The Vitals - February 2016

February 2016, Vol 4, No 2 - The Vitals

In This Article

Passive Smoke Exposure Associated with Obesity, Poorer Cognition in Children

Exposing children to passive, secondhand smoke has been found to be associated with obesity and poorer cognition, according to a study recently published in Childhood Obesity.

Based on data that passive smoking may be a risk factor for children being obese or overweight, and having worse neurocognitive development, cognition, and sleep, Catherine L. Davis, PhD, Professor, Department of Pediatrics, Augusta University, GA, and colleagues conducted a study examining the effects of secondhand smoke on adiposity, cognition, and sleep in overweight and obese children.

From 2003 to 2006, a total of 222 overweight or obese children aged 7 to 11 years were included in the study, and were recruited from schools near Augusta, GA, over the course of the school year; data were analyzed in 2009-2010. The study authors used plasma cotinine to measure passive smoke exposure, and obtained health, cognitive, and sleep measures, in addition to parent reports of smoke exposure.

Overweight and obese children who were passively exposed to smoke had greater overall and central adiposity compared with nonexposed overweight and obese children (P <.03). Secondhand smoke exposure was also associated with poorer cognitive scores (P <.04) regardless of adiposity, but was not related to sleep-disordered breathing, prediabetes, insulin resistance, or visceral fat.

"Passive smoke exposure is associated with fatness and poorer cognition in children," concluded Dr Davis and colleagues. "Tailored interventions that target multiple health risk factors including nutrition, physical activity, and tobacco use in children and families are needed to prevent adverse health outcomes related to tobacco use and obesity."

  1. Davis CL, Tingen MS, Jia J, et al. Passive smoke exposure and its effects on cognition, sleep, and health outcomes in overweight and obese children. Child Obes. 2016 Jan 26. Epub ahead of print.

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Advocate Health Care to Own and Operate Retail Clinics at 56 Walgreens Locations

In an announcement released January 11, 2016, Walgreens and Advocate Health Care revealed that Advocate would own and operate 56 healthcare clinics at Walgreens locations across the greater Chicago area starting in May 2016. Functioning as part of Advocate and branded as Advocate Clinic at Walgreens, the retail clinics will strengthen care coordination, convenience, and access for patients.

"Advocate Clinic at Walgreens expands Advocate's care delivery locations to provide more options for patients and meet the needs of consumers in an evolving healthcare environment," stated Lee Sacks, MD, Executive Vice President and Chief Medical Officer of Advocate, in a press release from Walgreens. "With Walgreens' unmatched footprint coupled with our leading clinical expertise and commitment to delivering high quality, affordable health care, more patients will have access to the best care when and where they need it," he added.

Operating in Cook, DeKalb, DuPage, Kane, Kendall, Lake, McHenry, and Will counties, the Advocate Clinic at Walgreens will provide consumers with easy access to well-known, trusted healthcare providers; effective care coordination; and high-quality, affordable treatment options for common illnesses and injuries. Walk-ins and same-day appointment scheduling will continue to be offered at these clinics. The staff at Advocate Clinic at Walgreens will include board-certified nurse practitioners who are employed, trained, and supervised by Advocate Medical Group.

For Walgreens, this union supports a 2-pronged growth strategy for its retail clinics, which includes the expansion of services to build a solid, practical model for future growth, and allows for the deeper development of more innovative approaches for health systems. The alignment also furthers Walgreens' and Advocate's efforts to improve the delivery of healthcare.

  1. The Walgreens Company. Advocate Health Care to operate Walgreens healthcare clinics in Chicagoland area [news release]. January 11, 2016. Accessed January 27, 2016

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FDA Approves 3 Oral Barium Sulfate Products for Adults and Pediatric Patients

On January 11, 2016, the US Food and Drug Administration (FDA) approved barium sulfate for oral suspension (E-Z-HD; Bracco Diagnostics Inc., Monroe Township, NJ) to help visualize the gastrointestinal (GI) tract of patients aged ≥12 years in double-contrast radiographic examinations of the esophagus, stomach, and duodenum.

Four days later, the FDA also approved READI-CAT 2 and READI—CAT 2 Smoothie (Bracco Diagnostics Inc.)—both forms of oral suspension barium sulfate-for use in adult and pediatric patients during computed tomography scans of their abdomen to delineate the GI tract.

These drugs are the only barium-sulfate–containing products listed in the FDA's database of approved drug products. They are contraindicated in patients with known or suspected perforation of the GI tract, known obstruction of the GI tract, conditions associated with high risk for aspiration or GI perforation, and known hypersensitivity to barium sulfate or any other substances in the drug. Healthcare providers should advise patients to maintain adequate hydration in the days following a barium sulfate procedure to avoid obstruction or impaction.

Common adverse reactions to these products include nausea, vomiting, diarrhea, and abdominal cramping.

  1. E-Z-HD [package insert]. Monroe Township, NJ: Bracco Diagnostics Inc.; 2016.
  2. READI-CAT 2 (barium sulfate) oral suspension; READI-CAT 2 SMOOTHIE (barium sulfate) oral suspension [package insert]. Monroe Township, NJ: Bracco Diagnostics Inc.; 2016 safety measures. Published December 18, 2015. Accessed December 28, 2015.

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Link Exists Between Off-Patent Drug Price Increases and Shortages

At the first in a series of hearings of the US Senate Special Committee on Aging to investigate the reason behind sudden price spikes affecting medications that are no longer protected by patents, experts stated that there was a close relationship between the recent increases in drug prices for off-patent generics and hospital drug shortages.

"There's a line at which huge price increases on prescription drugs go from rewarding innovation to price gouging," said Claire McCaskill, US Senator from Missouri and Ranking Member of the Committee.

Americans are expected to spend more than $328 billion on prescription drugs this year alone. Approximately $50 billion of this is expected to be paid out-of-pocket; another $110 billion in payments will be picked up by the federal government through programs such as Medicare, Medicaid, and Veterans Affairs.

"The first indication of a market failure in the generic market was drug shortages," said Gerard Anderson, PhD, Director, Center for Hospital Finance and Management, Baltimore, MD, in his testimony. "The second indication of a problem in the generic market is the recent price increases. When patients have limited access due to high prices, they often end up in the hospital with worsening of their medical condition."

In her testimony, Erin Fox, PharmD, Director, Drug Information Service, University of Utah Health Care, Park City, explained the impact of these price hikes on hospitals.

"When medication prices increase in an unpredictable and dramatic way, this can create an access issue for hospitals and patients," she explained. "If hospitals cannot afford to stock a product in the same amount due to price increases, this effectively creates a shortage."

"We work hard to predict potential inflation for medications and also to predict new drug approvals that will increase our budget. What we cannot predict are older, off-patent medications with exponential price increases," she added, speaking directly about University of Utah Health Care.

One goal of the Committee's ongoing investigation will be to understand why companies can impose such outstanding price increases on off-patent drugs that they have acquired, and what policies we should consider to counter this concerning practice.

  1. US Senate Special Committee on Aging. Senate Aging Committee holds 1st hearing on off-patent Rx drug price spikes. Published December 9, 2015. Accessed January 28, 2016.

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The Little Clinic Celebrates Reaching 4 Million Patient Visits Milestone

On January 14, 2016, retail clinic operator The Little Clinic, which is a wholly owned subsidiary of The Kroger Co., reached a milestone of 4 million patient visits. Spread across 10 states, The Little Clinic has 188 clinics operating under 5 Kroger store banners.

"Hitting the 4 million patient milestone is quite an accomplishment for our company and for the great team of providers The Little Clinic has working with patients each and every day," stated Colleen Lindholz, President and Chief Executive Officer of The Little Clinic, in a press release published by the company. "It is also an indication that today's consumers desire quality, affordable care on their timetable."

The board-certified nurse practitioners and physician assistants who work at The Little Clinic, which is open for business 7 days weekly, are authorized to diagnose, treat, and write prescriptions for common illnesses, including sinus infections, seasonal allergies, influenza, and bronchitis. The Little Clinic's clinicians are also sanctioned to perform a wide variety of services, such as physicals for camps and sports, health screenings, and administration of several vaccines.

  1. The Little Clinic. Kroger's The Little Clinic reaches 4 million patient visits [news release]. Published January 14, 2016. Accessed January 27, 2016.

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Last modified: March 16, 2016
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