As more than a million people struggle with illnesses such as anorexia, two reports say more must be done.
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Category Archives: Mind Building
Shedding light on ‘black box’ of inpatient opioid use
People who receive opioids for the first time while hospitalized have double the risk of continuing to receive opioids for months after discharge compared with their hospitalized peers who are not given opioids, according to research led by scientists at the University of Pittsburgh Graduate School of Public Health.
The findings, published today in the Annals of Internal Medicine, are among the first to shed light on the little-studied causes and consequences of inpatient opioid prescribing.
“I was surprised by the level of opioid prescribing to patients without a history of opioid use,” said lead author Julie Donohue, Ph.D., professor in Pitt Public Health’s Department of Health Policy and Management. “About half of the people admitted to the hospital for a wide variety of medical conditions were given opioids. The stability of this prescribing also was surprising. Nationally and regionally, as people have become more aware of how addictive opioids can be, we’ve seen declines in outpatient opioid prescribing. But we didn’t see that in inpatient prescribing.”
Previous studies have shown that some surgical and medical patients who fill opioid prescriptions immediately after leaving the hospital go on to have chronic opioid use. Until this study, however, little was known about how and if those patients were being introduced to the opioids while in the hospital.
Donohue and her colleagues reviewed the electronic health records of 191,249 hospital admissions of patients who had not been prescribed opioids in the prior year and were admitted to a community or academic hospital in Pennsylvania between 2010 and 2014.
Opioids were prescribed in 48% of the admissions, with those patients being given opioids for a little more than two-thirds of their hospital stay, on average.
Almost 6% of patients receiving opioids during their hospital stay were still being prescribed opioids three months later, compared with 3% of those without inpatient opioid use. And 7.5% of patients who received opioids less than 12 hours before discharge were still receiving opioids 90 days later, compared with 3.9% of their peers who were free of opioids for at least 24 hours prior to discharge.
Additionally, non-opioid painkillers and anti-inflammatory medications, such as ibuprofen, aspirin or naproxen, were rarely tried before an opioid was administered — as little as 7.9% of the time for some conditions.
“Inpatient opioid use has been something of a black box,” Donohue said. “And, while our study could not assess the appropriateness of opioid administration, we identified several practices — low use of non-opioid painkillers, continuous use of opioids while hospitalized, opioid use shortly before discharge — which may be opportunities to reduce risk of outpatient opioid use and warrant further study.”
Kennedy, M.S., Christopher Seymour, M.D. M.Sc., Timothy Girard, M.D., M.S.C.I ., Oscar Marroquin, M.D., F.A.C.C., and Chung-Chou H. Chang, Ph.D., all of Pitt; Wei-Hsuan Lo-Ciganic, Ph.D., M.S.Pharm., of the University of Florida; Catherine H. Kim, Pharm.D., of UPMC; and Patience Moyo, Ph.D., of Brown University.
This research was funded by UPMC and Pitt.
The evolution of puppy dog eyes
New research comparing the anatomy and behavior of dogs and wolves suggests dogs’ facial anatomy has changed over thousands of years specifically to allow them to better communicate with humans.
In the first detailed analysis comparing the anatomy and behavior of dogs and wolves, researchers found that the facial musculature of both species was similar, except above the eyes. Dogs have a small muscle, which allows them to intensely raise their inner eyebrow, which wolves do not.
The authors suggest that the inner eyebrow raising movement triggers a nurturing response in humans because it makes the dogs’ eyes appear larger, more infant like and also resembles a movement humans produce when they are sad.
The research team, led by comparative psychologist Dr Juliane Kaminski, at the University of Portsmouth, included a team of behavioural and anatomical experts in the UK and USA.
It is published in the journal Proceedings of the National Academy of Sciences (PNAS).
Dr Kaminski said: “The evidence is compelling that dogs developed a muscle to raise the inner eyebrow after they were domesticated from wolves.
“We also studied dogs’ and wolves’ behavior, and when exposed to a human for two minutes, dogs raised their inner eyebrows more and at higher intensities than wolves.
“The findings suggest that expressive eyebrows in dogs may be a result of humans unconscious preferences that influenced selection during domestication. When dogs make the movement, it seems to elicit a strong desire in humans to look after them. This would give dogs, that move their eyebrows more, a selection advantage over others and reinforce the ‘puppy dog eyes’ trait for future generations.”
Dr Kaminski’s previous research showed dogs moved their eyebrows significantly more when humans were looking at them compared to when they were not looking at them.
She said: “The AU101 movement is significant in the human-dog bond because it might elicit a caring response from humans but also might create the illusion of human-like communication.”
Lead anatomist Professor Anne Burrows, at Duquesne University, Pittsburgh, USA, co-author of the paper, said: “To determine whether this eyebrow movement is a result of evolution, we compared the facial anatomy and behaviour of these two species and found the muscle that allows for the eyebrow raise in dogs was, in wolves, a scant, irregular cluster of fibres.
“The raised inner eyebrow movement in dogs is driven by a muscle which doesn’t consistently exist in their closest living relative, the wolf.
“This is a striking difference for species separated only 33,000 years ago and we think that the remarkably fast facial muscular changes can be directly linked to dogs’ enhanced social interaction with humans.”
Dr Kaminski and co-author, evolutionary psychologist Professor Bridget Waller, also at the University of Portsmouth, previously mapped the facial muscular structure of dogs, naming the movement responsible for a raised inner eyebrow the Action Unit (AU) 101.
Professor Waller said: “This movement makes a dogs’ eyes appear larger, giving them a childlike appearance. It could also mimic the facial movement humans make when they’re sad.
“Our findings show how important faces can be in capturing our attention, and how powerful facial expression can be in social interaction.”
Co-author and anatomist Adam Hartstone-Rose, at North Carolina State University, USA, said: “These muscles are so thin that you can literally see through them — and yet the movement that they allow seems to have such a powerful effect that it appears to have been under substantial evolutionary pressure. It is really remarkable that these simple differences in facial expression may have helped define the relationship between early dogs and humans.”
Co-author Rui Diogo, an anatomist at Howard University, Washington DC, USA, said: “I must admit that I was surprised to see the results myself because the gross anatomy of muscles is normally very slow to change in evolution, and this happened very fast indeed, in just some dozens of thousands of years.”
Soft tissue, including muscle, doesn’t tend to survive in the fossil record, making the study of this type of evolution harder.
The only dog species in the study that did not have the muscle was the Siberian husky, which is among more ancient dog breeds.
An alternative reason for the human-dog bond could be that humans have a preference for other individuals which have whites in the eye and that intense AU 101 movements exposes the white part of the dogs eyes.
It is not known why or precisely when humans first brought wolves in from the cold and the evolution from wolf to dog began, but this research helps us understand some of the likely mechanisms underlying dog domestication.
Facebook posts better at predicting diabetes, mental health than demographic info
Language in Facebook posts may help identify conditions such as diabetes, anxiety, depression and psychosis in patients, according to a study from Penn Medicine and Stony Brook University researchers. It’s believed that language in posts could be indicators of disease and, with patient consent, could be monitored just like physical symptoms. This study was published in PLOS ONE.
“This work is early, but our hope is that the insights gleaned from these posts could be used to better inform patients and providers about their health,” said lead author Raina Merchant, MD, MS, the director of Penn Medicine’s Center for Digital Health and an associate professor of Emergency Medicine. “As social media posts are often about someone’s lifestyle choices and experiences or how they’re feeling, this information could provide additional information about disease management and exacerbation.”
Using an automated data collection technique, the researchers analyzed the entire Facebook post history of nearly 1,000 patients who agreed to have their electronic medical record data linked to their profiles. The researchers then built three models to analyze their predictive power for the patients: one model only analyzing the Facebook post language, another that used demographics such as age and sex, and the last that combined the two datasets.
Looking into 21 different conditions, researchers found that all 21were predictable from Facebook alone. In fact, 10 of the conditions were better predicted through the use Facebook data instead of demographic information.
Some of the Facebook data that was found to be more predictive than demographic data seemed intuitive. For example, “drink” and “bottle” were shown to be more predictive of alcohol abuse. However, others weren’t as easy. For example, the people that most often mentioned religious language like “God” or “pray” in their posts were 15 times more likely to have diabetes than those who used these terms the least. Additionally, words expressing hostility — like “dumb” and some expletives — served as indicators of drug abuse and psychoses.
“Our digital language captures powerful aspects of our lives that are likely quite different from what is captured through traditional medical data,” said the study’s senior author Andrew Schwartz, PhD, a visiting assistant professor at Penn in Computer and Information Science, and an assistant professor of Computer Science at Stony Brook University. “Many studies have now shown a link between language patterns and specific disease, such as language predictive of depression or language that gives insights into whether someone is living with cancer. However, by looking across many medical conditions, we get a view of how conditions relate to each other, which can enable new applications of AI for medicine.”
Last year, many members of this research team were able to show that analysis of Facebook posts could predict a diagnosis of depression as much as three months earlier than a diagnosis in the clinic. This work builds on that study and shows that there may be potential for developing an opt-in system for patients that could analyze their social media posts and provide extra information for clinicians to refine care delivery. Merchant said that it’s tough to predict how widespread such a system would be, but it “could be valuable” for patients who use social media frequently.
“For instance, if someone is trying to lose weight and needs help understanding their food choices and exercise regimens, having a healthcare provider review their social media record might give them more insight into their usual patterns in order to help improve them,” Merchant said.
Later this year, Merchant will conduct a large trial in which patients will be asked to directly share social media content with their health care provider. This will provide a look into whether managing this data and applying it is feasible, as well as how many patients would actually agree to their accounts being used to supplement active care.
“One challenge with this is that there is so much data and we, as providers, aren’t trained to interpret it ourselves — or make clinical decisions based on it,” Merchant explained. “To address this, we will explore how to condense and summarize social media data.”
The current study received funding from a Robert Wood Johnson Foundation Pioneer Award.
Other authors on this study include David A. Asch, Patrick Crutchley, Lyle H. Ungar, Sharath C. Guntuku, Johannes Eichstaedt, Shawndra Hill, Kevin Padrez, and Robert J. Smith.
Health24.com | Testicular cancer treatment unlikely to trigger birth defects
New research should reassure dads-to-be who’ve had testicular cancer that treatment with radiation or chemotherapy doesn’t raise the risk of fathering babies with birth defects.
“Our research set out to investigate whether treatment for the most common cancer among young men leads to a higher risk of fathering a child with a birth defect and we saw no increased risk associated with cancer therapies,” said lead researcher Yahia Al-Jebari, of Lund University in Sweden.
The report was published online in the journal PLOS Medicine.
Slightly greater risk
Testicular cancer treatment has raised concerns because radiation and chemotherapy can cause genetic damage to sperm. Some people theorised that this damage might increase the risk for birth defects.
For the study, Al-Jebari and colleagues followed more than 4 200 children born to nearly 2 400 fathers between 1994 and 2014, in Sweden.
Children conceived after the father had been treated for testicular cancer had a slightly greater risk of birth defects than those conceived before the treatment, the investigators found.
Not a cause for concern
But the risk was small – about four children in every 100 – which shouldn’t worry parents, the study authors said.
“We did see a slightly raised risk to children of these fathers, but this was only very small and was not associated with treatment given.
“Patients should be reassured that this is not a cause for concern,” Al-Jebari said in a journal news release.
The findings are limited by the lack of data on frozen or donor sperm.
Also, not many patients were treated with radiation and high doses of chemotherapy, the authors noted.
Image credit: iStock
Listeria outbreak: More affected hospitals named
Eight hospitals have reported cases of listeria linked to sandwiches and salads eaten by patients.
Health24.com | Vitamin D supplements don’t prevent type 2 diabetes
Vitamin supplements don’t appear to prevent type 2 diabetes in those at highest risk for the disease, a new study finds.
Some studies have suggested that low vitamin D levels might increase the odds of developing diabetes and that boosting levels could prevent it, but these findings throw cold water on these assumptions.
Diversity of participants
In this study funded by the US National Institutes of Health (NIH), more than 2 400 people aged 30 and older across the United States were involved.
Researchers randomly assigned half of them to take 4 000 units a day of vitamin D and the other half to take a placebo.
After nearly three years, 24.2% of those taking vitamin D developed diabetes, as did 26.7% of those taking the placebo.
This difference isn’t statistically significant, researchers said.
“In addition to the study’s size, one of its major strengths is the diversity of its participants, which enabled us to examine the effect of vitamin D across a large variety of people,” lead author Dr Anastassios Pittas said in an NIH news release.
“When the study ended, we found no meaningful difference between the two groups regardless of age, sex, race or ethnicity.”
Pittas is a professor and co-director of the Diabetes and Lipid Center at Tufts University Medical Center in Boston.
The report was published in the New England Journal of Medicine to coincide with its presentation at a meeting of the American Diabetes Association, in San Francisco.
Image credit: iStock
Health24.com | Patients who read doctors’ notes more likely to take their meds
Reading the notes your doctor makes during your visit appears to be good medicine.
An online survey of 20 000 adults treated at three US health systems that have made clinical notes available to patients for several years finds that those who actually read them may be more likely to take medications as prescribed.
More likely to take medications
Patients listed several benefits of reading the notes: 64% said doing so helped them understand why a medication was prescribed; 62% felt more in control of their medications; 57% said the notes answered questions about medications; and 61% felt more comfortable with their prescriptions.
And 14% of patients at two of the health systems – Beth Israel Deaconess Medical Center (BIDMC) in Boston and Geisinger in rural Pennsylvania – said they were more likely to take their medications as prescribed after reading doctors’ notes, the study found.
Meanwhile, 33% of patients at the University of Washington Medicine in Seattle, the third health system studied, considered clinical notes very helpful.
“Sharing clinical notes with patients is a relatively low-cost, low-touch intervention,” lead author Catherine DesRoches, executive director of OpenNotes at BIDMC, said in a news release.
Though sharing notes is a cultural shift, electronic health record systems make it easier, she said, adding that the payoff could be “enormous” because poor adherence to medications costs the health care system about $300 billion (just under R4.5 trillion) a year.
Transparent communication
“Anything that we can do to improve adherence to medications has significant value,” DesRoches said.
Patients whose primary language was not English and those with lower levels of education were more likely to report benefits from being able to read their doctor’s notes, according to the study published in the Annals of Internal Medicine.
Still, this kind of transparent communication initially makes doctors uneasy, said study co-author Dr Tom Delbanco, co-founder of OpenNotes.
“They worry about many things, including potential effects on their workflow, and scaring their patients. But once they start, we know of few doctors who decide to stop, and patients overwhelmingly love it,” he added in the news release. “The promise it holds for medication adherence is enormous, and we are really excited by these findings.”
An accompanying editorial by Dr David Blumenthal and Melinda Abrams of the Commonwealth Fund noted that transparency is mandated by federal law and policy.
“Our challenge now is to make the best and most of shared health care information as a tool for clinical management and health improvement,” Blumenthal and Abrams wrote.
Image credit: iStock
What personalised medicine could mean for your health
Technology is making it possible to tailor treatments to ever smaller groups of patients.
Lyme disease has ‘dominated’ my life
Morven-May MacCallum speaks out as GPs are urged to be vigilant about the infection spread by ticks.
