Causes of death and influencing factors in patients with atrial fibrillation | Mental and emotional health of transgender youths | What are predictors of physical and sexual violence?
November 17, 2016
AJM: From the publisher of The American Journal of Medicine
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Top News
Causes of death and influencing factors in patients with atrial fibrillation
Atrial fibrillation is the most common sustained arrhythmia and significantly increases mortality and morbidity and impairs quality of life, but causes of death of atrial fibrillation patients and their specific predictors have been less well defined. We aimed to identify the causes of death among atrial fibrillation patients, and secondly, clinical predictors for the different modes of deaths.
The American Journal of Medicine (11/2016) 
New Complimentary Multiple Sclerosis CME
This CME program focuses on content presented during the 2016 ECTRIMS Annual Meeting in London, United Kingdom on September 14 - 17, 2016 regarding the management of patients with multiple sclerosis. Once complete, you may receive up to 1.00 AMA PRA Category 1 Credit(s). Click here to begin this activity!
Clinical Updates
Mental and emotional health of transgender youths
Transgender youths have higher rates of depression, suicidality and self-harm, and eating disorders. Research aimed at understanding the cause of this disparity and developing effective interventions aimed at fostering mental and emotional health is ongoing.
Journal of Adolescent Health (11/2016) 
What are predictors of physical and sexual violence?
Gender-based violence threatens women's health and safety, yet few prospective studies examine violence predictors. In a 20-year study of 2,838 women, 61% reported index gender-based violence history; over follow-up, 10% reported sexual violence and 21% reported physical violence. Time-varying risk factors for gender-based violence included recent transactional sex, low income, and marijuana use. For physical violence specifically, time-varying risk factors also included housing instability, unemployment, exceeding seven drinks/week, and use of crack, cocaine, or heroin. Violence prevention strategies must address accumulated trauma, underlying structural determinants of economic vulnerability, and persistent substance use to improve women's health and safety.
American Journal of Preventive Medicine (11/2016) 
Nosocomial infections and bronchopulmonary dysplasia
Although nosocomial infections lead to an increased risk of bronchopulmonary dysplasia (BPD) in neonates, these infections have declined in recent years due to quality improvements. In this retrospective, population-based cohort study of infants <30 weeks' gestational age and weighing <1500 grams, the authors found that from 2006-2010 to 2011-2013 the incidence of nosocomial infections declined 9.7% and the incidence of BPD declined 5%. Of the reduction in BPD, 8% was attributable to reductions in nosocomial infections. Preventing nosocomial infections is important in avoiding long-term neonatal morbidities.
The Journal of Pediatrics (11/2016) 
Reducing opioid misuse: Evaluation of a Medicaid controlled substance lock-in program
Opioid misuse, abuse, and overdose are public health concerns. Medicaid Lock-In Programs (MLIPs) are designed to prevent overutilization of controlled substances by Medicaid patients. However, despite widespread use, there is little information on their impact. Using North Carolina Medicaid claims data from October 2008 through June 2013, this report examined changes in Medicaid-reimbursed opioid prescriptions. Enrollment in this MLIP reduced both the likelihood that patients would present a claim for an opioid prescription and the number of opioid prescriptions patients secured each month. MLIPs may constitute a successful strategy for reducing the misuse, abuse, and diversion of prescription opioids. However, further research is needed to examine the program's potential unintended consequences.
The Journal of Pain (11/2016) 
High-protein supplements improve strength in the elderly
High-protein nutritional supplements and sarcopenia -- is there an improvement in strength? In a multicountry, multicity 24-week study, men and women 65 years and older with both malnutrition and sarcopenia were enrolled and randomized to receive either an oral nutritional supplement (ONS group) or a high-quality supplement called an Experimental ONS (EONS group). EONS contained higher levels of protein and vitamin D. Both groups gained muscle strength, and the EONS group gained notably more strength and greater performance levels.
Journal of the American Medical Directors Association (11/2016) 
Associations between maternal periconceptional exposure to secondhand tobacco smoke and major birth defects
While associations between secondhand smoke and a few birth defects (namely, oral clefts and neural tube defects) have been noted in the scientific literature, to the authors' knowledge, there is no single or comprehensive source of population-based information on its associations with a range of birth defects among nonsmoking mothers. The authors used data from the National Birth Defects Prevention Study, a large population-based multisite case-control study, to examine associations between maternal reports of periconceptional exposure to secondhand smoke in the household or workplace/school and major birth defects.
American Journal of Obstetrics & Gynecology (11/2016) 
Continuing Medical Education
Free CME Activity -- In Focus: The Amyloid-Tau Relationship in the Pathophysiology of Alzheimer's Disease
Free CME Activity -- In Focus: The Amyloid-Tau Relationship in the Pathophysiology of Alzheimer's Disease
The content for this activity is based on the satellite symposium presented at The Alzheimer's Association International Conference® 2016 (AAIC®) on July 26, 2016. The pathophysiology of Alzheimer's disease involves both amyloid and tau proteins; the exploration of the respective roles of these proteins in neuronal loss and neurodegeneration has important implications for future therapeutic interventions. Upon completion, you may receive up to 1.5 RCPSC Section 1 Maintenance of Certification credits. Begin the activity.
Medical News
Study: Heart disease declines 20% in US
US heart disease cases decreased 20% between 1983 and 2011 due to better risk factor prevention and detection, researchers reported in the Journal of the American Medical Association. Data showed that although there has been an increase in diabetes cases in recent years, the link between diabetes and heart disease decreased during the study period.
HealthDay News (11/14) 
More US youths suffering from depression
The prevalence of major depressive disorder in a single year among adolescents ages 12 to 17 and young adults ages 18 to 25 in the US rose from 8.7% and 8.8% in 2005, respectively, to 11.3% and 9.6% in 2014, according to a study in Pediatrics. The findings, based on National Survey on Drug Use and Health data involving more than 350,000 youths and young adults, also showed that teen girls had a significantly higher prevalence of major depressive episodes than boys.
Reuters (11/14),  CNN (11/14),  HealthDay News (11/14) 
Smoking cessation cuts abdominal aneurysm risk, study shows
People who smoke have a higher likelihood of experiencing an abdominal aortic aneurysm than nonsmokers, but middle-aged smokers who quit during a two-decade study reduced their risk by 29%. The research, published in the journal Arteriosclerosis, Thrombosis and Vascular Biology, found that among smokers who did not quit, men had close to a 13% chance of developing an abdominal aortic aneurysm, while risk was about 8% among women.
HealthDay News (11/11) 
Business Practice News
Hospitals want changes in readmission penalty calculations
Hospital lobbyists want Congress to act during the lame duck session on legislation that would change readmission penalty calculations so they factor in patient socioeconomic status. A study in the journal Surgery found socioeconomic factors such as income and race accounted for up to 65% of the increased risk for readmission at minority-serving hospitals, while hospital-related factors accounted for up to 40% of the increased risk.
Modern Healthcare (tiered subscription model) (11/14),  MedPage Today (free registration) (11/13) 
Experts: ACOs should address patients' nonmedical needs
Accountable care organizations and other health care groups should focus on patients' nonmedical needs to improve outcomes, experts said at Health Affairs' Culture of Health briefing. Survey data published in Health Affairs showed 16 of 32 ACOs it contacted had initiatives to address patients' nonmedical needs, including food security, housing instability and transportation.
MedPage Today (free registration) (11/10) 
Patient's Perspective
High protein diet may raise heart failure risk, study says
High-protein diet may raise heart failure risk, study says
(Sean Gallup/Getty Images)
Postmenopausal women consuming the highest levels of dietary protein had a 60% higher risk of heart failure than those who ate little protein, researchers reported at the American Heart Association annual meeting. Researchers linked the biggest risk to eating animal protein and noted women who ate mostly plant-based protein appeared to have an almost 20% lower risk of heart failure.
HealthDay News (11/14) 
Editor's Note
AJMPlus will not publish Nov. 24
In observance of the Thanksgiving holiday, AJMPlus will not publish on Thursday, Nov. 24. Publication will resume Thursday, Dec. 1.
My strength lies solely in my tenacity.
Louis Pasteur,
chemist and microbiologist
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