Medical News You May Have Missed - Week of February 11th

Suicidal Ideation Higher Among Stroke Survivors than Among Those with History of Cancer

One in 12 adult stroke survivors in the United States claimed to have had thoughts of suicide within the 2-week period preceding their response to a broad-based Patient Health Questionnaire, according to data presented last week at the American Stroke Association’s International Stroke Conference 2013. The prevalence of suicidal ideation (SI), among adults age 20 years or older with a self reported history of stroke was 7.8%, higher than SI reported by individuals with a history of MI (6.2%), diabetes (5.2%), and cancer (4.1%).

Individuals responding to the questionnaire were participants in the National Health and Nutrition Examination Survey from 2005 to 2010. Nearly 6 million US adults reported a history of stroke during that period.

Statistical modeling found that the following variables predicted SI among stroke survivors with 74% sensitivity and 81% specificity (overall accuracy of 80%) in decreasing order of importance: depression score, age, BMI, education level, income to poverty ratio, female sex, and marital status. The results suggest that screening for SI may be warranted during routine assessment of stroke patients.

The results were presented in a poster session at the annual stroke meeting and the full poster information is available here.

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Primary Care Physician Shortage Requires Action

A growing shortage of primary care physicians (PCPs) in the United States increases the number of emergency department visits and the number of patients who delay or altogether skip treatment for their health condition, according to a new government- sponsored report.

Titled Primary Care Access: 30 Million New Patients and 11 Months to Go: Who Will Provide Their Primary Care?, the report was issued by Bernard Sanders, chair of a Senate subcommittee on primary health and aging.

According to highlights of the report, the average PCP in the US is 47-years-old, and one-quarter of this population is nearing retirement. The shortage will only grow more pronounced as expansion of insurance benefits under the Affordable Care Act go into effect in 2014. The report notes that with 30 million newly-insured individuals seeking care, at least 52,000 new providers will be needed by 2025.

The full report is available as PDF, here.

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Meta-Analysis: Evidence of Efficacy Lacking for Pediatric Headache Prophylaxis

Only 2 medications in common use to reduce the incidence of headache in children and adolescents (<18 years of age) were found to be effective, based on results of a meta-analysis of 21 placebo-controlled and comparator trials. Twenty trials focused on episodic migraines and 1 on chronic daily headache. The analysis was published in JAMA: Pediatrics.
 
Topiramate and trazadone were shown to have only limited efficacy. Placebo was also found to be effective. For flunarizine, pizotifen, propranolol, and valproate, no evidence was found to support their use to treat headache in the pediatric population.

An accompanying editorial points out that “no evidence of efficacy does not mean the evidence of no efficacy.” When contemplating if the medications themselves are effective, or if clinicians are observing the placebo effect, editorial writer Marco A. Arruda, MD, PhD, questioned if it mattered, saying: “Although placebo is the enemy of great clinical trials, it is likely the best friend of good clinicians.”

The primary focus of the study was to assess trial design issues when testing preventive treatment for migraine headache. The authors state that “firm conclusions are impossible” based on the currently available data.

The abstract is available, here.  An excerpt of the editorial is available, here. (Full access available only with a subscription.)

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Use of Anti-Depressants Prolonged QT Interval

The use of antidepressants was found to produce a modest prolongation of QT interval, according to the results of a cross-sectional study of adult patients.

According to background information in the article, the FDA has issued a warning that the use of the selective serotonin reuptake inhibitor citalopram was associated with prolonged QT interval when prescribed at higher doses, and has subsequently restricted the dose of the drug to 20 mg for certain subgroups of patients.

The study, published in BMJ, included almost 40,000 adults with electrocardiograms after prescription of an antidepressant or methadone. Three antidepressants were found to have a statistically significant effect on QT prolongation: citalopram (P<.01), escitalopram (P<.001), and amitriptyline (P<.01).

“The question of whether patients for whom antidepressants will be prescribed should routinely have electrocardiograms before and/or after treatment starts cannot be addressed directly by this study,” the researchers wrote in their conclusion.

Read the full-texthere

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Calcium Supplements Increased CVD Risk in Men

The use of calcium supplements among men increased their risk of heart disease by 20%, according to data published in JAMA Internal Medicine. The same risk was not found in women examined in the study. The authors point out that, given the extensive use of supplemental calcium in the United States, it is essential to assess the long-term effects of the practice beyond bone health.

Researchers, led by Qian Xiao, PhD, of the National Cancer Institute, examined information from 388,229 men and women aged 50 to 71 years from the National Institutes of Health–AARP Diet and Health Study. The researchers were looking to established whether increased dietary or supplemental calcium intake was linked with mortality from cardiovascular disease, heart disease and cerebrovascular diseases.

After 12 years of follow-up, 7,904 CVD deaths occurred in men and 3,874 occurred in women. Of these groups, 51% of the men and 70% of the women had used calcium supplements. Men with an intake of 1,000 mg of calcium or more had an increased risk for CVD (risk ratio=1.20; 95% CI, 1.05-1.36) compared with men who did not take calcium supplements.

Read the full text of the study here

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