Osteoporosis in the Women's Health Initiative | The moderating effects of anger expressiveness | Female height more influenced by BMI than male
August 17, 2017
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Osteoporosis in the Women's Health Initiative
This analysis of data from the Women's Health Initiative discovered factors predictive of osteoporosis medication use following fracture or diagnosis of osteoporosis, revealing that certain subgroups of older women may be particularly vulnerable to suboptimal osteoporosis treatment and fracture prevention. Initiation of osteoporosis treatment after fragility fracture may represent an opportunity to improve later outcomes in these high-risk women.
The American Journal of Medicine (8/2017) 
New CME: Irritable Bowel Syndrome
This free CME provides participants with the opportunity to assess new data and challenges in the diagnosis and treatment of patients with IBS via interactive case scenarios. Upon completion of this activity you may receive up to 1.0 AMA PRA Category 1 Credit. Click here to begin this activity.
Clinical Updates
The moderating effects of anger expressiveness
In this study, individuals with chronic low back pain and healthy controls underwent ischemic pain induction under placebo, opioid blockade (naloxone), and morphine in counterbalanced order. The authors report that low back pain patients who express anger and also have deficient endogenous opioid function may be poor candidates for opioid therapy. In contrast, low back patients who tend not to express anger and who also have deficient endogenous opioid function may make optimal candidates for opioid therapy.
The Journal of Pain (8/2017) 
Female height more influenced by BMI than male
Overweight-obese females and males have an increased risk of being short compared with those with normal weight. A greater influence of body mass index on height was observed in females. Underweight females were significantly taller compared with those with normal weight, and taller than their expected genetic height.
Journal of Adolescent Health (8/2017) 
Association of inhaler errors (type and frequency) with asthma outcomes
The CRITIKAL study investigated the association between specific inhaler errors and asthma outcomes between 2011 and 2014 in 3,660 patients receiving fixed-dose combination treatment with inhaled corticosteroids and long-acting beta agonist by either a dry powder inhaler (DPI) or metered-dose inhalers (MDI). Insufficient inspiratory effort was common (made by 32-38% of DPI users) and was associated with uncontrolled asthma (adjusted odds ratios [95% confidence interval] 1.30 [1.08-1.57] and 1.56 [1.17-2.07] in those using Turbohaler and Diskus devices, respectively) and increased exacerbation rate. In MDI users, actuation before inhalation (24.9% of patients) was associated with uncontrolled asthma (1.55 [1.11-2.16]). Several more generic and device-specific errors were also identified as critical. Asthma management should target inhaler training to reduce key critical errors.
The Journal of Allergy and Clinical Immunology: In Practice (8/2017) 
RNA profiling of trophoblast subpopulations in preeclampsia
Global profiling of trophoblast subpopulations isolated by laser microdissection from the placentas of severe preeclampsia cases revealed novel aspects of RNA dysregulation in this syndrome.
American Journal of Obstetrics & Gynecology (8/2017) 
Adult smoking most effectively prevented in adolescence
The proportion of adult smoking that would be prevented if initiation had been prevented during adolescence ranges from 50% to 72% across countries. Tobacco control initiatives should be rebalanced to include a greater focus on adolescent initiation and early smoking cessation.
Journal of Adolescent Health (8/2017) 
Teen e-cigarette use part of a constellation of risk behavior
E-cigarette use is common among US adolescents, and there are robust associations between e-cigarette use and school- and substance-related risk behaviors. There is evidence that e-cigarette use clusters with risk behaviors and appears to represent a problem behavior, especially dual use of e-cigarettes and traditional cigarettes.
Journal of Adolescent Health (8/2017) 
Continuing Medical Education
NEW Psoriatic Arthritis Global Learning Center
The Psoriatic Arthritis Global Learning Center is a freely accessible platform that aims to increase clinical knowledge by providing continuing medical educational activities, research articles and resources for healthcare providers who treat patients with psoriatic arthritis. Visit the resource center!
Medical News
Study ties cancer diagnosis to higher CV events risk
A study in the Journal of the American College of Cardiology found patients with cancer had greater risks for arterial thromboembolism, heart attack and ischemic stroke six months after their diagnosis, compared with those who did not have cancer. The findings were based on Medicare linked-Surveillance Epidemiology and End Results Program data for 279,719 pairs of patients with cancer and matched controls.
Reuters (8/15),  MedPage Today (free registration) (8/15) 
Study supports lifestyle intervention for diabetes control
Diabetes patients in an intensive aerobic exercise and dietary program saw a greater decrease in average A1C levels than those in a standard care group, and 73.5% required less diabetes medication, compared with 26.4% in the standard care group, according to a study in the Journal of the American Medical Association. Researchers said the improvements in the intervention group did not reach the threshold for equivalence to standard care but were "in a direction consistent with benefit."
Medscape (free registration) (8/15) 
CDC data show 65% jump in US antidepressant use over 15 years
Data from the CDC's National Center for Health Statistics showed antidepressant use in the US was up by almost 65% over the last 15 years, increasing to 13% in 2011-2014 from approximately 8% in 1999-2002. Researchers said antidepressant use increased with age for both genders, but women were about twice as likely as men to report using the medications in the past month.
Medscape (free registration) (8/15),  HealthDay News (8/15) 
Business Practice News
Survey: Many practices spend $40K per physician on regulatory compliance
A Medical Group Management Association survey found almost half of physician practices said they spent more than $40,000 per full-time physician annually on compliance with federal regulations. The survey showed 84% of practices participated in the Merit-Based Incentive Payment System and 72% were reporting more than the minimum data required to avoid a financial penalty.
Medscape (free registration) (8/11) 
Study: Many physicians want to keep working past retirement age
A CompHealth study found that many older physicians are reluctant to retire, saying they would miss the social component of their work. Many physicians postpone retirement to age 68, about 5 years longer than the average retirement age in the US, and those who decide to retire say financial security and time for personal activities factor in to their decisions.
Physicians Practice magazine online (8/10) 
Patient's Perspective
Survey: 16% of cancer patients face financial distress
A survey of 300 cancer patients with insurance found 39% had a financial burden that was higher than expected and 16% had high or overwhelming financial distress. The survey findings, reported in a research letter in JAMA Oncology, showed factors tied to having an unexpected financial burden included having colorectal or breast cancer and being nonwhite, unmarried, younger, and unemployed but not retired.
Medscape (free registration) (8/10) 
A prosperous fool is a grievous burden.
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