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Update January 2019


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Health & Wellbeing
 

Experimental app might spot drug overdoses in time to help

This image from video provided by the University of Washington in January 2019 shows a demonstration of the smartphone app developed by Rajalakshmi Nandakumar, Shyamnath Gollakota and Jacob E. Sunshine that uses sound waves to measure breathing. In first-step testing reported Wednesday, Jan. 9 the device detected early breathing problems in some people who’d just injected illegal drugs. (Mark Stone/University of Washington via AP)

Lauran Neergaard

Washington (AP) - Too often people die of an opioid overdose because no one’s around to notice they’re in trouble. Now scientists are creating a smartphone app that beams sound waves to measure breathing - and summon help if it stops.

The app is still experimental. But in a novel test, the “Second Chance” app detected early signs of overdose in the critical minutes after people injected heroin or other illegal drugs, researchers reported Wednesday.

One question is whether most drug users would pull out their phone and switch on an app before shooting up. The University of Washington research team contends it could offer a much-needed tool for people who haven’t yet found addiction treatment.

“They’re not trying to kill themselves - they’re addicted to these drugs. They have an incentive to be safe,” said Shyamnath Gollakota, an engineering and computer science associate professor whose lab turns regular cellphones into temporary sonar devices.

But an emergency room physician who regularly cares for overdose patients wonders how many people really would try such a device.

“This is an innovative way to attack the problem,” said Dr. Zachary Dezman of the University of Maryland School of Medicine, who wasn’t involved in the research.

Still, “I don’t know if many folks who use substances are going to have the forethought to prepare,” he added.

More than 47,000 people in the U.S. died of opioid overdoses in 2017. The drugs suppress breathing but a medicine called naloxone often can save victims - if it reaches them in time. Usually, that means someone has to witness the collapse. Dr. Jacob Sunshine, a University of Washington anesthesiologist, notes that people have died with a relative in the next room unaware they were in trouble.

The research team settled on cellphones as potential overdose monitors because just about everyone owns one. They designed an app that measures how someone’s chest rises and falls to see if they’re slipping into the slow, shallow breaths of an overdose or stop breathing completely.

How? The software converts the phone’s built-in speaker and microphone to send out inaudible sound waves and record how they bounce back. Analyzing the signals shows specific breathing patterns.

It won’t work inside a pocket, and people would have to stay within 3 feet. The researchers are in the process of making the app capable of dialing for help if a possible overdose is detected.

They put the experimental gadget to the test at North America’s first supervised injection site in Vancouver, British Columbia, where people are allowed to bring in illegal drugs and inject themselves under medical supervision in case of overdose. Study participants agreed to have doctoral student Rajalakshmi Nandakumar place the app-running cellphone nearby during their regularly monitored visit.

The software correctly identified breathing problems that could signal an overdose - seven or fewer breaths a minute, or pauses in breathing - 90 percent of the time, the researchers found. Most were near-misses; two of the 94 study participants had to be resuscitated.

For a bigger test, the researchers next turned to people who don’t abuse drugs but were about to receive anesthesia for elective surgery. Rendering someone unconscious for an operation mimics how an overdose shuts down breathing.

Measuring 30 seconds of slowed or absent breathing as those patients went under, the app correctly predicted 19 of 20 simulated overdoses, the researchers reported. The one missed case was a patient breathing slightly faster than the app’s cutoff.

The findings were reported in the journal Science Translational Medicine. The researchers have patented the invention and plan to seek Food and Drug Administration approval.


Low carb? Low fat? What the latest dieting studies tell us

This June 9, 2014 file photo shows a dish of steak and cheese pasta in Concord, N.H. Two major studies in 2018 provided more fuel for the debate around carbs and fats, yet failed to offer a resolution to the polarizing matter of the best way to lose weight. (AP Photo/Matthew Mead)

Candice Choi

New York (AP) - Bacon and black coffee for breakfast, or oatmeal and bananas?

If you’re planning to try to lose weight in 2019, you’re sure to find a fierce debate online and among friends and family about how best to do it. It seems like everyone has an opinion, and new fads emerge every year.

Two major studies last year provided more fuel for a particularly polarizing topic - the role carbs play in making us fat. The studies gave scientists some clues, but, like other nutrition studies, they can’t say which diet - if any - is best for everyone.

That’s not going to satisfy people who want black-and-white answers, but nutrition research is extremely difficult and even the most respected studies come with big caveats. People are so different that it’s all but impossible to conduct studies that show what really works over long periods of time.

Before embarking on a weight loss plan for the new year, here’s a look at some of what was learned last year.

Fewer carbs,
fewer pounds?

It’s no longer called the Atkins Diet, but the low-carb school of dieting has been enjoying a comeback. The idea is that the refined carbohydrates in foods like white bread are quickly converted into sugar in our bodies, leading to energy swings and hunger.

By cutting carbs, the claim is that weight loss will be easier because your body will instead burn fat for fuel while feeling less hungry. A recent study seems to offer more support for low-carb proponents. But, like many studies, it tried to understand just one sliver of how the body works.

The study, co-led by an author of books promoting low-carb diets, looked at whether varying carb levels might affect how the body uses energy. Among 164 participants, it found those on low-carb diets burned more total calories than those on high-carb diets.

The study did not say people lost more weight on a low-carb diet - and didn’t try to measure that. Meals and snacks were tightly controlled and continually adjusted so everyone’s weights stayed stable.

David Ludwig, a lead author of the paper and researcher at Boston Children’s Hospital, said it suggests limiting carbs could make it easier for people to keep weight off once they’ve lost it. He said the approach might work best for those with diabetes or pre-diabetes.

Ludwig noted the study wasn’t intended to test long-term health effects or real-world scenarios where people make their own food. The findings also need to be replicated to be validated, he said.

Caroline Apovian of Boston University’s School of Medicine said the findings are interesting fodder for the scientific community, but that they shouldn’t be taken as advice for the average person looking to lose weight.

Do I avoid fat to be skinny?

For years people were advised to curb fats, which are found in foods including meat, nuts, eggs, butter and oil. Cutting fat was seen as a way to control weight, since a gram of fat has twice as many calories than the same amount of carbs or protein.

Many say the advice had the opposite effect by inadvertently giving us license to gobble up fat-free cookies, cakes and other foods that were instead full of the refined carbs and sugars now blamed for our wider waistlines.

Nutrition experts gradually moved away from blanket recommendations to limit fats for weight loss. Fats are necessary for absorbing important nutrients and can help us feel full. That doesn’t mean you have to subsist on steak drizzled in butter to be healthy.

Bruce Y. Lee, a professor of international health at Johns Hopkins, said the lessons learned from the anti-fat fad should be applied to the anti-carb fad: don’t oversimplify advice.

“There’s a constant look for an easy way out,” Lee said.

So which is better?

Another big study this past year found low-carb diets and low-fat diets were about equally as effective for weight loss. Results varied by individual, but after a year, people in both groups shed an average of 12 to 13 pounds.

The author noted the findings don’t contradict Ludwig’s low-carb study. Instead, they suggest there may be some flexibility in the ways we can lose weight. Participants in both groups were encouraged to focus on minimally processed foods like produce and meat prepared at home. Everyone was advised to limit added sugar and refined flour.

“If you got that foundation right, for many, that would be an enormous change,” said Christopher Gardner of Stanford University and one of the study’s authors.

Limiting processed foods could improve most diets by cutting down overall calories, while still leaving wiggle room for people’s preferences. That’s important, because for a diet to be effective, a person has to be able to stick to it. A breakfast of fruit and oatmeal may be filling for one person, but leave another hungry soon after.

Gardner notes the study had its limitations, too. Participants’ diets weren’t controlled. People were instead instructed on how to achieve eating a low-carb or low-fat in regular meetings with dietitians, which may have provided a support network most dieters don’t have.

So, what works?

In the short term you can probably lose weight by eating only raw foods, or going vegan, or cutting out gluten, or following another diet plan that catches your eye. But what will work for you over the long term is a different question.

Zhaoping Li, director of clinical nutrition division at the University of California, Los Angeles, says there is no single set of guidelines that help everyone lose weight and keep it off. It’s why diets often fail - they don’t factor into account the many factors that drive us to eat what we do.

To help people lose weight, Li examines her patients’ eating and physical activity routines to identify improvements people will be able to live with.

“What sticks is what matters,” Li said.


US urges doctors to write more Rx for overdose antidote

In this Tuesday, July 3, 2018 file photo, a Narcan nasal device which delivers naloxone lies on a counter as a health educator gives instructions on how to administer it in the Brooklyn borough of New York. On Wednesday, Dec. 19, 2018, the U.S. government told doctors to consider prescribing the overdose antidote naloxone to many more patients who take opioid painkillers. (AP Photo/Mary Altaffer)

Carla K. Johnson

(AP) - The U.S. government told doctors Wednesday to consider prescribing medications that reverse overdoses to many more patients who take opioid painkillers in a move that could add more than $1 billion in health care costs.

Assistant Secretary for Health Brett Giroir, a doctor appointed by President Donald Trump, announced the guidance, saying it’s important for doctors to discuss overdose dangers with patients.

Prescribing naloxone such as Narcan along with opioids forces a conversation that will lead to “a more informed decision by the patient,” he said.

The action comes a day after a close vote from a Food and Drug Administration expert panel endorsing the idea of rewriting opioid drug labels to include a naloxone recommendation for many or all patients. An FDA document said such a move could add more than $1 billion in health care costs.

“Even at a billion, it would be an investment that is well worth it,” Giroir said.

More than 47,600 Americans died of opioid overdoses last year, a toll that has been rising for two decades. The street drug fentanyl is the top killer today, but prescription painkillers are still a problem, contributing to nearly 15,000 overdose deaths last year.

Naloxone comes in a nasal spray, an injection and an automatic injector. The Narcan nasal spray costs about $125 for a two-dose kit, although government programs can get it for less. The automatic injector can cost as much as $4,000 per kit, although its maker recently authorized a cheaper generic version.

Critics said prescribing the antidote to pain patients does not address the growing share of fatal overdoses caused by illicit opioids, and could cause shortages for programs that hand out the kits to street drug users.

It “will have the unintended consequence of derailing efforts to provide naloxone to the very effective community programs we know are successful in saving lives,” said Dr. Raeford E. Brown Jr., who heads an expert panel advising the FDA.

The new guidance tells doctors to consider prescribing the antidote to patients on high doses of opioids, heavy drinkers, people with sleep apnea and other breathing problems, people taking benzodiazepines such as Xanax and people with addiction or mental health problems.

It expands upon a similar recommendation from the Centers for Disease Control and Prevention.

In April, U.S. Surgeon General Jerome Adams issued the office’s first national public health advisory in 13 years, calling on more Americans to start carrying naloxone and urging more federal money to be dedicated to broadening access.

Most states allow people to get naloxone from a pharmacy or community program under a statewide prescription and some states require doctors to also prescribe naloxone to patients on high doses of opioids.

The FDA is working toward an over-the-counter version of naloxone.

Brown said the government should use its emergency authority to buy and distribute large quantities of naloxone and immediately make it available over the counter. Trump directed the health agency to declare the opioid crisis a public health emergency last year.

“That’s the difference between declaring a public health emergency and actually acting as if there’s a public health emergency,” Brown said.
 


UPDATE

HEADLINES [click on headline to view story]

Experimental app might spot drug overdoses in time to help


Low carb? Low fat? What the latest dieting studies tell us


US urges doctors to write more Rx for overdose antidote