|
||||||||
|
RESEARCH BRIEFSPain Relievers May Explain Some Hypertension in WomenThough pain relievers are widely available over the counter and commonplace in household medicine cabinets, the effects of long-term exposure are not well understood. In a recent study, HSPH and HMS researchers have discovered a frequency-dependent increased risk for hypertension in women, aged 31 to 50 years, who reported regular use of nonsteroidal anti-inflammatory drugs and acetaminophen, active ingredients in popular medications such as Advil, Motrin, and Tylenol. The findings were not significant for aspirin. "We are not saying that women should stop using pain relievers. Individuals who use these medications regularly should be encouraged to have their blood pressure checked on an annual basis," said lead author Gary Curhan, HMS associate professor of medicine at Brigham and Women's Hospital. He and colleagues reviewed questionnaires of 80,020 women from the Nurses' Health Study II. The researchers, including senior author Meir Stampfer, HSPH professor of epidemiology and HMS professor of medicine, found that women without a prior history of high blood pressure who took nonsteroidal anti-inflammatory drugs for 22 or more days per month had an 86 percent greater risk of becoming hypertensive compared to nonusers. Under the same conditions, women who used acetaminophen were at twice the risk of nonusers. Infrequent users showed smaller effects. Intake of nonsteroidal anti-inflammatory drugs and acetaminophen one to four days a month was associated with an increased risk of 14 and 19 percent, respectively. Though blood pressure was derived from self-reports and not directly measured, and duration of use was unclear, the findings may help to explain a large proportion of the 50 million cases of hypertension in the U.S., almost half of which occur in women. "Given that these drugs are available over the counter, further research about their effects is needed. These drugs may increase blood pressure by narrowing blood vessels, but there may also be other mechanisms," explained Curhan. The paper appears in the Oct. 28 Archives of Internal Medicine. Co-authors include Walter Willett, HSPH chair of the Department of Nutrition and HMS professor of medicine, and Bernard Rosner, HSPH professor of biostatistics and HMS professor of medicine (biostatistics). --Trang Au
Diet Guidelines Predict Disease Risk BetterThe 1995 U.S. Dietary Guidelines, illustrated in the familiar USDA food guide pyramid, embody the government's advice to people who want to eat healthy, and are used to guide meal planning in schools and food assistance programs. But the guidelines have become "grossly inconsistent with scientific evidence," according to Walter Willett, chair of the Department of Nutrition at HSPH and professor of medicine at HMS. Studies show a minimal relationship between the guidelines suggested by the pyramid and chronic diseases incidence, he said. Using data from 38,615 men in the Health Professionals Follow-up Study and 67,271 women in the Nurses' Health Study, Willett; Marjorie McCullough of the American Cancer Society; and HSPH and HMS colleagues tested whether two alternative measures of diet quality worked better to predict disease risk. The Alternative Healthy Eating Index (AHEI) weighs quality of food choices (for example, ratio of white to red meat), while the Recommended Food Score (RFS) tallies healthy foods eaten. They examined the relationship between these measures and the incidence of cardiovascular disease, cancer, and non-traumatic death over 12 years in women and eight years in men. The researchers found that men in the highest, healthiest quintile of AHEI scores had a 20 percent lower risk for these events compared with men in the lowest quintile. For women, risk was reduced 11 percent. The RFS was associated with a small reduction of risk in men but not in women. These risk reductions primarily reflected the association of dietary scores with cardiovascular disease; neither score predicted cancer risk. "Our results suggest that dietary guidelines can be improved by providing more specific and comprehensive advice," they write in the Dec. 1 American Journal of Clinical Nutrition. --Tom Reynolds
Cardiology Visits Improve Survival After Heart AttackElderly heart attack patients who visit a cardiologist's office in the months after leaving the hospital are less likely to die within two years than patients who visit only a primary care doctor, a study by HMS researchers finds. Previous research suggests that patients may live longer if they are under a cardiologist's care while hospitalized for myocardial infarction. In the new study, John Ayanian, associate professor of medicine, and colleagues in the Department of Health Care Policy examined the records of patients covered under Medicare--average age 74--to see whether this holds true for outpatient care. They created two groups of 10,199 patients each. One group received outpatient care from cardiologists and the other did not. Each patient was matched to another in the opposite group who was very similar in ways that affect the estimated probability of visiting a cardiologist after discharge. This matching procedure--based on demographic and clinical variables, hospital care, medications at discharge, and hospital characteristics--was used to make the two groups as similar as possible. That way, the researchers could be more confident that differences in outcome were related to differences in outpatient care itself. Of patients who visited only an internist or family practitioner, 18.3 percent died within two years, compared with 14.6 percent of those who had seen a cardiologist. Patients who saw a cardiologist were more likely to undergo coronary procedures, exercise testing, and cardiac rehabilitation, but were not more likely to receive effective cardiovascular medications. This survival benefit associated with cardiology visits was greatest among patients who statistically were least likely to see a cardiologist, including those who were older, female, or black, had co-existing illnesses, or were treated in hospitals not offering invasive coronary procedures. "Among patients who saw a cardiologist, two-year mortality was lower for those who also saw an internist or family practitioner," the authors note, "indicating that concurrent--and ideally, collaborative--ambulatory care by generalists and specialists may provide the best prospects for improving outcomes after myocardial infarction." --Tom Reynolds
Clinical Exam Scores May Predict Future Performance on Boards"Evaluating clinical competency is now a central focus in medical education at HMS and around the country," said Steven Simon, assistant professor of ambulatory care and prevention at HMS and Harvard Pilgrim Health Care, who led a study to test the correlation between physical diagnosis scores on Objective Structured Clinical Examinations (OSCEs) and performance on the U.S. Medical Licensing Examination Step One. He and colleagues found a modest correlation between the exams and a strong correlation between scores in two skill areas. The researchers gathered data from 355 second-year students who attended an OSCE session. Their analysis revealed that skills related to identification of abnormality and differential diagnosis were most predictive of Step One performance. Designed in 1994 at HMS, the OSCE complements traditional evaluation, testing competency in patient interaction and physical diagnosis. During the exam, which takes place at the end of the Patient-Doctor II physical diagnosis course, students spend two and a half hours rotating through 16 clinical stations. Lasting either six or 12 minutes, each station is composed of nine formats, used alone or in combination: question and answer, preceptor role play, standardized patients, actual patients, mechanical or structural models, 35-mm slides, audiotape, videotape, and CD-ROM. The findings, which appear in the September Medical Teacher, suggest that OSCEs hold promise as a valid and reliable tool to predict other outcomes such as clerkship scores, advanced USMLE results, and specialty-certifying examinations. --Trang Au |
