(Press-News.org) Embargoed for release until 5:00 p.m. ET on Monday 18 December 2023
Annals of Internal Medicine Tip Sheet
@Annalsofim
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
----------------------------
1. Firearms and hanging top methods for suicide in U.S. as rates continue to rise
Suicide mortality highest among White, American Indian, and Alaska Native populations
Abstract: https://www.acpjournals.org/doi/10.7326/M23-2533
URL goes live when the embargo lifts
Suicide rates in the United States increased across all racial groups in the United States between 1999 and 2020 but were highest among White people, followed by American Indian and Alaskan Native (AIAN) persons. Firearms and hanging were the top methods used, with a sharp and substantial increase in hangings among women. This finding poses a conundrum for clinicians, as suicide prevention strategies based on means restriction are not effective when the primary means is hanging. The research report is published in Annals of Internal Medicine.
Researchers from Waseda University, Tokyo, studied data from the Centers for Disease Control and Prevention’s (CDC) WONDER database to assess temporal trends and patterns in method-specific suicide by sex and race in the U.S. from 1999 to 2020. Suicide methods were categorized using International Classification of Diseases, 10th Edition. The data showed that suicide rates in the United States increased across all racial groups but were highest among White people, followed by AIAN persons. Firearms were the most common method of suicide among men, but suicide by hanging increased rapidly among both men and women. Among AIAN men, firearms and hanging were the major means of suicide, but among AIAN women, hangings increased almost 200% between 1999 and 2020. Substantial increases in rates of hanging were also seen among White women.
According to the authors, these findings highlight the need for screening to assess suicide risk and to address underlying mental health issues. It is especially important to consider the role of other drivers of suicide, such as economic and social inequality and racism, such has been experienced by AIAN populations. The authors suggest that a combination of comprehensive and focused community-based suicide prevention strategies that are racially relevant need to be implemented at the community and individual levels.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Bibha Dhungel, DrPH, please contact bibha-dhungel@umin.ac.jp.
----------------------------
2. Prevalence of transgender-related diagnosis codes increased 9-fold between 2014 and 2021
Prescriptions for gender affirming hormone therapy and PrEP for HIV prevention also increased during this timeframe
Abstract: https://www.acpjournals.org/doi/10.7326/M23-2073
URL goes live when the embargo lifts
An analysis of trends in HIV testing and preexposure prophylaxis (PrEP) use among transgender men and women found that rates of HIV testing and PrEP prescriptions have increased significantly among these populations between 2014 and 2021. According to the authors, a simultaneous and much larger increase in gender affirming hormone therapy (GAHT) provides an important opportunity for clinicians to engage their transgender patients in HIV prevention care and provide PrEP prescriptions. The analysis is published in Annals of Internal Medicine.
Transgender persons, particularly transgender women, have a high lifetime risk for acquiring HIV. PrEP is a highly-effective intervention to prevent the acquisition of HIV among persons with sexual or injection drug use risk behaviors. It has been recommended that transgender persons use PrEP preventatively, and it is safe to use with gender-affirming hormone therapy. However, PrEP use has been low among transgender persons. Health care encounters for GAHT can provide opportunities for HIV testing, risk behavior assessment, and PrEP initiation.
Researchers from the Division of HIV Prevention, Centers for Disease Control and Prevention, analyzed data from the Merative MarketScan commercial databases from 2014 to 2021 to estimate the number of commercially insured transgender women (TGW) and transgender men (TGM) in the United States and their use of HIV prevention services. The authors found that the prevalence of transgender-related diagnosis codes increased by 9-fold between 2014 and 2021. The proportion of these persons receiving GAHT also increased substantially during this same period. They report that in 2021, among 10,613 TGW with a test for or diagnosis of a sexually transmitted infection (STI) within the previous year, 61.1 percent had an HIV test; among those, 20.2 percent were prescribed PrEP. Among 4,184 TGM with STI risk, 48.3 percent had an HIV test and 10.2 percent were prescribed PrEP. The prevalence of both groups receiving a test or diagnosis and were prescribed PrEP also increased substantially from 2014 to 2021. According to the authors, clinical encounters for GAHT may provide additional opportunities for HIV prevention services, such as HIV testing and PrEP.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Ya-Lin A. Huang, PhD, MS, please contact Matt Josey at una3@cdc.gov.
----------------------------
3. Black adults and children saw a decrease in asthma attacks and related emergency visits during the pandemic
Abstract: https://www.acpjournals.org/doi/10.7326/M23-2100
URL goes live when the embargo lifts
Relative to Whites, asthma attacks and related emergency department (ED) visits trended downward among Black adults and children during the COVID-19 pandemic. Narrowing asthma morbidity disparities through the pandemic suggest opportunities for mitigation, such as improving environmental conditions or developing and equitably delivering vaccines against common respiratory pathogens. Findings from a brief research study are published in Annals of Internal Medicine.
Researchers from Harvard Medical School/Cambridge Health Alliance analyzed National Health Interview Survey (NHIS) data from 2019 to 2022 to determine whether a decrease in exacerbations of asthma during the COVID-19 pandemic, which has been attributed to a decline in transmission of common respiratory viruses that often provoke asthma attacks, narrowed national disparities in asthma morbidity. The researchers examined three outcomes by racial and ethnic groups: a current asthma diagnosis; and, among those ever diagnosed with asthma, experiencing any asthma episode-attack or an asthma-related ED visit within the past year. The data showed that for adults, asthma prevalence overall increased slightly in 2022, driven by increases among White adults. Hispanic adults had the lowest and Black adults the highest prevalence throughout the study period, with the adjusted difference between Black and White adults decreasing over time. Asthma prevalence among children remained overall stable, and was consistently highest among Black children. Asthma attack rates were stable and comparable among White and Hispanic adults but decreased among Black adults, from 29.3% in 2019 to 22.1% in 2022. During the same timeframe, ED visits decreased among adults and children, with a particularly large drop among Black individuals. Disparities in ED visit rates between Black (as well as Hispanic) and White children evident in 2019 narrowed sharply during pandemic years. According to the authors, these findings suggest that policies are needed to address the multitude of factors that drive both asthma pathogenesis and exacerbations.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Adam Gaffney, MD, MPH, please contact David Cecere at dcecere@challiance.org.
----------------------------
4. Treatment with thiazide diuretics associated with higher risk for low blood sodium
Abstract: https://www.acpjournals.org/doi/10.7326/M23-1989
URL goes live when the embargo lifts
A cohort study of new users of bendroflumethiazide (BFZ) or hydrochlorothiazide plus a renin–angiotensin system inhibitor (HCTZ–RASi) found that the use of these diuretics was associated with a 2-year cumulative incidence of more than 3 percent for low blood sodium (below 130 mmol/L), also known as hyponatremia. The study is published in Annals of Internal Medicine.
Thiazide diuretics are commonly used to treat uncomplicated hypertension. Although thiazide diuretics are considered effective, low-cost, and generally well-tolerated, they may cause significant adverse effects. Currently, the frequency of thiazide-induced hyponatremia according to drug labels is unknown or uncommon to very rare, but the exact burden remains unclear.
Researchers from Statens Serum Institut and the Danish Cancer Institute, Copenhagen, Denmark, conducted a population and register-based cohort study using target trial emulation. One target trial emulation compared new use of BFZ versus a calcium-channel blocker (CCB). They found that the 2-year cumulative incidences for hyponatremia for persons taking BFZ was 3.83 percent. The second target trial emulation compared new use of HCTZ–RASi versus a RASi alone. They found that the two-year cumulative incidence for hyponatremia for persons taking HCTZ-RASi was 3.51 percent. The cumulative incidence for the thiazide diuretics were about 1.4 percentage points higher than for the other antihypertensive comparator drugs. According to the authors, their findings show that new use of thiazide diuretics suggests a substantial excess risk for hyponatremia that is higher than indicated by drug labeling. The risk is particularly pronounced during the first months of treatment and in persons who are older or have comorbidities.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Niklas Worm Andersson, MD, please contact Nanna Martensen at presse@ssi.dk
----------------------------
5. Individual and program-level factors affect flourishing among internal medicine residents
Abstract: https://www.acpjournals.org/doi/10.7326/M23-2233
URL goes live when the embargo lifts
A multi-institutional study provides insight into the individual- and program-level factors that influence flourishing among medical residents. While mean scores on the flourishing index for residents were lower than those of the general population, they were comparable to those in a prior study. The findings are published in Annals of Internal Medicine.
Studies of physician well-being commonly use narrow measures like happiness, life satisfaction, mental health, or burnout. However, well-being is a complex and multifaceted construct. The flourishing index (FI) measures 5 domains of happiness and life satisfaction while the Secure Flourish Index (SFI) measures adds a domain of financial and material stability.
Researchers from Washington University School of Medicine and Yale School of Medicine surveyed a convenience sample of residents from 14 residency programs in Connecticut, Illinois, and Pennsylvania from April to August 2021 to describe the FI and SFI and their domains as functions of resident characteristics and measures of well-being. They found that individual-level factors such as resilience, viewing medicine as a calling, and engagement with religion and spirituality as intrinsic contributors to flourishing. While the stability of these factors remains unclear, the research suggests that programs can enhance them through innovative approaches like narrative medicine, advocacy curricula, mindfulness-based stress reduction, and a commitment to celebrating workforce diversity and equity. Additionally, program-level factors such as Residency Program Community Well-being (RCWB) were identified as pivotal targets in fostering a culture of well-being. The findings underscore the importance of high-quality leadership, robust peer support, just program structures, and a clear shared mission in promoting the flourishing of individual residents.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, David Vermette, MD, MBA, MHS, please contact david.v@wustl.edu.
----------------------------
END
Firearms and hanging top methods for suicide in US as rates continue to rise
2023-12-18
ELSE PRESS RELEASES FROM THIS DATE:
B cell deficient patients gain protective T cell immunity following SARS-CoV-2 vaccination and infection, study finds
2023-12-18
B cell deficiency is a common condition that can result either from immunosuppressant drugs used to treat autoimmune disease or certain cancers — such as rituximab (RTX) — or from natural immune deficiency. These patients suffer from a weakened immune system that is less effective at combating both viral and bacterial diseases. As B cells are a key type of immune cell that produces antibodies, a deficiency results in a significant decrease in antibody count that can lead to severe disease or death upon infection with SARS-CoV-2.
Researchers at the Ragon Institute of Mass General, MIT, and ...
New guidelines released for practitioners treating anaphylaxis and atopic dermatitis
2023-12-18
ARLINGTON HEIGHTS, Ill. – (December 18, 2023) — Two new practice parameters from the Joint Task Force for Practice Parameters (JTFPP) offer evidence-based recommendations for the diagnosis and management of anaphylaxis and atopic dermatitis (AD) in pediatric and adult patients. The Joint Task Force is a partnership between the American College of Allergy, Asthma and Immunology (ACAAI) and the American Academy of Allergy, Asthma and Immunology.
“Both anaphylaxis and atopic dermatitis are allergic conditions that affect millions of people – in the United States and around the world,” says allergist Jay Lieberman, MD, co-chair of the JTFPP ...
Spike in dermatology visits for skin problems seen during summer of wildfires
2023-12-18
New research suggests that air pollution may contribute to the development or worsening of skin conditions.
The work, which is published in Dermatology and Therapy and led by scientists at Massachusetts General Hospital (MGH), a founding member of the Mass General Brigham healthcare system, points to the need to improve air quality to lower the burden of skin disease, especially for vulnerable communities.
“We were inspired to investigate the relationship between air pollution and skin inflammation after listening to patients who kept telling us that their skin conditions like eczema were particularly bad, and in some cases ‘worse than ever before,’ this summer,” ...
Melatonin and carcinogenesis in mice: The 50th anniversary of relationships
2023-12-18
“[...] murine models proved to be valuable and, in some cases, indispensable for advancing melatonin applications in oncology [...].”
BUFFALO, NY- December 18, 2023 – A new research perspective was published in Oncotarget's Volume 14 on December 12, 2023, entitled, “Melatonin and carcinogenesis in mice: the 50th anniversary of relationships.”
Fifty years ago, in 1973, Vladimir N. Anisimov and coauthors demonstrated for the first time an inhibitory effect of the pineal ...
Yale study finds “Forever chemicals” promote cancer migration
2023-12-18
New Haven, Conn. — In a new study by researchers at the Yale School of Public Health, two “forever chemicals” spurred cancer cells in the lab to migrate to new positions, an indication that the chemicals could contribute to cancer metastasis in living organisms.
The study addressed the group of industrial chemicals called per- and polyfluoroalkyl substances (PFAS). The substances are known as “forever chemicals” because they don’t break down in the environment and can build up in the human body. They have the ability to shed water and resist penetration by oils. They are ...
New survey: 79% of survey respondents overlook their health needs during the holidays; find the holidays more stressful than tax season
2023-12-18
Survey Highlights:
A majority of Americans (51%) say it takes them weeks to feel less stressed after the holidays, with more than a quarter of moms reporting it takes them a month or more to recover.
71% of respondents say that their biggest regret after the holidays is that they did not take the time to relax and enjoy the season.
Overall, respondents (63%) claimed that the holiday season is more stressful than tax season.
Eating healthy (69%), exercising regularly (64%), and getting enough sleep (56%) are the top three things that respondents have trouble prioritizing during the holiday season.
79% of people surveyed agree that, during the holidays, they are so focused on creating special ...
Public opinion polls may not be as straightforward as you think
2023-12-18
Public opinion polls are often considered "the will of the people" but a new study on the role of polls in South Korea shows that they may not always be that transparent.
"Using polls to gauge what people think about politics is not as simple as it sounds, as there are multiple mediating factors between what people think and how their views may be represented in the media," says co-author Sunmin Kim, an assistant professor of sociology at Dartmouth. "Our research shows more broadly, how in a democracy, measuring what people think or want can be a highly haphazard and unpredictable process based on the ways public opinion poll ...
Study assesses GPT-4’s potential to perpetuate racial, gender biases in clinical decision making
2023-12-18
A team of Brigham researchers analyzed GPT-4’s performance in four clinical decision support scenarios: generating clinical vignettes, diagnostic reasoning, clinical plan generation and subjective patient assessments.
When prompted to generate clinical vignettes for medical education, GPT-4 failed to model the demographic diversity of medical conditions, exaggerating known demographic prevalence differences in 89% of diseases.
When evaluating patient perception, GPT-4 produced significantly different responses by gender or race/ethnicity for 23% of cases.
Large language models (LLMs) like ChatGPT and GPT-4 have the potential to assist in ...
Apes remember friends they haven’t seen for decades
2023-12-18
Apes recognize photos of groupmates they haven’t seen for more than 25 years and respond even more enthusiastically to pictures of their friends, a new study finds.
The work, which demonstrates the longest-lasting social memory ever documented outside of humans, and underscores how human culture evolved from the common ancestors we share with apes, our closest relatives, was published today in the journal Proceedings of the National Academy of Sciences.
“Chimpanzees and bonobos recognize individuals even though they haven’t seen them for ...
Scientists might be using a flawed strategy to predict how species will fare under climate change
2023-12-18
EMBARGO LIFTS DEC. 18, 2023, AT 3:00 PM U.S. EASTERN TIME
As the world heats up, and the climate shifts, life will migrate, adapt or go extinct. For decades, scientists have deployed a specific method to predict how a species will fare during this time of great change. But according to new research, that method might be producing results that are misleading or wrong.
University of Arizona researchers and their team members at the U.S. Forest Service and Brown University found that the method – commonly referred to as space-for-time substitution – failed to accurately predict how a widespread tree of the Western U.S. called the ...