Centene warns of hit to fast-growing Medicare Advantage business next year

 Centene Corp on Tuesday said profit at its fast-growing Medicare Advantage (MA) business will take a beating in 2024 due to a sharp cut in its rating by a U.S. federal agency and likely lower-than-expected government payouts to health insurers.

The gloomy outlook for MA, one of the fastest growing businesses for health insurers, clouded Centene's fourth-quarter profit beat and sent the company's shares down nearly 2% in early trade.

Health insurers who operate MA plans have come under pressure after the U.S. Centers for Medicare and Medicaid Services (CMS) recently proposed new rules for an audit program to avoid overpaying the companies.

The agency proposed a 2.3% drop in reimbursement rates last week, compared with a 5% growth in 2023. The final rates are expected by April 3.

Bigger rival Cigna Corp has also said if the rate change goes through, it "will create some revenue dislocation".

Centene does not expect its MA business to grow next year and it will likely "shrink a little", Chief Financial Officer Andrew Asher said in a post-earnings conference call.

Asher said the company expects negative profit margins in the business in 2024 temporarily, after CMS cut star rating for Centene's MA plans in October.

MA plans are government-supported insurance plans that private companies offer people over 65 years of age.

In the fourth quarter, Centene reported an adjusted profit of 86 cents per share, beating Wall Street estimates by a cent.

The company said its quarterly health benefits ratio, which measures medical costs in relation to premiums collected, stood at 88.7%, better than estimates of 88.8%, according to six analysts polled by Refinitiv.

Revenue from Centene's Medicare health insurance business rose about 24% to $5.45 billion from a year earlier.

https://www.yahoo.com/entertainment/centene-quarterly-profit-beats-estimates-111347424.html

Doctor accused of spreading deadly meningitis arrested in Mexico

 Mexican police detained a medical doctor accused of using infected medicines that may have caused a mysterious meningitis outbreak in northern Durango state, after the disease killed at least 35 women in recent months.

Another 79 people have been hospitalized with signs of infection.

Police arrested the doctor who specializes in anesthesiology early on Tuesday morning on charges of illegal practices including the re-use of medications at the private hospitals where he worked. The doctor's full name was not disclosed.

Meningitis is typically associated with painful inflammation of the brain and spinal cord, often caused by a virus or in some cases bacteria or a fungal infection.

The affected patients in Durango were likely infected by fungal meningitis while having procedures in the same hospitals where the doctor worked, according to Durango state prosecutor Sonia Garza.

She told reporters at a news conference on Tuesday in the state capitol that the first procedures associated with the infected patients took place last August, and that many of them had been administered anesthesia for obstetric procedures.

"This specialist carried out procedures with no restraint," said Garza, adding that he brought his own medication for patients, including unauthorized controlled drugs.

The outbreak has raised concern in both Mexico and from international bodies after the outbreak's first death was confirmed last November.

Garza added that the detained doctor was the only physician who conducted procedures at the four hospitals where the infections have been observed. She said that he denied using his own medications at a hearing before prosecutors.

Reuters was not immediately able to request comment from the doctor, or locate his lawyer, but his son, contacted by Reuters, proclaimed his father innocence.

"They accused my father without any evidence," he said, declining to provide his name.

The meningitis outbreak is confined to private hospitals in the state capital, also known as Durango, according to Mexico's health ministry.

https://www.yahoo.com/now/doctor-accused-spreading-deadly-meningitis-221935389.html

Canada's decriminalization experiment no match for toxic drug supply

 A Canadian experiment to decriminalize small amounts of hard drugs could reduce stigma and police run-ins for addicts but does little to tackle a bigger problem of overdose deaths from drugs adulterated with lethal ingredients.

The province of British Columbia, at the epicentre of a drug poisoning crisis that has already killed more than 32,000 Canadians since 2016, last week began a three-year pilot programme in which people carrying less than 2.5 grams of drugs such as meth and heroin will not be prosecuted.

But doctors and advocates for drug users argue preventing overdose deaths also requires expanding a "safe supply" of drugs that allows those at risk of overdose to legally obtain banned substances through prescriptions.

In part due to disruptions in supply stemming from the COVID-19 pandemic, street drugs are increasingly laced with toxic or unknown ingredients, resulting in drug users overdosing and dying.

"There (are) no measures involved in decriminalization that address the fact that the supply is very, very variable and volatile and dangerous," said Gillian Kolla, a drug policy researcher at the University of Victoria's Canadian Institute for Substance Use Research.

"If you want to have an impact on the overdose crisis you are going to have to target the supply."

The thinking behind safe supply programs and other "harm reduction" initiatives is that people who use drugs will continue to do so and offering them a safer option keeps them alive. Proponents say they are not meant as an alternative to treatments for addiction but in addition to them.

In part, it reflects a broader shift away from criminal charges as a deterrent to drug use and a move toward treating addiction as a health issue instead.

'RECOVERY-ORIENTED APPROACH'

Still, expanding safe supply on a large scale would mean a major change in the government's approach to illicit substances, involving it in providing and regulating now-illegal drugs.

Critics worry it could backfire by encouraging drug use and result in the drugs being diverted for sale on the street, something clinicians prescribing drugs say is rare.

Studies show the programmes can be successful. A 2021 study by the British Columbia Centre on Substance Use of 42 participants in a Vancouver programme that distributed hydromorphone tablets - an opioid - found it reduced street drug use and overdose risk and improved health, wellbeing and pain management.

A 2016 Canadian Institutes of Health Research study found a 67% reduction in illicit drug use in a group treated with prescription heroin, or diacetylmorphine, and a 47.7% reduction in a group treated with the opioid methadone.

But not everyone in Canada favours that approach: Alberta, a province with a conservative government that neighbours British Columbia, has emphasized a "recovery-oriented" approach to addiction that favours more abstinence-based treatment.

Under that approach, people with addictions are encouraged to enter residential treatment centres and wean off substances.

Pierre Poilievre, leader of the opposition Conservative party, last week said he would end B.C.’s plan if he were prime minister, arguing that de facto decriminalization has been in place in B.C. for years and had been "a complete disaster" and "hell on earth."

Police in British Columbia file thousands of drug possession charges annually.

'SAFER TO LEAVE HOME'

About 32,632 Canadians have died of opioid-related deaths since 2016, with a rate of 20.9 opioid-related deaths per 100,000 people in 2021, compared to a rate of 24.7 in the United States for that year.

Canada faced the challenge of an adulterated illicit drug supply before the United States did and has been quicker to adopt harm reduction tools to address drug overdose cases, said Lindsey Richardson, a research scientist at the B.C. Centre on Substance Use.

British Columbia has been at the forefront of trying new methods to address the crisis, including opening North America's first official, sanctioned supervised drug consumption site in 2003. Its latest programme is being closely watched elsewhere.

Toronto also asked to decriminalize personal possession of illegal drugs last year and the city says it is working with authorities to decide how that will be defined.

Decriminalization could change life for the better for patients of Scott MacDonald, the lead physician at Vancouver's Providence Crosstown Clinic.

Many of them receive injectable pharmaceutical-grade heroin because they have severe addictions and cannot tolerate or do not respond to more conventional treatments, said MacDonald, who has 115 diacetylmorphine and hydromorphone patients there.

Some of them still buy street drugs. But he says they may now feel "it's safer to leave the house; it's safer to go to the grocery store; it safer to go to a clinic."

But Ryan Maddeaux, who started taking drugs as a teenager and continues to use them at age 44, says B.C.'s latest plan is of no help to him because he runs the risk of taking something deadly each time he buys street drugs.

"I don't know what they are, don't know the exact potency," he said.

https://www.yahoo.com/now/analysis-canadas-decriminalization-experiment-no-110859103.html

Researchers Find CTE in 345 of 376 Former NFL Players Studied

 The Boston University CTE Center announced today that they have now diagnosed 345 former NFL players with chronic traumatic encephalopathy (CTE) out of 376 former players studied (91.7 percent). Among those diagnosed in the last year are two former players who once represented the teams paired in this Sunday’s Super Bowl LVII matchup – former Philadelphia Eagles quarterback Rick Arrington, who played three seasons for the Eagles from 1970-73, and former Kansas City Chiefs defensive tackle Ed Lothamer, who played for the Chiefs in the very first Super Bowl and was a member of their winning team in Super Bowl IV.

For comparison, a 2018 Boston University study of 164 brains of men and women donated to the Framingham Heart Study found that only 1 of 164 (0.6 percent) had CTE. The lone CTE case was a former college football player. The extremely low population rate of CTE is in line with similar studies from brain banks in Austria, Australia and Brazil.

The NFL player data should not be interpreted to suggest that 91.7 percent of all current and former NFL players have CTE, as brain bank samples are subject to selection biases. The prevalence of CTE among NFL players is unknown as CTE can only be definitively diagnosed after death. Repetitive head impacts appear to be the chief risk factor for CTE, which is characterized by misfolded tau protein that is unlike changes observed from aging, Alzheimer’s disease, or any other brain disease.

“While the most tragic outcomes in individuals with CTE grab headlines, we want to remind people at risk for CTE that those experiences are in the minority,” said Ann McKee, MD, director of the BU CTE Center and chief of neuropathology at VA Boston Healthcare System. “Your symptoms, whether or not they are related to CTE, likely can be treated, and you should seek medical care. Our clinical team has had success treating former football players with mid-life mental health and other symptoms.”

McKee and her team are inviting former athletes, including women, to participate in research studies designed to learn how to diagnose and treat CTE. The BU CTE Center is collaborating with its education and advocacy partner the Concussion Legacy Foundation (CLF) to recruit former football players and other contact sport athletes to five active clinical studies.

One of the studies, Project S.A.V.E., is recruiting men and women ages 50 or older who played 5+ years of a contact sport, including American football, ice hockey, soccer, lacrosse, boxing, full contact martial arts, rugby and wrestling.

S.A.V.E. stands for Study of Axonal and Vascular Effects from repetitive head impacts. The major goal is to determine how repeated head impacts from playing contact sports can lead to long-term thinking, memory and mood problems. The results could highlight strategies to treat and prevent symptoms associated with head impacts from contact sports. To learn more about Project S.A.V.E. and four other studies enrolling participants, click here. To sign up for future clinical studies, enroll in the CLF research registry.

In addition, patients and families who believe they or a loved one has symptoms that may be related to prior concussions or CTE are encouraged to reach out to the CLF HelpLine, which provides referrals to doctors and care providers, educational resources, one-on-one peer support, and monthly online support groups.

“I miss my hero dearly,” said Jill Arrington, Rick Arrington’s daughter and former CBS/FOX/ESPN sideline reporter. “It pains me to know his life was cut short by the sport he loved most. As a brain donor, part of his legacy is in this research, and I want all former football players to know how important it is to contribute and sign-up for studies so Boston University CTE Center researchers and their collaborators around the world can learn how to treat, and one day cure, the disease that devastated our family.”

Research on CTE has advanced considerably over the past five years, and the BU CTE Center soon will publish its 182nd study on CTE. In part because of advances in research on CTE, in October 2022 the National Institutes of Neurological Disorders and Stroke (NINDS), a branch of the National Institutes of Health (NIH), updated their position on what causes CTE: “CTE is a delayed neurodegenerative disorder that was initially identified in postmortem brains and, research-to-date suggests, is caused in part by repeated traumatic brain injuries.”

“We’d like to thank our 1,330 donor families for teaching us what we now know about CTE, and our team and collaborators around the world working to advance diagnostics and treatments for CTE,” McKee said.

https://www.bumc.bu.edu/busm/2023/02/06/researchers-find-cte-in-345-of-376-former-nfl-players-studied/

Prolific autism researcher has two dozen papers retracted

 An autism researcher lost two dozen papers to retraction in January, eight years after the publisher was made aware of potentially troubling editorial practices. Elsevier, the publisher, cited undisclosed conflicts of interest, duplicated methodology and a “compromised” peer-review process as reasons for the retractions.

The papers were published in Research in Developmental Disabilities and Research in Autism Spectrum Disorders between 2013 and 2014 — a period when Johnny Matson, then professor of psychology at Louisiana State University (LSU) in Baton Rouge and an author on all of the papers, was editor-in-chief of both journals.

Long delay: Years after they started an investigation, Elsevier journals retracted 24 papers by researcher Johnny Matson.

Elsevier included the same explanation in 23 of the 24 retractions, saying the papers were being retracted because they “did not include a declaration of a conflict of interest of one author in relation to diagnostic tools which the paper endorses.” The statement also says that the same author was editor-in-chief of the journal at the time of publication, and that there was no evidence of independent peer review by external reviewers. One paper was not cited for a conflict of interest but instead was retracted for “lack of original methodology,” along with the same peer-review issue.

Dorothy Bishop, a developmental neuropsychologist at University of Oxford in the United Kingdom, who played a part in spurring the journals to investigate Matson’s papers eight years ago, was surprised to finally see it happen. “I never thought they’d get around to doing anything, but there you go,” she says.

Matson is now retired but was still publishing papers as recently as last month. He has more than 800 publications and is highly cited, with an h-index of 75. His research at LSU focused on methods to assess and treat autism and intellectual disability, and he developed diagnostic tools for the conditions. Many of his publications, including most of those that were retracted, include the use of diagnostic measures he developed, such as the Autism Spectrum Disorders-Diagnostic for Children and the Baby and Infant Screen for Children with Autism Traits (BISCUIT).

Elsevier began its investigation in 2015, based on a tip. The publisher convened a 12-person panel to review a number of publications in 2016 and assess whether papers submitted to these two journals between 1 January 2012 and 31 December 2014 had been published “without external, independent peer review.” In 2017 it published an update, noting that the peer-review policies of the journals in question had been adjusted, and new editors-in-chief had been appointed in early 2015.

A spokesperson for Elsevier told Spectrum that the panel examined 136 papers submitted and accepted during that two-year time frame and determined that 24 of them had not been sent to external reviewers. Papers published before 2012 were not included because 2012 is when the journals switched to an online management system for manuscripts.

The conflict-of-interest claims stem from the retracted papers using assessment batteries that Matson developed, which are sold by Disability Consultants, LLC, a business registered in the state of Louisiana to Matson’s wife, Deann Matson. This tie was not revealed in any of the 23 papers.

Matson says that at the time, he was not aware he needed the conflict-of-interest statement. As soon as he knew, he says, he “did that moving forward for all submissions to all journals.”

Regarding peer-review policy, Matson says the journal’s old policy allowed him to send papers only to associate editors — skipping external review — in an attempt to help speed up the processing of papers. Elsevier’s current policy no longer allows this, Matson acknowledges.

Autism researcher Michelle Dawson first flagged Matson’s work on Twitter in 2010, tweeting her suspicions that Matson had a penchant for self-citation and publishing in his own journals. In 2014, Dawson learned that Bishop was on the editorial board of Research in Autism Spectrum Disorders and alerted her. This was news to Bishop, and she approached Matson to be removed. (Matson says he asked Bishop to be on the board, and she accepted — Bishop says she does not remember this but concedes it is possible.)

Bishop then began looking into Matson’s apparent self-publishing and wrote a blog post on her findings in 2015. Bishop’s data analysis of Matson’s publications focused on two main points: self-citation and the share of his own publications in the journals he edited. Bishop calculated that more than half of Matson’s citations were self-citations — an outlier compared with the self-citation rates of other well-known researchers in the field at the time, which were under 10 percent. One example: A paper of Matson’s from 2012 meant to show the success of one of his evaluation scales, BISCUIT, published in Research in Autism Spectrum Disorders, has 65 self-citations out of a total of 86 references.

Self-citation is a relatively common and well-studied practice. When asked about it, Matson admits that 65 self-citations in one paper is high. “But let’s put this in perspective. I have over 900 publications, and this only applies to a small handful of articles,” Matson says, adding, “There is no rule about self-citations.”

The second issue Bishop raised in her analysis deals with Matson’s own publications in these two journals. Bishop found that his publication rate increased from about 15 to more than 30 per year after he became editor-in-chief of Research in Autism Spectrum Disorders in 2007. And between 2007 and 2015, Matson was an author on more than 10 percent of the papers published in Research in Autism Spectrum Disorders. The fact that many of Matson’s papers appeared in journals he edited is also not wholly unusual. A recent review of the publication practices of Elsevier editors found that 24 percent of journal editors publish at least 10 percent of their own papers in the journal they edit.

Matson feels Bishop’s blog, the press coverage and the online discourse on social media influenced Elsevier’s decision to retract. “I have published in over 100 different journals, and these are the only two that took this approach,” Matson says. Foremost on his mind, he says, are the other authors on the papers. “At this point I am retired, so this has little effect on me, but I am concerned about the former Ph.D. students who were also included,” he says.

“I doubt that he’s fraudulent,” Bishop says of Matson. “I think it’s just this factory for churning out fairly trivial papers.”

She still spends time scraping publication data from various databases to find others who fit the same patterns she detected back in 2015 with Matson’s publications, and she continues to find more editors who publish in their own journals with fast turnarounds. That, Bishop says, is “using your role as an editor to boost your publications. And it’s just unethical.”

DOI: https://doi.org/10.53053/YIME4862

https://www.spectrumnews.org/news/prolific-autism-researcher-has-two-dozen-papers-retracted/

Postoperative delirium is associated with grey matter brain volume loss

 Ilse M J Kant, Jeroen de Bresser, Simone J T van Montfort, Theodoor D Witkamp, Bob Walraad, Claudia D Spies, Jeroen Hendrikse, Edwin van Dellen, Arjen J C Slooter, the BioCog consortium

DOI: https://doi.org/10.1093/braincomms/fcad013

Abstract

Delirium is associated with long-term cognitive dysfunction and with increased brain atrophy. However, it is unclear whether these problems result from or predispose to delirium. We aimed to investigate preoperative to postoperative brain changes, as well as the role of delirium in these changes over time.

We investigated the effects of surgery and postoperative delirium with brain MRIs made before and three months after major elective surgery in 299 elderly patients, and an MRI with a three months follow-up MRI in 48 non-surgical control participants. To study the effects of surgery and delirium, we compared brain volumes, white matter hyperintensities, and brain infarcts between baseline and follow-up MRIs, using multiple regression analyses adjusting for possible confounders.

Within the patients group, 37 persons (12%) developed postoperative delirium. Surgical patients showed a greater decrease in grey matter volume than non-surgical control participants (linear regression: B (95% Confidence Interval) = -0.65% of intracranial volume (-1.01 to -0.29, p < 0.005). Within the surgery group, delirium was associated with a greater decrease in grey matter volume (B (95% Confidence Interval): -0.44% of intracranial volume (-0.82 to -0.06, p = 0.02). Furthermore, within the patients, delirium was associated with a non-significantly increased risk of a new postoperative brain infarct (logistic regression: odds ratio (95% Confidence Interval): 2.8 (0.7 to 11.1), p = 0.14).

Our study was the first to investigate the association between delirium and preoperative to postoperative brain volume changes, suggesting that delirium is associated with increased progression of grey matter volume loss.

https://academic.oup.com/braincomms/advance-article/doi/10.1093/braincomms/fcad013/7009174

Prenatal Screening to Expand to Hypertensive Disorders of Pregnancy

 Pregnant women should undergo frequent blood pressure checks to identify not just one but all hypertensive disorders of pregnancy, the U.S. Preventive Services Task Force (USPSTF) proposed.

In a draft recommendation statementopens in a new tab or window, the USPSTF said that all pregnant people should have their blood pressure measured at each prenatal visit to help identify and prevent serious health issues related to hypertensive disorders of pregnancy (B grade recommendation). The group "concludes with moderate certainty that screening for hypertensive disorders in pregnancy with blood pressure measurements has substantial net benefit."

This would extend the Task Force's 2017 final recommendation on screening for preeclampsia

opens in a new tab or window to include all hypertensive disorders of pregnancy, which cover gestational hypertension, preeclampsia or eclampsia, and chronic hypertension with and without superimposed preeclampsia.

"Hypertensive disorders of pregnancy are among the leading causes of serious complications and death for pregnant people in the United States," said Task Force member Esa Davis, MD, MPH, of the University of Pittsburgh, in a press release. "Fortunately, measuring blood pressure at each prenatal visit is an effective way to screen for these conditions so pregnant people can receive the care they need."

Management of hypertensive disorders of pregnancy include close fetal and maternal monitoring, antihypertension medications, and magnesium sulfate for seizure prophylaxis when indicated. A finding of preeclampsia can only be treated by delivery, timed according to gestational age and whether severe features of preeclampsia are present.

The USPSTF highlighted the increased risk of maternal chronic hypertension and cardiovascular disease later in life for those with a history of any hypertensive disorder of pregnancy. Even early-stage subclinical coronary artery disease (CAD) is linked back to these conditions.

A recent JAMA study

opens in a new tab or window found a significant association between history of adverse pregnancy outcomes and imaging-identified CAD in middle age in a cohort of more than 10,000 Swedish women undergoing coronary CT angiography screening. Hypertensive disorders of pregnancy in particular were linked to all five indices of CAD: coronary atherosclerosis, significant stenosis, noncalcified plaque, high segment involvement scores, and coronary artery calcium scores greater than 100.

"Taking a pregnancy history when assessing cardiovascular risk and incorporating adverse pregnancy outcomes, particularly preeclampsia and gestational hypertension, into the risk/benefit discussion around primary preventive strategies and risk factor targets is imperative," wrote Natalie Bello, MD, MPH, of Cedars-Sinai Medical Center in Los Angeles, in an accompanying editorialopens in a new tab or window.

"Clinicians must also educate birthing people at the time of their pregnancy to understand the impact of an adverse pregnancy outcome on their risk of future heart disease, encourage them to receive timely preventive care focused on risk factor modification, and empower them to share this important medical history with future clinicians if they are not asked about it. There is no time like the present to redouble the efforts to reduce cardiovascular disease in women," she emphasized.

In particular, USPSTF members highlighted the disproportionately higher rates of maternal and infant morbidity and greater risk for developing hypertensive disorders of pregnancy in Black and American Indian/Alaska Native women. Clinicians are advised to be on alert for the greater risk in these populations in order to "help improve equitable dissemination of preventive measures," such as low-dose aspirin to prevent preeclampsia.

"Importantly, we are using this draft recommendation statement to call attention to the inequities related to hypertensive disorders of pregnancy," said Task Force vice chair Wanda Nicholson, MD, MPH, MBA, of George Washington University in Washington, D.C.

"While taking blood pressure throughout pregnancy is an important first step, screening alone cannot fully address these inequities. We have highlighted additional promising ways to improve health outcomes for those at increased risk and are calling for more research to address this important issue," she continued.

Public comments on the USPSTF's proposed screening are being accepted until March 6.

https://www.medpagetoday.com/cardiology/hypertension/102998