Heated Mittens for Hand OA; Pediatric Firearm and Motor Vehicle Deaths

TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.

This week’s topics include warming mittens for hand osteoarthritis (OA), pediatric firearm and motor vehicle fatalities, buprenorphine in young adults with opioid use disorder (OUD), and e-cigs and respiratory symptoms.

Program notes:

0:40 Heated mittens and hand osteoarthritis

1:40 Majority women, average 71 years of age

2:40 American College of Rheumatology ambivalent

3:44 Respiratory symptoms and e-cigs

4:44 Reduced risk for worsening symptoms by 30%

5:44 Less harmful?

6:05 Use of buprenorphine in adolescents and young adults

7:05 Rate of dispensing decreased 25%

8:05 Young adults driving decreased dispensing

9:05 Ten to nineteen are getting more

9:20 Report on firearm and motor vehicle pediatric deaths

10:20 Absolute percentage increase in homicide

11:20 Highway death increasing

12:09 End

Transcript:

Elizabeth: Do heated mittens help with hand osteoarthritis?

Rick: Firearm and motor vehicle pediatric deaths.

Elizabeth: The use of buprenorphine among young folks with opioid use disorder in the United States.

Rick: And does substituting e-cigarettes for cigarettes improve respiratory symptoms?

Elizabeth: That’s what we’re talking about this week on TT HealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.

Rick: And I’m Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I’m also dean of the Paul L. Foster School of Medicine.

Elizabeth: Rick, I’d like to turn first to The BMJ. Here, in Baltimore this morning, it was a big old 8° and so this issue of heated mittens was sounding pretty good to me. In this case, what they are looking at is whether electrically heated mittens can help improve hand function in people who have got osteoarthritis in their hands.

This was a study conducted in Denmark. They had 200 folks with hand osteoarthritis who were 42 to 90 years of age — I feel sort of badly for those who are at that young end of the spectrum who developed this condition — and they divided them half and half to an intervention group and a control group. They provided them with these electrically heated mittens or control mittens where they disconnected their heating element. They asked them to wear them for at least 15 minutes daily for 6 weeks and they did this during the cold season in Denmark, so the external temperature was really pretty chilly. They had 91 participants in their intervention group and 95 in their control group who completed the trial. The majority of these participants were women (87%) with an average age of 71 years.

They assessed hand function using a commonly used scale and they also looked at a couple of other outcome measures. Basically, they saw that this heated mitten did appear to help just a little bit in all of these different outcomes. However, when they did the calculations, it turned out it really wasn’t all that helpful. Their small benefit was seen for hand pain, but none of the functional aspects of utilizing these mittens was improved.

Rick: Elizabeth, this is kind of disappointing for the one in six women or the one in 12 men over the age of 40 who actually have osteoarthritis of their hands. Typically, that’s treated with anti-inflammatory medications or sometimes surgery.

But there is some thought that heat therapy could be helpful. It’s been studied in different ways. There have been wax baths, mud packs, and even low-dose radiation therapy. The American College of Rheumatology guidelines are somewhat ambivalent. It’s recommended as possibly improving symptoms, but the evidence of the studies is really not very good.

This study, if it had been proven positive, would have thrown a lot of weight behind using heat therapy, but heated mittens really weren’t very helpful. On average, they wore them about 37 minutes a day. What they were trying to see is for 6 weeks, did it improve symptoms and hand function? As you noted, if there is any benefit at all, it’s pretty modest. Disappointing.

Elizabeth: One thing I learned as a result of this study was that they cite that skin temperature when heat is applied typically peaks after about 15 minutes. Look, if I’m going to apply heat in any kind of symptom I have, 15 minutes sounds like the thing to do. They also note that there was very high adherence to the mitten use in both groups. If it helps people feel better about their hands hurting, I think it’s a fine strategy to employ.

Rick: Well, I’ll remind you this was conducted in Denmark, so wearing mittens during a large part of the year is not a big issue. The compliance is pretty high.

Elizabeth: I think so, too. Which of your two would you like to turn to?

Rick: Respiratory symptoms that I mentioned.

This is an observational study. There are some individuals that suggest that people that are smoking tobacco products, if they switch to e-cigarettes it could potentially improve respiratory symptoms. When I say “improve,” you can take people that have very mild symptoms and see whether they worsen or not, or you can take people with severe symptoms and see whether they improve.

This study looked at about 5,600 adults that didn’t have long-standing respiratory disease — the major thing they had was asthma. They compared the relationship between important respiratory symptoms for those that continued smoking over the course of 1 or 2 years, for those who switched to e-cigarettes, and then for those that were kind of half-hearted — they did both.

Those that had very mild symptoms to begin with, they noticed that overall about 90% to 95% of the people continued smoking cigarettes. About 5% switched to e-cigarettes, and a smaller percentage continued using both. For those individuals that switched to using e-cigarettes or those that quit altogether, it reduced their risk of having worsening respiratory symptoms by about 30%. By the way, it was the same improvement whether you switched to e-cigarettes or stopped altogether. If you continued doing both, no improvement.

What about those that had severe symptoms? For those who either stopped smoking altogether or those that switched to e-cigarettes, it increased improving their symptoms by about 30% to 35%. This suggests that switching completely from cigarettes to e-cigarettes or stopping altogether has short-term benefits with regard to either improving symptoms or making sure they don’t get worse.

Elizabeth: Let’s note that this study is in The Lancet. There are quite a few concerns that are being raised about e-cigarettes and about the exposures to all of the plethora of chemicals that are found there. While this sounds like a pretty persuasive study, my personal predilection would be why don’t we just quit using these things altogether?

Rick: There are two issues. One is, should people start e-cigarettes instead of regular cigarettes because they are less harmful? Those individuals that start e-cigarettes, especially as adolescents, are more likely to go to tobacco products. Not starting it is really important. However, for those individuals that are long-term smokers, if we can get them to switch from cigarettes to e-cigarettes there is some benefit with regard to respiratory symptoms.

Elizabeth: Let’s turn now to JAMA, to a research letter, that looks at trends in buprenorphine dispensing among adolescents and young adults in the United States. This issue, of course, of opioid use disorder is just a big issue. While we have a little glimmer of hope on the horizon with the CDC’s most recent reporting of data that the deaths due to opioid overdose have declined in the last running year during which data was available, we still have an awful lot of folks who are reporting this.

They report here that they had 712,000 adolescents and young adults between the ages of 12 and 25 years who were reporting an opioid use disorder in the past year. The only medication that can be prescribed for opioid use disorder for adolescents 16 years of age and older that’s FDA-approved is buprenorphine. Despite this, the rate of dispensing to those youths ages 19 years or younger decreased by 25% from 2015 to 2020. Since then, increased buprenorphine prescribing flexibilities, including telehealth prescriptions and eliminations of the waiver requirement [have attempted] to improve access to this drug.

What’s going on in retail pharmacies in prescribing buprenorphine to adolescents and young adults from 2020 to 2023? They used this IQVIA Total Patient Tracker, which tracks 93% of all prescriptions dispensed from retail pharmacies in the U.S. I was unfamiliar with this database. They examined the data for adolescents and young adults overall, and then by age groups (10 to 15, 16 to 17, 18 to 19, and 20 to 24) and by prescriber specialty.

Sure enough, they declined, these overall prescriptions, but young adults — they were the ones who were driving that significant decrease in dispensing. The younger kids, and I have to call them kids — that puts me in a different age category, I know — were able to see an increase, although the absolute numbers remained low for those who were able to obtain a prescription.

They found that nurse practitioners prescribed more buprenorphine to adolescents and young adults than other specialties. While in some groups it seems to be increasing, there is successful outreach to pediatricians who might want to prescribe this. It seems to me that this is a medication that’s still underutilized.

Rick: Yep. Elizabeth, to put it in perspective, you said there were 712,000 adolescents between the ages of 12 and 25 that had opioid use disorders and less than 5% of them actually received this treatment. In the ages of 20 to 24, that decreased by about 9%. Now, that’s 85% of the opioid use disorder individuals; they’re getting less treatment. Those ages 10 to 19 are getting more, but they represent just 15%. If we are going to get the biggest bang for the buck, we have to address the largest proportion.

Elizabeth: I could not agree more. Maybe we can make that a New Year’s resolution. Let’s turn to your last one and that’s in JAMA Pediatrics.

Rick: Speaking of New Year’s resolutions, this study reports on firearm and motor vehicle pediatric deaths from 2011 to 2021. It broke it down by how often did these occur and are they increasing or decreasing. Then they broke it out by age, gender, race, and ethnicity so we can target those particular groups that seem to have the highest rate of firearm and motor vehicle pediatric deaths.

From 2011 to 2021, there were almost 36,000 firearms and almost 41,000 fatalities among U.S. youths ages 0 to 19. In fact, these are the leading causes of death in that age group. Overall, there was a 76% increase in firearm deaths among U.S. children and youth during that study period. That’s mostly homicides — that’s about 60% — followed by suicide and unintentional deaths.

There were notable differences when you looked at that by age, sex, race, and ethnicity. Homicide deaths had a 19% actual percentage increase since 2018 and unfortunately for Black males that absolute percentage was 33%. There was also an increase among Hispanic males, although the death rate is lower than among Black males.

When you look at suicides — and, unfortunately, even among females ages 15 to 19 — there was an increase that was substantial for Black females — 41% — nearly double for Black males.

With regard to motor vehicle accidents, there was an overall decrease till about 2019 and then a significant increase in 2019 to 2021, especially for individuals between the ages of 15 and 19. Specifically, among American Indians or Alaska Natives, that rate was twice that of all other racial and ethnic groups. We have work to do.

Elizabeth: Yeah. The motor vehicle deaths, of course, are really saddening. It’s something that we’ve witnessed also and we’ve reported among pedestrians, among cyclists, and just in general on our highways. People are driving without regard for the number of other people on the road.

Rick: When you look at this particular group — that is, Native American Indians or Alaskan Indians — the deaths probably have to do with geography. They are driving on rural roads. If they’re long distances, it’s easy to be distracted and there is limited access to emergency medical services. With regard to firearms, we need to address community violence, poverty, and also address suicide and mental health screening and treatment.

Elizabeth: Lots to do in 2025. On that note then, that’s a look at this week’s medical headlines from Texas Tech. I’m Elizabeth Tracey.

Rick: And I’m Rick Lange. Y’all listen up and make healthy choices.