The week in review: June 10-16, 2012
Medwire News: Among the week's featured stories are the results of surveys suggesting that today's US teens and young adults engage in risky behaviors (and may not be able to pay for the health consequences); a study showing the value of direct transport to a trauma center after a serious car accident; and studies suggesting that neither fish oil nor vitamin D supplements are all they are cracked up to be.
You're grounded until you're 21!
Those darn kids: a report from the US Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Surveillance System (YRBSS) reveals that in the month before the survey was completed, 32.8% of US high-school students reported texting or sending emails while driving, 38.7% said they drank alcohol, and 23.1% reported smoking marijuana.
Additionally, a substantial number of high-school students were exposed to violence in the previous year, with 32.8% reporting having been in a physical fight, 20.1% saying they had been bullied at least once on school property, and 7.8% reporting suicide attempts.
Other findings included that nearly half (47.4%) of all teens reported ever having sexual intercourse, and one-third (33.7%) of all students reported having sex within the past 3 months. Additionally, 15.3% said they had sex with four or more partners. Of those having intercourse, only 60.2% reported using a condom during their most recent encounters.
Many US youths are also smoking too much (18.1% of high school students say they had smoked cigarettes in the 30 days before the survey, and 7.7% reported using smokeless tobacco), not getting enough fruits and vegetables in the diet (4.8% had not eaten fruit or drunk a 100% fruit juice in the past month, and 5.7% eschewed vegetables), or enough exercise (31.1% had played a video/computer games for 3 or more hours on an average school day).
The good news, the authors report, is that some risky behaviors are declining in frequency over time. For example, in 1991 26% of high school students said they never or rarely used seatbelts, compared with only 8% in 2011. In 1997, 17% said they drove a car when they had been drinking alcohol, compared with 8% in 2011, and the percentage of those who said they had ridden in a car with a driver who had been drinking dropped from 40% in 1991 to 24% in 2011.
Insurance? Never heard of it
All that risky behavior may land young adults in the emergency department, but how they will pay for it is another question, suggest results of a study showing that nearly two-fifths of young adults in the USA had no health insurance for all or part of 2011. That gives this group the dubious distinction of having the highest uninsured rate of any age category,
Although one of the earliest provisions of the Affordable Care Act, derided by some as "Obamacare," has allowed an estimated 13.7 million Americans aged 19 to 25 years to remain on or join their parents' health plans, 39% of all US residents from 19 to 29 years still went without health insurance for some or all of 2011, according to Sara Collins and colleagues from The Commonwealth Fund.
Drawing on data from a Commonwealth Fund tracking survey, Collins et al found that of those who had lost a job in the past 2 years, 52% lost their insurance, 14% were able to go on their parents' insurance, 16% went on COBRA (Consolidated Omnibus Budget Reconciliation Act) extension, and 18% went on their spouses' or partners' insurance or found insurance through another source.
Among all participants in the survey, 28% said they had problems paying or were unable to pay medical bills, 16% had been contacted by a collection agency for unpaid bills, 16% had to "change their way of life" to pay a medical bill, and 20% were paying off the debts over time. More than one-third (36%) reported having any medical bill problem or debt in the past year.
The report notes that beginning in 2014, young adults without the option of joining their parents' health plans will be eligible for a variety of insurance options that include expanded Medicaid eligibility and subsidized private health insurance for those with incomes up to 400% of the federal poverty level (maximum annual income levels of $ 43,560 for singles, and $ 89,400 for a family of four).
Express transport to trauma center saves lives
And speaking of risky behaviors, people who are seriously injured in a motor vehicle accident have a 30% greater chance for surviving for a minimum of 48 hours if they are triaged directly to a Level I or Level II trauma center than if they are transported first to a facility without specialty trauma services, Canadian investigators report.
Accident victims transported directly to a trauma center had a significantly lower risk for death than victims triaged to non-trauma centers at both 24 hours (odds ratio [OR]=0.58) and 48 hours (OR=0.68), report Barbara Haas (University of Toronto, Ontario, Canada) and colleagues.
There were also trends, albeit nonsignificant, toward better 7- and 30-day survival among patients triaged directly to trauma centers, the authors report in the June issue of The Journal of Trauma and Acute Care Surgery.
The findings underscore the importance of having adequate emergency medical transport systems in place, and for training emergency medical technicians, paramedics, and emergency department personnel to recognize when trauma patients need the urgent services of specialty trauma center, according to co-author Avery Nathens (St Michael's Hospital, Toronto).
A fish tale
In less gruesome news, fish oil has floundered in attempts to improve cognitive function among older adults or prevent cardiovascular events among high-risk patients, two new studies suggest.
Although evidence from observational studies has hinted that the fish-oil components omega-3 long-chain polyunsaturated fatty acids (PUFAs) have a beneficial effect on cognitive function, a review of data from three randomized trials suggests otherwise, write Emma Sydenham (London School of Hygiene and Tropical Medicine, London, UK) and colleagues.
The authors looked at three studies in which participants received omega-3 PUFA in capsules or in a margarine spread, while controls received olive or sunflower oils or a conventional margarine. Two of the studies focused on cognitive health, and one looked at cognitive function as a secondary outcome.
In two of the studies, including a total of 3221 participants, there were no differences between fish oil consumers and controls in Mini-Mental State Examinations at either 24 or 40 months of follow-up. Similarly, there were no significant differences between the intervention group and controls among 1043 participants of two studies in word learning, digit span, verbal fluency, or other tests of cognitive function," they write in a report published in The Cochrane Library.
In a second study, Jackie Bosch (McMaster University, Hamilton, Ontario, Canada) and colleagues evaluated the ability of an omega-3 PUFA capsule to prevent cardiovascular events in 12,535 patients with diabetes who were enrolled in a clinical trial of a long-acting insulin.
As reported in New England Journal of Medicine, there were no significant differences in the primary outcome of death from cardiovascular causes between patients in the intervention group or controls (9.1 vs 9.3%, hazard ratio= 0.98). No associations were found between mega-3 PUFA use and other endpoints, including major vascular events, death from any cause, or death from arrhythmia. Adverse events were similar between the groups.
Hold the vitamin D
Also on the disappointing supplement front comes news that there is insufficient evidence to support the routine use of vitamin D and calcium supplements to prevent fractures among postmenopausal women, nor vitamin D with or without calcium to prevent cancer among adult men and women, despite the widespread adoption of both approaches, as judged by the US Preventive Services Task Force (USPSTF) in a draft recommendation.
"The USPSTF recommends against daily supplementation with ≤400 IU of vitamin D3 and 1000 mg of calcium carbonate for the primary prevention of fractures in noninstitutionalized postmenopausal women," the recommendation states.
It is mute on whether vitamin D supplementation is inadvisable for cancer prevention, however.
The advice applies to asymptomatic adults without previous history of fractures or cancer who are not living in an assisted-living facility, nursing home, or other institutional care setting.
In May the USPSTF issued a recommendation noting that in older, community-dwelling adults, vitamin D supplementation combined with exercise and/or physical therapy is moderately effective at preventing falls in those who are at increased risk for falling.
The current draft recommendation notes that although there is insufficient evidence to support a benefit from vitamin D supplementation in the target population, there is "adequate evidence that supplementation with ≤400 IU of vitamin D3 and 1000 mg of calcium carbonate increases the incidence of renal stones. The USPSTF assessed the magnitude of this harm as small."
By Neil Osterweil