Physician's First Watch: Archives

Pass the Paci: Parental Pacifier-Sucking May Ward Off Allergies

By Kelly Young

Infants whose parents "clean" their pacifiers by sucking on them are at lower risk for developing asthma and eczema, a small study in Pediatrics indicates.

Researchers in Sweden followed nearly 200 infants, 80% of whom had at least one allergic parent. At 6 months, parents were asked how they cleaned their child's pacifiers. Nearly half said they sucked them before returning them to the infant.

Parental pacifier-sucking was associated with significantly reduced risks for asthma and eczema at 18 months, compared with other cleaning methods. By 36 months, only the association with eczema was still significant.

DNA analysis of infant saliva collected at 4 months showed that infants whose parents sucked their pacifiers could be identified based on the patterns of saliva microbes. The authors conclude: "Exposure of the infant to parental saliva might accelerate development of a complex oral/pharyngeal microbiota that ... might beneficially affect tolerogenic handling of antigens."

LINK(S):

Pediatrics article (Free PDF)

Published in Physician's First Watch May 7, 2013

Featured in Journal Watch: Has the 'Breast Is Best' Campaign Gone Too Far?

By The Journal Watch Editors

In Obstetrics & Gynecology, a physician's essay on her personal experience illustrates the shame and guilt that policies promoting breast-feeding can cause.

LINK(S):

Journal Watch Women's Health summary (Free)

Published in Physician's First Watch May 6, 2013

Lower Oxygen Saturation Levels in Preemies Associated with Higher Mortality by Discharge

By Joe Elia

The question of which oxygen-saturation level is best for very premature infants remains open after the publication of two studies over the weekend. Commentators suggest that levels under 90% should be avoided, however.

Researchers in the BOOST II study (published in the New England Journal of Medicine) report outcomes at hospital discharge for some 2400 infants randomized to lower (85 to 89%) or higher (91 to 95%) saturation levels. Interpretation is muddied somewhat by the fact that the oximeters had a measurement flaw that wasn't discovered until halfway through the study. Among infants measured with corrected oximeters, mortality was higher for those receiving lower oxygen saturation (23% vs. 16%). Retinopathy was lower with lower saturation.

In JAMA, COT study researchers found no significant differences in the rates of mortality or retinopathy by 18 months in some 1200 infants similarly studied.

Commentators say the best interim course would be to target saturation levels between 90% and 95%, realizing the dangers of retinopathy.

LINK(S):

NEJM article (Free abstract)

NEJM editorial (Subscription required)

JAMA article (Free)

JAMA editorial (Free)

Published in Physician's First Watch May 6, 2013

Urological Group's Guidelines Recommend Against PSA Screening in Most Men

By Kelly Young

The American Urological Association's new guidelines recommend prostate cancer screening only in men aged 55 to 69 and based on shared decision-making and the patient's preferences. The guidelines put AUA's position more in line with other medical organizations.

In the 55-to-69 age group, one prostate-cancer death is prevented for every 1000 men screened over a decade. For men who decide to undergo prostate-specific antigen screening, AUA recommends testing every two years or more, rather than annual testing.

The group now recommends against routine PSA screening for men younger than 55 who are at average risk, those older than 69, and those with less than 10 to 15 years of expected life remaining.

The recommendations come less than a year after the U.S. Preventive Services Task Force recommended against routine PSA screening in all men.

LINK(S):

American Urological Association guidelines (Free)

New York Times story (Free)

Background: Physician's First Watch story on USPSTF recommendations (Free)

Published in Physician's First Watch May 6, 2013

Pre-ordering School Lunches Could Lead to Healthier Choices

By Kelly Young

Elementary students who pre-ordered their cafeteria lunches were nearly twice as likely to choose healthier entrees as those who made their selections in the lunch line, according to a research letter in JAMA Pediatrics.

Researchers studied two elementary schools in New York where students usually use an electronic system to pre-order their entrees. Classrooms discontinued pre-ordering during some weeks to serve as the control group. Roughly 30% of students who pre-ordered their entree selected the healthier option, compared with 15% who did not pre-order.

LINK(S):

JAMA Pediatrics research letter (Free abstract)

Published in Physician's First Watch May 6, 2013

FDA Approves New Cholesterol-Cutting Combination Drug

By Kristin J. Kelley

The FDA has approved a new ezetimibe-atorvastatin tablet (brand name, Liptruzet) for lowering cholesterol in patients with primary or mixed hyperlipidemia, and in those with homozygous familial hypercholesterolemia.

In a trial of some 620 patients, the once-daily tablet reduced LDL cholesterol by 53% at the lowest dose (10/10 mg) and 61% at the highest dose (10/80 mg). Common side effects include changes in liver function tests, muscle pain, memory loss, and tendon problems.

The combination treatment has not been shown to improve cardiovascular outcomes better than atorvastatin, which has some cardiologists questioning the FDA's decision. Steven Nissen, chairman of cardiology at the Cleveland Clinic, says in Forbes that the agency seems to be "tone deaf" to concerns "about approving drugs with surrogate endpoints like cholesterol without evidence of a benefit for the disease [cardiologists] are truly trying to treat — cardiovascular disease."

LINK(S):

Manufacturer's press release (Free)

Forbes story (Free)

Patient information sheet (Free PDF)

Published in Physician's First Watch May 6, 2013

Exercise-Induced Bronchoconstriction Guidelines Released

By The Editors

The American Thoracic Society has released guidelines on exercise-induced bronchoconstriction.

The guidelines, published in the American Journal of Respiratory and Critical Care Medicine, strongly recommend that all patients with exercise-induced bronchoconstriction use a short-acting β2-agonist before physical activity. Patients whose symptoms continue despite using a short-acting β2-agonist should use a daily inhaled corticosteroid, a daily leukotriene receptor antagonist, or a mast cell stability agent prior to exercise.

LINK(S):

American Journal of Respiratory and Critical Care Medicine article (Free abstract)

Published in Physician's First Watch May 3, 2013

Zolpidem-Related Emergency Department Visits Triple over 5 Years

By Amy Orciari Herman

The number of emergency department visits related to the insomnia drug zolpidem (e.g., Ambien) more than tripled in the U.S. from 2005 to 2010, according to a report from the Substance Abuse and Mental Health Services Administration.

Overall, the number rose from 6111 to 19,487. Females were especially at risk, accounting for over two thirds of visits in 2010. (In January 2013, the FDA halved the recommended dose of zolpidem in women, noting that women process the drug more slowly than men.) One third of visits involved adults aged 65 and older.

The report concludes: "Physicians and pharmacists can emphasize the importance of using zolpidem safely and only for short-term problems with insomnia. This may be especially crucial for older adults, for whom insomnia is a common complaint and who often take other prescription medications that may interact with zolpidem."

LINK(S):

SAMHSA report (Free)

Background: Physician's First Watch coverage of zolpidem dose change (Free)

Published in Physician's First Watch May 3, 2013

Guidance on Medical 'Breakthroughs' in Mainstream Media

By The Journal Watch Editors

If you see a medical "breakthrough" lurking in a media headline, how to act? Paul Sax offers advice.

LINK(S):

HIV and ID Observations blog (Free)

Published in Physician's First Watch May 3, 2013

Sharp Rise in Suicide Among Middle-Aged Adults

By Cara Adler

Suicide among people aged 35 to 64 increased 28% from 1999 to 2010, according to a CDC analysis of national mortality data published in MMWR.

The annual age-adjusted suicide rate in this group increased from 13.7 to 17.6 per 100,000 people. Among adults in their 50s, the rate rose nearly 50%. Suicide by suffocation (mostly hanging) increased more than 80%.

Noting that suicide prevention typically focuses on youth and older adults, MMWR's editors say the findings highlight the need for prevention efforts aimed at the stresses faced by middle-aged adults, such as job loss, caregiver responsibilities, and declining health.

LINK(S):

MMWR article (Free)

CDC's suicide prevention resources (Free)

Published in Physician's First Watch May 3, 2013