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    <recommendedItem id="20100101_19_132"
                     title="Economic Burden of Diabetes Tops $200B"
                     score="-0.004"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/17950?impressionId=1265760714175"
                     
      &lt;p&gt;Medical costs and reduced work productivity associated with diabetes cost the U.S. $218 billion in 2007, researchers said.&lt;/p&gt;
&lt;p&gt;The annual average cost per patient was $9,975 for diagnosed diabetes and $2,864 for undiagnosed disease, according to Timothy M. Dall of the Lewin Group in Falls Church, Va., and colleagues.&lt;/p&gt;
&lt;p&gt;&quot;The burden of diabetes to society is even higher when one considers intangible costs from reduced quality of life,&quot; the researchers wrote online in &lt;em&gt;Health Affairs&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;The sobering statistics presented in this paper underscore the urgency to better understand the cost-mitigation potential of prevention and treatment strategies.&quot;&lt;/p&gt;
&lt;p&gt;Dall and his colleagues, working with funding from Novo Nordisk, developed the estimates from a proprietary economic model based on medical literature, government statistics, and insurance claims data.&lt;/p&gt;
&lt;p&gt;Results from the National Health Interview Survey, corrected with claims data, indicate that about one million Americans had type 1 diabetes and 16.5 million had type 2 diabetes in 2007.&lt;/p&gt;
&lt;p&gt;The economic model indicated that the per-patient economic burden was $14,856 for type 1 diabetes and $9,677 for type 2 disease.&lt;/p&gt;
&lt;p&gt;National Health and Nutrition Examination Survey findings indicate that some 57 million individuals had &quot;prediabetes,&quot; and another 6.3 million Americans had diabetes but have not been formally diagnosed.&lt;/p&gt;
&lt;p&gt;Their average costs were $443 for prediabetes (medical costs only) and $2,864 for undiagnosed diabetes, Dall and colleagues estimated.&lt;/p&gt;
&lt;p&gt;Compared to those with no diagnosis, people with known diabetes accounted for vastly more use of various services, including outpatient care, emergency visits, and hospitalization.&lt;/p&gt;
&lt;p&gt;For example, ambulatory visits for neurological symptoms were nearly eight times as common among among type 1 diabetics as among nondiabetics, and five times as common among those with type 2 diabetes.&lt;/p&gt;
&lt;p&gt;Inpatient days for cardiovascular problems were increased more than six-fold for both types of diabetes, and emergency visits for such problems were about three times as common.&lt;/p&gt;
&lt;p&gt;Undiagnosed diabetes had smaller but still detectable consequences for medical expenses. Compared with people with no history of diabetes, undiagnosed diabetics had 70% more outpatient visits and more than twice as many hospital inpatient days for cardiovascular complaints.&lt;/p&gt;
&lt;p&gt;Overall, the bill for medical services associated with diabetes was $153 billion, according to Dall and colleagues  --  about 7% of the total national healthcare expenditure.&lt;/p&gt;
&lt;p&gt;The researchers put the loss of work productivity at $65 billion, including absenteeism, reduced productivity while at work, disability, and premature death.&lt;/p&gt;
&lt;p&gt;Some of the data underlying the estimate came from National Health Interview Survey data on missed workdays and disability rates, reports in the literature, and CDC estimates of diabetes-related mortality.&lt;/p&gt;
&lt;p&gt;Dall and colleagues noted that patients and their families bear much of the burden in the form of out-of-pocket expenses and reduced earnings  --  not to mention the impaired quality of life and other intangibles.&lt;/p&gt;
&lt;p&gt;But everyone else shares the costs as well, they argued.&lt;/p&gt;
&lt;p&gt;&quot;This diabetes burden represents a hidden &apos;tax&apos; in the form of higher health insurance premiums and reduced disposable income,&quot; Dall and colleagues wrote.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_112"
                     title="Heart Risk of BPA Confirmed (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/tb/17921?impressionId=1265760714175"
                     
      Researchers have confirmed that the bisphenol A (BPA)  --  widely used in plastics including baby bottles and other drink containers  --  increases the risk of cardiovascular disease.&lt;br&gt;
&lt;br&gt;Patients with the highest levels of the endocrine disruptor in their urine carried a 33% increased risk of coronary heart disease, a follow-up analysis of National Health and Nutrition Examination Survey (NHANES) data showed.&lt;br&gt;
&lt;br&gt;But associations with diabetes and elevated liver enzymes, which were found in earlier data that the researchers reported in 2008, were no longer significant, David Melzer, PhD, of Peninsula Medical School in Exeter, England, and colleagues reported online in &lt;em&gt;PLoS ONE&lt;/em&gt;. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/10924&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/10924&quot; target=&quot;_blank&quot;&gt;Common Chemical Linked to Metabolic and Cardiovascular Disorders&lt;/a&gt;)&lt;br&gt;
&lt;br&gt;Yet an increased risk of all three conditions remained in pooled analyses.&lt;/p&gt;
&lt;p&gt;&quot;This is only the second analysis of BPA in a large human population sample,&quot; Melzer said in a statement. &quot;It has allowed us to largely confirm our original analysis and exclude the possibility that our original findings were a statistical &apos;blip.&apos;&quot;&lt;/p&gt;
&lt;p&gt;Frederick vom Saal, PhD, of the University of Missouri in Columbia, an expert on BPA who was not involved in the study, said the analysis indeed demonstrates that the initial finding is not just an isolated one.&lt;/p&gt;
&lt;p&gt;&quot;This is a big deal because it is possible to do something about this factor: reduce BPA exposure by altering its use,&quot; vom Saal said in an e-mail.&lt;/p&gt;
&lt;p&gt;BPA is found in dozens of household products  --  from drink containers and food packaging to the lining of canned goods.&lt;/p&gt;
&lt;p&gt;The vast majority of the U.S. population  --  over 90%  --  is exposed to the chemical by some means or another. It&apos;s an endocrine disruptor that&apos;s been shown to have both estrogen-agonist and androgen-antagonist activity.&lt;/p&gt;
&lt;p&gt;So for the present study, the researchers assessed information on 1,493 patients from the 2005-2006 NHANES data (their previous analysis looked at data from the 2003-2004 NHANES).&lt;/p&gt;
&lt;p&gt;They found that urinary BPA concentrations were lower than in the previous study (1.79 ng/mL versus 2.49 ng/mL).&lt;/p&gt;
&lt;p&gt;Still, higher BPA concentrations were associated with coronary heart disease (OR 1.33, 95% CI 1.01 to 1.75, &lt;em&gt;P&lt;/em&gt;=0.043).&lt;/p&gt;
&lt;p&gt;Associations with diabetes were no longer significant, but pooled estimates over time did remain significant at &lt;em&gt;P&lt;/em&gt;=0.001.&lt;/p&gt;
&lt;p&gt;As for liver enzymes, the present study found no overall association with gamma glutamyl transferase concentrations. Again, pooled associations with alkaline phosphatase and lactate dehydrogenase remained significant.&lt;/p&gt;
&lt;p&gt;Philip Landrigan, MD, of Mount Sinai School of Medicine, who was likewise not involved in the study, said that recognizing lifestyle factors associated with heart disease  --  including smoking, hypertension, and obesity  --  have reduced the death rate from heart disease. Now, researchers are beginning to understand environmental triggers for the disease as well.&lt;/p&gt;
&lt;p&gt;&quot;Fine particulate air pollution, dioxins, and PCBs are three classes of chemicals that have been found within the past few years to be closely linked to heart disease,&quot; Landrigan said in an e-mail. &quot;Now with the publication of this paper, the evidence appears increasingly strong that BPA may be a fourth toxic chemical risk factor.&quot;&lt;/p&gt;
&lt;p&gt;How does BPA affect the heart? The researchers said the metabolism of BPA may induce oxidative stress and endothelial cell damage.&lt;/p&gt;
&lt;p&gt;The researchers noted that the study was limited by its cross-sectional nature.&lt;/p&gt;
&lt;p&gt;Michele Marcus, PhD, MPH, of Emory University, brought attention to this limitation.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s not clear whether the association is due to BPA or something else related to BPA exposure,&quot; Marcus said in an e-mail. &quot;For example, a major route of exposure to BPA is from the lining of soda cans. So people with diabetes might have higher BPA because they drink more soda.&quot;&lt;/p&gt;
&lt;p&gt;Melzer and colleagues said further studies evaluating the association and its mechanisms are needed.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
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                     title="IDSA: Virulent Skin Infections From Cuts Soaked in Sea Water"
                     score="-0.005"
                     href="