influenza vaccination design with COVID vaccine
1: 43 Vaccination rates, states, age
2: 41 Target those not likely to get immunized
3: 40 Now have three COVID vaccines in stage III trials
4: 35 Pregnancy and COVID
5: 35 Same risk elements for non-pregnant individuals
6: 34 Mommies with persistent disease 4 times more likely to need ICU
7: 35 Consistently test pregnant ladies
7: 45 Weight-loss in underserved clients
8: 43 Extensive way of life modification had 5%loss
9: 46 Distinction between self-perceived and evaluated hearing loss
10: 45 Fixed for several factors
11: 41 Long term cognitive problems
12: 36 Do not understand if listening devices correct
13: 18 End
Records:
Elizabeth Tracey: What are the manifestations of COVID-19 infection in pregnancy?
Rick Lange: Addressing weight loss in underserved clients.
Elizabeth: Exists a disparity in between self-perceived and objectively determined hearing loss?
Rick: And can flu vaccination inform us about COVID vaccination?
Elizabeth: That’s what we’re talking about this week on TT HealthWatch, your weekly take a look at the medical headings from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.
Rick: And I’m Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I’m likewise dean of the Paul L. Foster School of Medication.
Elizabeth: Rick, I believe the top-of-mind one for me, a minimum of today, is this analysis of whether influenza vaccination can model for us what we might do when it pertains to coronavirus vaccinations. This remains in the Journal of General Internal Medication
Rick: To put it in perspective, everyone is talking about the COVID vaccine being a vital part of preventing disease in the future, however there are numerous individuals that are not likely to get vaccinated and so we will not be able to establish that herd resistance.
What these authors tried to do was to notify us about what kind of people do or don’t get influenza vaccines since the important things that influence that are highly likely to influence who gets COVID vaccination. In reality, when you take a look at the demographics concerning flu– and I’m simply going to talk about the 2017/2018 season– there were 45 million symptomatic cases in the U.S. and over 61,000 deaths, however under half of U.S. grownups and only two-thirds of children are vaccinated, despite the reality the goal is to have 80%.
The authors took a look at an annual national survey of over 400,000 adults carried out by the CDC and state health departments, took a look at vaccination rates, the state, geography, age, race, sex, annual income, persistent conditions, to determine who was or who wasn’t likely to get vaccinated. They had the ability to detain over 95%of the information on over 400,000 adults and unfortunately approximated just one-third of them really were vaccinated.
Vaccination rates were higher amongst older, white, and Asian, female, higher-income adults, and those with persistent conditions.
You will not be surprised to understand that having medical insurance and a personal physician were individually associated with a two-fold higher rate of vaccination. Disappointingly, to me, the state of Texas’s vaccination rate was only 26%versus the highest rate in the District of Columbia, 44%. This information ideally will allow us to target these individuals that are unlikely to get vaccinated, not just for flu vaccines, however likewise when the COVID vaccine becomes available.
Elizabeth: I believe among the things that comes quickly to mind when I listen to this is the truth that as we grow older we engage more with the health care system and it just promises to me that in that interaction there is going to be the tip or the suggestion that we get vaccinated for the flu.
Rick: You’re right. They’re more likely to see a medical care doctor and that belongs. They’re more likely to have insurance because of Medicare also, and they’re most likely to have chronic conditions so they engage with the health care system. Once again, our target is 80%. There wasn’t a single group that had a 60%or a higher vaccination rate, so we’ve got a great deal of work to do simply throughout the spectrum.
Elizabeth: Obviously, the huge issues right now about approaching COVID-19 vaccine are that we’re fretted about, is it going to be approved before it’s really prepared, before the information’s actually ripe?
Rick: We certainly need to encourage individuals to get vaccinated for flu; there’s no concern about that. As a COVID vaccine becomes available and is shown to be efficacious– and we now have 3 that are in phase III research studies here in the United States and others worldwide– then we’ll be able to embrace them. However if we don’t do a much better task disseminating the influenza vaccine, we’re not going to do any much better with a COVID vaccine when it’s finally offered.
Elizabeth: I would just include one more thing, having listened to rather a lot about this vaccine coming by the transom. With so numerous activities being cut, or frankly closed, points of contact for individuals to be administered the vaccine– which a lot of people feel is going to be a two-dose kind of a vaccine– are fewer and so there’s all kinds of issues about that part of it.
Rick: You’re.
Elizabeth: On a benefit, I would say that a minimum of just recently, pharmacists are now empowered to offer vaccinations even to the pediatric population and so pharmacists, I think, are going to be a point of contact for a lot of us when it comes to this.
Let’s rely on the British Medical Journal This is a take a look at that population in whom there was a lot of debate– gosh, what is the effect of COVID-19 infection in ladies who are pregnant?
This is a meta-analysis. They included in this 28 studies, over 11,000 women, pregnant, just recently pregnant, going to or admitted to hospital for any factor and were identified as having actually suspected or confirmed COVID-19
Surprisingly, their clinical symptoms did not include fever and cough as they do for a lot of other individuals. They were less most likely to report either fever or muscle pains and pains. They were more most likely to need admission to an extensive care system and intrusive ventilation.
In this research study, they only see 0.1?aths among pregnant females and I believe there’s still some fuzziness surrounding that number, so I’m not convinced. When women had this, they were more most likely to get extreme COVID-19 throughout pregnancy, so the pregnancy appears like it was practically an aside.
Okay.
Rick: A really intriguing research study and they are calling it a living organized review and meta-analysis due to the fact that here’s what occurred. Early on were case reports or small series and then individuals started to build up these, and some reported them in a meta-analysis, and there would be another couple cases or a little research study. It would be updated and the ball simply kept rolling. It got very challenging to stay up with all the info. They collected all the info to date and then continue to upgrade their analysis, so this is the most current up-to-date and the largest series reported on the results in pregnant ladies and with the outcomes of their births.
As you discussed, the moms that had those persistent health problems were 4 times more most likely to be in intensive care system or on a ventilator.
Elizabeth: Well, I think that one of the issues about pregnancy was the anergic condition and if there’s already sort of an immune compromise, is COVID-19 disease going to be even worse? I think that in this case I’m kind of buoyed by the information that it’s disappointing that it will be worse if you weren’t overweight and had high blood pressure and diabetes.
Rick: Yep. It appears that the way this study was built is they took a look at pregnant females with or without comorbidities and COVID infection. They didn’t compare it to a similarly-aged group that weren’t pregnant, so it was hard to make that contrast directly. It is somewhat reassuring that the death rate is fairly low.
The intriguing aspect of this study that we didn’t speak about was that lots of centers now regularly test pregnant females to see whether they’re COVID-infected or not since the huge bulk of females are asymptomatic. And in reality, what they discovered remains in a few of these research studies as numerous as 10%of the females tested positive for COVID and really didn’t demonstrate the typical signs.
Elizabeth: Yeah.
Rick: This is an actually well-done research study taking a look at weight reduction in underserved clients. Multiple studies have looked extensive training in terms of encouraging and sustaining weight reduction, however extremely few of those research studies have been carried out in underserved populations and focused in medical care clinics. The question is, are those particular strategies practical in this population?
These authors performed what’s called a cluster-randomized trial to check the effectiveness of a high-intensity, lifestyle-based program for dealing with weight problems and it was centered in primary care centers.
With the intensive way of life, what they did was they embedded health coaches in the clinics and they had weekly sessions for the first 6 months followed by monthly sessions for the staying 18 months, and they followed the people for 24 [months].
I’m delighted to report that in this 800- patient study, the people that were in the extensive lifestyle modification had a 5?crease in weight versus the typical care [at 2 years], where essentially there was no change. The major weight loss was done at 1 year.
Elizabeth: I like this, obviously, due to the fact that what we have actually been seeing in abundance with the COVID-19 pandemic has actually been this disproportionate impact on individuals who are obese and of other ethnicities. Therefore if we can develop this intervention– low-priced and ideal where they live– and really have a favorable impact, I think that’s a win-win.
Rick: It didn’t involve any drug store or medication, no negative effects, and I believe it’s a terrific study. I’m glad you chose it. This makes a considerable distinction. Then by the method, it improved their quality of life also. I understand that you’re not amazed by that.
Elizabeth: Finally, let’s rely on JAMA Network Open I like this one because it’s something that I think we’re seeing in abundance, that a male hears what he wants to hear and ignores the rest in so many locations relative to health. In this case, this is a take a look at an aging population and their self-assessment of their hearing loss compared to an objective assessment of their hearing loss.
This belongs to the English Longitudinal Research Study of Ageing. This is a population-based potential friend research study that’s been taking a look at aging folks in England for a while now. This friend had 9,600- plus people– it’s called their Wave 7– and they asked these individuals, “Hey, do you have any hearing loss?” Then they compared that to a screening test that was done by a certified nurse to see whether or not they really did have it.
They also fixed for other things: age, marital status, retirement status, indicators of socio-economic position, way of life aspects– consisting of BMI, physical activity, and tobacco and alcohol usage– and then they stated, “Hey, how does this impact on our self-reported hearing problems or our unbiased steps?”
Basically, a third of them stated, “I truly don’t have a problem,” and they did have an issue. Remarkably, I believed this was remarkable since normally I believe it’s guys who inform themselves stories about things, however it turns out that female sex was more highly associated with this dissociation, this discordance in between unbiased and self steps of hearing loss.
Rick: Elizabeth, this is kind of the guideline of thirds. If you just take a look across older Americans, a third of them have considerable hearing loss, and as you discussed, a 3rd of those people didn’t even know it.
What you desire to do is you desire to acknowledge it, and it’s quickly treatable with hearing help, but it’s only treatable if individuals understand that it’s going on.
Maybe I require to have my wife’s hearing evaluated.
But there are other things that were associated with the lack of recognition.
Elizabeth: As you said, definitely we have hearing help that are readily available to help rectify this specific problem. I do not think we have information yet that develop whether or not the use of hearing aids ameliorates much of the other issues that are related to hearing loss.
Rick: I would approve the reality that, again, hearing losses have been associated with cognitive disability and an increased cognitive decline. I believe it’s quite clear that hearing aids can improve quality of life– even if for that, or to communicate better with your marital partner or partner, I think, is necessary as well.
Elizabeth: On that note then, that’s a take a look at today’s medical headlines from Texas Tech. I’m Elizabeth Tracey.
Rick: And I’m Rick Lange. Y’ all listen up and make healthy choices.
Last Updated September 04, 2020
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