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Vaughan, Ontario, Canada - July 26, 2014: People riding the Leviathan rollercoaster at Canada's Wonderland amusement park

This week’s topics include roller coasters and kidney stones, colonoscopy in those older than 70, benefits of exercise in older folks, and the health impact of cleft palate.

Program notes:
0:42 Kidney stones and roller coasters
1:41 Model kidney and stones
2:41 Might want to ride post-lithotripsy
3:35 Exercise, mobility and older adults
4:39 Length of immobility and repeated episodes
5:39 My take place in senior centers
6:00 Colonoscopy in aged 70 or older
7:01 Reduction of colorectal ca very modest
8:01 Screening may not be so effective in elders
8:20 Health impact of cleft palate
9:20 Cleft palate alone substantial risk
10:22 End
Related blog:
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Anchor lead:  Partner abuse during pregnancy is much more common than you might think, Elizabeth Tracey reports

Are you aware of just how big a problem domestic abuse during pregnancy is?  Phyllis Sharps, an expert in the field at the Johns Hopkins School of Nursing, reviews what’s known.

Sharps: Anywhere from 9% to almost 20% of all women will report being abused during a pregnancy. I like to think of it also as that childbearing year because you’re pregnant for about nine months and then there’s the three months or so, what we call the early postpartum period, right after the baby’s born, that sometimes if there was a pause during the pregnancy it may escalate again right after the baby’s born.  :26

Sharps and colleagues have just published a study on an intervention known by the acronym DOVE that reduces instances of domestic violence against pregnant women.  The intervention is carried out by health care providers who visit women at home, and is integrated into a comprehensive health assessment. Women who’ve received the intervention report benefits up to two years later.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: It is possible to reduce domestic abuse of pregnant women, Elizabeth Tracey reports

A program known by the acronym DOVE, for Domestic Violence Enhanced Home Visitation Program, developed by Phyllis Sharps and colleagues at the Johns Hopkins School of Nursing, is able to significantly reduce instances of violence against women while they’re pregnant, the latest data show.  Sharps describes the program.

Sharps: As the home visitor, often a nurse but it could be a community health worker, is talking to the mother and finds out that the mother is concerned it she can implement our intervention, which is education about what abuse it, why we worry about it in pregnancy, how it can harm her as the pregnant woman and her baby that she’s carrying, other children in the home. And then we work with them to develop their own patient centered safety plan.  What is it that they want to do, what can they do to help them stay safe.  :32

Sharps would like to see the program expanded nationally.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Should the Drug Enforcement Agency be concerned about kratom? Elizabeth Tracey reports

Kratom is an herbal concoction sold mostly in head shops in the US, formed from the leaves of a coffee-related plant native to southeast Asia. Now the DEA has stepped in to categorize kratom as schedule 1, a group of drugs with high abuse potential but no medical benefit, and some people are objecting.  Eric Strain, a drug abuse expert at Johns Hopkins, offers his perspective.

Strain: The DEA has done it because there have been concerns about deaths associated with it, although that’s been a gnarly sort of knot because a lot of those deaths involve other drugs as well as kratom.  So how do we know is it the kratom? Or is it the other drugs? At the same time I don’t think that we should think that it’s just something benign.  I really do think that we need to have some research with it, then we can make an informed decision about what to do with it.  :29

Advocates say the drug can relieve pain and ease opioid withdrawal. Strain says for now, he would proceed with an abundance of caution until more is known.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What are the barriers to the use of buprenorphine for opioid addiction? Elizabeth Tracey reports

Buprenorphine helps people kick the opioid habit, but it is a prescription drug that requires some work for a physician to use. That may be one reason it isn’t utilized as often as it could be, as shown in a recent research letter in the Journal of the American Medical Association.  Eric Strain, a drug abuse expert at Johns Hopkins, describes what’s required.

Strain: There’s a training to prescribe sublingual buprenorphine but that training is really pretty simple. A lot of the training is now done online, so I don’t think that that’s a major barrier for people to prescribe sublingual buprenorphine. The new form that’s been approved, the Probuphine, the insertable rods, will require training to put the rods in and take them out and that’s going to be a little more complicated, but I don’t think the training is a barrier.  :25

Strain says in order to use the rods, physicians must first stabilize a person on the oral medication, then make the switch. He hopes more physicians will be willing to learn to use these products to help stem the tide of national opioid abuse and overdose death.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Why aren’t more doctors using buprenorphine to help people overcome opiates? Elizabeth Tracey reports

Buprenorphine is one drug that helps people who are trying to overcome opioid addiction, but a recent research letter in the Journal of the American Medical Association shows it is sadly underutilized.  Eric Strain, a drug abuse expert at Johns Hopkins, describes the current situation.

Strain: When buprenorphine was first approved there was a limit to the number of patients that a provider could treat with it, that limit was raised after a year or two to 100, but most providers aren’t treating anywhere near 100 patients.  Now there’s a limit to 275 patients, but is that going to make any real impact because if people aren’t treating 100 patients why would they go up to 275? This article showed that indeed, there’s very very few people who are prescribing buprenorphine even up the limit of 100.    :33

Strain is in favor of getting more physicians to take on a few patients who need buprenorphine rather than creating huge practices focused exclusively on the addiction problem.  At Johns Hopkins, I’m Elizabeth Tracey.

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Canton, GA, USA - July 24, 2015 A fitbit charge and a android smart phone with the fitbit app. The fitbit is a fitness tracker capable of monitoring your steps per day, distance, stairs climbed, calories burned and also monitors your sleep activity.

This week’s topics include appropriate use of beta blockers after heart attack, timing of allergenic foods for infants, a wearable device and its impact on weight loss, and vasectomy and prostate cancer.

Program notes:

0:38 A device and weight loss
1:39 Those with the device lost less
2:38 Do a real world trial
3:06 Introducing allergenic foods
4:07 Moderate evidence it reduced
5:06 Incidence increased with avoidance
5:31 Vasectomy and prostate cancer risk
6:32 Over 360,000 men
7:34 Beta blockers after a heart attack
8:33 Mortality time points relative to use
9:34 No benefit longer than a year
10:40 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2016/09/23/no-joy-with-fitness-trackers/

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