Analysis of ST segment alarms in children admitted to the paediatric and cardiac intensive care units and cardiac progressive care unit: a single-centre retrospective study.

ST segment monitoring in the adult population allows for the early detection of myocardial ischaemia. In children admitted to the paediatric intensive care unit (PICU), cardiac intensive care unit (CICU), and cardiac progressive care unit (CPCU), it is unclear if continuous ST segment alarm monitoring is necessary in all patients. All patients admitted to the PICU, CICU, and CPCU during the study period were included. Children with any ST segment alarms were compared with those without an alarm during their stay. The electrocardiogram confirmed true ST segment alarms were compared with all other ST segment alarms. Demographic and clinical data were extracted from the medical record. Medical interventions and procedures occurring around ST segment alarms were recorded for multivariable analysis assessing for the association of true ST segment. Logistic regression was used to evaluate the associations with ST segment alarms during hospital stays. ST segment alarms occurred in 36% of hospital stays, and only 3.4% were considered true. True alarms were significantly more common among patients with a cardiac-related diagnosis, located in both cardiac units, and having received an intervention with any vasoactive medication. In the multivariable logistic regression, patients 11 years or older, hypotension, supraventricular tachycardia, and initiation/escalation of any vasoactive were independently associated with a true ST segment alarm. True ST segment alarms were infrequent, occurring in 1.2% of stays during the study period. Alarm monitoring may be beneficial in those with an underlying cardiac diagnosis.

Is Austerity Responsible for the Stalled Mortality Trends Across Many High-Income Countries? A Systematic Review.

This article systematically reviews evidence evaluating whether macroeconomic austerity policies impact mortality, reviewing high-income country data compiled through systematic searches of nine databases and gray literature using pre-specified methods (PROSPERO registration: CRD42020226609). Eligible studies were quantitatively assessed to determine austerity's impact on mortality. Two reviewers independently assessed eligibility and risk of bias using ROBINS-I. Synthesis without meta-analysis was conducted due to heterogeneity. Certainty of evidence was assessed using the GRADE framework. Of 5,720 studies screened, seven were included, with harmful effects of austerity policies demonstrated in six, and no effect in one. Consistent harmful impacts of austerity were demonstrated for all-cause mortality, life expectancy, and cause-specific mortality across studies and different austerity measures. Excess mortality was higher in countries with greater exposure to austerity. Certainty of evidence was low. Risk of bias was moderate to critical. A typical austerity dose was associated with 74,090 [-40,632, 188,792] and 115,385 [26,324, 204,446] additional deaths per year. Austerity policies are consistently associated with adverse mortality outcomes, but the magnitude of this effect remains uncertain and may depend on how austerity is implemented (e.g., balance between public spending reductions or tax rises, and distributional consequences). Policymakers should be aware of potential harmful health effects of austerity policies.

Benefits managers' attitudes toward obesity treatment coverage.

Despite the existence of effective treatments, obesity continues to present a severe public health crisis. Limited access to treatments works against efforts to reduce obesity prevalence. A major barrier to treatment access is a lack of insurance coverage. This study focused on an important population of stakeholders: benefits managers. The purpose of this study was to explore the relationships between attitudes about insurance coverage of obesity treatments and obesity stigma. Benefits managers have the ability to advocate for insurance coverage of medical interventions. We assessed whether attitudes toward covering obesity benefits for employees could be modified by receiving targeted information or were associated with particular factors. We recruited participants from Dun & Bradstreet's employer database using emails. Participants were randomized to one of three conditions that provided written information about: (1) prevalence of obesity (control), (2) prevalence + financial implications of obesity, and (3) prevalence + physiology of obesity. Questionnaires were self-administered online. The response rate was 4.8%, with 404 participants meeting eligibility criteria. While attitudes toward coverage of obesity interventions did not differ significantly based on condition (p > 0.05), gender, history of previous obesity treatment, and an individual's likelihood to attribute obesity to biological and environmental factors showed significant associations with supporting coverage of obesity treatment (p < 0.05). Findings suggest that understanding obesity as a condition caused by biological factors as opposed to personal responsibility and behavior is associated with greater support for coverage of all its treatments.

Health care providers' attitudes and counseling behaviors related to obesity.

Background: Obesity affects over 42% of the U.S. adult population, yet it remains undertreated. Many healthcare providers are biased in their perceptions and attitudes regarding obesity management and lack knowledge about how to treat it. Methods: The authors analyzed the results of the 2021 DocStyles survey to examine primary care providers' treatment and perceptions of obesity. The sample consisted of primary care physicians and nurse practitioners/physician assistants. Questions assessed healthcare providers' attitudes and counseling behaviors related to obesity, including referrals, use of medical therapy, barriers to care, and perceived risk factors for obesity. Results: 1168 primary care providers who treat obesity participated in the survey. About half of the providers reported referring patients for obesity treatment. Almost two-thirds of providers had prescribed anti-obesity medications in the last 12 months. Those who did not prescribe anti-obesity medications reported a lack of familiarity with the medications or concerns about safety. Over three-quarters of providers indicated at least one barrier to treating obesity. Over half of the providers reported that poverty and food insecurity contributed significantly to the high prevalence of obesity in communities of color. Conclusion: Increased familiarity with anti-obesity medications may improve treatment. Reasons for patients' low priority accorded to obesity care remain the focus of future research.

A Comprehensive Obesity Benefit as a Guide for Employers on the Core Components of Obesity Care: Guidance From the American College of Occupational and Environmental Medicine (ACOEM) Roundtable on Obesity.

OBJECTIVE: The need to confront the obesity epidemic and its impact on employers requires a serious look at how we address the treatment of obesity. This article focuses on the core components of obesity care and the need for employers to offer a comprehensive obesity benefit (COB) as part of employee insurance coverage. METHODS: In May 2022, the American College of Occupational and Environmental Medicine convened a roundtable meeting, which brought together five corporate medical directors and representatives from aerospace/defense and energy industries to learn about the disease of obesity and provide clinical insights regarding health and safety in their respective industries. The goals of the program were to provide awareness of benefits for the treatment of obesity and identify the feasibility for employers of implementing a COB for their employees. Participants learned how a comprehensive approach to covering obesity treatments is necessary, and what benefits should be offered to employees. RESULTS: Participants were invited to review the insurance benefits they currently offer to employees and compare them to the COB. Outcomes were limited by a lack of participation by the employers invited to participate. Participants identified actions that need to be addressed for employers to develop a more comprehensive approach to obesity care. CONCLUSION: Implementing a COB can help employers increase access and utilization of comprehensive obesity care by employees.

Coverage for obesity prevention and treatment: analysis of state employee health plans and use of benefits.

OBJECTIVE: Using data from 2017, the authors have previously examined the coverage of obesity-related services in state employee health plans since 2009 and found improvements in coverage for obesity-related treatments. This study repeated the collection of similar data for 2021 and explored whether coverage had continued to increase or decline. METHODS: Data on obesity benefits for state employees were obtained from publicly available documents from relevant state websites. Source documents were reviewed for language that would indicate the availability of coverage for nutritional counseling, pharmacotherapy, and bariatric surgery. Use data were collected when available, but availability was limited. RESULTS: Coverage for some treatments of obesity continued to trend upward, as was the case between 2009 and 2017, but coverage for pharmacotherapy declined from 2017 to 2021. Use data were received from only eight states; analysis of these data indicated underuse of obesity benefits by plan enrollees compared with each state's rate of obesity. CONCLUSIONS: Despite promising new therapies, states in 2021 were less likely to provide coverage for antiobesity medications. Additionally, limited use data suggested that few eligible individuals may be receiving these services. In conclusion, state employee health plans are currently inadequate given the prevalence, severity, and costs of obesity.

Weight Can't Wait: A Guide to Discussing Obesity and Organizing Treatment in the Primary Care Setting.

OBJECTIVE: The objective of this study was to develop a simple and practical guide for discussing and managing obesity in primary care settings. METHODS: This study convened representatives from 12 primary care and obesity specialty organizations for a series of roundtable meetings to discuss the key components of obesity treatment in primary care. Attendees identified the need for a guide for primary care providers that outlined the key steps for discussing obesity with patients and managing their care while recognizing the significant time constraints on such provider/patient encounters. RESULTS: Prevailing themes from the roundtable sessions suggested that the key components of addressing obesity in primary care settings are obtaining patient permission, addressing weight bias, providing a diagnosis, and emphasizing shared decision-making. A modified "6A" framework with the steps "Ask," "Assess," "Advise," "Agree," "Assist," and "Arrange" was deemed appropriate to organize the process of weight management in primary care. An algorithm was developed to provide a script for the patient/provider encounter. CONCLUSIONS: The expert panel developed a short, accessible, practical, and informative guide for obesity management by primary care clinicians. Efforts are under way to disseminate the guide to primary care providers through the 11 participating organizations that have endorsed it.

A Proposed Standard of Obesity Care for All Providers and Payers.

OBJECTIVE: The aim of this work is to develop a practical, tangible, measurable, and simple standard of care for the treatment of adult obesity that provides guidance for both clinical providers and community settings. METHODS: Three roundtables with relevant stakeholder groups were convened by the STOP Obesity Alliance at The George Washington University to develop the proposed standard of care. RESULTS: The proposed standard of care for adult obesity treatment proposes practices for the spectrum of clinical, community, and digitally based entities and for clinical providers. Coverage and payment policy standards are also provided. CONCLUSIONS: These standards are intended to augment published guidelines developed for obesity care providers and can also be viewed as the first step to define an optimal benefit package.

Coverage for Obesity Prevention and Treatment Services: Analysis of Medicaid and State Employee Health Insurance Programs.

OBJECTIVE: This study examined changes in coverage for adult obesity treatment services in Medicaid and state employee health insurance programs between 2009 and 2017. METHODS: Administrative materials from Medicaid and state employee health insurance programs in all 50 states and the District of Columbia were reviewed for indications of coverage and payment policies specific to evidence-based treatment modalities for adults (≥ 21 years of age) with obesity, including nutritional counseling, pharmacotherapy, and bariatric surgery. RESULTS: From 2009 to 2017, the proportion of state employee programs indicating coverage increased by 75% for nutritional counseling (from 24 to 42 states), 64% for pharmacotherapy (from 14 to 23 states), and 23% for bariatric surgery (from 35 to 43 states). The proportion of Medicaid programs indicating coverage increased by 133% for nutritional counseling (from 9 to 21 states) and 9% for bariatric surgery (from 45 to 49 states), with no net increase for pharmacotherapy (16 states in both plan years). CONCLUSIONS: Coverage for adult obesity care improved substantially in Medicaid and state employee insurance programs since 2009. However, recommended treatment modalities are still not covered in many states. Where coverage has expanded, educating providers and beneficiaries on the availability and proper use of evidence-based obesity treatments may improve health outcomes.

Current Knowledge of Obesity Treatment Guidelines by Health Care Professionals.

OBJECTIVE: The objective of this study was to assess health care professionals' knowledge of evidence-based guidelines for the nonsurgical treatment of obesity. METHODS: A nationally representative sample of internists, family practitioners, obstetricians/gynecologists, and nurse practitioners completed a web-based survey between June 9 and July 1, 2016 (n = 1,506). RESULTS: Only 16% of respondents indicated that obesity counseling should be provided approximately twice monthly in an individual or group setting for at least 6 months, in accordance with United States Preventive Services Task Force and Centers for Medicare and Medicaid Services guidelines. Only 15% of respondents identified BMI ≥ 27 kg/m2 with an obesity-associated comorbid condition as the appropriate indication to prescribe pharmacotherapy for patients. Two-thirds of respondents indicated that it is appropriate to continue long-term pharmacotherapy under conditions inconsistent with evidence-based guidelines, with nearly one-quarter indicating that obesity medications should never be prescribed beyond 3 months regardless of weight loss. CONCLUSIONS: These findings suggest that provider understanding of appropriate clinical care for obesity is inconsistent with evidence-based recommendations. As coverage for behavioral counseling services and pharmacotherapy expands, it is imperative that health care professionals understand how to effectively leverage these treatment modalities to optimize health outcomes for patients with obesity.

Current attitudes and practices of obesity counselling by health care providers.

INTRODUCTION: Relatively few patients receive obesity counselling consistent with the USPSTF guidelines, and many health care professionals (HCPs) are biased in their attitudes towards obesity management. METHODS: A national sample of family physicians, internists, OB/GYN physicians, and nurse practitioners (NPs) completed a web-based survey of beliefs, practice, and knowledge regarding obesity management. RESULTS: A majority of HCPs believe that it is both the patient's and the provider's responsibility to ensure that the patient is counselled about obesity. Obesity (77%), obesity-related diseases (79%), or obesity-related risk factors (71%) prompt HCPs to offer obesity counselling; 59% of HCPs wait for the patient to broach the subject of their weight. Increased blood pressure (89%) and heart disease risks (90%) are the most common themes in counselling. Across all HCPs except NPs "exercise" is discussed more frequently than "physical activity" (85% vs 81%), "diet" more frequently than "eating habits" (77% vs 75%), and "obesity" more frequently than "unhealthy weight" (60% vs 45%). NPs are more likely to discuss physical activity, eating habits, and unhealthy weight instead. To improve counselling for obesity, HCPs reported needing more time (70%), training in obesity management (53%), improved reimbursement (53%), and better tools to help patients recognise obesity risks (50%). Obesity-related diseases, risk factors, or obesity alone predict obesity counselling amongst HCPs. CONCLUSION: Better training in weight management and tools to help patients recognise risks appear to be key elements in helping patients compare the risks of what they may consider invasive therapy against the risks of continued obesity.