Weapons & alcohol tied to domestic abuse

Weapons tied to repeat domestic abuse. (below, separate study on alcohol)

From the 29 January 2014 ScienceDaily article

Date:

January 29, 2014

Source:

Michigan State University

Summary:

Women are up to 83 percent more likely to experience repeat abuse by their male partners if a weapon is used in the initial abuse incident, according to a new study that has implications for victims, counselors and police.

Women are up to 83 percent more likely to experience repeat abuse by their male partners if a weapon is used in the initial abuse incident, according to a new study that has implications for victims, counselors and police.

Michigan State University researcher Amy Bonomi and colleagues studied the domestic abuse police reports of nearly 6,000 couples in Seattle during a two-year period. An estimated one in four women in the United States experience domestic violence at least once in their lifetime.

Because previous research showed that domestic abuse is more common in poor urban neighborhoods, the researchers expected to find that repeat violence could be predicted by where the couple lived.

But that wasn’t the case. Instead, the main predictor of ongoing domestic violence was the use of a knife, gun or even a vehicle in the first incident. In those cases, women were 72 percent more likely to make follow-up calls to police for physical abuse and 83 percent more likely to call for nonphysical abuse — such as a partner threatening to kill them.

“What this is telling police is that they are likely to be called back to this particular residence if a weapon is involved the first time they are called out,” said Bonomi, chairperson and professor in MSU’s Department of Human Development and Family Studies. “It’s an indication of the danger and severity of abuse over time.”

“The presence of weapons in the home,” she added, “is also a red flag for the women themselves and the counselors who deal with domestic violence.”

The study appears online in the research journal Violence Against Women.

Research finds link between alcohol use, not pot, and domestic violence

From the 27 January 2014 Science Daily article

Date:

January 27, 2014

Source:

University of Tennessee at Knoxville

Summary:

Research among college students found that men under the influence of alcohol are more likely to perpetrate physical, psychological or sexual aggression against their partners than men under the influence of marijuana.

• More options

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Alcohol use is more likely than marijuana use to lead to violence between partners, according to studies done at the University of Tennessee, Knoxville.

Research among college students found that men under the influence of alcohol are more likely to perpetrate physical, psychological or sexual aggression against their partners than men under the influence of marijuana. Women, on the other hand, were more likely to be physically and psychologically aggressive under the influence of alcohol but, unlike men, they were also more likely to be psychologically aggressive under the influence of marijuana.

The research has implications for domestic violence intervention and prevention programs.

The studies were conducted by Ryan Shorey, a psychology doctoral student; Gregory Stuart, a psychology professor; Todd Moore, an associate psychology professor; and James McNulty, an associate professor of social psychology at Florida State University. The study of male participants is published in the journal Addictive Behaviors and the study of female participants is published in the journal Psychology of Addictive Behaviors.

The researchers’ goal was to find correlations between alcohol and marijuana use and the potential for physical, psychological and sexual violence against partners. The studies are among the first to investigate the timing of alcohol and marijuana use and intimate partner violence in college students.

Two studies included male and female college students who were at least 18 years old, had been a relationship for at least a month that involved two days a week of face-to-face contact, and had consumed alcohol in the previous month. The subjects completed an online diary once a day for 90 days.

The study of men found that odds of psychological, physical and sexual violence increased with subsequent use of alcohol. Specifically, odds of physical and sexual abuse increased on days where any alcohol was consumed and with each drink consumed. Odds of psychological abuse increased only on days when five or more drinks were consumed.

Marijuana use was unrelated to violence between intimate partners.

The study of college women found that alcohol use increased the odds of physical and psychological aggression while marijuana use increased the odds of psychological aggression.

“I think it is too early to make definitive conclusions regarding the role of marijuana and intimate partner violence perpetration, as the research in this area is quite young and, to date, studies have provided conflicting evidence regarding its role in increasing the odds for violence,” said Stuart. “However, we now have numerous studies suggesting alcohol use does increase the odds for violence between partners.”

Another study by the authors and psychology doctoral student Sara Elkins looked at women arrested for domestic violence. This study, published in the Journal of Consulting and Clinical Psychology, found that when women used marijuana they were less likely to perpetrate physical violence.

The authors say their findings provide further support for the numerous negative consequences associated with heavy alcohol consumption, particularly among college students.

“Our findings suggest that dating violence prevention and intervention programs should target reduction in alcohol use, but surprisingly, most of these programs largely ignore alcohol use,” said Shorey.

Stuart noted that their other research has shown that men arrested for domestic violence in batterer intervention programs received short-term benefits when they were given a 90-minute treatment addressing their alcohol problems…..

 

Potential Effects of the Affordable Care Act on Income Inequality | Brookings Institution

Potential Effects of the Affordable Care Act on Income Inequality | Brookings Institution.

From the 27 January 2014 Brookings Institute post
The Affordable Care Act (aka “Obamacare”) was designed to expand health insurance coverage and hold down the cost of insurance, but it will also change incomes of many Americans according to initial projections of Brookings Senior Fellows Henry Aaron and Gary Burtless.

In their new, preliminary paper “Potential Effects of the Affordable Care Act on Income Inequality,” Aaron and Burtless find sizeable income gains in the bottom quarter of the income distribution offset by small losses spread across higher income groups. Their estimates are highly sensitive to the definition of income. They discussed their paper in a recent event, joined by three other economists in a panel discussion.

The Affordable Care Act (aka “Obamacare”) was designed to expand health insurance coverage and hold down the cost of insurance, but it will also change incomes of many Americans according to initial projections of Brookings Senior Fellows Henry Aaron and Gary Burtless.

In their new, preliminary paper “Potential Effects of the Affordable Care Act on Income Inequality,” Aaron and Burtless find sizeable income gains in the bottom quarter of the income distribution offset by small losses spread across higher income groups. Their estimates are highly sensitive to the definition of income. They discussed their paper in a recent event, joined by three other economists in a panel discussion.

Scientists find genetic mechanism linking aging to specific diets

Scientists find genetic mechanism linking aging to specific diets.

From the 27 January 2014 ScienceDaily article

…

“These studies have revealed that single gene mutations can alter the ability of an organism to utilize a specific diet. In humans, small differences in a person’s genetic makeup that change how well these genes function, could explain why certain diets work for some but not others,” said Curran, corresponding author of the study and assistant professor with joint appointments in the USC Davis School of Gerontology, the USC Dornsife College of Letters, Arts and Sciences, and the Keck School of Medicine of USC.

Curran and Pang studied Caenorhabditis elegans, a one-milimeter-long worm that scientists have used as a model organism since the ’70s. Decades of tests have shown that genes in C. elegans are likely to be mirrored in humans while its short lifespan allows scientists to do aging studies on it.

In this study, Curran and Pang identified a gene called alh-6, which delayed the effects of aging depending on what type of diet the worm was fed by protecting it against diet-induced mitochondrial defects.

“This gene is remarkably well-conserved from single celled yeast all the way up to mammals, which suggests that what we have learned in the worm could translate to a better understanding of the factors that alter diet success in humans,” Curran said.

Future work will focus on identifying what contributes to dietary success or failure, and whether these factors explain why specific diets don’t work for everyone. This could be the start of personalized dieting based on an individual’s genetic makeup, according to Curran.

“We hope to uncover ways to enhance the use of any dietary program and perhaps even figure out ways of overriding the system(s) that prevent the use of one diet in certain individuals,” he said.

Biases in animal studies may differ from those in clinical trials — ScienceDaily

Biases in animal studies may differ from those in clinical trials — ScienceDaily.

From the 27 January 2014 article at ScienceDaily

Source:

University of California – San Francisco

Summary:

A new analysis of animal studies on cholesterol-lowering statins found that non-industry studies had results that favored the drugs even more than studies funded by industry.

new analysis of animal studies on cholesterol-lowering statins by UC San Francisco researchers found that non-industry studies had results that favored the drugs even more than studies funded by industry.

The analysis of 63 animal studies of statins, led by Lisa Bero, PhD, UCSF professor clinical pharmacy, was published online January 21, 2014, in the scientific journal PLoS Biology.

In previous studies, Bero determined that drug-company-sponsored clinical trials were associated with publication of outcomes that favor the sponsor. Bero’s work has been cited as part of policy reform efforts that have led many journal publishers, agencies and institutions to require researchers to disclose funding sources and possible conflicts of interest when presenting their research.

The impetus for the current study, Bero said, was to explore whether or not industry-funded animal studies also would be likely to yield more positive outcomes for the companies’ drug candidates.

But in their analysis the researchers found the opposite: Results of animal studies that had industry sponsorship were less likely to measure a benefit for statins in slowing or preventing arterial disease. Of the studies that disclosed funding, 9 of 19 industry-sponsored studies had results that favored statins, in comparison to 18 out of 28 studies that favored statins among studies not funded by industry.

The explanation may be, said Bero, that “the interests of the pharmaceutical industry might be best served by underestimating efficacy prior to clinical trials, and overestimating efficacy in clinical trials. By underestimating efficacy in preclinical studies, the pharmaceutical industry could reduce the money spent on clinical trials that did not lead to marketable products.”

“Because demonstrating drug efficacy in human studies is linked to drug company profits, drug companies may have more incentive to publish favorable efficacy findings of human drug studies than animal studies.”

However, the reason for the opposite findings obtained in analyzing animal and human studies merits additional investigation, Bero said. Selective reporting of study outcomes might play a role, she suggested.

Conclusions of all the studies tended to be favorable in Bero’s PLoS Biology analysis. While the industry-sponsored animal studies had somewhat less favorable results, they nonetheless were more likely to present conclusions that favored the statin even when data were less favorable. This result highlights the role of “spin” in communicating research findings, Bero said.

The UCSF researchers also found methodological problems to be common, both in non-industry and industry-sponsored studies. Furthermore, Bero found that harmful side effects were not investigated.

“Not a single animal study we looked at assessed adverse events following the statin intervention,” Bero said. “As toxicity data from animal studies must be submitted to drug regulatory authorities before a compound can proceed to testing in humans, it is surprising that so little data on harm appear in the published scientific literature.”

In about half the studies analyzed, it appeared that animals were not assigned to treatment or placebo arms of the study randomly, a requirement of high-quality clinical trials. Furthermore, in about half the animal studies analyzed animals were identifiable to the person assigning treatment, a violation of the practice of “blinding.”

Criteria for including or excluding animals from studies often were not included in published reports, the UCSF researchers found, and many studies also failed to account properly for changes in the assigned treatment arm that occurred during the course of treatment.

Most of the industry and non industry studies analyzed in Bero’s PLoS Biology report were done using rabbits and mice. To gauge atherosclerosis, targeted by statins, researchers quantified blood vessel qualities such as number of damaged blood vessels, blood-vessel diameter, plaque severity, blockage to coronary and other arteries, and plaque rupture.

Cannabis during pregnancy endangers fetal brain development

Cannabis during pregnancy endangers fetal brain development.

From the 27 January 2014 Karolinski Institute press release

      IMAGE:   Professor Tibor Harkany has shown that the use of Cannabis during pregnancy endangers fetal brain development. The findings are presented online in the EMBO Journal in January 2014….

Click here for more information.An increasing number of children suffer from the consequences of maternal drug exposure during pregnancy, and Cannabis is one of the most frequently used substances. This motivated the study, published in the EMBO Journal, cunducted in mice and human brain tissue, to decipher the molecular basis of how the major psychoactive component from Cannabis called delta-9-tetrahydrocannabinol or THC affects brain development of the unborn foetus.

The study highlights that consuming Cannabis during pregnancy clearly results in defective development of nerve cells of the cerebral cortex, the part of the brain that orchestrates higher cognitive functions and drives memory formation. In particular, THC negatively impacts if and how the structural platform and conduit for communication between nerve cells, the synapses and axons, will develop and function. Researchers also identified Stathmin-2 as a key protein target for THC action, and its loss is characterized as a reason for erroneous nerve growth. It is stressed that Cannabis exposure in experimental models precisely coincided with the fetal period when nerve cells form connections amongst each other.

According to study leader Professor Tibor Harkany, who shares his time between Karolinska Institutet and the Medical University Vienna in Austria, these developmental deficits may evoke life-long modifications to the brain function of those affected. Even though not all children who have been exposed to Cannabis will suffer immediate and obvious deficits, Professor Harkany warns that relatively subtle damage can significantly increase the risk of delayed neuropsychiatric diseases.

“Even if THC only would cause small changes its effect may well be sufficient to sensitize the brain to later stressors or diseases to provoke neuropsychiatric illnesses in those affected in the future”, says Professor Harkany. “This concerns also the medical use of Cannabis, which should be avoided during pregnancy.”

Prices Drop When Health Consumers Shop Around For Healthcare | The Health Care Blog

Prices Drop When Health Consumers Shop Around For Healthcare | The Health Care Blog.

From the 25 January 2014 post at The Health Care Blog

By William H. Frist, MD

Here’s a point most of us can agree on. Tackling ballooning health care costs requires more than insurance reform because the charge and cost structure for health services in the U.S. is inconsistent and irrational. The same quality CT scan that costs $500 at one outpatient facility costs $2,000 at a nearby teaching hospital.

Obamacare’s typical high-deductible insurance plans encourage many cost-conscious consumers to shop around for low-ticket items below their deductible — and that is good. However, the bulk of health care spending is attributable to patients who rapidly blow through their deductible, after which they have no incentive to shop for value. Those 5 percent of people — who spend a whopping 50 percent of the nation’s health care dollars — have little incentive to consider price. With the cost of multiple medications, frequent doctors visits, use of specialists and one or more hospitalizations a year, these 5 percent will exceed even the highest deductible in the first few months of each year.

So what might be the single most powerful tool to slow the seemingly intractable yet unsustainable increases in health spending affecting practically every family in America? “Referenced-based” pricing for health services encourages patients — most significantly, those with the highest costs — to act as smart consumers by seeking the most cost-effective care, even after they have exceeded their deductible.

Here’s how it works. Insurance companies or employers set a limit they are willing to pay for a specified service of excellent quality — say, $1,000 for a CT scan — and communicate that reference price clearly to consumers. If patients choose a location where the charge is below the maximum set reimbursement rate, they pay nothing. If they choose a provider where the charge is higher, they pay the difference.

As patient-consumers shop around for the best price and quality services, competition in the market pushes prices down and value up.

 

[Reblog] JAMA Network | JAMA | Evidence-Based Medicine—An Oral History

JAMA Network | JAMA | Evidence-Based Medicine—An Oral History.

From the January 22/29 2014 issue

The phrase evidence-based medicine (EBM) was coined by Gordon Guyatt1 and then appeared in an article in The Rational Clinical Examination series in JAMA in 1992,2 but the roots of EBM go much further back. The personal stories of the origins of EBM were recently explored in a filmed oral history of some of the individuals most strongly associated with the birth of the movement (see Video, Evidence-Based Medicine: An Oral History).

JAMA and the BMJ invited 6 individuals (including us, with one of us as host, R.S.) who have played a prominent part in the development of EBM to participate in an oral history event and filming. Videos of this event and of interviews with 3 other EBM leaders (Box) have been woven together and may be accessed athttp://ebm.jamanetwork.com. Just 20 years after the term EBM began to be used, an early and informal history has emerged.

…

Evidence-based medicine grew out of critical appraisal. When Gordon Guyatt, currently a professor of epidemiology and biostatistics and medicine at McMaster University, took over as director of the internal medicine residency program at McMaster in 1990, he wanted to change the program so that physicians managed patients based not on what authorities told them to do but on what the evidence showed worked. He needed a name, and the first was “scientific medicine.” The faculty reacted against this name with rage, arguing that basic scientists did scientific medicine. The next name was “evidence-based medicine” (Evidence-Based Medicine: An Oral History Video).

…

In the Oral History Video, Sackett distinguishes EBM from critical appraisal because it combines research evidence with clinical skills and patient values and preferences.

            [Oral history video here –> http://jama.jamanetwork.com/multimediaPlayer.aspx?mediaid=6391356]

…
Guyatt acknowledges that in the 1992 JAMA article there was little about patient values.2 It was over the next 5 years that patient values and preferences became much more central, and since then strongly emphasized (Evidence-Based Medicine: An Oral History Video).

…

Evidence-based medicine quickly became popular, Sackett believes, for 2 main reasons: it was supported by senior clinicians who were secure in their practice and happy to be challenged and it empowered young physicians—and subsequently nurses and other clinicians. Evidence-based medicine did, however, produce a backlash, particularly, says Sackett, “among middle-level guys who were used to making pronouncements,”

…

 

Related articles (varying viewpoints)

• Flawed evidence based medicine
• Rethinking Evidence-Based Medicine: from rubbish to real
• Evidence-Based Practice: The Misunderstandings Continue
• [Reblog] JAMA papers raise questions about FDA drug and device approval
• JAMA Forum: The Public Health Challenge of Drug Overdose ” news@JAMA

 

[Reblog] JAMA papers raise questions about FDA drug and device approval

JAMA papers raise questions about FDA drug and device approval.

JAN24 2014

Posted by Gary Schwitzer in FDA

An important series of papers was published in the Journal of the American Medical Association this week.

“Clinical Trial Evidence Supporting FDA Approval of Novel Therapeutic Agents, 2005-2012,” by Dr. Joseph Ross and colleagues, concluded that the quality of clinical trial evidence used by the FDA as the basis of approving new drugs varies widely.  A couple of interesting data points:

• in the seven-year period of analysis, 37% of drugs were approved on the basis of a single pivotal trial.
• trials using surrogate end points as their primary outcome formed the exclusive basis of approval for 45% of drugs approved. (See our primer, “Surrogate markers may not tell the whole story.”)

In an opinion piece,  “Opening the FDA Black Box,” Drs. Steven Goodman and Rita Redberg said the study:

“…raises a host of questions needing further exploration. Despite the FDA requirement for evidence from a minimum of 2 randomized clinical trials supporting an effect on health outcomes, 37% of product approvals were based on only 1 trial, 53% of cancer trials were nonrandomized, and an active comparator was used in only 27% of non–infectious disease trials. Surrogate end points were used in almost all approvals via the accelerated approval process and in 44% of nonaccelerated approvals. Trials were comparatively short, with most lasting less than 6 months, even those assessing chronic treatments for chronic diseases. Cancer drugs, perhaps predictably, were more often approved via the accelerated process and with weaker designs.”

Another paper looked at the reasons that FDA marketing approval for new drugs was delayed or denied.

And a fourth paper looked at FDA regulation of medical devices, “a process that has received relatively little attention,” according to Goodman and Redberg, who continued:

In USA Today, Liz Szabo wrote a good summary of the JAMA papers under the headline, “Not all FDA-approved drugs get same level of testing: Evidence behind FDA-approved drugs and devices often has major limitations.”

Read the entire article here

Related Resources

• ClinicalTrials.gov

ClinicalTrials.gov is a registry and results database of publicly and privately supported clinical studies of human             participants conducted around the world.
When available, study results information is included in the study record under the Study Results tab. See How to Find Results of Studies for more information on finding results entered in the results database.

Results (after 2008, only those required by US federal requirements) include
–Participant data (how many started the trial, dropped out, etc)
—  Information about participants (age, gender, blood pressure readings, etc)

[Speaking of gender…]

Good to know, most drugs can affect women and men differently

    —   Outcome (results of taking the drug plus any placebo), with statistics

    –Adverse effects , serious and other (this was not required before 2008)

• Evaluating Health Information (from my personal Google site)

  • Research Articles Summarized for Us All

  • How to Read a Research Paper

Related articles

Another take on the “relaxation of standards”

• Drug Approvals Take Customized Approach Based on Disease
• [Reblog] Last week “clinical trial system broken”; this week “luxury journals distort/damage science”
• Newly published survey shows drug shortages still have major impact on patient care
• [Reblog] Misleading BMJ news releases may be one reason journalists report on more observational studies
• Does taking multiple medicines increase risk of being admitted to hospital? Yes and no
• [Reblog] Who is making your medical app?
• [Reblog] What happens to medicine when it has no heroes?

Health Care Consumerism: Patients Still Lack Agency at the Point of Care | Health care and the digital revolution

Health Care Consumerism: Patients Still Lack Agency at the Point of Care | Health care and the digital revolution.

From the 27 January 2013 post at Health care and the digital revolution — A graduate student’s take on health care going digital – Claudia Paz

Something we have been hearing a lot of lately is how this is the moment for the healthcare consumer (see, Bloomberg Review video, MedCity Article, Forbes article on trends to be excited about).  Basically, people are noting that EMR’s and patient portals, the proliferation of health and wellness related mobile apps, and greater transparency across the system, will all lead to a new age of health care where patients have the information and tools to savvily navigate a streamlined healthcare delivery system oiled by customer reviews, online tools, and digital gadgets. Think Yelp and MenuPages meets healthcare.

While all of the trends listed above are exciting leaps forward, not enough attention is being paid to the patient’s needs at the point of care. Research on patient activation andshared or participatory decision making all points to the following:

Empowered patients who actively participate in decisions about their health and treatment options are more likely to be compliant with their medications, make less risky and more cost effective decisions, and are more confident in the management of their health outcomes.

For the purposes of this blog, I am focusing on the concept of a patient as an active participant at the point of care. From my own personal experience, it seems that “doctor knows best” remains the dominant paradigm. Instead of having a conversation about treatment options, the pros and cons of alternatives, variations in costs and side affects, I am more often than not prescribed a medication or treatment option and sent about my day. If I feel like knowing more about the medication (that I have already agreed to take), I usually conduct research after the appointment.

,,,,,

Related articles

• Patient portals for hospitalized patients: Do they make sense?
• Patient portals for hospitalized patients: Do they make sense?
• TODAY’S TALKING POINT – hospital care – Hertfordshire Mercury
• The Intersection Of Healthcare And Mobile Technology Is Changing Everything