Bulletin Today
Older adults with functional impairments may be at a higher risk of medical cannabis use, as well as prescription opioid and tranquilizer or sedative misuse, suggests new research published in the online edition of the American Journal of Preventive Medicine.
“It is important to recognize that any psychoactive substance may be risky for this vulnerable population,” said Benjamin Han, MD, lead study author from the Department of Medicine at University of California San Diego. “Many older adults use these substances due to chronic pain, insomnia, or anxiety—conditions that can affect daily functioning. These symptoms can be challenging to manage, especially in the setting of multiple chronic conditions and other prescribed medications.”
CDC defines functional impairment as difficulties performing daily activities, such as bathing or getting dressed, or problems with concentration or decision making affected by physical, mental, or emotional conditions.
In the study, the researchers analyzed data from individuals ages 50 years and older from the 2015 to 2019 National Survey on Drug Use and Health. Participants were asked about cannabis use, prescription opioids, and tranquilizers/sedatives, as well as the presence of any functional impairments.
The study found that adults ages 50 and older reporting medical cannabis use, prescription opioid use and misuse, or prescription tranquilizer/sedative use and misuse were more likely to report having an impairment.
“Our findings suggest the symptoms of this patient population are not always being fully addressed or that something else is going on, such as a substance use disorder or a mental health issue like depression and anxiety,” said Han. “As health care providers, we need to take a closer look at chronic symptoms among older patients with functional impairments. Managing these conditions often requires a multidisciplinary approach.”
Can a diabetes medication benefit patients with asthma?
GLP-1 receptor agonists may benefit patients who have asthma, suggests new research published in the American Journal of Respiratory and Critical Care Medicine.
In the retrospective, observational study, the researchers analyzed electronic health record data of patients with asthma and type 2 diabetes who initiated treatment with GLP-1R agonists. They found lower rates of asthma exacerbations and reduced asthma symptoms compared with patients who used type 2 diabetes medications other than GLP-1R agonists.
“In a 6-month period, type 2 diabetes patients who received this form of medication to improve blood sugar control also had better control of their asthma disease and symptoms compared to those who took alternative therapies,” said lead study author Katherine Cahill, MD, from Vanderbilt University Medical Center (VUMC), in a news release. “We have demonstrated really for the first time that this class of medications used to treat type 2 diabetes and obesity may also have benefit for our patients who have asthma.”
Cahill said they found that patients reported better breathing symptoms and had fewer episodes of shortness of breath and cough.
“We found that patients with asthma received benefits from this medication because they had improved asthma control, so fewer asthma symptoms, and fewer acute flares, or what we call exacerbations, of their asthma,” Cahill said.
Other early preclinical data also suggest it is possible for GLP-1R agonists to have benefits for other airway diseases.
Cahill and VUMC colleagues have received NIH funding to initiate a randomized, controlled clinical trial of GLP-1R agonists for asthma, which will be necessary to confirm that these medications do provide benefit for asthma.
AMA calls for standardized training for blood pressure management
The American Medical Association (AMA) unveiled an initiative to encourage the use of uniform techniques for taking BP readings to ensure accuracy.
The association developed three free learning modules on BP measurement techniques intended for use at medical, nursing, physician assistant, medical assistant, and pharmacy schools across the country.
“We know that inaccurate blood pressure measurements are linked to errors in diagnosing and treating high blood pressure and may lead to more adverse outcomes, yet medical and health profession students are not currently receiving consistent training in BP measurement,” said AMA president Susan Bailey, MD. “We believe this step is critical given that the percentage of American adults who have their blood pressure under control is significantly declining.”
AMA is collaborating with five medical schools to pilot the learning modules in the fall 2021 semester. AMA intends to extend the learning modules to other schools nationally in 2022.
Naloxone prescriptions took a dive during the pandemic
New research published in JAMA Network shows that nationwide naloxone prescriptions declined at the start of the pandemic and have yet to reach prepandemic levels.
The researchers examined claims data from community pharmacies, mail-order pharmacies, and specialty pharmacies from May 2019 to December 2020. They found a 26% reduction in naloxone prescriptions in March 2020, which did not noticeably rise afterward. Naloxone prescriptions for patients on Medicare and commercial insurance were lower compared with those on Medicaid or those who paid with cash.
Naloxone is typically prescribed with an opioid, but these prescriptions fell by only 9%, suggesting an obstacle to access, according to the study authors.
Do adolescents have better HPV vaccination rates than young adults?
Researchers from the University of Michigan examined vaccination against human papillomavirus (HPV) in young adults versus adolescents for an 8-year period, from 2010 to 2018. Regardless of what age they were at first dose, more survey respondents opted for vaccination as the years passed. Still, compared with adolescents—68% of whom received one or more HPV doses by 2018—overall takeup among young adults was low.
The research included self-reported vaccination data from over 6,000 females and 6,000 males ages 18 to 21 years. Within the sample, only 254 of the young women received their first HPV vaccination between the ages of 18 to 21 years, as did 162 of the young men. The share of young women who received at least one dose at any age grew from 32% in 2010 to 55% in 2018, while the proportion increased from 2% to 34% among young men over the same time period.
The study authors recommend staging university or community vaccination campaigns, raising the prospect of HPV immunization during influenza vaccination, removing cost barriers, and improving education of primary care clinicians on the risk of HPV-related cancers. Efforts to improve HPV vaccination in young adults also give special attention to males, who had lower take-up in general than females.
Obesity in adolescence linked to increased risk of stroke
New research from the American Heart Association (AHA) shows that even after accounting for type 2 diabetes, adolescents with a higher BMI are at a significantly increased risk of first ischemic stroke.
The researchers analyzed adolescent BMI and first-stroke data before age 50 among 1.9 million men and women from two nationwide databases: the Israel Defense Forces and the Israeli National Stroke Registry.
“Our findings underscore the importance of effective treatment and prevention of high normal and excessively high BMI during adolescence,” said study coauthor Gilad Twig, MD, an associate professor in the Medical Corps of the Israel Defense Forces and the department of military medicine at The Hebrew University in Jerusalem, in a news release. “Our study is also the first to show that the risk of stroke associated with higher BMI values is the same for both men and women.”
During the follow-up period between 2014 and 2018, researchers found the following among all 1.9 million participants:
Overall, 1,088 strokes occurred (921 ischemic strokes, 167 hemorrhagic strokes), and the average age at the time of the stroke was 41. Adoles-cent BMI was directly related to the risk of first ischemic stroke.
Compared with participants in the low- to normal-BMI group, adolescents who were in the overweight category had a two-times higher stroke risk before age 50, and adolescents with obesity had a 3.4-times higher risk.
Even adolescents with BMIs in the high to normal range were more likely to have a stroke before age 50 compared with those whose BMI was in the low to normal range.
After accounting for type 2 diabetes, adolescents who were in either the overweight or obesity category still had a higher risk of stroke (1.6-times and 2.4-times, respectively) compared with individuals who had BMIs within the normal range.
The researchers noted they were surprised to find that type 2 diabetes did not explain the higher risk for ischemic stroke, which occurred even before age 30 in some participants.
Twig said the current medical literature has shown that having a stroke early in life may lead to recurrent stroke, heart attack, long-term care, and premature death.
The research was published in AHA’s journal Stroke on May 13.
Hypertension seems to worsen with these common prescription medications
Study findings reveal that adults in the United States diagnosed with hypertension often take other medications that contribute to high blood pressure.
The findings, which are part of the ongoing National Health and Nutrition Examination Survey, found that 18.5% of more than 27,000 Americans with hypertension also take a prescription medication that elevates blood pressure. These include prescription antidepressants and estrogens as well as OTC NSAIDs such as ibuprofen and naproxen.
The pattern could explain why so many Americans have uncontrolled hypertension, the researchers said. The study findings will be presented at the American College of Cardiology’s virtual scientific sessions.
FDA: Don’t use antibody testing to evaluate immunity after COVID-19 vaccination
FDA reminded health care professionals and the public that results from currently authorized COVID-19 antibody tests should not be used to assess a person’s level of immunity or protection from COVID-19 at any time, particularly after the person has received a COVID-19 vaccination.
“Currently authorized SARS-CoV-2 antibody tests have not been evaluated to assess the level of protection provided by an immune response to COVID-19 vaccination,” FDA said. “If antibody test results are interpreted incorrectly, there is a potential risk that people may take fewer precautions against SARS-CoV-2 exposure.”
The agency noted that additional research is necessary to better understand the meaning of a positive or negative antibody test, beyond the presence or absence of antibodies, including in people who have been vaccinated against COVID-19, those who have been exposed and have SARS-CoV-2 antibodies, and those who are not fully vaccinated.
Delayed prescribing strategy may help cut down on antibiotic use
As health care providers know, overuse of antibiotics is associated with a host of problems—from intestinal infections and other adverse effects to the development of resistant strains of bacteria. However, “delayed prescribing” promises to temper this trend.
The strategy, which involves giving a patient an order for antibiotics but asking them not to fill it unless their condition fails to improve in a few days, has already demonstrated safety and efficacy for common ear infections and for nasal congestion of sinusitis.
New research published in BMJ indicates that delayed prescribing also may be appropriate for most respiratory tract infections. Researchers reviewed data on more than 55,000 participants in 13 studies, finding that symptoms persisted for 11.4 days on average in patients who received delayed prescriptions—not much different from 10.9 days documented in patients who received antibiotics right away.
“A lot of these symptoms clear up in a few days anyway,” noted lead author Beth Stuart, an associate professor at England’s University of Southampton.