2 Minute Medicine Rewind July 15, 2019

Association between heart failure and postoperative mortality among patients undergoing ambulatory noncardiac surgery

Patients with heart failure are at an increased risk of experiencing postoperative adverse events and mortality. While ambulatory surgical procedures are perceived as being low risk, morbidity and mortality outcomes in this surgical setting have not been well studied. In this retrospective cohort study, 355,121 adult patients  with and without heart failure undergoing ambulatory, elective, non-cardiac surgery in the Veterans Affairs Surgical Quality Project database (2009-2016) were followed up to study post-operative complications at 30 days and post-operative mortality at 90 days. Of the patients studied, 19,353 patients were identified as having heart failure (5.5%). Researchers found that patients with heart failure were at a higher risk of 90-day mortality (OR 1.95, 95% CI 1.69 to 2.44), with mortality increasing with decreasing systolic function. This risk was pronounced in patients with symptomatic heart failure (OR 2.76, 95% CI 2.07 to 3.70), but also observed in patients with asymptomatic heart failure (OR 1.85, 95% CI 1.60 to 2.15). The risk of experiencing a postoperative complication within 30 days was also increased in patients with heart failure (OR 1.10, 95% CI 1.02 to 1.19). This study therefore shows that patients with heart failure undergoing ambulatory, elective, non-cardiac surgery are at an increased risk of experiencing postoperative morbidity and mortality.

Association of marijuana laws with teen marijuana use: new estimates from the youth risk behavior surveys

The recreational use of marijuana has been legalized in 10 states and the District of Columbia. Despite this, however, there are concerns surrounding the use of medicinal and/or recreational use of marijuana among youth, as it has been established that repeated use in adolescence may result in long-term changes in cognitive function. In this study, researchers used data from the Youth Risk Behavior Surveys (1993-2017), which are administered to US high school students, to study marijuana use before and after medical marijuana and/or recreational marijuana law adoption. Based on survey data on 1,414,826 students, researchers found that medical marijuana laws were not statistically associated with marijuana use or frequent marijuana use. Recreational marijuana laws were, in fact, associated with an 8% decrease in the odds of marijuana use (OR 0.92, 95% CI 0.87 to 0.96) and a 9% decrease in the odds of frequent marijuana use (OR 0.91, 95% CI 0.84 to 0.98). This study therefore shows that the legalization of medical marijuana has not encouraged use amongst youth. In addition, marijuana use in youth may, in fact, decline with legalization of marijuana for recreational purposes.

Association of nonmedical prescription opioid use with subsequent heroin use initiation in adolescents

It is not uncommon for adolescents to inappropriately access prescription opioids from friends or family members. Recently, concerns surrounding the use of opioids that are not medically indicated, and an increased risk of initiating heroin use, have surfaced. In this prospective cohort study, 3298 high school students from Los Angeles, California, were surveyed and followed up for 42 months to estimate the association between non-medical prescription opioid use and subsequent heroin initiation. Surveys were administered semi-annually from grade 9 to 12, over the course of 4 years. Cox regression models assessed nonmedical prescription opioid use at survey waves 1 through 7, as a time-varying and time-lagged regressor and subsequent heroin use initiation across waves 2 to 8 as the outcome. Based on multivariate analyses for waves 1 to 7, researchers found that prior non-medical prescription opioid use, when compared to no use, was associated with an increased likelihood of subsequent heroin use (HR 3.18, 95% CI 1.68 to 6.02, p<0.001). Current alcohol use (HR 2.04, 95% CI 1.10 to 3.92) and other substance use (HR 1.54, 95% CI 0.92 to 2.62) were also associated with an increased likelihood of subsequent heroin use. This study therefore shows that prior non-medical prescription opioid use may be associated with subsequent heroin use in adolescence.

Efficacy of short-term treatment of internet and computer game addiction: A randomized clinical trial

Internet gaming disorder, listed in the DSM-5, is characterized by preoccupation, withdrawal, tolerance and continued use despite negative consequences. The behavior that characterizes Internet addiction (IA) causes significant impairment in the various spheres of an individual’s life, including social, education, personal, occupational or other relevant areas of functioning. Cognitive behavioral therapy (CBT) has been proposed in the treatment of IA. In this randomized clinical trial, 143 men, aged 17-52 years, meeting diagnostic criteria for IA, were randomized to participate in a manualized CBT program combining group and individual interventions, or a wait-list control, to assess whether this intervention is effective in treating individuals with internet and computer game addiction. Based on a multivariate analysis, researchers found that the odds of remission were greater in the intervention group (OR 10.10, 95% CI 3.69 to 27.65). This study therefore shows that short-term CBT may be an effective treatment modality in the management of IA. However, further studies assessing the long-term efficacy of these types of interventions are needed.

Sugary drink consumption and risk of cancer: results from NutriNet-Santé prospective cohort

It has been well established that the consumption of sugary drinks is linked to an increased risk of weight gain, diabetes, hypertension and cardiovascular disease. The association between sugary drink consumption and cancer, however, has been less investigated. NutriNet-Santé is a French, web-based cohort, that was established in 2009 with the aim of studying associations between nutrition and health. In this prospective cohort study, 101,257 participants age 18 years and older were followed up for a median time of 5.1 years to assess associations between the consumption of sugary drinks, artificially sweetened beverages, and the risk of cancer. Researchers found that the consumption of sugary drinks was significantly associated with the risk of overall cancer (sub-distribution HR for 100mL/d increase 1.18, 95% CI 1.10 to 1.27, p<0.0001) and breast cancer (HR 1.22, 95% CI 1.07 to 1.39, p=0.004). No association was detected for prostate and colorectal cancers. The consumption of 100% fruit juice was also significantly associated with the risk of overall cancer (HR 1.12, 95% CI 1.03 to 1.23, p=0.007). This study therefore shows that the consumption of sugary drinks is associated with an increased risk of overall cancer, and breast cancer, specifically. It should help inform further research and policy regarding public health issues surrounding sugary beverages.

Image: PD

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