Category Archives: General Health

Suicide Rate Up 33% in Last 20 Years & Can We Stop It?

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A recent article in USAToday highlights the increasing problem of suicides in U.S.:Suicide rate up 33% in less than 20 years, yet funding lags behind other top killers

Also, at the bottom of this post is more information on the topic of whether we can stop suicide from happening.

An excerpt from USAToday:

“More than 47,000 Americans killed themselves in 2017, the Centers for Disease Control and Prevention … contributing to an overall decline in U.S. life expectancy. Since 1999, the suicide rate has climbed 33 percent. 

Americans are more than twice as likely to die by their own hands, of their own will, than by someone else’s. But while homicides spark vigils and protests, entering into headlines, presidential speeches and police budgets, suicides don’t. Still shrouded in stigma, many suicides go unacknowledged save for the celebrities – Robin Williams, Kate Spade, Anthony Bourdain – punctuating the unrelenting rise in suicide deaths with a brief public outcry. 

And research suggests our ways of living may be partly to blame, in ways that don’t bode well for the future.

Alcohol and substance abuse are risk factors, and both are increasing. Isolation raises the risk, and nearly half of Americans say they sometimes or always feel alone. Increasing smartphone use has been linked to suicidal thoughts in teens. Even climate change has been found to have roughly the same effect on increasing suicides as an economic recession.”

A related commentary from the NY Times: Can We Stop Suicides? details the reasons for suicides and discusses the potential of ketamine as a treatment for depression/suicidality.

 

Interesting Study -Detrimental Dose-Response of Screen Time

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In 1995, there was a Batman movie, “Batman Forever,” in which one of the central villains, the Riddler, places these brainwave devices over the TVs to gain control of Gotham.  The sad part, according to a recent study (J Zhao et al. J Pediatr 2018; 202; 157-62) is there is no need to add a brainwave device to a TV set.  Excessive screen time alone is quite detrimental.

In this cross-sectional survey in Shanghai with more than 20,000 children, the authors found the following:

  • Mean screen time for preschool children was 2.8 hrs per day.  78.6% exceeded 1 hour per day and 53% exceeded 2 hrs per day.
  • Every additional hour of screen time was associated with increased risk for poor psychosocial well-being; this effect on well-being had a number of mediators including reducing parent-child interaction as well as increased body mass index and reduced sleep duration.

My take: This study reinforces the consequences of excessive screen time  –now, the hard part — how to translate these findings into reduction in screen time.

Related blog posts:

 

 

Adverse Childhood Experiences

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Recently, I attended the 17th Annual Donald Schaffner lecture.  This lecture honors the legacy of an outstanding surgeon who I had the opportunity to work with many years ago.  One of my partners, Dr. Jeff Lewis, has been instrumental in arranging these annual lectures.

This terrific lecture by Emory physician, Dr. Stan Sonu, focused on Adverse Childhood Experiences (ACEs).  While this has been a pervasive long-standing problem, there has been heightened interest in this topic following the shameful policy of promoting childhood separations at the U.S.-Mexico border.

This lecture explained how widespread the problem of ACEs is among children born in the U.S., even among the affluent.  Much of the lecture focused on the ACEs study which included a cohort of 17,000 –all of whom were insured and 75% were white and 75% were college educated.

Here are pictures of some of the slides -which explain the scope the problem and the consequences of ACEs:

The above slide provides the three take home points.

The slide above shows associations between ACEs and smoking drinking, and IV drug use. The slides below shows associations between ACEs and negative mental health outcomes,  chronic diseases, and poor work performance.

The slide above demonstrates that adverse health effects are increased even among 18-34 year olds. The slide below showed that learning problems are associated with ACEs as well; thus, the effects of ACEs start in childhood.

The slide above coincided with discussions (&other slides) of how toxic stress can result in physical changes to the brain.

The slide above (which is difficult to see)  indicates that while we see the health effects, we often are not seeing ACEs directly.

Dr. Sonu stated the single most protective factor was having a stable relationship with caregiver.

 

 

Are Patients (but not Doctors) Better Off with EMRs?

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A terrific piece by Atul Gawande explores the issues related to adoption of EMRs (electronic medical records): Why Doctors Hate Their Computers

He reviews in-depth many of the reasons why doctors face difficulties with their EMRs:

  • Spending twice as long in front of computer screen instead of with patients
  • Longer days
  • Endless problem lists
  • Inability to delegate some tasks (that previously were done by staff) and needing to provide more information on orders

“Gregg Meyer … the chief clinical officer at Partners HealthCare, Meyer supervised the software upgrade.

‘We think of this as a system for us and it’s not,’ he said. ‘It is for the patients.’

While some sixty thousand staff members use the system, almost ten times as many patients log into it to look up their lab results, remind themselves of the medications they are supposed to take, read the office notes that their doctor wrote in order to better understand what they’ve been told. Today, patients are the fastest-growing user group for electronic medical records.”

Hospital systems can use EMRs in various ways:

Other topics:

  • the emergence of scribes, including scribes in places like India where doctors transcribe recorded patient visits.
  • physician burnout
  • alarm/signal fatigue
  • ” the inevitability of conflict between our network connections and our human connections.”

My take: This is a terrific article and shows why physicians are struggling with EMRs; this article explains the problem in a way that is easy for non-physicians to grasp.  It shows that other professions face similar challenges.

Related blog posts on EMRs:

 

More on the Flu -5 Reasons for the Flu Shot

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Last year’s deadly flu was likely due in part due to a low rate of vaccination.

From NPR: 5 Reasons Why You Need the Flu Shot

Last year “more than 80,000 people died from flu-related illnesses in the U.S. — the highest death toll in more than 40 years.” So 5 reasons to get your shot:

1. You are vulnerable.

People 65 and older are at higher risk of flu-related complications, but the flu can knock young, healthy people off their feet, too. It does every year.

2. Getting a flu shot is your civic duty.

“Nobody wants to be the dreaded spreader,” says Schaffner. But everybody gets the flu from somebody else.

3. You can still get the flu, but you won’t be as sick.

After last winter’s severe season, some people are skeptical. They say: “I got the flu shot, but I still caught the flu.”

4. Pregnant women who get the flu shot protect their babies from flu.

Women who are pregnant should be vaccinated to protect themselves. The vaccine also offers protection after babies are born

5. You cannot get flu from the flu vaccine.

It’s still a common misperception: the idea that you can get the flu from the flu shot.

Related blog posts:

 

 

 

Mental Health of Medical Students

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It is well-recognized that there is a high rate of burnout and even suicides among physicians.  The concern regarding mental health extends to medical students.  According to a recent commentary (JF Karp, AS Levine. NEJM 2018; 1196-8), “despite entering medical school with relatively good mental health, medical students become depressed, burned out, and suicidal at alarming rates.”  This is thought to be due to “demanding schedules, cost, and stigma” to obtain mental health services.

The editorial advocates for medical students: “Working closely with the physician-services divisions of large hospital systems may help schools and hospitals leverage resources and provide shared opportunities to improve the care of students, trainees, and faculty and staff physicians.”

Related blog posts on burnout:

Frpm NEJM twitter feed

Expansive View of Endoscopy from Porto IBD Group

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The pediatric IBD Porto Group of ESPGHAN has updated endoscopy guidelines: S Oliva et al. JPGN 2018; 67: 414-430.   In total, the authors make 17 recommendations –here are a few of them:

A) In non-emergency situations, the diagnostic evaluation for suspected IBD in children should include a combination of EGD and colonoscopy.  Multiple biopsies from each segment are recommended even in the absence of macroscopic disease.

B) Endoscopic evaluation is recommended for the following:

  • before major treatment changes
  • in symptomatic patients when it is not clear whether the symptoms are inflammation-related
  • in Crohn’s disease(CD) to ensure mucosal healing during clinical remission
  • in Ulcerative colitis (UC) to ensure mucosal healing during clinical remission only if fecal calprotectin is elevated

C) 6-12 months after bowel resection to identify postoperative recurrence

D) Endoscopic surveillance in pediatric UC after 10 years from the onset of disease (as early as 8 years in older children (>16 years) with risk factors like extensive disease and strong family history

E) In patients with concurrent primary sclerosing cholangitis (PSC), surveillance colonoscopy may be considered every 1-2 years, starting from time of PSC diagnosis. However, in children <12 years of age, surveillance could be postponed based on individual risk factors.

In addition to discussions of conventional endoscopy, the authors favor evaluation of small bowel inflammation: “the choice to perform CE [capsule endoscopy], MRE or both, depends on local availability and expertise.”  The authors caution to consider strictures and the potential need for patency capsule prior to CE.

Conclusion of authors: “Endoscopy in pediatric IBD provides a more definitive diagnosis and disease extent evaluation, assesses therapeutic efficacy and leads to targeted therapy, which lessens complications and progression.”

My take: While I agree that endoscopy increases our understanding of disease extent and response to treatment, I do have some concerns about the recommendations (under section B above) regarding assessment of mucosal healing.  Part of the concern is that there is not a single accepted definition of mucosal healing.  Also, as a practical matter, there needs to be a discussion of the costs and more proof that frequent endoscopy will improve outcomes; it is possible that increased use of endoscopy will lead to some detrimental outcomes in some patients based on the interpretation of the results (eg. dropping a therapy that may be helping and replacing with a less effective treatment)..

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.