Tip sheet from Annals of Internal Medicine, Sept. 9, 2014

(Press-News.org) 1. Health insurance not affordable for many under Affordable Care Act For many younger adults, the penalty for not buying health insurance may be less than the price of the least expensive plan available under the Patient Protection and Affordable Care Act (ACA), according to a study being published in Annals of Internal Medicine. The ACA aims to expand health care coverage in part by providing subsidies to individuals with low annual incomes. The law mandates that individuals purchase health insurance or pay a penalty. The penalty is waived if the cost of the least-expensive plan available is greater than 8 percent of an individual's income. Researchers assessed marketplace affordability for all health plans offered in every county in the United States after accounting for income-based subsidies. They found that, even with subsidies, many individuals lack access to an affordable plan. Younger adults who are eligible for subsidies may be more likely than older adults to remain uninsured because premium costs were often much higher than the cost of paying a penalty for not buying insurance. Note: The URL will be live at 5:00 p.m. on Monday, September 8 and can be included in news stories. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Peggy Reisser at mreisser@uthsc.edu or 901-448-4072. 2. Task Force recommends daily low-dose aspirin for women at high risk for preeclampsia Free content The U.S. Preventive Services Task Force recommends daily low-dose aspirin (81 mg/day) after 12 weeks of pregnancy in women who are at high risk for preeclampsia, according to a recommendation statement being published in Annals of Internal Medicine. The recommendation applies to pregnant women who are at high risk for preeclampsia and who don't show signs or symptoms of the condition and haven't had any health problems from using aspirin in the past. Preeclampsia is a complex condition that occurs in pregnant women and is marked by a rise in blood pressure and excess protein in the urine after 20 weeks of pregnancy. It is one of the leading causes of health complications for expectant mothers and their babies, affecting about 4 percent of all pregnancies in the United States. This recommendation is intended only for women at high risk for preeclampsia. Specifically, the high risk factors for preeclampsia include: history of preeclampsia (including early-onset preeclampsia), multifetal gestation, and some preexisting chronic and autoimmune diseases. Note: The URL will be live at 5:00 p.m. on Monday, September 8 and can be included in news stories. For a PDF, please contact Megan Hanks. To interview a member of the USPSTF, please contact Nicole Raisch at newsroom@uspstf.net or 202-572-2044. 3. Researchers review evidence on comparative benefits of osteoporosis drugs A comprehensive review being published in Annals of Internal Medicine looks at the latest evidence on drugs for patients with low bone density. Various pharmaceuticals are available to treat osteoporosis and questions remain about comparative effectiveness, optimal duration of therapy, and adverse events. Researchers conducted a systematic review of 294 articles to update a 2007 review on the benefits and harms of pharmacological treatments used to prevent fractures in adults with low bone density. While few studies directly compared different drugs used to treat osteoporosis, strong evidence suggests that several low bone density drugs, including bisphosphonates, denosumab, and teriparatide, are safe and effective for reducing fractures in at-risk patients. Optimal treatment duration and side effects profiles varied among treatments. The authors of an accompanying editorial write that the clear reporting on side effects provided in the current review will help physicians make informed decisions about treatments. However, they caution that the reviewers' conclusions may not apply to persons aged 75 or older with nonskeletal risk factors for fracture because this population is insufficiently represented in current clinical trials. Note: The URL will be live at 5:00 p.m. on Monday, September 8 and can be included in news stories. For a PDF, please contact Megan Hanks. The lead author may be contacted through Enrique Rivero at erivero@mednet.ucla.edu or 310-794-2273. INFORMATION:

For an embargoed copy of a study, contact Megan Hanks at mhanks@acponline.org or 215-351-2656 or Angela Collom at acollom@acponline.org or 215-351-2653.