The JAMA Report™: Recent Episodes
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The JAMA Report is a weekly video and audio new release highlighting a study appearing in the Journal of the American Medical Association, the most widely circulated medical journal in the world. The JAMA Report uses interviews with researchers and patients to summarize important findings from new research and review articles. Published continuously since 1883, JAMA is published 48 times per year, with more than 325,000 print recipients and more than 14 million annual visits to the journal’s website. JAMA is a member of The JAMA Network family of journals, which are freely available at http://www.jnreader.com. In Partnership with
JAMA Report videos provided pursuant to license. ©2017 American Medical Association, publisher of JAMA® and The JAMA Network® journals.
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Suicide is the 10th leading cause of death in the United States and identifying those at risk can be challenging. According to a new study, certain words in hospital discharge notes may be one way to identify patients who are at an increased risk of suicide.
Researchers from Massachusetts General Hospital examined more than 450,000 patients’ discharge notes from 2005 to 2013. They analyzed these notes by using a sentiment analysis computer program which searches for positive or negative words. The researchers found that certain words like gloomy, unfortunate, and sad can predict a higher risk for suicide, as opposed to words like lovely, delightful or pleasant.
In general, there is an elevated risk for suicide after hospital discharge so this is a moment for increased intervention.
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The increasing cost of prescription drugs in the United States has become a source of growing concern for patients, prescribers, payers, and policy makers. A new study examined the reasons for these high prices and also suggests policy changes that could help contain costs.
Researchers from Brigham and Women’s Hospital reviewed the medical and health policy literature on prescription drug prices in the U.S. and found high drug costs stem from various factors such as market exclusivity, limitations on payers and their ability to negotiate prices, and limitations on competition.
The researchers state that the most realistic short-term strategies include enforcing stricter requirements for exclusivity rights, ensuring timely generic drug availability, providing greater opportunities for price negotiation by patients, and effectively educating patients, prescribers, payers, and policy makers about these choices.
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The FDA recently approved a new class of cholesterol-lowering drugs called PCSK9 inhibitors. These new medications could substantially reduce heart attacks, strokes and cardiovascular deaths, however they are very expensive. A new study evaluated the cost-effectiveness of this therapy and how increased use might affect the U.S. healthcare system.
Researchers from the University of California San Francisco used a simulation model that included all U.S. adults 35 and older and evaluated outcomes such as expected numbers of deaths due to cardiovascular disease, heart attacks and strokes, and balanced this with the cost and potential benefits of these drugs.
With an estimated 9 million people eligible for this therapy and a price of $14,000 per patient per year, researchers estimated that total prescription drugs expenditures could increase by 40 percent. In order to be cost-effective, the PCSK9 inhibitor costs would have to come down to about $4,000 a year.
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Patients who might benefit from a heart valve replacement but are too ill for open heart surgery can sometimes undergo a less invasive procedure known as transcatheter aortic valve implantation or "TAVI". About 10% of patients undergoing TAVI can experience small strokes and related brain injury as a complication. A new study found that the use of a cerebral protection device, which captures debris dislodged from blood vessels during the TAVI procedure, reduced the number and volume of brain lesions seen on MRI.
Researchers from the University of Leipzig Heart Center, Germany studied 100 patients with an average age of 80 who underwent TAVI. Half of the patients received the cerebral protection device and the other half did not. Patients underwent brain MRIs before the implantation and again at 2 and at 7 days after the procedure. The results found that using the filter device helped to decrease the number of brain lesions seen in the brain by about half.
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According to a new study, eating a diet that includes more plant-based protein is associated with a lower risk of death, while eating more animal protein is associated with a higher risk of death, especially among adults with at least one unhealthy behavior such as smoking, drinking alcohol, being overweight or living a sedentary lifestyle.
Researchers from Massachusetts General Hospital examined how each protein source influenced long-term health. They looked at more than 131,000 adults participating in two long-running national health studies. Participants provided 25 to 30 years of detailed data on diet, lifestyle, and medical conditions. Researchers reviewed detailed food questionnaires that were sent to the participants every four years.
They found that higher intake of animal protein was positively associated with mortality and that the association was higher among adults who lived an unhealthy lifestyle. Substituting plant protein for animal protein, especially processed red meat, was associated with lower mortality, suggesting the importance of protein source.
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Since the legalization of marijuana in Colorado, there has been an increase in hospital visits and calls to regional poison centers due to unintentional marijuana exposure among young children. Researchers from the University of Colorado evaluated the number of children with exposures before and after recreational marijuana was legalized.
Between 2009 and 2015 they found a rise in the annual number of unintentional pediatric exposures. On average, these children were about two years old. Most children ingested the drug in edible forms such as candies and baked goods. Almost half of the patients seen in the children's hospital in the 2 years after legalization had exposures from recreational marijuana, suggesting that legalization did affect the incidence of exposures.
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A new study suggests that teens undergoing bariatric surgery can experience benefits in terms of walking speed and joint pain. Researchers from the University of Minnesota School of Medicine are tracking long-term outcomes for 242 teens that underwent bariatric surgery at five centers around the United States.
For the current study, researchers specifically focused on improvements in mobility and pain related to muscles and joints is a subset of 206 patients. All patients participated in a quarter mile walk test before and after surgery at six months, twelve months and twenty-four months. Improvements in time to complete the walk, resting heart rate and heart rate differences continued at one and two years after surgery.
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Chronic use of prescription pain medications known as opioids is increasing in the United States. New research shows that a portion of patients undergoing several common surgical procedures may be at increased risk for chronic opioid use several months after surgery.
Researchers from Stanford University School of Medicine reviewed the records of more than 641,000 patients who underwent one of 11 common operations and were not taking opioid pain medication during the year prior to surgery.
They found that some patients were at an increased risk for chronic opioid use following surgery, with the risks ranging from about one and a half times more likely, to as high as five times more likely, depending on the procedure. Males and the elderly had a higher risk, as well as patients with a history of drug or alcohol abuse. The overall risk of chronic opioid use remained low at about 1 percent depending on the type of surgery.
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According to a new study, euthanasia and physician-assisted suicide (PAS) in the United States, Canada, and Europe are increasingly being legalized, but remain relatively uncommon. Researchers from the University of Pennsylvania examined the legal status of both procedures and available data on attitudes and practices from the late 1940s to present day.
They found that public support for euthanasia and PAS in the United States had increased through the 1990s, but has since plateaued. More than 70 percent of cases of euthanasia and PAS worldwide involved patients with cancer. Typical patients are older, white, and well-educated. Motivations for requesting PAS include loss of autonomy and dignity, inability to enjoy life and regular activities, and other forms of mental distress. Pain is mostly not reported as the primary motivation.
Although the ethics and legality continue to be controversial, cases of these procedures remain relatively rare. Researchers did not find evidence that vulnerable patients have been receiving euthanasia or PAS at higher rates.
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The U.S. Preventative Services Task Force has updated the recommendations regarding colorectal cancer screening. The Task Force strongly recommends screening average risk adults age 50 to 75 for colorectal cancer, and then making individual screening decisions for adults age 76 to 85, taking into account the patient's overall health and screening history.
Colorectal cancer is the second leading cause of cancer death in the United States, and about one-third of adults in the United States have never been screened.
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According to a new study, in 2013 to 2014 there was an increase in obesity rates among U.S. women but not U.S. men. The overall prevalence of obesity during this time period was 40 percent among women and 35 percent among men.
Researchers from the National Center for Health Statistics examined trends in obesity among U.S. adults from 2005 to 2014. Using data from the National Health and Nutrition Examination Survey (NHANES), researchers looked at a sample of more than 13,000 men and 13,000 women. They found no recent changes in obesity or extreme obesity rates among men, but saw an increase in both for women.
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Despite targeted efforts to reduce obesity through diet and exercise, these rates continue to rise. A new study from Ontario, Canada found that obesity and diabetes rates were lower in more walkable neighborhoods compared to less walkable neighborhoods, where they saw an increase in these rates.
Researchers from St. Michael's Hospital in Toronto studied almost 9,000 neighborhoods in Southern Ontario looking at walkability scores, along with government health data and survey results during a twelve-year period. They examined whether neighborhoods that were more walkable experienced a slower increase in obesity and diabetes compared to less walkable neighborhoods.
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Many critically ill patients are unable to make medical decisions for themselves. Family members or close friends are often asked to serve as surrogate decision makers. However, expectations about a patient's overall prognosis sometimes differ between physicians and surrogate decision makers.
Researchers from the University of Pittsburgh enrolled 99 physicians and 229 surrogates who made decisions for 174 critically ill patients in a new study. They found that in about half of the cases, surrogates were substantially more optimistic about a patient's prognosis compared to physicians and that the physician's estimates were much more accurate than that of surrogates.
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Therapeutic substitution is a practice that replaces chemically different compounds within the same class of medications for one another. A new study examined how using this practice could save money on prescription drug costs.
Researchers from the Ohio State University reviewed records of more than 107,000 patients between 2010 and 2012 and looked at their prescription drug use and estimated how much money could be saved using therapeutic substitution.
The authors report that an extra $73 billion was spent between 2010 and 2012 on brand name medications. Therapeutic substitution could help lower those costs. Although therapeutic substitution is somewhat controversial, the authors conclude that if implemented in a way that does not negatively affect quality of care, this is a useful approach to decreasing healthcare costs.
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Out-of-hospital cardiac arrest (OCHA) is a major public health problem in the United States. Bystander CPR has been shown to double or even triple survival from OCHA. A new study examined whether providing CPR instruction over the phone ("telephone CPR") with the help of trained 9-1-1 dispatchers could improve survival rates after cardiac arrest.
Researchers from the Arizona Department of Health Services provided additional training to dispatchers in two regional centers in the Phoenix on how to be more assertive and confident while on the phone with rescuers. They measured outcomes from more than 2,300 out-of-hospital cardiac arrests during a three year period. The researchers found increases both in the number of patients that survived to hospital discharge as well as those with good functional outcomes, which means patients were able to return to their normal baseline.
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An estimated 15 million Americans do some kind of rotating shift work, including overnights, evenings and early morning shifts. But can this type of shift work increase the risk of coronary heart disease? A new study examined the link between rotating night shift work and heart disease in a group of female nurses.
Researchers at Brigham and Women's Hospital used data from the Nurses' Health Studies (1 and 2), which followed participants for a twenty-four year period. They specifically looked at 189,000 women who reported their lifetime exposure to rotating night shift work. Over the course of the study period, more than 10,000 new cases of coronary heart disease were reported.
The results suggested that rotating night shift work was associated with modest risk of coronary heart disease, but further research is needed to help determine whether the association is related to specific work hours and/or individual characteristics.
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In a new study, researchers from the University of California-Los Angeles studied tumor response and overall survival following the administration of a new treatment among patients with advanced melanoma. This agent, called pembrolizumab, is an antibody that blocks PD-1, a protein which prevents the body's immune system from attacking the cancer.
The researchers tested pembrolizumab on more than 650 patients in North America, Europe and Australia. They looked at tumor response before and after treatment and found that the lesions were smaller in about one third of patients. In patients who responded to the treatment, seventy-five percent maintained the response at one or two years.
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Air pollution is associated with chronic respiratory health problems in children. A new study examined whether decreases in air pollution levels are associated with significant reductions in respiratory symptoms in children.
Researchers from the University of Southern California followed over 4,600 children in eight Southern California communities across three different time periods from 1993-2012. In addition to monitoring air quality, they also looked at children with and without asthma, and whether they reported respiratory symptoms like bronchitis, congestion, phlegm production, or a daily cough for three months in a row, during the previous year.
Along with significant improvements in air pollution levels, the authors found a decrease in reported respiratory symptoms in children both with and without asthma. Respiratory symptoms decreased by 32 percent in children with asthma and 21 percent in children without.
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Among a group of patients with severe obesity who underwent bariatric surgery, a large percentage experienced improvement in pain, physical function, and walking capacity over 3 years, according to a new study.
Severe obesity can be associated with joint pain and impaired physical function, like the ability to bend, lift, carry, and walk.
Researchers from the University of Pittsburgh studied more than 2,200 patients from 10 U.S. hospitals. Patients filled out questionnaires about their pain and physical function before surgery and each year, for 3 years after surgery. Patients also participated in a 400 meter walking test.
The results found that 50 to 70 percent of patients experienced significant improvements in body pain and physical function and in the walking test. In addition, they found three-fourths of participants with severe knee and hip pain experienced improvements in arthritis symptoms.
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Low back pain is a leading cause of disability in the United States. A new study shows that among adults with chronic back pain, both mindfulness-based stress reduction (MBSR) and cognitive behavioral therapy (CBT) resulted in meaningful improvement in back pain compared to traditional care.
Researchers from Group Health Research Institute randomly assigned 342 adults age 20 to 70 years with chronic low back pain to receive MBSR, CBT, or traditional care. Both MBSR and CBT were delivered in 8 weekly 2 hour groups. They found that study participants who received MSBR and CBT showed more improvement in pain and physical limitations at both 6 and 12 months.
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Recent outbreaks of vaccine-preventable diseases in the United States have prompted clinicians, public health officials and the public to pay closer attention to the growing phenomenon of vaccine refusal. A new study looks at the role of vaccine refusal and the risk of measles and pertussis. In recent years, a substantial proportion of US measles cases occurred in people who were intentionally unvaccinated. Vaccine refusal was also found to be associated with an increased risk of pertussis in some populations.
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Approximately one-third of children who experience a concussion will experience persistent post-concussion symptoms. Researchers have developed a new clinical scoring system that may help predict which patients are at a higher risk for prolonged symptoms.
Canadian researchers evaluated more than 3,000 patients, ages 5 to 18, who presented within 48 hours of an acute head injury. About thirty percent ended up with persistent post-concussion symptoms at 28 days. Researchers identified nine clinical factors that were predictive of post-concussive symptoms. These factors were then used in a twelve point risk score that included items like age, sex, history of migraines or depression, prior history of concussion, and problems with balance.
Although the clinical score was better than a physician's judgement alone, further research is needed before it is fully adopted into clinical practice.
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According to a new study, low dose aspirin taken regularly was associated with a reduced risk for cancer.
Researchers from Massachusetts General Hospital examined data from two large national studies that include about 136,000 men and women who have been providing detailed information about their overall health for decades.
Researchers identified 20,414 cancers among 88,084 women and 7,571 cancers among 47,881 men during a 32-year follow-up. Regular use of aspirin, two times or more per week, was associated with a 3 percent lower overall risk for cancer. This was mostly due to a 15 percent lower risk for gastrointestinal tract cancers and a 19 percent lower risk for cancers of the colon and rectum.
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Sepsis is a clinical syndrome of physiologic, pathologic, and biochemical abnormalities caused by serious infection. Sepsis is a major public health concern. Besides being a leading cause of mortality worldwide, sepsis accounted for more than $20 billion of U.S. hospital costs in 2011. In addition, there is increasing awareness that patients who survive sepsis are often left with long-term disabilities.
Updated definitions and clinical criteria for sepsis should help promote earlier recognition and more timely treatment of patients with sepsis or suspected sepsis. In a related study, researchers reviewed the electronic health records of more than one million patients to assess the usefulness of a clinical score known as "SOFA", which is used to help identify patients with sepsis.
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A new study suggests that family and other unpaid caregivers who provide substantial help with health care were twice as likely to experience physical, financial or emotional difficulty, five times as likely to restrict social activities, and more than three times as likely to experience a loss in job productivity as individuals who did not provide this type of help.
Researchers from Johns Hopkins Bloomberg School of Public Health used data from two nationally representative samples that provided insight into older adults and the caregivers who help them. The study sample represented 14.7 million caregivers assisting 7.7 million older adults, who either had dementia or a severe disability. About 45 percent of caregivers provided substantial help, (around 28 hours of care per week), often resulting in significant emotional difficulty and other caregiver role-related effects.
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Rates of genetic testing for BRCA1 and BRCA2 mutations have increased among younger women diagnosed with breast cancer, according to a new study. The study focused on nearly 900 women diagnosed with breast cancer at age 40 or younger. Researchers looked at rates of genetic testing, barriers to testing, and how the test results affected treatment decisions.
In 2006, the rates of BRCA testing were in the seventy percent range and by 2012 that proportion rose to ninety-five percent. While the majority of women reported being tested for BRCA 1 and 2, many were not, and a small minority reported that no one had discussed genetic risk or testing options. The study authors note that the overall goal of genetic testing is to help women make informed treatment decisions. Assessment of a young woman's genetic risk after a breast cancer diagnosis can affect treatment decisions and the results can also have health implications for her relatives.
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A new study examined the brains of deceased individuals and found that moderate seafood consumption correlated with lesser Alzheimer disease.
Researchers from Rush University Medical Center in Chicago enrolled older people living in public housing and retirement communities in an ongoing study of memory and aging. Participants had normal memory function when they entered the study and were asked to keep track of their diet using a detailed questionnaire. The participants also agreed to brain donation after they died, providing researchers a total of 286 brains to examine.
They found that participants who reported consuming seafood at least once a week had decreased occurrence of the plaques and tangles associated with Alzheimer disease. Increased seafood consumption was associated with increased brain mercury levels, but the mercury did not appear to have an impact on brain health.
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Depression is a common clinical problem, and is a leading cause of disability in adults. This condition is often under recognized and under treated, affecting individuals, families, businesses and society. The U.S. Preventive Services Task Force is an independent group of medical professionals that makes evidence-based recommendations about clinical preventive services in the primary care setting. The Task Force is recommending screening for depression in adults, including pregnant and postpartum women.
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To some, end of life care in the United States is considered resource intensive, expensive, and inattentive to patients' needs. So how does the United States compare to other countries? A new study examined several health care measures at the end of life for cancer patients in five European countries, Canada and the United States.
Researchers from the University of Pennsylvania Perelman School of Medicine compared the health care experience for cancer patients older than 65, in Canada, Belgium, Germany, England, the Netherlands, Norway and the United States. They examined several clinical measures during the final six months of life.
The United States and Netherlands had the lowest percentage of patients dying in the hospital. The United States also had the fewest hospitalizations and the smallest number of days patients spent in the hospital. In contrast, intensive care admissions were twice as common in the United States compared to the other countries.
During the last six months of life, patients in Norway and Canada had higher hospital costs than patients in the United States. There was less spending in Germany and Belgium, but the lowest expenditures were in the Netherlands and …
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Emphysema is a serious lung disease that results in severe shortness of breath and impaired quality of life. Management of emphysema is challenging since there is no cure and current therapies, including lung reduction surgery, can be risky. A new study examined a minimally invasive procedure to see if it could improve shortness of breath and also be a safe and cost effective way to treat emphysema.
Researchers from Hôpital Universitaire de Reims, France studied a new procedure that permanently places several coils into the lung. The study included one hundred patients from ten centers across France. Fifty patients had coils placed in their lungs and the other fifty received standard medical treatment. Both groups were followed closely and assessed at six and twelve months. They participated in a six minute walk test to see if their breathing had improved, allowing them to walk farther.
Results showed that thirty-six percent of patients who received the coil treatment had improvement in the six minute walk test, compared to only eighteen percent in the control group. There was also a significant improvement in quality of life at six and twelve months for patients who received …
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Among obese older patients with an increasingly common type of heart failure, calorie restriction and/or exercise training improved their ability to participate in physical activity without experiencing shortness of breath, according to a new study.
Heart failure with preserved ejection fraction (HFPEF) is the most rapidly increasing form of heart failure in the United States. Although the heart pumps normally, it does not fill with enough blood because the lower chamber of the heart is too stiff. More than eighty percent of patients with HFPEF are overweight or obese. Despite multiple studies, so far, no currently available medications have improved symptoms in patients with HFPEF.
Researchers from the Wake Forest School of Medicine randomly assigned 100 older obese participants with HFPEF to 20 weeks of diet, exercise, or both. They found that the exercise participants lost three percent of body weight, the diet group lost seven percent and the combined group lost ten percent of body weight. Patients in both the diet and exercise groups showed improvement in their ability to participate in exercise without significant symptoms.
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Women facing infertility often turn to in vitro fertilization (IVF). Although IVF technology has improved, there is still a widely held belief that if a woman doesn't experience a successful live birth after three or four IVF cycles, her chances of a successful live birth are very low. A new study looked at IVF success rates after repeated treatment cycles well beyond the third or fourth attempts.
Researchers from the University of Bristol, in England reviewed the medical records of almost 160,000 women in the United Kingdom who underwent nearly 260,000 full IVF cycles between 2003 and 2010. They examined live birth rates among these women thru 2012.
They found that women under the age of forty who used their own eggs had a 33 percent success rate within the first cycle. This rate remained at above 20 percent up to and including the fourth cycle. By the sixth cycle, women had a cumulative live birth rate of 68 percent. Women between ages forty and forty-two, also saw an increased success rate up until the ninth cycle.
Overall, researchers reported that patients had an increased chance of success up to the ninth …
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Glioblastoma is the most devastating form of brain cancer in adults; most patients die within one to two years of diagnosis. A new study examined whether using tumor-treating fields, a type of electromagnetic therapy, combined with maintenance chemotherapy in patients with glioblastoma who had already completed standard chemotherapy and radiation, could increase survival.
Researchers from University Hospital in Zurich, Switzerland are conducting a worldwide trial with 695 glioblastoma patients. One out of three received a standard maintenance course of chemotherapy, while the other two received maintenance therapy plus the tumor treating fields for up to two years.
The current results are for the first 315 patients. Researchers found that use of the tumor-treating fields increased both progression-free survival and overall survival. Overall survival is prolonged by an average of three months in patients getting the tumor-treating fields therapy.
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Even in the general population, people often don't want to talk about depression, which is one of the major reasons it isn't always treated properly. Depression is also a concern in the medical community, particularly affecting physicians in training known as medical residents. A considerable number of medical residents suffer significant depressive symptoms at various times during their training. What should be done to address the problem?
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The most common operation done worldwide is the cesarean or C-section. Cesarean delivery is lifesaving for obstructed labor and other obstetrical emergencies; however, as with any surgical procedure, there are risks of complications and overuse can be harmful to both mothers and newborns. There were about 22.9 million cesarean deliveries worldwide in 2012. Based on older analyses from the mid-1980s, the World Health Organization (WHO) recommends that cesarean delivery rates should not exceed 10 to 15 per 100 live births.
In a study in the December 1 issue of JAMA, Harvard Researchers examine the relationship between cesarean delivery rates and maternal and infant death, and other adverse outcomes in children following planned cesarean delivery. The results indicate that the optimal cesarean delivery rate in relation to maternal and neonatal mortality is approximately 19 per 100 live births. Higher cesarean delivery rates were not associated with better outcomes in mothers and children.
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Preschool children who experience repeated episodes of severe lower respiratory tract infections (LRTI) often present with symptoms like wheezing and difficulty breathing. A new study looked at whether the use of the common antibiotic, azithromycin, would help prevent progression of the illness, if given early enough in the episode.
Researchers from Washington University in Saint Louis School of Medicine, studied more than 600 children, ranging from ages one to six years old, with a history of repeated episodes of severe respiratory illness. Children were randomly assigned to either receive azithromycin or a placebo early in these episodes.
They found that children in the antibiotic group experienced a lower risk of progressing to severe LRTI than the placebo group.
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Proliferative diabetic retinopathy (PDR) is a leading cause of vision loss in patients with diabetes, resulting in up to 24,000 cases of blindness each year in the United States. Laser therapy has been the most common treatment used to help reduce severe vision loss, but the procedure has many side effects including permanent loss of peripheral vision and swelling of the retina.
A group of researchers from across the US tested an alternative treatment using an injectable medication called ranibizumab, to see if it would be as effective as the laser therapy. They studied more than 300 patients with PDR, assigning them to either receive standard laser therapy or an injection into the eye. In total, they treated close to 400 eyes.
Outcomes, especially loss of vision, were compared at two years. Over the two year period, researchers found that patients receiving the injections of medication had fewer side effects and did somewhat better in terms of vision loss than those who received laser therapy.
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Financial incentives for physicians or patients are one way healthcare organizations are trying to improve health outcomes. A new study examined whether providing these financial incentives would help improve low-density lipoprotein cholesterol (LDL-C) in patients with a high-risk for cardiovascular disease.
Researchers from the University of Pennsylvania, Philadelphia studied 1,500 patients and 340 primary care physicians. Physicians were randomly assigned to one of four groups. One group solely focused on providing physicians with financial incentives, while another group focused on financially rewarding patients when they showed improvements in their cholesterol levels. A third group consisted of shared incentives for both physicians and patients, while the last group (a control group) did not receive any financial incentives.
Overall, shared financial incentives for both physicians and patients, but not incentives to physicians or patients alone, resulted in a significant reduction of LCL-C levels at 12 months.
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Use of prescription drugs represents a major healthcare expense in the United States, and the number of adults taking prescription medications continues to increase. Researchers from the Harvard T.H. Chan School of Public Health examined trends in prescription drug use from 1999-2012 using data from nearly 40,000 adults, 20 years and older, who participated in the National Health and Nutrition Examination Survey. They found that the prevalence of prescription drug use increased from 51 percent in 1999-2000 to 59 percent in 2011-2012, while the use of five or more prescription drugs increased from 8 percent to 15 percent.
Eight of the 10 most commonly used drugs in 2011-2012 are used to treat components of the cardiometabolic syndrome, including high blood pressure, diabetes, and high cholesterol. Researchers note that the increase in use of several medications may reflect the growing need to treat obesity related complications. Use of antidepressants also increased from 7 percent in 1999-2000 to 13 percent in 2011-2012. The most commonly used individual drug was simvastatin, a medication used to treat high cholesterol. Simvastatin was used by 8 percent of the adult population in 2011-2012, up from 2.0 percent in 1999-2000.
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Evaluating long-term trends in mortality is important for health planning, priority setting and also to identify modifiable factors contributing to poor health. In a new study, researchers from the American Cancer Society reviewed changes in the overall U.S. death rate, as well as trends in the six leading causes of death.
The researchers gathered data from the National Center for Health Statistics from 1969 to 2013. They report that overall death rates have decreased by 43 percent. During this time period, death rates continued to decrease for heart disease, cancer, stroke, injuries and diabetes. However, the decrease in heart disease, stroke and diabetes related deaths has slowed during the last five years.
The researchers also found that deaths from chronic obstructive pulmonary disease (COPD) have doubled since 1969, and continue to increase, specifically among women.
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In the United States, it is estimated that approximately 230,000 women will be diagnosed with breast cancer, and more than 40,000 will die from the disease this year alone. Early detection using mammography remains the best way to prevent premature death from breast cancer. A panel of experts examined decades of research to update the American Cancer Society's (ACS) recommendations for breast cancer screening. Based on this review, the 2015 recommendations for breast cancer screening for women at average risk of cancer include the following:
- Women should undergo regular screening mammography starting at age 45.
- Women 45 to 54 years of age should be screened annually.
- Women 55 years and older should transition to every other year screening or have the opportunity to continue annual screening.
- Women should have the opportunity to begin annual screening between the ages of 40 and 44 years.
- Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer.
- Clinical breast examination is not recommended for breast cancer screening among average-risk women of any age.
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In the United States, seasonal influenza epidemics are responsible for an estimated 226,000 hospitalizations and between 3,000 and 49,000 deaths each year. Pneumonia, the leading infectious cause of hospitalization and death in the United States, is a serious complication of influenza. A new study examined whether getting a flu shot can help reduce hospitalizations due to influenza pneumonia.
Researchers from Vanderbilt University Medical Center evaluated more than 2,700 patients from January 2010 to June 2012. All patients had pneumonia and were admitted to the hospital from the emergency department. Overall, about six percent of patients had pneumonia due to influenza.
Researchers estimated that the patients who received influenza vaccine had a 57 percent less chance of getting hospitalized with influenza-pneumonia than those patients who were not vaccinated.
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Successful treatment of stage II or stage III rectal cancer relies on surgical removal of the tumor. However, researchers from Baylor University Medical Center wanted to know if a "minimally invasive" procedure called a laparoscopy, would be as effective as a standard or "open" operation for patients with rectal cancer.
Researchers assigned 486 patients to receive either a standard open operation or the less invasive laparoscopic approach. All procedures were done by forty-six highly trained surgeons. Specimens from each procedure were examined to see whether all the tumor was removed ("complete resection").
Results found that 90 percent of the patients who underwent the open operation had a complete resection, where patients who underwent the laparoscopy only had an 81 percent success rate. The researchers concluded that these findings do not support laparoscopic removal of rectal cancer.
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Agitation is common in patients with dementia and can contribute to distress for patients and caregivers and an increased risk of institutionalization. Nonpharmacological interventions are recommended as first-line therapy, but many patients fail to respond, and medications are often needed. Currently available medications don't work very well and can have serious side effects. A new study tested a combination of two existing medications, dextromethorphan hydrobromide and quinidine sulfate, to see if this would help control agitation in patients with Alzheimer's dementia.
Researchers from the Cleveland Clinic recruited 220 patients with Alzheimer's dementia and agitation. During a preliminary 10 week trial, participants were randomly assigned to receive either the dextromethorphan- quinidine combination or a placebo.
Results showed that patients receiving the combination medication demonstrated fewer episodes of agitation compared to patients who received the placebo. When agitation did occur, it tended to be less severe. Researchers also found that not only is the combined drug effective, but safe.
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About 42 percent of the general U.S. population has low vitamin D levels. In addition to promoting calcium and bone health, vitamin D may also affect the brain and cognitive function. A new study by JAMA Neurology looked at the association between baseline vitamin D levels and the rate of cognitive decline in a group of ethnically diverse older adults.
A researcher from Rutgers University, along with colleagues from the University of California Davis, studied 382 older adults with an average age of 75. Among the group, 61 percent of participants were women, 41 percent white, about 30 percent were African American and 25 percent were Hispanic. At study enrollment, about 18 percent had dementia, 33 percent had mild cognitive impairment and half were cognitively normal.
Vitamin D levels and cognitive function were measured at baseline. Cognitive function was also followed in 318 of the participants for an average of 5 years.
Researchers found:
- About 60 percent of the group, regardless of their race or ethnicity, was low in vitamin D.
- Vitamin D levels were lower for African American and Hispanics, compared with their white counterparts.
- …
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Autism Spectrum Disorder (ASD) represents a diverse group of neurodevelopmental conditions. If researchers can better understand the genetics of ASD, it may be possible to identify and diagnose at-risk children sooner. A new study looked at the results of two newer genetic testing technologies, chromosomal microarray and whole-exome sequencing, in children diagnosed with ASD.
Researchers from Newfoundland, Canada studied more than 250 children diagnosed with ASD. All participants underwent the chromosomal microarray analysis, however, only 95 randomly selected participants had whole-exome sequencing. Results found that sixteen percent of the children had an ASD related genetic finding on either microarray or whole-exome sequencing.
In addition to the new tests, researchers also closely examined the children for subtle physical differences and screened them for birth defects. Based on these exams, they were put into three groups of increasing physical severity: essential, equivocal, and complex. Researchers found that thirty-five percent of children in the complex group had a positive genetic test. In that group, the diagnosis of autism was more delayed than in the children of the other groups.
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Some evidence suggests that physical activity can help slow cognitive decline. A new study evaluated whether a program of moderate physical activity would result in better cognitive function, lower risk of dementia, or both, for older adults compared with a health education program.
Researchers from Wake Forest School of Medicine, Winston-Salem, North Carolina evaluated more than 1,600 sedentary adults, between the ages of 70 and 89, and randomly assigned them to either physical activity or a health education program. The participants were monitored for 24 months, during which their cognitive function was measured using a variety of clinical tests.
Results found that both groups preserved their cognitive function over the two year study period. Although there was no difference between the groups, the outcomes still prove notable, since steady decline in cognitive function would generally be expected within this age group.
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Electronic cigarettes (e-cigarettes) are becoming increasingly popular among teens. A new study looks at whether younger teens who never smoked cigarettes and who begin using e-cigarettes might be more likely to go on to use conventional tobacco products.
Researchers from the University of Southern California, Los Angeles surveyed more than 2,300 Los Angeles area high school students who reported never using tobacco products at the beginning of 9th grade. The students were surveyed again six months later and also when entering the 10th grade.
In a comparison of teens who had used e-cigarettes to those who had not, the researchers found that those who had used e-cigarettes were four times more likely to have gone on to use conventional tobacco products, including cigarettes and cigars. The researchers acknowledge that their findings, while suggestive, cannot prove that e-cigarette use directly causes subsequent tobacco use.
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The popularity of testosterone supplementation among older men has increased substantially over the past decade. However, the risks and benefits of long-term administration are still unclear. A new study examined whether using testosterone supplements affected the development of atherosclerosis (hardening of arteries), which is linked to heart attack and stroke.
Researchers from Brigham and Women's Hospital in Boston studied more than 300 men who were sixty years of age and older, in relatively good health, and had low or low-normal testosterone levels. Half the men applied a testosterone gel daily to the skin for three years, while the other half were given a placebo gel. During the course of the trial, hardening of the arteries was measured in the carotid and coronary arteries, which supply the brain and heart.
Results were that during the three year study, there was no significant effects in terms of hardening of the carotid or coronary arteries. Testosterone supplementation also did not improve overall sexual function or health-related quality of life.
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Posttraumatic stress disorder (PTSD) affects twenty-three percent of veterans returning home from deployments in Afghanistan and Iraq. Left untreated, PTSD is associated with high rates of other disorders, disabilities, and poor quality of life. A new study evaluated a different approach to managing PTSD related symptoms, a mindfulness-based stress reduction therapy.
Researchers at the Minneapolis Veterans Affairs Health Care System randomly assigned 116 veterans with PTSD to receive nine sessions of mindfulness-based stress reduction therapy, which teaches participants to be present in the moment in a nonjudgmental, accepting manner. The others attended group therapy, primarily focusing on current life problems. The veterans were monitored before, during and after treatment.
Results found that among veterans with PTSD, mindfulness-based stress reduction therapy, compared to group therapy, resulted in a greater decrease in PTSD symptom severity.
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America's landmark health care programs, Medicare and Medicaid, celebrate their 50th anniversaries on July 30th. Over the past five decades, the United States healthcare system has experienced dynamic changes, most notably in recent years with improvements in technology, care delivery and health related behaviors. A new study examined key outcomes among the Medicare population over a 15 year period.
Researchers from Yale University School of Medicine reviewed the records of nearly 70 million Medicare beneficiaries enrolled in fee-for-service and Medicare Advantage plans from 1999 to 2013, to better understand long-term trends in mortality, hospitalizations, and healthcare costs.
Results found that among Medicare beneficiaries, death rates have dropped an estimated twenty percent, there have been ten percent fewer hospitalizations, and overall expenditures have decreased from 1999 to 2013. In the last six months of life, total hospitalizations and inpatient costs have also decreased.
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Out-of-hospital cardiac arrest is a major public health issue, accounting for approximately 200,000 deaths per year in the United States. A new study examined whether increased use of defibrillators and cardiopulmonary resuscitation (CPR) by first responders and bystanders could help increase survival for people who experience an out-of-hospital heart attack.
In recent years, statewide initiatives in North Carolina have encouraged improvement in the use of CPR and automated external defibrillators (AEDs) by training more members of the general public.
Bystander-initiated CPR was associated with a greater likelihood of survival with favorable neurologic outcome. The combination of bystander CPR and first responder defibrillation increased from 14 percent in 2010 to 23 percent in 2013. Results found, patients who received bystander or first responder interventions before arrival of the emergency medical services (EMS) were more likely to survive compared to those who received EMS intervention alone.
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An increasing number of pregnant women are undergoing noninvasive prenatal testing to help identify fetal genetic abnormalities. This is done using a blood test that looks at the DNA of both the mother and fetus. In a small percentage of these tests, the results appear abnormal, but the baby's genetics are later shown to be normal. A new study examined if the rare diagnosis of maternal cancer could be one cause of such discrepancies. The study is being released to coincide with its presentation at the 19th International Conference on Prenatal Diagnosis and Therapy in Washington, D.C.
Researchers at Tufts Medical Center in Boston examined more than 125,000 noninvasive prenatal test results over the course of a two year period. Approximately 3,800 women had abnormal test results, and ten of those women were subsequently diagnosed with cancer. Medical records and additional genetic information were examined in eight of those women to look for patterns suggestive of underlying cancer.
Based on the results of the study, researchers estimate there is between a twenty and forty-four percent risk of maternal cancer if an abnormal number of chromosomes are detected. Further studies are needed to fully understand …
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Each year, nearly 800,000 Americans experience a stroke, and for survivors, cognitive decline including memory and thinking speed, is a major cause of disability. Many patients experience these declines immediately after a stroke, but a new study examined whether cognitive decline continues several years after the initial stroke.
Researchers from the University of Michigan Medical School, Ann Arbor examined changes in cognitive function in more than 23,000 individuals who were 45 years of age or older. All participants were free of cognitive impairment at the start of the study. Memory and other measures of cognitive function were recorded at the beginning and at regular intervals throughout a six year follow up period. 515 participants experienced a stroke during the study, the rest remained stroke free.
Results found that stroke survivors had a faster rate of cognitive decline after stroke compared with the pre-stroke rate. Stroke was associated with an early decline in cognitive function and also accelerated and persistent cognitive decline over the next six years.
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