Category: 8. Health

Risk factors of not receiving direct-acting antiviral (DAA) prescription among hepatitis C virus (HCV) patients entering opioid use disorder (OUD) treatment include female sex and recent pregnancy, according to a recent study published in O&G Open.¹

A 16-fold increase in HCV infections was observed in US patients from 1998 to 2018, increasing the prevalence of associated adverse outcomes such as perinatal transmission. DAAs have a success rate of over 95% for curing this condition, but only 39% of affected adults and 9% of reproductive-aged women receive DAA prescriptions.²

“Sex and gender disparities in access to DAAs have been described,” wrote investigators.¹ “For example, among people who inject drugs, HCV incidence is higher among women, but men are 24% more likely to access DAAs.”

Comparing DAA prescriptions between men and women

The study was conducted to compare DAA prescriptions between men and women and to determine the impact of past-year pregnancy on DAA prescription. Data for inpatient and outpatient claims was obtained from the Merative MarketScan Commercial and Multi-State Medicaid Databases.

Inpatient, outpatient, and prescription data were linked, and deidentification was performed. Participants were aged 18 to 64 years and were diagnosed with any OUD and HCV based on International Classification of Diseases codes. The date of OUD treatment initiation was reported as the index date.

Participants were organized by treatment episodes, beginning after a period of at least 45 days without record of OUD treatment. Treatment episodes had a duration of 360 days, and subsequent treatment episodes following this period were also evaluated. Prescription DAAs were reported as the primary outcome of the analysis.

Defining HCV treatment

HCV treatment initiation was defined as a first-time prescription for a DAA. These included velpatasvir, sofosbuvir, grazoprevir, daclatasvir, elbasvir, paritaprevir, ombitasvir, ritonavir, dasabuvir, simeprevir, ledipasvir, telaprevir, glecaprevir, boceprevir, and pibrentasvir.

Sex and pregnancy status were reported as exposure variables. Categories of sex included male and female as recorded in claims data. A recent pregnancy was determined by more than 1 claims data for any pregnancy-related condition within the prior 360 days.

Year of enrollment, age, health insurance type, psychiatric comorbidities, and race and ethnicity were reported as covariates. Investigators also collected information about co-occurring substance use disorders, hospitalization for drug-related poisoning, type of OUD treatment, and Charlson Comorbidity Index score.

Patient characteristics and odds of DAA

There were 22,347 episodes from 19,668 patients included in the final analysis, 45.1% of whom were men, 38.5% women without recent pregnancy, and 16.5% women with recent pregnancy. Most of these patients were aged at least 35 years, but women with recent pregnancy were more often aged 26 to 30 years.

Of patients, 90.8% were enrolled in Medicaid, 89.2% were non-Hispanic White, and 76% received psychosocial treatment without medications for OUD. The remaining received medications, with 12.6% prescribed buprenorphine, 6.7% methadone, 1.5% oral naltrexone, and 3.3% extended-release naltrexone.

The odds of being prescribed DAAs were significantly higher among men vs women, with rates of 40.6% for men, 35.7% for women without recent pregnancy, and 31.8% for women with recent pregnancy. Additionally, a hazard ratio (HR) for receiving HCV treatment of 1.19 was reported among men vs women.

Implications

When compared to women with recent pregnancy, men and women without pregnancy had adjusted HRs of 1.18 and 1.09, respectively, for receiving HCV treatment. Similar results were reported in a sensitivity analysis restricting the cohort to women with a pregnancy code at least 9 months before enrollment.

Overall, the results highlighted recent pregnancy as a barrier to HCV treatment, alongside potentially contributing to sex-based disparities in treatment. Investigators recommended additional research to determine optimal care delivery strategies in this population.

“Given the challenges described regarding postpartum linkage to HCV care, we suggest that pregnancy could be a window of opportunity for HCV treatment that must be further studied,” wrote investigators.

References

1. Cary CB, McCrary ML, Marks LR, et al. Association between sex and recent pregnancy and hepatitis C virus treatment in people with opioid use disorder. O&G Open. 2025;2(4). doi:10.1097/og9.0000000000000096
2. Biondi BE, Munroe S, Lavarin C, et al. Racial and ethnic disparities in hepatitis C care in reproductive-aged women with opioid use disorder. Clin Infect Dis. 2024;79:1428–36. doi:10.1093/cid/ciae426

Surya Bhatt, M.D.The diagnosis of chronic obstructive pulmonary disease, or COPD, is improved by incorporating CT lung imaging and respiratory symptoms. This fresh, multidimensional approach better identifies patients who are at risk of poor respiratory outcomes, while ruling out those who have airflow obstruction without respiratory symptoms or structural lung disease, Surya Bhatt, M.D., and colleagues report in the Journal of the American Medical Association.

“This new COPD diagnostic schema, which includes chest imaging, respiratory symptoms and spirometry, identified additional individuals at risk of poor respiratory outcomes,” said Bhatt, a professor in the Department of Medicine at the University of Alabama at Birmingham Marnix E. Heersink School of Medicine and director of the Center for Lung Analytics and Imaging Research.

The schema includes airflow obstruction on spirometry as the major criterion and minor criteria based on chest imaging and respiratory symptoms. Imaging includes visual signs of emphysema and airway wall thickening on computed tomography, and symptom-based criteria consider difficulty breathing, reduced quality of life and the presence of chronic bronchitis. Under the new framework, a patient must have airflow obstruction and at least one minor criterion or, in the absence of airflow obstruction or if lung function tests are not available, at least three of five minor criteria.

Bhatt and colleagues found that, among 9,416 participants enrolled in a multicenter cohort, those newly diagnosed with COPD by the schema had greater all-cause and respiratory-specific mortality, more frequent exacerbations, and faster lung function decline compared with people classified as not having COPD based on the new classification. This new diagnostic schema included additional individuals with high respiratory morbidity and excluded some with airflow obstruction who had no symptoms or evidence of structural lung disease.

Before this study, clinicians had increasingly recognized that lung function tests did not capture all aspects of the complex heterogeneous disease COPD, a leading cause of disability and death. Some 392 million people globally, and 16 million in the United States, are estimated to have COPD.

“This new diagnostic schema will likely change the way we diagnose COPD and enable its diagnosis, even in the absence of overt airflow obstruction on spirometry,” Bhatt said. “Whether treating individuals newly diagnosed this way will result in improved outcomes remains to be tested, but practitioners have already been using imaging and symptoms to diagnose COPD. This new schema sets some parameters to operationalize this.”

In an editorial in JAMA, Francesca Polverino, M.D., Ph.D., called the study a milestone in COPD diagnosis. “COPD classification has remained overly dependent on airflow limitation as the main diagnostic criterion,” Polverino wrote. “What truly sets this reclassification apart is its groundbreaking assertion that airflow obstruction is no longer a requirement for a COPD diagnosis.”

In the system proposed by Bhatt and colleagues, airflow obstruction remains the major criterion for COPD. “However, what makes this model significantly more inclusive and reflective of clinical COPD diversity are the minor criteria, which are split between imaging and symptom-based factors,” said Polverino, a professor at the Baylor College of Medicine, Houston, Texas.

Bhatt is corresponding author of the study, “A new multidimensional diagnostic approach for chronic obstructive pulmonary disease,” and Edwin K. Silverman, M.D., Ph.D., Brigham and Women’s Hospital, Boston, Massachusetts, and James D. Crapo, M.D., National Jewish Health, Denver, Colorado, are co-senior authors. Other UAB authors include Mark Dransfield and  Sandeep Bodduluri, UAB Department of Medicine Division of Pulmonary, Allergy and Critical Care Medicine; and Arie Nakhmani, UAB School of Engineering Department of Electrical and Computer Engineering.

The study includes 52 authors from 24 universities and institutions in the United States and Canada.

At UAB, Bhatt works in the Division of Pulmonary, Allergy and Critical Care Medicine.

More than 80,000 Americans died from drug overdoses in 2024. Younger demographics have seen the worst effects of this along with mental health concerns, poor mental health reports amongst teens and adolescents are rising over the nation and highlighting the two largest concerns surrounding the youth population.

The Centers for Disease Control and Prevention (CDC) launched a new national campaign “Free Mind.” This campaign aims to provide young adults aged 12-17 and their parents & caregivers with the resources and educational information surrounding mental health, and substance abuse issues.

Young Americans are facing one of the most lethal drug epidemics in recent memory, with the main culprit being illegally produced fentanyl. An estimated 75% of reported drug overdoses from 2020 to 2024 were directly linked to the illegally manufactured drug. Overdose casualties are not the only concern amongst today’s youth as mental health problems are on the rise, with reports of day-to-day lifestyle impacts on teens. The beginning of this mental health dilemma traces back to 2023, were data shows that 40% of high school students suddenly ceased their standard daily routines, citing feelings of depression and despair. These negative mindsets affect young adults in a variety of ways, but the most concerning is self-harm.

Being in a negative mindset can led to poor and sometimes dangerous decisions, especially in adolescents suffering from poor mental health. Recent data suggests that one in five high school students will have a serious attempt of suicide, showing the deadly turn untreated mental health can take. The correlation between drug overdose and mental health in the youth community have started to blend, with both issues adversely affecting one another.

Dr. Allison Arwady, director of the CDC national center for injury prevention and control touched on the effects of substance abuse and bad mental health on young adults, saying, “Teens may use alcohol and other substances to cope with stress, anxiety, and depression. Talking openly about mental health and substance use, and knowing when to get professional help, is critical to helping teens stay healthy. That’s why this campaign supports youth, parents, and caregivers in having those conversations early, before an issue arises.”¹

To assist in establishing its new campaign, the CDC reached out to youth groups regarding the community’s knowledge around substance abuse, aiming to use this to produce branding and messages that resonate with younger audiences. Free Mind will provide educational support covering the connection between bad mental health and drug abuse, while also touching on associated risk factors of substance abuse, and strategies for young adults to provide protection from drug use. The new campaign will also offer parents and caregivers the resources to assist and inform their child on the importance of mental health and staying safe from drug abuse.

1. CDC Launches New Campaign to Address Youth Substance Use and Mental Health The Centers for Disease Control and Prevention August 7, 2025 https://www.prnewswire.com/news-releases/cdc-launches-new-campaign-to-address-youth-substance-use-and-mental-health-302524817.html

Drugs such as Ozempic, Wegovy and Mounjaro (known as semaglutide and tirzepatide) have changed the way clinicians manage diabetes and obesity around the world.

Collectively known as GLP-1 agonists, these drugs mimic the hormone GLP-1. This limits both hunger and interest in food, helping users lose weight, and helps control blood sugar levels.

But two new studies published today show that people taking these drugs may have a small increased risk of serious eye conditions and vision loss.

Here’s what you need to know if you’re taking or considering these medications.

What damage can occur?

Non-arteritic anterior ischaemic optic neuropathy, or NAION, is a rare but devastating eye condition that occurs when blood flow to the optic nerve is suddenly reduced or blocked. It’s also called an “eye stroke”.

The exact cause of NAION remains unclear and there are no current treatments available. People with diabetes are at increased risk of developing NAION.

Unlike other eye conditions that develop gradually, NAION causes a sudden, painless loss of vision. Patients typically notice the condition when they wake up and discover they’ve lost vision in one eye.

Vision tends to worsen over a couple of weeks and slowly stabilises. Recovery of vision is variable, but around 70% of people do not experience improvement in their vision.

What has previous research shown?

A previous study from 2024 found participants prescribed semaglutide for diabetes were four times more likely to develop NAION. For those taking it for weight loss, the risk was almost eight times higher.

In June, the European Medicines Agency concluded NAION represented a “very rare” side effect of semaglutide medications: a one in 10,000 chance. In a first for medicines regulators, the agency now requires product labels to include NAION as a documented risk.

However the recent studies suggest the risks may be lower than we first thought.

In addition to NAION, there is also evidence to suggest GLP-1 drugs can worsen diabetic eye disease, also known as diabetic retinopathy. This occurs when high blood sugar levels damage the small blood vessels in the retina, which can lead to vision loss.

It may sound counter-intuitive, but rapid blood sugar reductions can also destabilise the fragile blood vessels in the retina and lead to bleeding.

What do the new studies say?

Two newly published studies investigated people with type 2 diabetes living in the United States over two years. The studies looked at the medical records of 159,000 to 185,000 people.

One study found semaglutide or tirzepatide was associated with a more modest risk of developing NAION than previously thought. Of 159,000 people with type 2 diabetes who were taking these drugs, 35 people (0.04%) developed NAION, compared with 19 patients (0.02%) in the comparison group.

The researchers also found an increased risk of developing “other optic nerve disorders”. However, it’s unclear what kind of optic nerve disorders this includes, as the medical record codes used didn’t specify.

Counter to this, the second study did not find an increased risk of NAION among those taking GLP-1 drugs.

However, the researchers found a small increase in the number of people developing diabetic retinopathy in those prescribed GLP-1 drugs.

But overall, participants on GLP-1 drugs experienced fewer sight-threatening complications related to their diabetic retinopathy and required less invasive eye treatments compared to the group taking other diabetes medications.

Further studies are still needed to understand how GLP-1 drugs can lead to eye complications. A current, five-year clinical trial is studying the long-term effects of semaglutides and diabetic eye disease in 1,500 people, which should tell us more about the ocular risks in the future.

What does this mean for people taking GLP-1 drugs?

NAION is a serious condition. But we need to strike a balance between these (and other) risks and the benefits of GLP-1 medications in diabetes care, obesity treatment, reducing heart attack risks and extending lives.

The key lies in informed decision-making and identifying different levels of risk.

People with multiple NAION risk factors – such as sleep apnoea, high blood pressure and diabetes – should undergo careful consideration with their treating doctor before starting these medications.

“Crowded” optic nerve heads are also a risk factor for NAION. This is an anatomical feature where blood vessels at the optic nerve head are tightly packed together. People with crowded optic nerve heads should also undergo careful consideration before starting GLP-1 medications.

Although NAION can strike without warning, regular comprehensive eye examinations with your optometrist or ophthalmologist still serve important purposes. They can detect other drug-related eye problems, including worsening diabetic retinopathy, and can identify patients with crowded optic nerve heads. It’s also important to tell them if you are taking GLP-1 medications so they can keep a close watch on your eye health.

Emerging research also suggests that improving your heart health might help reduce risks of developing NAION. This includes proper management of high blood pressure, diabetes and cholesterol – all conditions that compromise the small blood vessels feeding the optic nerve.

Studies also show patients with heart conditions who better adhere to their medication prescriptions have lower risks of NAION than those who don’t.

Doctors should discuss NAION risks during prescribing decisions and work with eye care providers to monitor regularly for diabetic eye disease. Patients need clear instructions to seek immediate medical attention for sudden vision loss and the need for regular eye examinations.

Aggressive treatment of sleep apnoea and other heart conditions may also help reduce NAION risks. But for now, there remains an ongoing need for more research to understand how GLP-1 medications can affect the eye.

LOS ANGELES — Researchers at City of Hope^®, one of the largest and most advanced cancer research and treatment organizations in the United States with its National Medical Center ranked among the nation’s top cancer centers by U.S. News & World Report, today published a new study which found that some survivors of childhood cancer are more at risk for serious health issues as they grow older, including new cancers and chronic conditions like heart disease.

While a cause for concern, the findings published in the Journal of Clinical Oncology also point to a silver lining: The ailments are potentially manageable if caught early and treated.

“Our study underscores the importance of partnership among patients, their primary care providers and cancer survivorship programs to ensure survivors receive necessary screening for the early detection, prevention and treatment of conditions, including secondary cancers, resulting from lifesaving treatment,” said Rusha Bhandari , M.D., a pediatric hematologist-oncologist at City of Hope and corresponding author of the new study. “We at City of Hope are continuing to learn more about what health conditions survivors of childhood cancer are at risk for at different times in their life to inform the updating of evidence-based guidelines for cancer survivors.”

The City of Hope-led study is the first to look at childhood cancer survivors who reached the age of 50, a population that is expected to grow as cancer treatments continue to improve and become more targeted and personalized.

Nearly 15,000 children and adolescents in the United States are diagnosed with leukemia, lymphoma or other types of cancer each year. The rate of young patients surviving cancer for at least five years is now 85%, up from 58% a few decades ago.

To determine long-term risks, Dr. Bhandari, Saro Armenian , D.O., M.P.H., a pediatric hematologist-oncologist at City of Hope Children’s Cancer Center, and their colleagues reviewed a national database that tracks about 40,000 people who were diagnosed with cancer before they turned 21. The researchers identified individuals who were still alive at age 50 and then compared any new incidence of cancer with the rate of cancer found in the general population. The risks for chronic health conditions were compared to the patients’ siblings.

Having overcome cancer at an early age, survivors face new risks when they turn older, the study found. Young patients have a higher risk of secondary cancers and are five times more likely to die from the disease compared to other individuals over the age of 50.

Cancer survivors face increased risks for heart disease as well. In fact, pediatric cancer survivors had a higher incidence of heart problems at age 55 compared to their 70-year-old siblings. They were also more frail, had trouble with physical exertion and suffered poorer health in general.

Looking at the type of cancer treatment survivors had received, the team found that radiation therapy was the main culprit for future risks, rather than chemotherapy.

“Radiation causes cellular DNA damage that can lead to mutations and the development of new cancers,” said Dr. Armenian, senior author of the study.

The study was based on treatment regimens used in the 1970s and 80s. There have been vast improvements since then, including delaying or avoiding radiation in favor of targeted cancer drugs and emerging treatments such as immunotherapy and precision oncology. Still, Dr. Bhandari urges greater vigilance to protect against future health problems.

“Some survivors should screen for conditions like breast or colon cancer at an earlier age than is recommended for the general population,” Dr. Armenian said. “Teamwork is needed to ensure survivors receive necessary screening and preventative care for conditions, including secondary cancers.”

While young cancer patients faced more health problems as they got older, the study did find a bright spot when it came to mental health. Cancer survivors were no more likely to report mental health issues than their siblings at age 50.

“This mental health finding may reflect the resilience and positive mindset of our long-term survivors who have battled cancer,” Dr. Bhandari said. “This is a wonderful example of how our patients continue to inspire us as they navigate their cancer and survivorship journeys.”

A new study supports the first-line role of cervical spine x-ray as a screening exam in blunt pediatric trauma patients. 

The finding is from a 10-year review in which cervical spine (c-spine) x-ray screening had a sensitivity of 100% for clinically significant injuries, noted lead author William Starr, MD, of the University of Utah Health in Salt Lake City, and colleagues. 

“Our study provides a large contemporary cohort where national c-spine protocols are followed showing a normal c-spine [x-ray] and a normal physical examination resulted in zero missed clinically significant injuries,” the group wrote. The study was published August 3 in Trauma Surgery & Acute Care Open. 

Detection of pediatric c-spine injuries and the process by which cervical collars are removed is of the utmost importance, as missed injuries can be devastating, the authors explained. C-spine x-ray has been shown to be a valid screening tool for c-spine injury when coupled with a normal physical examination, and it is recommended by the Pediatric Trauma Society, they added. 

“Despite these recommendations, [x-rays] have been abandoned as a screening tool at some institutions,” the group wrote. 

Furthermore, the sensitivity and negative predictive value of c-spine x-rays have not been evaluated in a large, contemporary cohort of pediatric trauma patients, they noted. 

Thus, the group conducted a retrospective review of cases at their level 1 pediatric trauma center from 2012 to 2021. The hospital’s protocol is to start with x-ray in patients with Glasgow Coma Scale (GCS) scores between 14 and 15 and then go to multidetector CT in patients with a depressed GCS score. The researchers compared a group with negative c-spine x-ray and no additional imaging to a group with negative c-spine x-ray followed by additional c-spine CT and/or MRI. 

According to the results, out of 2,081 patients with negative x-rays, 1,974 (95%) had their c-spines cleared without additional imaging. The remaining 108 patients had additional c-spine imaging after negative c-spine x-ray for c-spine clearance (24 CT, 76 MRI, and 8 both CT and MRI). Indications for additional c-spine imaging were pain (48.1%), a GCS score ≤ 14 (43.5%), and paresthesia (8.3%), the researchers reported. 

“In this cohort, screening [x-ray] had a sensitivity of 100% for clinically significant c-spine injuries,” they wrote. 

Ultimately, although x-ray has been supported as a safe initial c-spine imaging modality for blunt, evaluable pediatric trauma patients, its use remains a complex and debated topic, the authors noted. X-ray has been shown to be more cost-efficient, associated with increased quality of life, and to have a decreased radiation burden when used as the initial screening modality. 

Meanwhile, in adult trauma, the utilization of x-ray has been almost completely replaced by CT, making c-spine x-ray a foreign test in many locations other than pediatric-specific centers, they wrote. 

“As pediatric specialists, it is important that we continue to promote [x-ray] as an important tool in pediatric trauma,” the group concluded. 

The full study is available here.

A study in Israel confirms antibiotic use as a major risk factor for Clostridioides difficile infection (CDI) in hospital patients, particularly for those who don’t carry the bacterium, researchers reported last week in JAMA Network Open.

For the study, which was conducted from June 2017 through June 2023, researchers analyzed data on patients admitted to a large tertiary medical center in Israel that routinely screens high-risk patients for C difficile carriage. While broad-spectrum antibiotic use is a known risk factor for CDI, the researchers wanted to evaluate the rate of hospital-onset CDI among asymptomatic C difficile carriers compared with noncarriers and assess the role of antibiotic exposure in shaping CDI risk in the two populations.

Antibiotic exposure linked to double the risk of CDI

Among 33,756 hospitalizations (median age, 78 years; 52.8% male), 1,624 (4.8%) had a positive screening result for C difficile. Overall, CDI occurred in 67 (4.1%) of 1,624 carriers and 47 (0.1%) of 32,132 noncarriers. 

In the entire cohort, exposure to any antibiotic was associated with double the risk for CDI (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.24 to 3.16), with each additional day of antibiotic exposure having an HR of 1.08 (95% CI, 1.03 to 1.13). Beta-lactam/beta-lactamase inhibitor combinations were associated with significantly increased risk, with piperacillin-tazobactam showing the most pronounced hazard for CDI (HR, 2.18; 95% CI, 1.41 to 3.36).

Although a positive C difficile screening result at admission was associated with a high risk of CDI (HR, 27.5; 95% CI, 18.7 to 40.3), antibiotic exposure among asymptomatic C difficile carriers was not significantly associated with a further increase in CDI risk (HR, 1.07; 95% CI, 0.73 to 1.58).

The study authors say the findings suggest that, while antibiotic stewardship may reduce CDI risk in noncarriers, additional strategies may be needed for asymptomatic carriers.

“Among carriers, preventive measures in addition to antibiotic stewardship should be evaluated in hospitalized patients and may include probiotics, monoclonal antibodies, or biotherapies,” they wrote. “However, further research is necessary to evaluate the potential effectiveness of these interventions, their association with microbiome alterations, and potential changes in antimicrobial resistance patterns among patients and within the hospital environment.”