COVID Caused 4.6-Year Drop in NYC Life Expectancy

 Life expectancy in New York City fell to 78 years from 2019 to 2020, a 4.6-year drop mostly caused by the COVID-19 pandemic, NYC Health said Friday in releasing its annual summary of vital statistics. 

Non-white demographic groups had the highest drops. Life expectancy fell to 73 years for Black New Yorkers (a 5.5-year drop from 2019) and 77.3 years for Hispanic/Latino New Yorkers (a 6-year drop.) For white New Yorkers life expectancy only fell to 80.1 years (about a 3-year drop.)

Overall, the city had a mortality rate of 241.3 deaths per 100,000 population in 2020. That's even higher than the 228.9 deaths per 100,000 reported during the 2018 influenza pandemic, NYC Health said in a news release. 

"The sharp decline in life expectancy from 2019 was largely due to the COVID-19 pandemic," said NYC Health Commissioner Ashwin Vasan, MD.

Another factor was a 42.2% rise in unintentional drug overdoses from 2019 to 2020. Again, the pandemic highlighted racial disparities, with the drug-related death rate highest among Black New Yorkers.

The pandemic also affected the premature death rate, meaning deaths before age 65. That rate went up 48.8% from 2019 to 2020. In the eight previous years, from 2011 to 2019, it fell 8.6%
"New Yorkers' lifespans are falling, on top of years of relative flattening before COVID, and that cannot continue," Vasan said in a news release. 

"It is the great challenge of our time, our city, and our Department to lay out an agenda for the next era of public health, to reverse these trends, and set us out on a new path where all New Yorkers can lead healthier, longer lives."

Sources:

NYC Health. "Summary of Vital Statistics 2020"

NYC Health. "2020 Vital Statistics Report Reveals Toll of COVID-19 on New Yorkers and Life Expectancy"

https://www.medscape.com/viewarticle/990601

High Proportion of Diabetes Drug Dispenses in British Columbia Goes to Americans

 Data from the Canadian province of British Columbia (BC) reveal that an unusually high percentage of all dispenses of semaglutide, marketed as Ozempic, have been sold to residents of the United States. For January and February alone, 15% or 15,798 of all semaglutide dispenses from pharmacies in BC were sold to US residents.

In addition, 88% of the 15,798 dispenses for US residents were issued by two BC pharmacies. "This is very concerning," according to a statement from the BC Ministry of Health.

Semaglutide is a medical therapy for type 2 diabetes that has become popular because of its weight-loss benefits. The situation raises questions about ensuring the adequate supply of drugs for Canadians and maintaining necessary drug safety monitoring.

David Davison, MD, a doctor from Nova Scotia now living in Texas, wrote many of the semaglutide prescriptions that were dispensed in BC. His license to practice in Nova Scotia was suspended. "Based on volume alone, the prescribing is not in keeping with the standards of the profession," Gus Grant, MD, registrar and CEO of the College of Physicians & Surgeons of Nova Scotia, said in a statement.

Securing the Supply

BC Health Minister Adrian Dix has asked the province's pharmacists to curb the sale of the drug to nonresidents of Canada and focus on prescribing it to patients with type 2 diabetes. The measures are intended to protect the supply of the drug for patients.

BC has not experienced any shortages of the 1-mg formulation of injectable semaglutide, but a national shortage in Canada was reported in mid-March.

"The situation is concerning, and we need to ensure that those who need this drug the most in BC, and in Canada, continue to have access to it," according to the BC Ministry of Health's statement.

"Coverage of Ozempic in BC is only available for residents of Canada with type 2 diabetes mellitus who have tried metformin before and need a new treatment," according to the health ministry. "It is not for people with other diseases or for those looking to lose weight." The ministry is asking physicians who prescribe semaglutide and pharmacists who dispense semaglutide to comply with the product's approved indication in Canada.

Dr. Alika Lafontaine

Dix has also written to his counterparts in Canada's other provinces and territories and the Canadian Minister of Health, and is engaging in discussions with other provincial and territorial governments.

CMA Voices Concerns

The phenomenon of Americans procuring medications from Canada is not new, and the situation raises concerns beyond safeguarding the supply of medical therapies for Canadians, said Canadian Medical Association (CMA) President Alika Lafontaine, MD, an anesthesiologist in Grande Prairie, Alberta.

"Americans often turn to Canada for cheaper access to pharmaceuticals," Lafontaine told Medscape Medical News. "This is not a new issue. I think the thing that we are starting to consider is whether it's this drug or another drug, how does it impact Canadian supply, the safety of these prescriptions, and how do we ensure that patients who receive access to these drugs, wherever these patients come from, take it in a safe way and have that safety monitored appropriately? I think those are the core issues we have to work out."

Dr Jennifer Lake

Off-label use of semaglutide may mean that patients who do not have type 2 diabetes and are not obese or overweight are using the drug for a "quick fix" for weight loss and are not considering adverse events associated with the therapy, said Jennifer Lake, PharmD, PhD, assistant professor of pharmacology and pharmacotherapeutics at the University of Toronto, Ontario.

"I think from a healthcare professional point of view that patients who need it for health reasons, which for me would be patients with type 2 diabetes and patients who are obese and at risk of health conditions, are definitely people that are benefiting from this drug," Lake told Medscape Medical News. "When we start to move from overweight into slightly overweight and into normal weight [patients], that is where the risks may start to outweigh the benefits."

Lake noted that Americans procuring the drug in Canada are not benefiting from counseling that they would otherwise receive from their local healthcare professional. "They are really losing out on that therapeutic relationship that they have with primary care providers, their specialty physicians, and their local pharmacists that they normally deal with," she said.

https://www.medscape.com/viewarticle/990585

Brookdale: Favorable Preliminary View on First Quarter 2023 Financials

 Brookdale Senior Living Inc. (NYSE: BKD) today announced favorable updates to its first quarter 2023 financial expectations based upon preliminary, unaudited results. The improved expectations are based on management's estimates derived from the information available at this time and are subject to revision upon finalization of the Company's quarter-end accounting and financial reporting processes and reviews.

Preliminary First Quarter 2023 Financial Expectations

Based on the Company's preliminary, first quarter 2023 financial results, the Company expects:

• Year-over-year first quarter RevPAR growth of approximately 12.9%;

• First quarter Adjusted EBITDA meaningfully above the previously issued guidance range. Compared to the Company's original first quarter 2023 guidance, the Company now anticipates:

Commenting on first quarter performance, Lucinda ("Cindy") Baier, Brookdale's President and CEO said "I'm pleased that our disciplined execution has resulted in preliminary financial results that have meaningfully surpassed our expectations and previously provided guidance. I want to thank our residents for the opportunity to serve them and to recognize the tremendous efforts of our associates who continue to prioritize providing high quality care and service to our residents. We look forward to serving even more seniors as the year progresses."

The Company will provide second quarter 2023 guidance in its upcoming quarterly earnings release. As a reminder, seasonal factors affecting quarterly expectations should be reviewed and can be found on page 19 of the Investor Presentation dated February 21, 2023, which is available at brookdaleinvestors.com.

The Company plans to release its first quarter 2023 financial results after the market closes on Monday, May 8, 2023. The Company also plans to discuss the results on a conference call scheduled for Tuesday, May 9, 2023, at 9:00 AM ET. Additional conference call details will be provided at a later date.

https://finance.yahoo.com/news/brookdale-provides-favorable-preliminary-view-201500506.html

How to Assess ADHD Symptoms in Children

 When evaluating individuals for attention-deficit/hyperactivity disorder (ADHD), it is typical to use multiple stages of assessment prior to a formal diagnosis. This typically involves a comprehensive evaluation of information gathered from a number of sources, including parents/carers, family members, teachers, or partners and colleagues, depending on the age of the individual.

In this exclusive MedPage Today video, Zachary K. Blumkin, PsyD,opens in a new tab or window psychologist and a senior clinical director at NewYork-Presbyterian/Columbia University Irving Medical Center in New York City, discusses the two types of symptoms he looks for when trying to observe for ADHD in children, and the importance of treating those patients.

Following is a transcript of his remarks:

The first signs that somebody wants to be looking for when you're trying to observe for ADHD is the presence of developmentally inappropriate levels of hyperactive, impulsive, or inattentive symptoms. And you're going to want to make sure that they're present for at least 6 months and two different settings. So school could be one setting, sports could be another, or camp or art, or in the home. Just we need to make sure it's in two different settings.

And what we're looking for is essentially two types of symptoms. One would be categorized as inattentive. And in the inattentive category, we're looking for kind of careless mistakes, or doesn't seem to be listening to you when you're speaking directly to them. Or maybe they're losing things often or they're often easily distracted. That would be the inattentive presentation.

Hyperactive impulsive presentation is when children are often fidgeting with things. They might leave their seat in situations when it's really not appropriate to, they might talk excessively or interrupt others. And then that would be the more hyperactive, impulsive presentation. And of course, you could have children and adolescents that present with both.

So when thinking about assessments, it's really important to just name it. There is no one objective task that can confirm or rule out a diagnosis of ADHD. We also want to make sure, and my colleague Dr. [Adrian Jacques H.] Ambrose can talk about this

opens in a new tab or window, that we're not using medications to see how folks respond as testing the diagnosis as well. Really to diagnose somebody with ADHD, you want to do a really nice clinical interview. You can use rating scales to help kind of augment that clinical interview. And getting rating scales in multiple settings could be really important.

And again, you're looking for that impairment in two different settings, as well as possibly doing some behavioral observation in some of these settings as a provider or one of your colleagues who you're working with.

The last thing I'll say is neuropsychological testing is not something that's necessary for a diagnosis of ADHD, and for our straightforward cases, it's not necessarily something that you'll need. But certainly for complex cases where there's multiple comorbidities or maybe some learning issues involved, neuropsych testing can be really helpful. And so in addition to making sure that these treatments are available for minoritized populations and providing them support through psychoeducation and validation and the understanding of what their experience might have been with the health and medical field historically, we want to also convey the message that ADHD is a treatable issue. And the treatment is safe and it's effective. And when we treat it, we are dramatically reducing the chances that adverse events will occur.

And this list of adverse events is extremely long, but to name a few: accidental injuries, motor vehicle accidents, emergency visits, premature death, suicide, criminal behavior, depression, substance use. These are just a few of those. And really recognizing and empowering the patients that we see to truly engage in this very effective treatment for a really debilitating issue.

https://www.medpagetoday.com/video-coverage/adhd-video-insights/103938

Marijuana Is Not the Solution, May Harm, in PTSD

 A growing number of states have identified post-traumatic stress disorder (PTSD) as an approved condition for medical marijuana. According to Colorado's Medical Marijuana Registry

opens in a new tab or window, there are 70,533 patients as of February 2023 with an active medical marijuana registration in the state, and 10,734 of them indicate PTSD as the reason they are using medical marijuana. This is despite the lack ofopens in a new tab or window any high-quality, randomized, controlled studies proving that marijuana helps PTSD in the long-term. Because of this lack of evidence, the American Psychiatric Association adopted a policyopens in a new tab or window in 2019 opposed to using medical cannabis treatment for PTSD.

While many people find that cannabis seems to initially help PTSD symptoms, it likely does this by providing some temporary relief, numbing the individual and disconnecting them from the traumatic emotions. However, to keep the symptoms at bay, the individual often needs to use daily, sometimes multiple times a day, which can then set them up for significant consequences associated with daily cannabis use, such as cannabis use disorder (CUD), psychotic symptoms, cognitive problems, suicidal ideation, worsening depression and anxiety, and cannabinoid hyperemesis syndrome.

Outcomes of Marijuana Use for PTSD: A Review of the Literature

The problems with regular cannabis use in those with PTSD were demonstrated by a 2020 studyopens in a new tab or window from Canada in which anonymous data was obtained from a phone app, Strainprint. In the study, 404 medical cannabis users, self-identified as having PTSD, used the app to track symptoms of intrusive thoughts, flashbacks, irritability, and anxiety. The users would then indicate the strain of cannabis they were about to use and the effects on their symptoms. The results indicated that acute cannabis intoxication provided temporary relief from intrusions, flashbacks, irritability, and anxiety. However, baseline PTSD symptom ratings did not change over time, and the researchers detected evidence that people used higher doses over time to manage anxiety, indicating the development of tolerance to the drug. They concluded that while these results indicate that cannabis may reduce PTSD symptoms in the short-term, it may not be an effective long-term remedy for the disorder.

There have been an increasing number of studies demonstrating that the use of marijuana can worsen PTSD over time. An observational study

opens in a new tab or window assessed 2,276 veterans treated in VA PTSD treatment programs at the time of intake and then again 4 months after discharge. They found that those who had been using marijuana prior to the program but stopped had the lowest level of PTSD symptoms 4 months post-discharge, and second lowest were those who never used marijuana. Those who started using marijuana again after the treatment program had the highest levels of violent behavior, alcohol use, and PTSD symptoms.

A more recent studyopens in a new tab or window using the 2019-2020 National Health and Resilience in Veterans Study (NHRVS) data on 4,069 U.S. military veterans from around the country found that frequent cannabis use worsens PTSD symptoms in veterans. Those who used cannabis frequently were roughly twice as likely to screen positive for co-occurring major depressive disorder, generalized anxiety disorder, and suicidal ideation. They also showed small-to-moderate decrements in cognitive functioning.

A prospective study

opens in a new tab or window of 361 veterans returning from deployment in Iraq and Afghanistan found more frequent cannabis use linked to greater severity in PTSD-related intrusion symptoms 6 months later and a prospective association from PTSD diagnosis to cannabis use disorder (CUD) diagnosis 1 year later. Importantly, there was no evidence of improvement in PTSD-related intrusion symptoms or remission in PTSD diagnosis in association with long-term use of cannabis. The researchers concluded that these results strengthen the argument for a causal link between frequent cannabis use and subsequent greater severity of PTSD-related intrusion symptoms and the links between PTSD and CUD.

This is especially concerning considering the evidence that CUD is associated withopens in a new tab or window suicidal ideation and suicide attempts in veterans. Another study found that while neither past 30-day heavy alcohol use nor opioid use predicted an increase in suicidal ideation or suicidal behavior, increased marijuana use, in the presence of elevated PTSD symptoms, strongly predictedopens in a new tab or window suicidal ideation, PTSD symptoms, and suicidal behavior in veterans.

An overview of peer-reviewed studies and randomized controlled trials

opens in a new tab or window in humans of THC or THC and CBD in PTSD from 1974 to 2020 reported that low doses of THC (7.5 mg THC) can potentiate fear memory extinction in healthy volunteers and reduce anxiety responses in anxious and PTSD patients without inducing a psychotic effect. However, high doses of THC (greater than or equal to 10% THC), do not facilitate fear memory extinction and are related to clinically relevant anxiogenic and psychotic effects in healthy volunteers. The fact that most products available in medical and recreational marijuana dispensaries are greater than 15% THCopens in a new tab or window (with many in the 60-90% THC range) complicate attempts from patients to find products that help with PTSD.

Evidence-Based Treatment Exists

As an addiction psychiatrist and a medical director of a 90-day inpatient treatment program, I have overseen the treatment of hundreds of people with PTSD. I know it is a very treatable condition. Evidence-based treatments have been shown to help permanently alleviate symptoms, allowing patients to process and assimilate their memories so they no longer bother the person when they are recalled. A recent meta-analysisopens in a new tab or window of randomized controlled trials of evidenced-based therapies found that narrative exposure therapy (NET), cognitive processing therapy (CPT), and eye movement desensitization reprocessing (EMDR), had the highest correlation with overcoming the PTSD diagnosis.

I've seen that when a patient is actively using an addictive substance such as cannabis while attempting to engage in these therapies, the treatment is less effective. Another concern with cannabis use by someone in PTSD treatment is that cannabis users show increased susceptibility to false memories

opens in a new tab or window. It is extremely difficult to treat fixed delusions or false memories that never actually happened.

The evidence shows that marijuana does not treat PTSD in the long-term, and contributes to worsening symptoms and outcomes. Meanwhile, we have very effective, evidence-based treatments available for PTSD, which can eliminate the symptoms and the diagnosis. They are more effective when the patient quits using cannabis. It is imperative that treatment providers educate their patients with PTSD and follow the science when recommending treatment options.

Libby Stuyt, MD, is an addiction psychiatrist in Colorado, and a board member of the International Academy on the Science and Impact of Cannabis. The opinions of the author are her own and do not necessarily reflect those of any organization with which she is affiliated.

https://www.medpagetoday.com/opinion/second-opinions/103944

FBI warns against using public phone charging stations in airports and hotels: Hackers use hubs

 Free public charging stations in the US have become the latest weapon for cyber criminals to infect devices with malware and tracking software.

The Federal Bureau of Investigation (FBI) warns people not to connect to the free power but instead carry their own chargers and USB cord that plug into an outlet.

The attack lets bad actors scrape personal information from devices, such as account logins, passwords, credit card details and photos. 

The FBI's alarming message, however, was not sparked by a recent attack but is to provide a service announcement to people visiting airports, hotels and shopping centers where stations are widespread.

'Everyday tasks—opening an email attachment, following a link in a text message, making an online purchase—can open you up to online criminals who want to harm your systems or steal from you,' the FBI's website reads.

'Preventing internet-enabled crimes and cyber intrusions requires each of us to be aware and on guard.'

The agency urges against doing sensitive transactions, such as purchasing goods, on devices before connecting to a public network.

Hackers have become creative over the past decade, finding new, inconspicuous ways of infiltrating our devices to steal personal information.

The FBI urges users to examine the email address in all correspondence, scrutinize website URLs, and not click links in unsolicited text messages, which has recently become a major issue.

Recent data shows that Americans are being attacked by more than 376 million scamming text messages daily, posing as Netflix, Amazon and banks to steal their money or voices.

These fake messages claim users' accounts are frozen, or credit cards are expired, prompting them to click a link that asks for personal information.

'If you get a text message you weren't expecting and it asks you to give some personal or financial information, don't click on any links. Legitimate companies won't ask for information about your account by text,' according to the Federal Trade Commission.

'If you think the message might be real, contact the company using a phone number or website you know is real. Not the information in the text message.'

Mobile devices have advanced our lives in ways we could never imagine, but they have also become a vital tool for scammers to weasel their way into our lives.

The Federal Communications Commission (FCC) reported that between 2015 and 2022, the number of robotext complaints skyrocketed from 3,300 to 18,900 per year.

And Americans lost $10 billion to these scams in 2021 alone.

FCC Chairwoman Jessica Rosenworcel said in a statement: 'Scam artists have found that sending us messages about a package you never ordered or a payment that never went through along with a link to a shady website is a quick and easy way to get us to engage on our devices and fall prey to fraud.'

Netflix released a statement about such schemes that urgently claimed 'your account is on hold,' stating an issue with the current billing information.

A link is attached to the message with a note telling recipients they have 48 hours to take action before their account is permanently suspended.

The link takes users to a site that looks like Netflix and asks them to reenter their credit card details, which the scammer steals.

https://www.dailymail.co.uk/sciencetech/article-11957879/FBI-warns-against-using-public-phone-charging-stations-airports-hotels.html

Sanofi to withdraw, refile reg documents for Provention merger to allow more review time

 Sanofi announced today that it has withdrawn and refiled its Premerger Notification and Report Form under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended (the “HSR Act”), in connection with Sanofi’s pending acquisition of Provention Bio, Inc. As previously announced on March 24, 2023, Sanofi commenced a cash tender offer to purchase all outstanding shares of common stock of Provention Bio, Inc. (the “Shares”), for $25.00 per Share, to the seller thereof in cash, without interest and subject to any withholding taxes required by applicable law.

Sanofi has elected to withdraw and refile its Premerger Notification and Report Form, which was initially filed on March 24, 2023, to provide the Federal Trade Commission (the “FTC”) with additional time for review. Following such refiling, the waiting period under the HSR Act will expire at 11:59 P.M., Eastern Time, on April 25, 2023. The acquisition is expected to close in the second quarter of 2023.

Consummation of the tender offer remains subject to, among other conditions, the expiration or termination of the applicable waiting period under the HSR Act. As a result, Sanofi is extending the tender offer, which was previously scheduled to expire at one minute after 11:59 P.M., Eastern Time, on April 20, 2023, until one minute after 11:59 P.M., Eastern Time, on April 26, 2023. The tender offer may be extended further in accordance with the merger agreement and the applicable rules and regulations of the U.S. Securities and Exchange Commission (the “SEC”). All other terms and conditions of the tender offer will remain unchanged during the extended period.

https://finance.yahoo.com/news/press-release-sanofi-announces-withdrawal-201500279.html