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Health Capsules: March 7

By: Lisa Russell

Consulting a rheumatologist will become more difficult for Americans in the coming years as a shortage of doctors practicing in that specialty worsens.

Shortage of rheumatologists looms in the U.S.

Americans’ demand for doctors and other medical professionals who specialize in treating conditions like osteoarthritis, gout, rheumatoid arthritis, lupus, vasculitis, and other autoimmune diseases soon will greatly exceed the available supply of these professionals. Two recent analyses, one published in Arthritis & Rheumatology and the other in Arthritis Care & Research, noted that the need for rheumatologists has begun to rapidly overtake the projected growth of the workforce.

According to the American College of Rheumatology, 50 percent of current specialists in the field are expected to retire over the next 15 years. As many as 80 percent of those doctors plan to reduce their patient loads to a part-time level for a number of years before leaving their practices, which will strain resources even further. Pediatric rheumatologists are especially scarce: There currently are fewer than 300 of these specialists practicing in the U.S.

At the same time, an aging population is projected to drive up demand for rheumatology services by about 138 percent by 2030. And although the analyses stated that there have been recent increases in the number of rheumatology fellowship programs along with the number of doctors being trained in those programs, even a doubling of that number would not meet the projected rheumatology workforce needs in 2030.

The investigators also found wide variations in geographic distribution of rheumatologists, which they said will worsen in the coming years, leading to large areas of the country being underserved. For example, in 2015, the ratio of rheumatology providers per 100,000 patients by region ranged from 3.07 in the Northeast to 1.28 in the Southwest. By 2025, this ratio is expected to decrease in all regions, and will range from 1.61 providers per 100,000 in the Northeast to 0.5 in the Northwest.

Unfortunately, there are no simple solutions for the coming shortfall, according to experts.

“Innovative strategies will be needed to address access to patient care, as it will not be possible to solve the supply-demand gap by training more rheumatologists alone,” said senior author Seetha Monrad, M.D., of the University of Michigan. “Decreasing insurance barriers and healthcare regulations may allow more rapid, timely and creative solutions to offset the projected rheumatologist shortage and the maldistribution of rheumatologists in the United States.”

MU’s nuclear reactor is key factor behind new cancer drug 

A new cancer drug called Lutathera, recently approved by the U.S. Food and Drug Administration to treat certain tumors of the gastrointestinal tract and pancreas, would not be available without the University of Missouri’s Research Reactor [MURR]. More than 15 years ago, MU scientists identified promising anticancer properties of the radioisotope lutetium-177 [Lu-177], upon which Lutathera is based. MURR is the only U.S. supplier of Lu-177 for use in the drug, which was developed by Advanced Accelerator Applications, S.A., a Novartis company.

“Being the nation’s sole supplier for the active ingredient in a commercially approved cancer therapy such as Lutathera is a pride point for MU and a responsibility the MURR team takes very seriously,” said Vice Chancellor Mark McIntosh.

The reactor has played an important role in research at MU for more than 50 years. Scientists from across the university’s departments use the 10-megawatt facility, the most powerful university-based research reactor in the U.S., to date artifacts and to improve medical diagnostic tools, among other uses.

Low iodine may interfere with pregnancy

Women who are trying to become pregnant perhaps shouldn’t worry about limiting salt in their diets, according to new research from the National Institutes of Health. The study showed that women with moderate to severe iodine deficiency – a surprisingly common condition among Americans –  may take longer to achieve a pregnancy than those with normal levels.

Iodine, a mineral essential to regulating the body’s metabolism, only can be obtained from food sources. In addition to iodized table salt, iodine can be found in dairy products, seafood, meats, eggs, and some breads. Along with its essential health functions in adults, iodine helps regulate bone growth and brain development in children; severe iodine deficiency long has been known to cause intellectual and developmental delays in infants.

The NIH researchers analyzed data collected from American couples participating in the Longitudinal Investigation of Fertility and the Environment [LIFE] study from 2005-2009, who were attempting to become pregnant. Of the 467 women whose iodine levels were tested, the level was sufficient in 260 [55.7 percent], mildly deficient in 102 [21.8 percent], moderately deficient in 97 [20.8 percent] and severely deficient in eight [1.7 percent]. The researchers found that women who had moderate to severe iodine deficiency had a 46-percent lower chance of becoming pregnant each month, compared to women who had sufficient iodine levels.

“Our findings suggest that women who are thinking of becoming pregnant may need more iodine,” said James L. Mills, M.D., who led the study, published in the journal Human Reproduction.

Women who are concerned they may not be getting enough iodine should consult their physicians before making dietary changes or taking supplements.

On the calendar

A Babysitting 101 course, sponsored by St. Louis Children’s Hospital, is from 9 a.m.-1 p.m. on Wednesday, March 14 at the Wildwood Municipal Building, 16860 Main St. This class covers the business of babysitting, child development, safety and first aid, and fun and games. A workbook and light snack are provided. There is no minimum age requirement; the course fee is $30. To register, visit stlchildrens.org/registration or call (314) 454-KIDS.

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When Bad Things Happen to Good Shoulders, a free informational program sponsored by St. Luke’s Hospital, is from 6-7 p.m. on Wednesday, March 14 at the hospital’s Desloge Outpatient Center, Building A, 121 St. Luke’s Center Drive in Chesterfield. Join a St. Luke’s physician for this comprehensive session on the causes of, and treatments for, shoulder problems like arthritis, rotator cuff tears, bursitis, tendinitis, impingements, instability and more. Register online at stlukes-stl.com.

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St. Luke’s Hospital offers cholesterol and glucose wellness screenings from 7:30-9 a.m. on Friday, March 23 at St. Luke’s Convenient Care [Inside Dierbergs Des Peres],1080 Lindemann Road in Des Peres. Receive your cholesterol and glucose numbers, along with a one-on-one consultation with a registered nurse/health coach, which includes blood pressure and body composition measurement. A 10-12 hour fast and advance appointments are required. The cost for all screenings is $20. To register, visit stlukes-stl.com.

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