Study suggests statins may help prevent deaths from seasonal flu.

Moral of the story: Again, just like with pneumonia, if you are already taking statins you are likely to be able to better fight off the flu (not swine flu). Not that you should start taking statins to fight off pneumonia or the flu, but a statin regimen will help. If you want to be proactive about fighting off the flu, get a flu shot.

Source: AMA Morning Rounds 10/30/09

The AP (10/30, Marchione) reports that individuals already taking statins "when they caught seasonal flu and had to be hospitalized were twice as likely to survive than those who were not on such medicines," according to a study presented at an Infectious Diseases Society of America conference. Investigators looked at data on "2,800 people hospitalized with lab-confirmed seasonal flu in 10 states in 2007-2008." While "more than three percent of those not taking statins died in the hospital or in the following month," the researchers found that "the rate was half that among statin users, even though they were more likely to have underlying health problems like heart disease."

Reuters (10/30, Fox) quotes one of the study's researchers as saying, "This early research suggests there may be a role for statins in influenza treatment and it should be studied further."

WebMD (10/29, Laino) reported that the researchers "are now analyzing the data to determine if one brand of statin is associated with better odds of surviving the flu than another." HealthDay (10/29, Reinberg) also covered the story.

Heroin abuse among teenagers rising across the US.

Moral of the story: Wait more 8th graders have tried heroin than 12th graders? That's a problem.

Source: AMA Morning Rounds 10/30/09

The CBS Evening News (10/29, story 7, 3:10, Couric) reported, "Heroin abuse by teenagers is on the rise all over the country." National Correspondent Jim Axelrod reported, "Forget injecting heroin. The stuff on the street is so pure now, that kids in the suburbs are snorting it." Axelrod reported that "users are getting younger. More 8th graders now say they've tried heroin in the last year than 12th graders," according to data from the Substance Abuse and Mental Health Services Administration. Axelrod noted that 46 people died "from a heroin overdose last year" in Nassau County, New York. That is a 75 percent increase from 2008. According to Axelrod, "That's a troubling spike being felt nationwide."

Comparison of Liquid-Based Cytology With Conventional Cytology for Detection of Cervical Cancer Precursors

Moral of the story: Conventional PAP smear is just as good (but FAR cheaper) than liquid cytology.

Source: JAMA. 2009;302(16):1757-1764.

Comparison of Liquid-Based Cytology With Conventional Cytology for Detection of Cervical Cancer Precursors

A Randomized Controlled Trial

Albertus G. Siebers, MSc; Paul J. J. M. Klinkhamer, MD; Johanna M. M. Grefte, MD, PhD; Leon F. A. G. Massuger, MD, PhD; Judith E. M. Vedder; Angelique Beijers-Broos; Johan Bulten, MD, PhD; Marc Arbyn, MD, MSc, DrTMH

Context Liquid-based cytology has been developed as an alternative for conventional cervical cytology. Despite numerous studies and systematic reviews, controversy remains about its diagnostic accuracy.

Objective To assess the performance of liquid-based cytology compared with conventional cytology in terms of detection of histologically confirmed cervical intraepithelial neoplasia (CIN).

Design, Setting, and Participants Cluster randomized controlled trial involving 89 784 women aged 30 to 60 years participating in the Dutch cervical screening program at 246 family practices. One hundred twenty-two practices were assigned to use liquid-based cytology and screened 49 222 patients and 124 practices were assigned to use the conventional Papanicolaou (Pap) test and screened 40 562 patients between April 2004 and July 1, 2006. Patients were followed up for 18 months through January 31, 2008.

Intervention Screening for CIN using liquid-based cytology or conventional papanicolaou (Pap) test and the blinded review of all follow-up of screen-positive women (blinded to the type of cytology and the initial result).

Main Outcome Measures Intention-to-treat and per-protocol analysis of the detection rates of and positive predictive values for histologically verified CIN in both cytology systems. Outcomes are presented as crude and adjusted rate ratios (adjustment for age, urbanization, study site, and period).

Results The adjusted detection rate ratios for CIN grade 1+ was 1.01 (95% confidence interval [CI], 0.85-1.19); for CIN grade 2+, 1.00 (95% CI, 0.84-1.20); for CIN grade 3+, 1.05 (95% CI, 0.86-1.29); and for carcinoma, 1.69 (95% CI, 0.96-2.99). The adjusted positive predictive value (PPV) ratios, considered at several cytological cutoffs and for various outcomes of CIN did not differ significantly from unity.

Conclusion This study indicates that liquid-based cytology does not perform better than conventional Pap tests in terms of relative sensitivity and PPV for detection of cervical cancer precursors.

Trial Registration trialregister.nl Identifier: NTR1032


Author Affiliations: Departments of Pathology (Mr Siebers, Drs Grefte and Bulten, and Ms Vedder) and Obstetrics and Gynaecology (Dr Massuger), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; Laboratory of Pathology, PAMM Laboratories, Eindhoven, the Netherlands (Dr Klinkhamer and Ms Beijers-Broos); and Scientific Institute of Public Health, Brussels, Belgium (Dr Arbyn).

Study suggests letting children sleep late on weekends may help them avoid becoming overweight.

Source: AMA Morning Rounds 10/29/09

HealthDay (10/28, Freeman) reported that "letting children sleep late on weekends and holidays might help them avoid becoming overweight or obese," according to a study published in the Nov. issue of Pediatrics. Investigators "found that children who got less sleep tended to be heavier (as measured by...BMI) than children who slept more." However, "among children who slept less than eight hours a night, those who compensated for their weekday sleep deficit by sleeping late on weekends or holidays were significantly less likely to be overweight or obese."

Migraine with aura doubles the risk of stroke

Moral of the story: If you have migraine headaches with aura you should reevaluate taking oral contraceptives and smoking based on stroke risk.

Source: AMA Morning Rounds 10/28/09
HealthDay (10/27, Reinberg) reported, "Women who get migraine headaches with aura should stop smoking and using birth control pills, because they may increase their risk of stroke," according to a study appearing online Oct. 27 in the British Medical Journal. Investigators "analyzed nine studies concerning the association between migraine, with and without aura, and cardiovascular disease." The study showed that "migraine alone does not appear to alter the risk for heart attack and death from cardiovascular disease."

Source: British Medical Journal press releases
(Research: Migraine and cardiovascular disease: systematic review and meta-analysis)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3914
(Editorial: Migraine with aura and increased risk of ischaemic stroke)
http://www.bmj.com/cgi/doi/10.1136/bmj.b4380

Migraine with aura (temporary visual or sensory disturbances before or during a migraine headache) is associated with a twofold increased risk of stroke, finds a study published on bmj.com today. Further risk factors for stroke among patients with migraine are being a woman, being young, being a smoker, and using oestrogen containing contraceptives.

The risk was highest among young women with migraine with aura who smoke and use oestrogen containing contraceptives.

Migraine is a common, chronic disorder that affects up to 20% of the population. Women are affected up to four times more often than men. Up to one third of sufferers also experience an aura prior to or during a migraine headache (often described as the perception of a strange light, an unpleasant smell or confusing thoughts or experiences).

Doctors have long suspected a connection between migraine and vascular events such as stroke. So to investigate this further, an international team of researchers analysed the results of nine studies on the association between any migraine (with and without aura) and cardiovascular disease. Differences in study design and quality were taken into account to minimise bias.

They show that migraine with aura is associated with a twofold increased risk of ischemic stroke. This risk is further increased by being female, age less than 45 years, smoking, and oestrogen containing contraceptive use.

There was no association between migraine and heart attack or death due to cardiovascular disease.

In light of these findings, the authors recommend that young women who have migraine with aura should be strongly advised to stop smoking, and methods of birth control other than oestrogen containing contraceptives should be considered. They also call for additional research to investigate the association between migraine and cardiovascular disease in more detail.

The absolute risk of stroke for most migraine patients is low, so a doubling of risk is not cause for panic, explains Elizabeth Loder from Brigham and Women's Hospital, Boston, in an accompanying editorial. However, at a population level, this risk deserves attention because the prevalence of migraine is so high.

She suggests that patients who have migraine with aura should be followed closely and treated aggressively for modifiable cardiovascular risk factors.

Contacts:
Research: Kevin Myron, Manager, Media Relations, Brigham and Women's Hospital, Office of Public Affairs, Boston, MA, USA
Email: kmyron@partners.org

Editorial: Elizabeth Loder, Chief, Division of Headache and Pain, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Email: eloder@partners.org

Research suggests 20 percent of US children under 12 may not get enough vitamin D.

The AP (10/26, Tanner) reports that, according to a study published in Pediatrics, "at least one in five US children aged one to 11 don't get enough vitamin D and could be at risk for a variety of health problems, including weak bones." Harvard University researchers analyzed "data from a 2001-06 government health survey of nearly 3,000 children" who had undergone "blood tests measuring vitamin D levels." The investigators found that "about 20 percent of kids" under 12 had "blood levels that are too low." In addition, "applying a less strict, higher cutoff," the study authors found that "two-thirds of children that age, including 90 percent of black kids and 80 percent of Hispanics, are deficient in vitamin D." -AMA daily


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Research indicates surgery may decrease symptoms, frequency of migraines.

The Los Angeles Times (10/24, Maugh) "Booster Shots" blog reported, "Surgery to remove so-called trigger points for migraines can lead to dramatic improvements in patients' health, researchers from University Hospitals in Cleveland reported" at the American Society of Plastic Surgeons meeting. In a study of 69 migraine sufferers who underwent surgery, 61 "maintained their positive response to the procedure for the full five years," of which 20 "patients reported elimination of the migraines entirely." Another "41 reported a significant decrease in symptoms and frequency, and eight experienced less than a 50 percent improvement." -AMA daily update