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Pediatric patients who use antidepressants may have an elevated risk for type 2 diabetes, the authors of a new study report. In a retrospective cohort study of more than 119,000 youths 5 to 20 years of age, the risk for incident type 2 diabetes was nearly twice as high among current users of certain types of antidepressants as among former users, Mehmet Burcu, PhD, and colleagues report in an article  published online October 16 in  JAMA Pediatrics . The risk intensified with increasing duration of use, greater cumulative doses, and higher daily doses of these antidepressants. The findings point to a growing need for closer monitoring of these products, including greater balancing of risks and benefits, in the pediatric population, the authors caution. They undertook the study because, despite growing evidence of an association between antidepressant use and an increased risk for type 2 diabetes in adults, similar research in pediatric patients was scarce. "To our know...

Electronic health record (EHR) vendors should imbed metrics into their systems to measure how EHRs affect clinicians' work, experts write in a commentary  published online  October 10 in the  Annals of Internal Medicine . Yumi T. DiAngi, MD, a fellow in clinical informatics at Stanford University School of Medicine in Palo Alto, California, and colleagues propose six areas metrics should cover and recommended the creation of a "national council of clinicians" to design measures and create guidelines to address privacy and other issues. "The EHR, which was intended to improve patient care, has had the ironic and unintended consequence of impairing practice efficiency, largely because of poor design, a focus on regulatory reporting, and the burden placed on clinicians by data entry," they write. EHRs have also led to high levels of burnout as physicians' satisfaction in their work has declined, they note. To gain insight into the stresses that have pro...

Opioid analgesics have a way of getting physicians as well as patients into trouble. These painkillers account for more medical-malpractice claims related to drug errors than any other drug class, according to a new study released today by the medical liability insurer Coverys that illustrates the far-reaching effects of the opioid abuse epidemic. The company analyzed more than 10,000 closed malpractice claims from 2012 through 2016. Twenty-four percent of medication-related claims involved opioids, even though these drugs accounted for only about 5% of prescription drugs dispensed in 2016, according to published data from QuintilesIMS, a firm that tracks pharmaceutical activity. The next riskiest drug class identified by Coverys was anticoagulants, at 14% of medication-related claims. In claims involving opioids, "overdoses are primarily what we see," said study coauthor Robert Hanscom, vice president of business analytics at Coverys. Some claimants also alleged that...

Despite many prevention initiatives, the prevalence of conventional stroke risk factors, including hypertension, diabetes, dyslipidemia, drug abuse, and smoking, actually appears to be on the rise among new ischemic stroke patients in the United States, a new study shows. Other vascular conditions, such as chronic renal failure, coronary artery disease, and carotid stenosis, also appear to be increasing in the acute ischemic stroke population. These observations come from a new analysis of data from the Nationwide Inpatient Sample, which includes 922,451 hospitalizations for acute ischemic stroke. The authors say this represents "the most comprehensive assessment to date of temporal trends in the prevalence of major stroke risk factors." The study was  published online  in  Neurology  on October 11. "Our data show that all risk factors increased from 2004 to 2014 and the prevalence of raised cholesterol more than doubled during this time. These are truly ...

High prevalence rates of oral human papillomavirus (HPV) of any type, as well as high-risk, oncogenic HPV types, are being reported among all ethnic groups of men in the United States, according to a comprehensive analysis of the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014. Among a sample of 4493 men and 4641 women, the prevalence of any type of oral HPV infection was 11.5% among men and 3.2% among women. This means that 11 million men and 3.2 million women in the United States are infected with some type of oral HPV, the study authors point out. Disturbingly, however, the prevalence of high-risk oral HPV infection was 7.3% among men and 1.4% among women. This translates into 7 million men and 1.4 million women who have high-risk oral HPV infection. By far the most common type is HPV 16, which is commonly associated with oropharyngeal cancer. Such risk factors as having more than 16 lifetime sexual partners, smoking, and marijuana use signi...

Eating a diet rich in omega-6 polyunsaturated fatty acids (PUFAs), which are found in soybean and sunflower oils, as well as in nuts, may protect against the development of type 2 diabetes, say an international team of researchers. Pooling data on levels of linoleic acid and its metabolite arachidonic acid in almost 40,000 individuals from 10 countries, they found that those with the highest linoleic acid levels had a 35% reduction in the risk of developing type 2 diabetes compared with those with the lowest levels. The research was  published online  in  Lancet Diabetes & Endocrinology  on October 11. The results indicate that a "simple change in diet" may help protect against type 2 diabetes, said lead author Jason HY Wu, PhD, the George Institute for Global Health, University of New South Wales, Sydney, Australia, in a press  release  from his institution. Current US guidelines recommend that between 5% and 10% of energy consumption come ...

       ORLANDO — For patients infected with  Clostridium difficile , significant opioid use appears to be associated with increases in the severity of infection and in-hospital mortality, new research suggests. "As physicians, when we see someone in pain, we often will default to opioids. This study raises awareness that, in  C difficile  patients in particular, opioids should be avoided," said Elizabeth John, MD, from Rutgers University in New Brunswick, New Jersey. Opioid use has not been typically associated with  C difficile  infection. However, in a preliminary study, Dr John and her colleagues found an association between opioid use, longer hospital stays, and higher white blood cell counts in infected patients ( Gastroenterology .  2017;5[Suppl 1]:S347 ). In a follow-up study, which Dr John presented here at the World Congress of Gastroenterology 2017, the researchers reviewed the medical record...

As President Donald Trump signals impatience to wind down emergency aid to Puerto Rico, the challenges wrought by Hurricane Maria to the health of Puerto Ricans and the island’s fragile health system are in many ways just beginning. Three weeks after that direct hit, nearly four dozen deaths are associated with the storm. But the true toll on Puerto Rico’s 3.4 million residents is likely to involve sickness and loss of life that will only become apparent in the coming months and in indirect ways. As victims continue to be found and stranded people reached, it will take time to assess the consequences of their missed care or undertreatment. The situation in Puerto Rico’s health system is far more vulnerable than those in Texas or Florida, which also weathered hurricanes this fall — medically, economically and politically. A month after Hurricane Katrina in 2005, only about half of the final official fatalities had been tallied. Puerto Rico has a  higher rate of diabetes ...

PHILADELPHIA — The new position statement on hormone therapy from the North American Menopause Society is in the public eye here at the 2017 annual meeting, where fears about treatment are being discussed and women and healthcare providers are being reassured that hormone therapy is safe and effective for menopausal symptoms that disrupt a woman's quality of life ( Menopause .  2017;24:728-753 ). "Fear has been driving the conversation about hormone therapy," said JoAnn Pinkerton, MD, from the Midlife Health Center at the University of Virginia in Charlottesville, who is executive director of NAMS and chair of the 20-member position statement advisory panel. But "hormone therapy remains the most effective treatment for vasomotor symptoms and the genitourinary syndrome of menopause, and has been shown to prevent bone loss and fracture," she said. Hormone therapy is approved by the US Food and Drug Administration for vasomotor symptoms in women without con...