Healthcare News and Research

[*Anya*]

By Reshma Jagsi, MD, DPhil; Kent A. Griffith, MS; Abigail Stewart, PhD; Dana Sambuco, MPPA; Rochelle DeCastro, MS; Peter A. Ubel, MD
[+] Author Affiliations

JAMA. 2012;307(22):2410-2417. doi:10.1001/jama.2012.6183
ABSTRACT
Objectives: To determine whether salaries differ by gender in a relatively homogeneous cohort of physician researchers and, if so, to determine if these differences are explained by differences in specialization, productivity, or other factors.

Design and Setting: A US nationwide postal survey was sent in 2009-2010 to assess the salary and other characteristics of a relatively homogeneous population of physicians. From all 1853 recipients of National Institutes of Health (NIH) K08 and K23 awards in 2000-2003, we contacted the 1729 who were alive and for whom we could identify a mailing address.

Participants: The survey achieved a 71% response rate. Eligibility for the present analysis was limited to the 800 physicians who continued to practice at US academic institutions and reported their current annual salary.

Main Outcome Measures A linear regression model of self-reported current annual salary was constructed considering the following characteristics: gender, age, race, marital status, parental status, additional graduate degree, academic rank, leadership position, specialty, institution type, region, institution NIH funding rank, change of institution since K award, K award type, K award funding institute, years since K award, grant funding, publications, work hours, and time spent in research.

Results: The mean salary within our cohort was $167 669 ($158 417-$176 922) for women and $200 433 ( $194 249-$206 617) for men. Male gender was associated with higher salary (+$13 399) even after adjustment in the final model for specialty, academic rank, leadership positions, publications, and research time. Peters-Belson analysis (use of coefficients derived from regression model for men applied to women) indicated that the expected mean salary for women, if they retained their other measured characteristics but their gender was male, would be $12 194 higher than observed.

Conclusion: Gender differences in salary exist in this select, homogeneous cohort of mid-career academic physicians, even after adjustment for differences in specialty, institutional characteristics, academic productivity, academic rank, work hours, and other factors.

http://jama.jamanetwork.com/article....icleid=1182859

[*Anya*]

July 23, 2012

Robin W. Simon, PhD

Professor of Sociology, Wake Forest University, Winston-Salem, NC

First published in Psychiatry Weekly, Volume 7, Issue 14, July 23, 2012

Introduction
The connection between social relationships and mental health is a fundamental component of both the sociological and psychiatric literatures. Robin W. Simon, PhD, is a sociologist whose work has focused on social relationships—especially marriage—and mental health for 25 years.

Why is Marriage Associated with Mental Health?
“Sociologists have long been interested in the link between social relationships and mental health,” explains Dr. Simon. “Let’s take marriage as an example. At this point, hundreds of studies document a robust relationship between marriage and improved mental health: married people report significantly fewer symptoms of depression and are significantly less likely to abuse substances than their non-married counterparts. This is because marriage provides social support—including emotional, financial, and instrumental support. Also, married people have greater psychosocial (or coping) resources than the non-married—higher self-esteem and greater mastery. Social support and psychosocial resources not only increase emotional well-being but also buffer the negative emotional effects of stressors that people experience during the life course.”

There are, of course, many nuances in this narrative. For instance, poor marital quality can lead to lower levels of well-being among the married than the non-married, because marital conflict is highly stressful. However, although it was believed for decades that men derive greater benefit from marriage than women, Dr. Simon’s 2002 study1 and other sociological research show that the mental health advantage of marriage is evident among both genders. At the same time, it appears that marriage is less beneficial for individuals with a mentally ill than an emotionally healthy spouse.2

The Direction of the Relationship Between Marriage and Mental Health
The psychiatric literature recognizes the protective effects of marriage for mental illness. For example, among adults with schizophrenia, being in a marital or cohabiting relationship is associated with a 5-year delay in experiencing a first episode of psychosis (FEP) and higher quality of life, and is a significant predictor of symptom remission within 1 year of FEP.3,4

There is a debate about whether a person’s depression increases the risk of marital loss through divorce, or whether a marital loss itself (including cases where a spouse dies) is largely responsible for depression onset.

The former scenario fits into the hypothesis known as social selection, which states—to summarize it roughly—that healthy individuals gravitate toward intimate relationships and are seen as desirable partners. This view assumes that people who marry are more likely to have better mental health, anyway, and that “the healthiest, most robust people select into marriage,” says Dr. Simon. The alternative hypothesis—the perspective that most sociologists embrace—is social causation, which holds that marriage wards off mental illness and improves mental health by virtue of its built-in support system.

In a 2002 study1 Dr. Simon analyzed longitudinal data from a large nationally representative sample to examine, among other things, both the social causation and selection hypotheses of the relationship between marital status and mental health.

“In this study I examined whether a change in marital status between study onset and endpoint caused a change in mental health,” explains Dr. Simon. “I found that people who became divorced and widowed during the study experienced a significant decline in mental health between data points, which supports the social causation hypothesis. But those who divorced also reported more symptoms before the actual divorce. This latter finding could be interpreted as evidence that people who experience mental health problems are more likely to get divorced (in agreement with the social selection hypothesis). I argued, however, that some of these people might have been experiencing marital conflict at study onset, increasing symptoms of depression and alcohol abuse. In terms of marital gain, people who got married during the study reported a significant decrease in symptoms of depression and alcohol abuse, but there was no evidence that mentally robust people are more likely to marry than their less healthy peers.”

In an era where cohabitation and state-sanctioned same-sex marriage are increasingly common, do the mental health benefits of marriage apply exclusively to heterosexual marriages?

Unfortunately, there are no existing national data sets that would allow us to answer this question. Studies addressing this issue are underway, however, and Dr. Simon predicts that there would be no difference in the mental health benefits of marriage between individuals in heterosexual and same-sex marriages. “If anything,” she says, “marriage may be even more protective for people in same-sex marriages, because they fought long and hard for their partnerships to be recognized by the state.” As for cohabitation, Dr. Simon says that studies show that cohabitation, too, is good for mental health, “though not as good as marriage.”

“We still have much to learn about why marriage in particular, and social relationships in general, improve mental health,” concludes Dr. Simon, “but sociological research on this topic is clear; having a deep emotional connection with another person provides individuals with social support and coping resources, a sense of purpose and meaning in life, an important social identity, and feelings of social integration and mattering—which are all important for both the development and maintenance of mental health.”Disclosure: Dr. Simon reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest.

References:

1. Simon RW. Revisiting the relationships among gender, marital status, and mental health. AJS. 2002;107:1065-1096.

2. Lam D, Donaldson C, Brown Y, Malliaris Y. Burden and marital and sexual satisfaction in the partners of bipolar patients. Bipolar Disord. 2005;7:431-440.

3. Nyer M, Kasckow J, Fellows I, et al. The relationship of marital status and clinical characteristics in middle-aged and older patients with schizophrenia and depressive symptoms. Ann Clin Psychiatry. 2010;22:172-179.

4. Álvarez-Jiménez M, Gleeson JF, Henry LP, et al. Road to full recovery: longitudinal relationship between symptomatic remission and psychosocial recovery in first-episode psychosis over 7.5 years. Psychol Med. 2012;42:595-606.

5. Bulloch AG, Williams JV, Lavorato DH, Patten SB. The relationship between major depression and marital disruption is bidirectional. Depress Anxiety. 2009;26:1172-1177.

[*Anya*]

Topol on 5 Devices Physicians Need to Know About
Eric J. Topol, MD

I'm Dr. Eric Topol, Director of the Scripps Translational Science Institute and Editor-in-Chief of Medscape Genomic Medicine and theheart.org. In this series I will detail the driving forces behind what I believe is the biggest shakeup in the history of medicine.

What I'll be doing in these segments is outlining the parts of my book that represent the digital revolution occurring in the practice of medicine and how this revolution can radically improve the healthcare of the future. In this segment, I'd like to play the role of Dr. Gizmodo and show you many of the devices that I think are transforming medicine today. These devices represent an exciting opportunity as we move forward in the practice of medicine.

Let me just run through some of these. This is 2012, obviously, and this is something that we're going to build upon. You're used to wireless devices that can be used for fitness and health, but these are now breaking the medical sphere. One device you may have already noticed turns your smartphone into an electrocardiogram (ECG). The ECG adaptor comes in the form of a case that fits on the back of a smartphone or in a credit card-size version. Both contain 2 sensors. With the first model, you put the smartphone into the case and then pull up the app -- in this case I'm using the AliveCor app -- and put 2 fingers on each of the sensors to set up a circuit for the heart rhythm. Soon you'll see an ECG. What's great about this is you don't just get a cardiogram, which would be like a lead II equivalent; using the "credit card" version, you get all the V-leads across the chest as well. I have found this to be really helpful. It even helped me diagnose an anterior wall myocardial infarction in a passenger on a flight. It was supposed to be a nonstop flight, but, because of my diagnosis, it wound up stopping along the way. As an aside, after the passenger was taken off the plane to get reperfusion catheter-based therapy at a hospital, the pilots and flight attendants all wanted to have their cardiograms checked.

The second device I will show you is another adaptation of the smartphone, but this one is for measuring blood glucose. Obviously we do that now with finger-sticks, but the whole idea is to get away from finger-sticks. I'm wearing a sensor right now that can be worn on the arm. It also can be worn on the abdomen. What's nice about this is that I can just turn on my phone, and every minute I get an update of my blood glucose right on the opening screen of the phone. It's a really nice tool, because then I can look at the trends over the course of 3, 6, 12, or even 24 hours. It plays a big behavioral modification type of a role, because when you're looking at your phone, as you would be for checking email or surfing the Web, you also are integrating what you eat and your activity with how your glucose responds. This is going to be very helpful for patients -- not only those with diabetes, but also those who are at risk for diabetes, have metabolic syndrome, or are considered to be in the prediabetic state.

The third device I'd like to talk about is another device from the cardiovascular arena that comes in the form of an adhesive patch. It's called the iRhythm, and I tried this out on myself. It's really a neat device, because the results are sent by mail to the patient. You put it on your chest for 2 weeks, and then you mail it back. It's the Netflix equivalent of a cardiovascular exam. The company then sends the patient 2 weeks' worth of heart rhythm detection. I think it's a far better, practical way, as compared to the Holter monitor wireless device. It's not as time-continuous as the ECG or glucose device, but it's in that spectrum.

I want to now explain a fourth device, which I use on my iPad. This device allows physicians the ability to monitor patients in the intensive care unit on their iPads. I use it to monitor patients at the Scripps ICU. You can use it for any ICU that allows for the electronic transmission of data. Right now, I'm monitoring 4 patients simultaneously. You can change the field to monitor up to 8 patients simultaneously. This is a great way to monitor patients in the ICU because you can do it remotely and from anywhere in the world where you have access to the Web. This is just to give you a sense of what this innovative software sensor can do to change the face of medicine.

Finally, I wanted to describe is something that I've become reliant upon, and that's this high-resolution ultrasound device known as the Vscan. I use this in every patient to listen to their heart. In fact, I haven't used a stethoscope for over 2 years to listen to a patient's heart. What's really striking about this is that it's a real stethoscope. "Scope" means look into. "Steth" is the chest. And so now I carry this in my pocket, and it's just great. I still need a stethoscope for the lungs, but for the heart this is terrific. You just pop it open, put a little gel on the tip of the probe, and get a quick, complete readout with the patient looking on as well. I'm sharing their image on the Vscan while I'm acquiring it and it only takes about a minute. We validated its usefulness in an Annals of Internal Medicine paper, in July 2011,[1] describing how it compares favorably to the in-hospital ultrasound echo lab-type image. This could be another very useful device in emergency departments, where the wireless loops could be sent to a cardiologist. Another application it could be used for is detecting an abdominal aortic aneurysm. Paramedics who are out in the field, or at a trauma case, could use this to wirelessly send these video loops to get input from a radiologist or expertise from any physician for interpretation.

These are just a few of the gadgets that give you a feel for the innovative, transformative, and really radical changes that will be seen going forward in medicine. We'll be back soon with more on The Creative Destruction of Medicine. Until next time, I'm Dr. Eric Topol.

http://www.medscape.com/viewarticle/765017?src=ptalk

[*Anya*]

www.medscape.com
From Heartwire

Polypill for Primary Prevention: Largest-Yet Reductions in BP, Cholesterol in Small UK Trial

Lisa Nainggolan
July 19, 2012 (London, United Kingdom) — Results of the first trial to look at the effects of a polypill given to people solely on the basis of age for the primary prevention of CVD have shown the largest reductions in blood pressure and cholesterol levels of any polypill study to date [1].

On average, participants--who were aged >50--experienced a 12% reduction in BP and 39% fall in LDL cholesterol during the 12-week study, achieving levels typical of people aged 20, says lead author Dr David S Wald (Wolfson Institute of Preventive Medicine, London, UK), who together with colleagues, report the findings in PLoS One. "The health implications of our results are large. If people took the polypill long term from age 50, an estimated 28% would avoid or delay a heart attack or stroke during their lifetime and gain, on average, 11 years of life free of cardiovascular events," he told heartwire .

If people took the polypill long term from age 50, an estimated 28% would avoid or delay a heart attack or stroke during their lifetime.

Wald says the vision of his group at the Wolfson Institute is that everyone over a certain age, say 50 or 55 years, will take the polypill without necessarily having to see a doctor. They hope to file for UK regulatory approval for this use of their polypill, manufactured by the Indian company Cipla, within a year or so, once two further ongoing trials in India are completed.

The notion of a polypill for CVD prevention has been much debated since it was first proposed by Drs Nicholas Wald (a coauthor of the current study) and Malcolm Law (Wolfson Institute of Preventive Medicine) in 2003. A number of different formulations have been tested, in both primary and secondary prevention populations, and there are a handful of groups working on this concept worldwide. The idea is not without its detractors, however, with some arguing that the approach to give a polypill to all, as suggested by Wald et al, is far too radical. Many others working in the field believe the polypill is best placed as a treatment for secondary prevention, because those people would already be taking the individual components of a polypill. But critics feel that the global polypill approach is altogether misplaced and argue that individual risk assessment and reduction are the cornerstones of preventive cardiology.

Unique Crossover Design Gives the Most Accurate Results to Date

Wald says the polypill used in their study is three-layered and "easy to swallow"; it contains three BP-lowering medications--a calcium channel blocker, amlodipine 2.5 mg; an angiotensin-receptor blocker, losartan 25 mg; and a diuretic, hydrochlorothiazide 12.5 mg--along with the lipid-lowering simvastatin 40 mg.

Inventors Have Patents, Would License Polypill

Wald says there are four main groups working on the polypill worldwide, including his in London. The others are groups led by Dr Salim Yusuf (McMaster University, Hamilton, ON), who are working with another Indian company, Cadila Pharmaceuticals; an Australian consortium led by Dr Anthony Rodgers (George Institute for Global Health, Sydney, Australia), who are developing the red heart pill with a third Indian firm, Dr Reddy's Laboratories; and a Spanish team, led by Dr Valentin Fuster (Mount Sinai Medical Center, New York, NY), who are working with the Spanish company Ferrer Pharmaceuticals.

The inventors of the polypill, Nicholas Wald and Law, have a patent granted in Europe and Canada, and one pending in the US, that covers all formulations currently being tested by other groups, says David Wald.

"So, in terms of approvals and marketing, any other polypill would need to seek a license from us or they would be infringing the patent in those markets," he explains. "But in all other countries, there is freedom to operate, and that was always our intention, that the intellectual property would remain free to developing countries." He told heartwire that he and Nicholas Wald have invested in development of the polypill and would hope to recover that investment, "but our overwhelming motivation is the public health objective."

Wald explains why aspirin was not included in their formulation: "We took a decision to leave aspirin out of a CVD prevention polypill because it is the only component that runs a reasonable chance of serious harm. Of course it's also useful in preventing heart attacks and strokes, but once you have achieved the large BP and cholesterol reductions that we have shown in our trial, the residual benefit you get from aspirin does not justify its risk in CVD prevention."

Aspirin is the only component of a polypill that runs a reasonable chance of serious harm.

In total, 86 participants who were already enrolled in a CVD-prevention program at the Wolfson Institute and had previously been taking the individual components of the polypill were randomized to the polypill or placebo for 12 weeks. They then crossed over and took the other treatment. Mean within-person differences in BP and LDL cholesterol at the end of each 12-week period were determined, and 84 of 86 participants completed the study.

The mean systolic BP reduction was 17.9 mm Hg, diastolic BP fell by 9.8 mm Hg, and LDL was cut by 1.4 mmol/L; these results are almost identical to those predicted when the polypill was first proposed by Wald and Law, say the researchers.

Although the trial was too short to assess the impact on CV events, sustained reductions in BP and cholesterol of this magnitude would reduce ischemic heart disease events by 72% and stroke by 64%, they estimate.

The fact that this is the only crossover trial of a polypill is an important design issue, says Wald, "because it has allowed us to produce highly accurate estimates of effectiveness, with a relatively small number of participants." Previous trials that used a parallel-group design have shown smaller effects, he notes, with as many as a quarter of participants in such trials not adhering to the allocated treatment. "We believe that our results are the most accurate, direct, observations of the use of a polypill to date," he notes.

We believe that our results are the most accurate, direct, observations of the use of a polypill to date.

However, the trial design also means there are some limitations, he says. First, the high adherence rate observed (98%) is likely a result of those in the trial previously having taken the individual components of the polypill and, as such, this adherence rate cannot be used to estimate compliance in the general population. Second, "the results on tolerability cannot be used to estimate the prevalence of side effects in people who have not previously taken polypill components," he says.

Side effects were more frequent with the polypill than placebo (29% vs 13%, p=0.01), although none were serious enough to cause discontinuation. Myalgia was more common with the polypill compared with placebo (11% vs 1.2%, respectively).

'No-Fuss' Approach Starting to Be Embraced by Medics

"Scientifically, age is the dominant risk factor in predicting whether somebody will or won't have a heart attack or stroke, so it makes sense to use it in the selection of people who are offered the polypill," Wald commented. "Information on a person's BP and cholesterol adds very little extra information and is not worth the cost and complexity."

I do not believe that everybody would choose to take [the polypill], but it's really up to the regulatory agencies to make it clinically available and the medical profession.

The idea that a polypill could be an acceptable treatment offered purely on the basis of age "is one that was initially rejected by the medical community, but now it is starting to be embraced," he notes. "People like the idea of a no-fuss approach to having access to preventive treatment that does not necessarily involve going to your doctor and certainly does not involve being labeled as a patient."

"I do not believe that everybody would choose to take [the polypill], but it's really up to the regulatory agencies to make it generally available, and the medical profession to provide people with the information on its effectiveness and the possibility of its side effects, then let individuals choose for themselves," he concludes.

Nicholas Wald jointly holds European and Canadian patents (EU1272220 priority date April 10, 2000) for a combination pill for CVD prevention (pending in the USA) and, together with David Wald, has an interest in its development. Cipla provided the pills used in their crossover trial free of charge.

References

1. Wald DS, Morris JK, Wald NJ. Randomized polypill crossover trial in people aged 50 and over. PLoS ONE 2012; 7:e41297. Available here.
Heartwire © 2012 Medscape

[Kobi]

Originally Posted by *Anya*

Topol on 5 Devices Physicians Need to Know About
Eric J. Topol, MD

I'm Dr. Eric Topol, Director of the Scripps Translational Science Institute and Editor-in-Chief of Medscape Genomic Medicine and theheart.org. In this series I will detail the driving forces behind what I believe is the biggest shakeup in the history of medicine.

What I'll be doing in these segments is outlining the parts of my book that represent the digital revolution occurring in the practice of medicine and how this revolution can radically improve the healthcare of the future. In this segment, I'd like to play the role of Dr. Gizmodo and show you many of the devices that I think are transforming medicine today. These devices represent an exciting opportunity as we move forward in the practice of medicine.

http://www.medscape.com/viewarticle/765017?src=ptalk

This is so cool. I no longer feel odd for having advocated computer chips in peoples bodies to house their medical information for ready access.

I also no longer feel odd for saying......health care needs one of those wand things like Dr. McCoy had in Star Trek. Who knew the wand thing was actually a combo smartphone/ipod/netflix thingy.

I promise to buy one of those fancy phones as soon as there is an app for a defibrillator.

[Kobi]

Two cases of people in Louisiana who died after contracting "brain-eating amoeba" infections from their own household water systems are prompting health officials to warn about a popular home remedy for treating sinus problems and allergies.

People who use neti pots to irrigate their nasal passages and sinuses should use only water that has been boiled, filtered or distilled, said the researchers at the Centers for Disease Control and Prevention who investigated the unrelated cases, which occurred months apart in 2011 in different parts of Louisiana.

The cases are the first evidence reported in the U.S. of municipal, disinfected tap water used in nasal irrigation causing infections of Naegleria fowleri, as the amoebas are properly called. The infections which pass into the brain from the nose are almost always deadly, with only one report of a survivor ever documented in the U.S., according to the CDC.

Infections have only been known to occur in cases in where water is forced up the nose, Yoder said. There have not been any cases where people contracted the infections by bathing or showering, and "there is certainly not a risk with drinking water," he said.

Pass it on: Neti pot users should use only sterile water, which has been boiled, distilled or filtered, the CDC says.

http://news.yahoo.com/brain-eating-a...111807585.html

[Kelt]

I'm not sure if this thread is the best place for this, but I couldn't think of where else would be.

I just found out that the "shingles" vaccine age limit has been lowered from 60 to 50. If you don't know what it is, check into it (zoster virus). If you have ever had chickenpox you carry the virus in your system. It usually only affects people who are over 60 years of age or have some compromise in their immune system.

Even if you do not fit into this group you can get it. I have had it twice, both times in my forties, five years apart and had no other health issues. You don't want to get it. Check with your health care provider to see if it would be a good idea for you.

This change was made in March 2011, I have been told by two different pharmacies since then that the age was still 60. This is incorrect, you can now get it a participating Costco pharmacies (and probably others). Check your insurance, because this one isn't cheap without it. $188.00 Ouch.

Not giving medical advice, just encouraging folks to check into it this vaccine season and learn about it.

[Toughy]

I think this is the best place for this tidbit of happy information.

I get my health care at the San Francisco Veterans Administration Medical Center. Today at the VA it was Transgender Awareness Day and there was a half day mini conference (with CME/CEU) on Transgender Health with 3 presentations.It was a great conference and I talked about all of it in the Trans News thread, but I wanted to post this part here for a wider audience....

Marci Bowers, MD is probably the best known surgeon who does Sex Reassignment Surgery was one of the presenters. The best and most interesting thing I heard from her had to do with female genital mutilation/female circumcision. It seems the damage can be repaired and a woman will end up with normal looking and functioning genitalia. Yes it can be fixed with what she called 'a simple surgery'.The clitoris works and they can have vaginal penetration and even deliver a baby. She is the only surgeon (she knows about) in the US that is doing this surgery and she does every one of them pro bono. There are surgeons who Europe who do it and she went to Paris and trained. I was stunned and so were the rest of the audience.