Global medical news in review: April 29-May 6, 2012
MedWire News: A roundup of select stories of interest to US physicians from the univadis Global Medical News wire.
One baby born every hour in the USA is addicted to opiates, say researchers in JAMA .
Their research highlights the need for increased public health measures to reduce the number of babies exposed to opiate drugs, given that newborns with neonatal abstinence syndrome (NAS; a drug-withdrawal syndrome among newborns) experience longer, medically complex, and costly initial hospitalizations, said senior co-author Matthew Davis (University of Michigan, Ann Arbor, USA) in a press statement.
The study, which the researchers say is the first to assess national trends in NAS and mothers using opioid drugs, estimated that the number of newborns born with the syndrome in 2009 stood at 13,539, corresponding to one baby each hour.
US hospitals that employ strategies such as always having a cardiologist on site could reduce 30-day risk-standardized mortality rates (RSMRs) after acute myocardial infarction (AMI), show study findings.
Other hospital strategies found to reduce RSMRs included monthly meetings between hospital clinicians and staff who transported patients to hospital to review AMI cases, creating an environment in which clinicians are encouraged to solve problems creatively, and having physician and nurse champions rather than just nurse champions.
Such strategies could not only improve AMI patients' outcomes but could also be associated with clinically important reductions in RSMRs, say the researchers.
Beliefs, technology improve drug adherence
Elderly people's beliefs about their medication for hypertension influence their adherence to treatment, a pilot study reveals.
Believing that a medication was necessary had the strongest impact, leading the researchers to hypothesize that targeting health beliefs could help to improve adherence levels, said Todd Ruppar (University of Missouri, Columbia, USA) and co-workers. The investigators used the Beliefs About Medicines Questionnaire, and electronic pill monitoring to evaluate 33 adults aged on average 74 years.
Using logistic regression analysis, Ruppar's group showed that people who had a stronger belief in the necessity of their medication were more than twice as likely to be adherent, at an odds ratio (OR) of 2.03 versus those with a weaker belief.
Other significant predictors of adherence were the total number of medications (OR=0.530) and educational level (OR=0.005), whereas age, antihypertensive dose, and general concern about medications did not influence adherence.
A second study suggests that texting and other electronic messaging can help boost medication adherence.
Marcia Vervloet (Netherlands Institute for Health Services Research, Utrecht) and team examined the effectiveness of electronic reminders in improving medication adherence in a systematic review, published in the Journal of the American Medical Informatics Association.
Nine of 13 studies found that the electronic reminders were associated with improved adherence, and this effect was statistically significant in eight. Of these, four studies were rated as being of high methodologic quality and four were rated as low quality.
Short message service (SMS) reminders seemed to be the most effective form of electronic reminders, the authors found.
Hip fracture patients return for medical reasons
Most hip fracture patients re-admitted to hospital within 28 days of discharge are seen for medical rather than surgical matters, UK study findings indicate.
"Multidisciplinary management in reducing postoperative active clinical problems may reduce early re-admission," suggest M Khan and co-workers, from Hull Royal Infirmary.
The team reviewed medical records for 467 patients who underwent hip fracture surgery between April 2009 and March 2010 at a high-volume tertiary care hospital. In all, 11.8% of patients were re-admitted to hospital within 28 days of discharge.
Pneumonia was the most common reason for re-admittance (27.3%), followed by dehydration and renal dysfunction (18.2%), and general deterioration (18.2%). Other diagnoses included noninfective bowel or urinary disorders, urinary tract infection, and hip implant issues.
Fast food ads foster fatness
Familiarity with fast food advertising is significantly associated with obesity in US adolescents, show data presented at the Pediatric Academic Societies Annual Meeting in Boston, Massachusetts, USA, this week.
Auden McClure (Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA) and colleagues surveyed 2359 adolescents aged 15-23 years about their height, weight, age, gender, race, socioeconomic status, exercise, consumption of soda or sweet drinks, frequency of eating at fast-food restaurants, how many hours they spend watching TV each day, and whether they snack while watching TV.
They also were shown 20 still images selected from TV ads for the top 25 fast food companies that aired in the year before the survey, with images digitally edited to remove the brands. Each individual was given a food advert recognition-recall (FARR) score, with 1 point for having seen the advert, 1 for liking it, and 2 for identifying the brand.
FARR scores ranged from 0 to 65, and increased significantly with increasing weight, from a mean of 21.4 in normal-weight participants to 22.3 and 23.7 in overweight and obese participants, respectively.
In multivariate analysis, adjusted for age, race, gender, parent education, daily soda/sweet drink consumption, exercise, and TV snacking, each 1-point increase in FARR score was associated with a 3% increase in the likelihood for obesity.
Integrated care eases back pain
An integrative care model for patients with low back pain (LBP) may be of benefit, say researchers. David Eisenberg (Harvard Medical School, Boston, Massachusetts, USA) and team.
Their pilot trial compared an individualized 12-week program of intensive care (IC) plus usual care (UC) with UC alone for 20 adults aged 18-70 years with LBP of 3-12 weeks' duration.
Participants who were randomly assigned to receive UC continued to receive treatment at their primary care facilities, which typically included nonsteroidal anti-inflammatory drugs, muscle relaxants, as-needed referrals to physical therapy, limited bed rest, education, and activity alterations.
The integrative care intervention was provided by a trained multidisciplinary team with licensed practitioners who could provide acupuncture, chiropractic, and internal medicine consultation as needed, plus massage therapy, occupational therapy, mind-body techniques, neurology consultation, nutritional counseling, and orthopedics, psychiatry, and rheumatology consultation.
At 12 weeks, participants in the integrative care group experienced significantly greater improvements than those who received UC alone in terms of symptom bothersomeness, pain, and functional status.
By Neil Osterweil