Newly released 2014 data from the National Center for Health Statistics on life expectancy showed a worrisome decline in life expectancy for whites in the US, to 78.8 years in 2014 from 78.9 in 2013.
The good news is that, in contrast, life expectancy increased by 0.2 years for the Hispanic population (from 81.6 to 81.8 years) and by 0.1 years for the non-Hispanic black population (from 75.1 to 75.2). This continues a trend of a decreasing gap in life expectancy between black and white populations, with improving black life expectancies attributed to decreases in death rates due to heart disease, cancer, HIV disease, unintentional injuries, and perinatal conditions.
Life expectancy rates had steadily for decades, then flattened in 2010-2013. The decline in life expectancy is driven by increased death rates among young and middle-aged whites (mid 20’s to mid 50’s), especially among those with no more than a high school education. A recent study attributed the rise in mortality in this group to rising rates of suicide, liver disease and drug overdoses.
Life expectancy has dipped before–most recently in 2005, the year of a severe influenza epidemic.
Today’s post is a question: what is the most important health story of 2015? What was the most important health news this year for the health of people in our country, or worldwide? Closer to home, what was most important news for you in how you promote your own health, that of family members, or that of patients?
Jerome Gropman released a list of the top medical news of the past year in this week’s New Yorker. I would have come up with only 2 on this list (1 and 6) in my own top 10, although I still have a week to contemplate that final list, hence my initial question. Here is his top-7 list:
- The Institute of Medicine recommended the creation of a national tracking system that would, in part,
encourage the teaching of bystander CPR, based in part on a New England Journal of Medicine report showing that when a bystander performed CPR before the arrival of E.M.T.s, the thirty-day survival rate was 10.5%, versus 4% when no bystander CPR took place.
- A clinical trial showing 86% reduction in the risk of transmission of H.I.V. by taking antiviral medication just prior to and after unsafe sex
- The rapid spread of the Zika virus–could this be the Chikungunya of 2015?
- U.S. Food and Drug Administration approval of a cholesterol-lowering medication based on genomic research; the drug mimics the action of the protective PCSK9 gene found in many individuals with low cholesterol levels.
- The classic approach to treating chronic lymphocytic leukemia (CLL), as with many cancers, is to poison malignant cells with chemotherapy. Last week’s report in the New England Journal of Medicine demonstrates success in a new approach: targeting the signals cells use to communicate with one another, an approach with the promise to render treatment more specific and less toxic. Specifically, they showed that ibrutinib, which interferes with the signalling molecule BTK, produced superior remissions in patients with CLL.
- The Open Science Framework’s project to replicate 100 studies published in three psychology journals using high-powered designs and original materials when available. In August, the Reproducibility Project reported they could replicate the findings of only 39% of the studies tested.
- A study showed that some are more prone to the placebo effect than others based on genetics. The relevant genes govern molecules that shape our moods and goal-driven behaviors.
On a similar note, Gretchen Reynolds of the New York Times compiled the top fitness-related findings of 2015 in a piece yesterday. Her top finding, reproduced in different ways by numerous studies this year, is that regular exercise leads to improvements in our thinking and the structure of our brains. Here’s to an active, healthy and cognitively productive 2016!
An article in today’s New York Times reminds us that the quality of cardiopulmonary resuscitation varies widely region-to-region in the US. As a result, survival rates after cardiac arrest also vary widely. Although advances in CPR research are ongoing, their adoption by citizens and providers vary by location.
The best evidence is synthesized every 5 years by the American Heart Association (AHA), and summarized in updated guidelines for resuscitation care. The AHA’s 2015 Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care were released in October.
The following are the most important changes and reinforcements to the Pediatric Advanced Life Support recommendations (co-authored by my colleague Halden Scott) made in the 2010 Guidelines:
There is new evidence that when treating pediatric septic shock in specific settings, the use of restricted volume of isotonic crystalloid leads to improved survival, contrasting with the long-standing belief that all patients benefit from aggressive volume resuscitation. New guidelines suggest a cautious approach to fluid resuscitation, with frequent patient reassessment, to better tailor fluid therapy and supportive care to children with febrile illness.
New literature suggests limited survival benefit to the routine use of atropine as a premedication for emergency tracheal intubation of non-neonates, and that any benefit in preventing arrhythmias is controversial. Recent literature also provides new evidence suggesting there is no minimum dose required for atropine use.
Children in cardiac arrest may benefit from the titration of CPR to blood pressure targets, but this strategy is suggested only if they already have invasive blood pressure monitoring in place.
New evidence suggests that either amiodarone or lidocaine is acceptable for treatment of shock-refractory pediatric ventricular fibrillation and pulseless ventricular tachycardia.
Recent literature supports the need to avoid fever when caring for children remaining unconscious after out of hospital cardiac arrest (OHCA).
The writing group reviewed a newly published multicenter clinical trial of targeted temperature management that demonstrated that a period of either 2 days of moderate therapeutic hypothermia (32° to 34° C) or the strict maintenance of normothermia (36° to 37.5° C) were equally beneficial. As a result, the writing group feels either of these approaches is appropriate for infants and children remaining comatose after OHCA.
Hemodynamic instability after cardiac arrest should be treated actively with fluids and/or inotropes/vasopressors to maintain systolic blood pressure greater than the fifth percentile for age. Continuous arterial pressure monitoring should be used when the appropriate resources are available.
To update your own CPR skills, visit the AHA’s website.