Jennifer Nessel, Assistant Editor

Older patients who experience daytime sleepiness may be at risk of developing new medical conditions, including diabetes, cancer, and high blood pressure. The findings were presented at the American Academy of Neurology’s 72nd Annual Meeting in Toronto, Canada.

Hypersomnolence is known to be excessive daytime sleepiness despite having 7 or more hours of sleep. It can be debilitating for some individuals, affecting the way that they perform at work, and in other daily activities.

“Paying attention to sleepiness in older adults could help [providers] predict and prevent future medical conditions,” said study author, Maurice M. Ohayon, MD, PhD, DSc, researcher at Stanford University. “Older adults and their family members may want to take a closer look at sleeping habits to understand the potential risk for developing a more serious medical condition.”

The study included 10,903 individuals, and 34% of these participants were aged 65 years or older. The researchers interviewed participants over the phone twice, 3 years apart. In the first interview, 23% of individuals over age 65 years met the criteria for excessive sleepiness, whereas in the second interview, 24% reported excessive sleepiness, and of those, 41% said that sleepiness was a chronic problem.

Participants who reported sleepiness in the first phone interview had a 2.3 times greater risk of developing diabetes or high blood pressure 3 years later than those who did not experience sleepiness.

Of the people who reported sleepiness at the first interview, 6.2% developed diabetes, while 2.9% of respondents who were never sleepy during the day developed diabetes. Additionally, 2.4% of the individuals with daytime sleepiness developed cancer, compared to 0.8% of those who were not sleepy during the day.

The results remained the same after researchers adjusted for other factors that could affect daytime sleepiness, such as gender and sleep apnea. Those that reported daytime sleepiness during both interviews had a 2.5 times greater risk of developing heart disease.

Additionally, participants who reported sleepiness only in the second interview were 50% more likely to also have diseases of the musculoskeletal system and connective tissue, such as arthritis, tendinitis ,and lupus, than those who did not have daytime sleepiness.

The authors noted that a limitation of the study included a reliance on participant’s memories, rather than monitoring their sleep length and quality, and daytime sleepiness in a sleep clinic.

Are Grandma, Grandpa Sleepy During the Day? They May Be at Risk for Diabetes, Cancer, More [news release]. Minneapolis, MN. Published March 1, 2020.

https://www.aan.com/PressRoom/Home/PressRelease/3776

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Older patients who experience daytime sleepiness may be at risk of developing new medical conditions, including diabetes, cancer, and high blood pressure.

Daytime Sleepiness Linked to Risk of Developing Diabetes, Cancer in Older Patients

Walmart, AT&T and other retail giants are moving into the health care space by effectively transforming some of their best selling assets into health care tools. Here&#39;s a look at what some retailers are doing to advance into health care:

Walmart has most recently opened its second primary health care facility, Walmart Health, in Calhoun, Georgia. The center will be staffed with health care providers offering services from walk-in and clinical care to x-rays and dental services, mirroring a similar center it opened in September 2019, in Dallas, Georgia.

Matt Parry, head of customer experience and strategy for Health and Wellness at Walmart, said that the company’s newest addition within health care is a matter of convenience for the consumer.

“We have 150 million shoppers who are coming in [to stores]. This is a convenient opportunity for them to combine a trip to pick up groceries, get their health care, get some glasses, whatever. So, there is obviously a big ecosystem [at] play in terms of making customers’ lives easier and saving them money,” Parry said at a recent CES 2020 event in Las Vegas as reported by

According to Simeon Gutman, analyst at Morgan Stanley, the retail giant’s momentum within health care is unlikely to stop. “From this starting point, we think expansion into stand-alone health clinics offering an array of services makes sense and should not be surprising,” said Gutman.

Best Buy and Comcast are turning to senior living facilities to develop solutions for remote health care. Best Buy is forming “health care squads,” similar to its well-known Geek Squad model, which may potentially conduct house calls at the homes of senior patients who may have limited mobility.

In order to monitor sleeping and eating habits, the mobile team places sensors throughout the patients’ homes. They can then use a medical device, known as GreatCall, to observe the data so that they can call the patient’s home to check on them.

Best Buy began piloting its health care projects in the homes of 1 million seniors last year, according to its CEO, Corie Barry.

Meanwhile, Comcast is concurrently creating a health care platform for patients’ TVs. The latest project is similar to its Quil system that launched in 2018, which is designed to help patients prepare for and recover from surgery, such as hip replacements.

The goal, Don Mathis, general manager of growth and strategic development at Comcast, said in an interview with

that the program’s goal “is to help people take better control of their health care.”

AT&T is delving into the market through the use of its wireless network to develop remote health care tools. The company started its work in health care about a decade ago, according to

The company is working to develop gurneys embedded with sensors that help EMTs and clinicians track patients. Another project involves collaborating with medical-bracelet company Zebra to create better forms of identification that also verifies a patient’s location.

A version of this article was originally published by

Is ‘Big Retail’ the next big health care disruptor?.

https://www.advisory.com/daily-briefing/2020/02/07/retail-disrupt

Brumley, James. Walmart Just Dragged Primary Care Into the Healthcare Cost Battle.

https://www.fool.com/investing/2020/02/04/walmart-just-dragged-primary-care-into-the-healthc.aspx

Blank, Christine. Walmart Tests Health Clinics. September 4, 2019.

https://www.drugtopics.com/walmart/walmart-tests-health-clinics

Nathan-Kazis, Josh. Walmart Could Disrupt Health Care the Same Way It Did Retail, Analyst Says. Published September 3, 2019.

https://www.barrons.com/articles/walmart-stock-health-care-stand-alone-health-clinic-51567522182

Walmart makes ecosystem play in healthcare.

https://www.warc.com/newsandopinion/news/walmart-makes-ecosystem-play-in-healthcare/43139

Walmart, AT&T and other retail giants are moving into the health care space by effectively transforming some of their best selling assets into health care tools. 

Large Retailers Advancing into Health Care

Australian researchers have analyzed how the immune system responds to urinary tract infections (UTIs), and the direct link this response has to magnifying bladder pain. Understanding how nerves in the bladder transmit different sensations to the brain could potentially help limit bladder dysfunction in patients with overactive bladders, according to study authors.

The study was conducted by researchers at Flinders University in South Australia in collaboration with the South Australian Health and Medical Research Institute in Adelaide, and Griffith University on the Gold Coast, Queensland.

“We believe that chronic pain and bladder dysfunction are a failure of these nerves to reset after inflammation, so by understanding how these nerves function with a UTI and what causes them to become more sensitive over time, we can develop effective treatments,” said Luke Grundy, MD, research fellow for Clinical Pharmacology and head of Bladder Research at Flinders, in a prepared statement.

UTIs are painful and usually short lived; however, low levels of infection can be found long after they are thought to have cleared. Research suggests that this process could be an unknown but leading cause of chronic bladder dysfunction.

“This is important, as many people diagnosed with an overactive bladder, a disorder than is currently considered to have no specific cause, have been shown to have persistent low levels of UTI. This may lead to enhanced patient diagnosis and alternative treatment options for those suffering with an overactive bladder,” said Grundy.

With a number of antibiotic resistant UTI’s growing globally each year, many individuals can no longer be treated with common antibiotics, despite the fact that 1 in every 2 women will develop a UTI in their lifetime. Grundy says this study provides new information into how UTI causes hypersensitivity of the nerves that carry sensation from the bladder to the brain, resulting in adverse events such as urinary frequency, urgency, and pelvic or suprapubic pain.

“Our study provides a new understanding of why some [patients with overactive bladder] do not respond to traditional medications and continue to suffer in silence and opens the door for the development of more specific and effective treatments in the future,” concluded Grundy.

New Hope to Reduce Bladder Pain [news release]. Flinders University website. Published February 3, 2020.

https://news.flinders.edu.au/blog/2020/02/03/hope-to-minimise-bladder-pain/

Understanding how nerves in the bladder transmit different sensations to the brain could potentially help limit bladder dysfunction in patients with overactive bladders.

New Research Reveals How Immune System Responds to Urinary Tract Infections

The World Health Organization (WHO) has declared the new coronavirus (2019-nCoV) to be a public health emergency of international concern,

as the CDC announced the 6th case of the virus in the United States, as well as the country’s first documented person-to-person transmission. In a tele-briefing Thursday, the CDC also reiterated that the threat to the general public in the US is still low.

“Over the past few weeks, we have witnessed the emergence of a previously unknown pathogen which has escalated into an unprecedented outbreak, and which has been met by unprecedented response,” said Tedros Adhanom, PhD, director general of WHO, during a press conference Thursday.

Adhanom said there are now 98 confirmed cases in 18 countries, besides China, including 8 cases of human-to-human transmission in 4 countries. There have been no deaths from the virus outside of China, which has seen more than 7000 cases of infection.

While the WHO’s declaration does not have the force of law, it serves as a notice to all United Nations member states that the organization’s leaders think the situation is serious. Governments then make their own decisions about responses, including whether to close their borders, cancel flights, screen people arriving at airports, or to take other protective measures.

In the US, Illinois and California each have confirmed 2 cases of the 2019-nCoV, while Arizona, and Washington State each have a single case.

According to CDC director Robert Redfield, MD, and Nancy Messonnier, MD, director of the National Center for Immunization and Respiratory Diseases, the latest US case of the virus is the 2nd in Illinois, and the first involving person-to-person transmission. The patient identified in this latest case  was in close contact to the individual from the first confirmed US case.

The first US case in Illinois was a woman aged in her 60s that had returned from Wuhan, China, where the virus is believed to have originated in humans. Her husband, who had been in close contact with her while she had been presenting symptoms, is being monitored, and has presented symptoms as well, leading health officials to determine that it is the first person-to-person transmission of 2019-nCoV within the US. In the second case, underlying illness has been confirmed.

This transmission of the virus makes the US the fifth country where the infection is now spreading through human-to-human contact, joining China, Germany, Japan, and Vietnam.

Chinese health authorities were the first to post the full genome of the 2019-nCoV, which as first detected in Wuhan City, Hubei Province. Coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats. The 2019-nCoV is a betacoronavirus, like MERS and SARS, all of which have their origins in bats.

CDC officials reported 21 pending cases of possible 2019-nCoV within Illinois, according to the CDC. The Illinois Public Health Department is actively monitoring the individuals at risk but has reiterated that the general public is not at risk. Illinois public health officials are not recommending the general public to cancel activities or to wear face masks.

Current recommendations from the World Health Organization for people with 2019-nCoV include

The patient should be provided with a face mask and placed in a closed room, preferably with structural safeguards against airborne transmission.

Anyone entering the room should follow standard, contact, and airborne precautions.

Patients managed at home should self-isolate in a single area, preferable with a separate bathroom, and should continue to wear a face mask during any contact with others.

The patient and anyone in contact with them should follow strict hygiene, including diligent hand washing, and cough hygiene.

“This is a serious public health threat. The fact that this virus has caused severe illness and sustained person-to-person spread in China is concerning, but it’s unclear how the situation in the United States will unfold at this time,” according to the CDC website.

Adhanom said the declaration of a public health emergency should not cause panic, but instead urged the global community to help prepare countries who may have weaker health systems which are less prepared for such a viral outbreak.

“Our greatest concern is the potential for the virus to spread to countries with weaker health systems,” Adhanom said.

The ongoing goal of the WHO, CDC, and affiliating public health departments is to contain the 2019-nCoV outbreak. More information on this developing situation can be found on the CDC’s

2019 Novel Coronavirus (2019-nCoV) in the United States. CDC website. Updated January 30, 2020.

https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

Novel Coronavirus (2019-nCoV) Situation Report. World Health Organization. Published January 27, 2020.

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200127-sitrep-7-2019--ncov.pdf

Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. World Health Organization, January 25, 2020.

https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125

The World Health Organization (WHO) has declared the new coronavirus (2019-nCoV) to be a public health emergency of international concern, as the CDC announced the 6th case of the virus in the United States, as well as the countryâ€™s first documented person-to-person transmission.

WHO Declares Coronavirus an International Public Health Emergency as US Reports First Human-to-Human Transmission

There are now 5 confirmed cases of coronavirus in the United States, according to the CDC, but the agency said the threat to the general public is still low. California has 2 confirmed cases of the virus, while Arizona, Illinois, and Washington State each have a single case.

The virus, first seen in Wuhan, China, is characterized by mild to severe respiratory illness, including fever, cough, and shortness of breath. Other symptoms may include fever, myalgia, fatigue, sputum production, headache, haemoptysis, and diarrhea.

The Wuhan region is experiencing an outbreak of the new coronavirus, and cases of the virus have been confirmed in more than 15 countries, including the US and Canada.

About 25% of reported cases have been classified as severe, according to Elsevier’s coronavirus information center. The mortality rate is approximately 3%, with 41 deaths in the first 1287 reported cases. So far, mortality has been associated with advanced age or comorbidities.

This human-to-human coronavirus is being spread by travelers to the Wuhan region, according to the CDC, and the agency is recommending that people avoid nonessential travel to China.

The CDC is continuing to monitor the situation and make aggressive strides toward better understanding the disease and establishing effective treatments.

“At this point, even in the CDC, there are still a lot of questions to be answered,” said Ken Thai, PharmD, president of the California Pharmacists Association (CPhA).

The simultaneous occurrence with flu season and similar symptoms have made identification difficult. In patients with respiratory symptoms, clinicians should inquire about recent travel history or close contact with someone who has recently traveled to China.

Symptoms may be slightly more severe than typical flu or pneumonia-like symptoms, including a higher fever, shortness of breath, or chest tightness. Pneumonia-like symptoms can be very general, Thai said, so clinicians should pay close attention to the demographics of the patient&#151;elderly patients or those who are immunocompromised are at the most risk.

Another key aspect of the virus is its human-to-human spread, Thai said.

“Coronaviruses are typically spread from animals to humans, so the fact that there’s human-to-human contraction is pretty rare,” Thai said.

In the US, suspected cases should be reported to local or state health departments, which will coordinate diagnostic testing through the CDC if the patient meets clinical and epidemiologic criteria. Collection of specimens from the upper respiratory tract, lower respiratory tract, and serum is a priority, according to the CDC. The agency also advised that testing for other respiratory pathogens by the provider should not be delayed by specimen shipping to the CDC.

There is currently no antiviral agent available for treatment of the infection, and there is no vaccine. Current recommended treatments are supportive, and include supplemental oxygen, and conservative fluid management.

Infection control measures should be implemented immediately once an infection is suspected.

Current recommendations from the World Health Organization include:

The patient and anyone in contact with them should follow strict hygiene, including diligent hand washing and cough hygiene.

Thai said there have been many inquiries about purchasing face masks in community pharmacies, especially from people in Asian communities where there may be more travelers from Wuhan City and the surrounding region. Still, Thai said, the virus is not a reason to panic.

“I am not going to say you should not be concerned,” Thai said. “I think that’s how global pandemics occur, when people are maybe not keeping up with the facts and the data. But there have been honestly very low numbers of [coronavirus] incidents thus far.”

CDC confirms additional cases of 2019 Novel Coronavirus in United States [news release]. Centers for Disease Control and Prevention; January 26, 2020.

https://www.cdc.gov/media/releases/2020/s0126-coronavirus-new-cases.html

CDC. Confirmed 2019-nCoV Cases Globally Global Map. CDC website.

https://www.cdc.gov/coronavirus/2019-ncov/locations-confirmed-cases.html

. Reviewed January 28, 2020. Accessed January 28, 2020.

Novel Coronavirus Information Center, Elsevier. Elsevier.com/connect/coronavirus-information-center. Accessed January 27, 2020.

CDC. Novel Coronavirus in China. CDC website.

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. Reviewed January 27, 2020. Accessed January 28, 2020.

CDC Confirms Additional Coronavirus Cases, Says Threat to US is Low

New Jersey Gov. Phil Murphy has signed Senate Bill 3265 into law, effectively banning the sale of most flavored electronic cigarettes in the Garden State. The law is the United States’ first permanent flavor ban.

“As Governor, I am first and foremost charged with protecting the health and safety of our people. Research shows that flavored electronic smoking devices and products, such as mint, candy, fruit, and chocolate, are extremely appealing, especially to children. I commend my partners in the Legislature for reacting swiftly to the Task Force’s recommendations to pass legislation that will protect both youth and adults from the hazards of flavored electronic smoking device use,” Murphy said in a prepared statement.

The ban will take effect in April, leaving 3 months for business owners to transition to the new restrictions, according to

Murphy also signed a measure that would bar the use of coupons, and other price rebates for the purchase of tobacco, and e-cigarette products. The ban extends to flavors with the exception of menthol, mint, and wintergreen. Fines as much as $2000 can be levied upon businesses that violate the ban, and repeat offenders could be subject to a 3-year license suspension after a third offense and total license revocation after a fourth offense.

“Study after study has shown that flavors such as cotton candy, and mango not only draw teens in, but keep them coming back when it comes to electronic cigarettes. Mint is especially popular since the menthol helps ease new users into vaping by cooling their throat, and reducing any harshness they would normally feel when inhaling the nicotine. We know what needs to be done to help keep kids safe ,and that’s what we’re doing with this law,” said State Assemblywoman Valerie Vainieri Huttle, in a prepared statement.

According to local news sources, opponents of the legislation argued that officials should better enforce the smoking age instead of barring of-age adults from buying products. Vape shop owners, and former cigarette-smokers testified that a ban could lead many users back to cigarettes, and put many local establishments out of business. The smoking age in New Jersey is 21 years.

“While banning flavored vape products may seem like a step in the right direction, today’s decision is ultimately short-sighted. We must&#151;and we can—do more than that. Users will now likely turn to street knock-offs instead, which does not address the root of the problem. In fact, consuming knock-offs may actually backfire, and expose our young people to even more contaminants,” said Indra Cidambi, MD, a New Jersey based addiction psychiatrist, and medical director at the Center for Network Therapy, in a press release.

from the FDA, prioritizing enforcement against unauthorized flavored e-cigarette products that appeal to children, including fruit and mint flavors.

Legislation gained steam during an outbreak beginning in March 2019, with the first

The Trump administration said earlier this month that it would move to prohibit fruit, candy, mint, and dessert flavors from small, cartridge-based e-cigarettes. The federal ban would allow for menthol, and tobacco flavored e-cigarettes to remain on the market.

The New Jersey law bars the sale, offer for sale, and distribution of flavored vaping products, but it does not prohibit possession, according to the

Governor Murphy Signs Legislation to Make New Jersey First State in the Nation to Impose Permanent Ban on Flavored Vape Products [press release]. Newark, NJ. Published January 21, 2020.

https://www.nj.gov/governor/news/news/562020/approved/20200121i.shtml

Munoz, Daniel. Garden States takes lead in prohibiting flavored vaping products.

https://njbiz.com/nj-become-first-us-ban-flavored-vaping-products/

Catalini, Mike. New Jersey law bans sale of flavored vaping product.

https://www.burlingtoncountytimes.com/news/20200121/new-jersey-law-bans-sale-of-flavored-vaping-product

. Published January 21, 2020. Accessed January 22, 2020.

Press statement on New Jersey’s ban of flavored vaping products from addiction expert [press release]. Dr. Cidambi. New Jersey. Rubenstein Public Relations [email]. Published January 21, 2020. Accessed January 22, 2020.

The ban will take effect in April, leaving 3 months for business owners to transition to the new restrictions. 