2 Minute Medicine Rewind October 31, 2016

State-Level Cancer Mortality Attributable to Cigarette Smoking in the United States

While data on the tobacco-related cancer exists on the national level, state-specific information could also be important as tobacco control occurs at the state level. The purpose of this study was to calculate the proportion of cancer deaths in each state in 2014 with the primary outcome of interest being the population-attributable factor (PAF) of cancer deaths due to cigarette smoking. This cross-sectional analysis used 2014 data from 2 large US prospective studies of adults 35 years and older to determine the relative risks for 12 smoking related cancers (acute myeloid leukemia, cancers of the oral cavity and pharynx, esophagus, stomach, colorectal, liver, pancreas, larynx, trachea, lung and bronchus, cervix uteri, kidney and urinary bladder).The authors estimated at least 167,133 cancer deaths in the US in 2014 were attributable to cigarette smoking (28.6% of all cancer deaths; 95% CI: 28.2% to 28.8%). In men, the proportion of cancer deaths ranged from 21.8% in Utah and 39.5% in Arkansas while in women it ranged from 11.0% in Utah to 29.0% in Kentucky. Nine of the top 10 ranked states for men and six of the top 10 ranked states for women were located in the South. The authors concluded that increasing tobacco control funding and strengthening tobacco control policies on the federal and state level may reduce the future burden of morbidity and mortality associated with smoking-related cancers.

Neonatal Morbidity After Maternal Use of Antidepressant Drugs During Pregnancy

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants and are currently not contraindicated in pregnancy as the consequences of untreated psychiatric illnesses during pregnancy are thought to outweigh the risks of SSRI use. The purpose of this retrospective study was to estimate the rate of NICU admissions, infant morbidity, and neonatal interventions after exposure to antidepressants in utero. Data from The Swedish Medical Birth Register and Prescribed Drug Register for all singleton births in Sweden between July 1, 2006 to December 31, 2012 were used to divide the study population into 4 main groups: 1) infants born to mothers receiving SSRIs at any time during or 1 month prior to pregnancy (any use), 2)those born to mothers receiving SSRIs within the last 90 days of pregnancy with or without prior use (late use), 3) those born to mothers only receiving SSRIs up until that time period (early use), and 4) those not listed (no use). Of the infants, 17,736 (2.4%) had mothers who used SSRIs during pregnancy. 13.7% of infants whose mothers used SSRIs were admitted to the NICU compared to 8.2% of the population. The odds ratio of NICU admission for infants whose mother had any SSRI use was 1.5 (95% CI: 1.4 to 1.5) relative to no antidepressant use. Comparing the neonatal outcomes between early use only and late use suggested that SSRI use in the final 90 days increased the odds of infant CNS and respiratory disorders (OR 95% CIs: 1.2 to 3.0 and 1.2 to 1.6, respectively). The authors concluded that maternal use of antidepressants during pregnancy was associated with increased neonatal morbidity and higher rate of admissions to NICU while the risk of severe disease however was low.

Child-Parent Familial Hypercholesterolemia Screening in Primary Care

In general, population-based child-parent hypercholesterolemia screening involves pediatric testing first and then the parent if the child was positive. However, adults diagnosed with familial hypercholesterolemia have a significantly increased risk of coronary heart disease. The purpose of this study was to assess the efficacy and feasibility of screening for hypercholesterolemia in children 1-2 years of age during primary care visits. This was a cross sectional study where blood samples were obtained to measure cholesterol levels and genetic testing was performed for 48 common familial hypercholesterolemia mutations in 10,095 children between 2012 to 2015. Children with a cholesterol level of ≥ 1.53 multiples of median (MoM) who also had a FH48 mutation or a repeat 3 month cholesterol level ≥ 1.53 MoM were considered to have a positive screen.  The parents of these children were considered to have positive screens if they had the same mutation as the child. The authors found that cholesterol level was ≥1.53 MoM in 92 children of which 28 had a positive screen for familial hypercholesterolemia (OR 0.3%; 95% CI 0.2% to 0.4%), 20 of whom had an FH48 mutation and 8 of whom had an elevated repeat cholesterol level. 10,003 children had cholesterol levels < 1.53 MoM, 17 of whom had an FH48 mutation. Overall, 37 children had an FH48 mutation and 32 of them had parents with FH48 mutation. Of these 32 parent pairs, 27 had elevated cholesterol in the parent with the FH48 mutation. The authors concluded that child-parent screening was feasible in primary care practices and that for every 1,000 children screened, 8 were identified as having positive screening results for familial hypercholesterolemia and were consequently high risk for cardiovascular disease.

A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation 

While studies from 1970’s showed that treatment of COPD with long-term oxygen therapy in patients with severe COPD was associated with a mortality benefit, underpowered trials in 1990’s failed to show a mortality benefit of oxygen therapy in patients with mild to moderate COPD. The purpose of this trial was to test whether long term treatment with supplemental oxygen would result in a longer time to death than no use of supplemental oxygen among patients who had stable COPD with moderate resting desaturation (SPO2 of 89-93%). 738 patients with moderate resting desaturation and moderate exercise-induced desaturation (during 6 minute walk test, SpO₂ ≥ 80% for ≥5 minutes and <90% for ≥10 seconds) were randomized to receive supplemental oxygen or no intervention and followed from 1 to 6 years. The study found that there was no significant differences in the primary outcome of death or first hospitalization for any reason (HR 0.94, 95% CI: 0.79 to 1.12, p = 0.52), mortality (p = 0.53), or first hospitalization for any cause (p = 0.37). The authors concluded that in patients with stable COPD and resting or exercise-induced moderate desaturation, the prescription of long-term supplemental oxygen did not result in a longer time to death or first hospitalization than no long-term supplemental oxygen.

Association of Persistent Postconcussion Symptoms with pediatric Quality of Life 

Concussions are a common consequence of traumatic injury in the pediatric population and long term outcomes for concussions are being investigated. The purpose of this study was to evaluate how persistent post-concussive symptoms affected health-related quality of life in children aged 5 to 18 years. This was a prospective multicenter cohort study of children aged 5 to 18 years who presented to the emergency department within 48 hours after head injury and were considered to have an acute concussion. The study recruited patients from 9 emergency rooms within the Pediatric Emergency Research Canada Network between 2013 to 2014. The primary outcome of interest was health related quality of life assessed with the Pediatric Quality of Life Inventory version 4 (PedsQL-4) at 4, 8, and 12 weeks after head injury. Of the 2006 children enrolled, 1667 (83%) completed the PedsQL-4 at all 3 time points. Of these 1667 children, 510 with post concussive symptoms (PCSS) had lower total PedsQL-4 scores than did those without PPCS. Patients with PPCS also had lower physical, emotional, social, and school PedsQL-4 scores at 4, 8, and 12 weeks. Patients who recovered from concussion also had lower health related quality of life than norms at 4 weeks (mean difference, 3.56; 95% CI: 1.28 to 5.85) and 8 weeks (mean difference, 2.75; 95% CI: 0.48 to 5.02, p  < 0.05). The authors concluded that children with PPCS have lower health related quality of life compared to those who have recovered from concussion, yet deficits may persist for months even in children whose symptoms have resolved.

Image: PD

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