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‘Alarming’ new data on disordered sleep after COVID-19
Such disturbances are especially common among Black people, new research shows.
The “high” prevalence of moderate to severe sleep disturbances is “alarming,” study investigator Cinthya Pena Orbea, MD, sleep specialist at the Cleveland Clinic, said in an interview.
The findings were presented at the annual meeting of the Associated Professional Sleep Societies.
Dr. Pena and colleagues analyzed data on 962 patients with PASC seen at the Cleveland Clinic ReCOVer Clinic between February 2021 and April 2022.
More than two-thirds of patients (67.2%) reported at least moderate fatigue, while 21.8% reported severe fatigue, Dr. Pena reported.
In addition, 41.3% reported at least moderate sleep disturbances, while 8% of patients reported severe sleep disturbances, including insomnia, “which may impair quality of life,” Dr. Pena said.
Obesity, mood disorders, and Black race emerged as contributors to problems with sleep and fatigue after COVID.
Notably, after adjusting for demographics, Black race conferred threefold higher odds of moderate to severe sleep disturbances.
“We don’t know why this is, and one of our next steps is to better understand race-specific determinants of sleep disturbances after COVID and create targeted interventions,” Dr. Pena said.
How long after COVID the fatigue and sleep problems last “remains uncertain,” Dr. Pena acknowledged. However, in her clinical experience with therapy, patients’ sleep and fatigue may improve after 6 or 8 months.
Ruth Benca, MD, PhD, cochair of the Alliance for Sleep, is not surprised by the Cleveland Clinic findings.
“Sleep disturbances and fatigue are part of the sequelae of COVID,” Dr. Benca, who was not involved in the study, said in an interview.
“We know that people who have had COVID have more trouble sleeping afterwards. There is the COVID insomnia created in all of us just out of our worries, fears, isolation, and stress. And then there’s an actual impact of having the infection itself on worsening sleep,” said Dr. Benca, with Wake Forest University and Atrium Health Wake Forest Baptist, both in Winston-Salem, N.C.
The study had no specific funding. The authors have disclosed no relevant financial relationships. Dr. Benca is a consultant for Idorsia Pharmaceuticals.
A version of this article first appeared on Medscape.com.
Such disturbances are especially common among Black people, new research shows.
The “high” prevalence of moderate to severe sleep disturbances is “alarming,” study investigator Cinthya Pena Orbea, MD, sleep specialist at the Cleveland Clinic, said in an interview.
The findings were presented at the annual meeting of the Associated Professional Sleep Societies.
Dr. Pena and colleagues analyzed data on 962 patients with PASC seen at the Cleveland Clinic ReCOVer Clinic between February 2021 and April 2022.
More than two-thirds of patients (67.2%) reported at least moderate fatigue, while 21.8% reported severe fatigue, Dr. Pena reported.
In addition, 41.3% reported at least moderate sleep disturbances, while 8% of patients reported severe sleep disturbances, including insomnia, “which may impair quality of life,” Dr. Pena said.
Obesity, mood disorders, and Black race emerged as contributors to problems with sleep and fatigue after COVID.
Notably, after adjusting for demographics, Black race conferred threefold higher odds of moderate to severe sleep disturbances.
“We don’t know why this is, and one of our next steps is to better understand race-specific determinants of sleep disturbances after COVID and create targeted interventions,” Dr. Pena said.
How long after COVID the fatigue and sleep problems last “remains uncertain,” Dr. Pena acknowledged. However, in her clinical experience with therapy, patients’ sleep and fatigue may improve after 6 or 8 months.
Ruth Benca, MD, PhD, cochair of the Alliance for Sleep, is not surprised by the Cleveland Clinic findings.
“Sleep disturbances and fatigue are part of the sequelae of COVID,” Dr. Benca, who was not involved in the study, said in an interview.
“We know that people who have had COVID have more trouble sleeping afterwards. There is the COVID insomnia created in all of us just out of our worries, fears, isolation, and stress. And then there’s an actual impact of having the infection itself on worsening sleep,” said Dr. Benca, with Wake Forest University and Atrium Health Wake Forest Baptist, both in Winston-Salem, N.C.
The study had no specific funding. The authors have disclosed no relevant financial relationships. Dr. Benca is a consultant for Idorsia Pharmaceuticals.
A version of this article first appeared on Medscape.com.
Such disturbances are especially common among Black people, new research shows.
The “high” prevalence of moderate to severe sleep disturbances is “alarming,” study investigator Cinthya Pena Orbea, MD, sleep specialist at the Cleveland Clinic, said in an interview.
The findings were presented at the annual meeting of the Associated Professional Sleep Societies.
Dr. Pena and colleagues analyzed data on 962 patients with PASC seen at the Cleveland Clinic ReCOVer Clinic between February 2021 and April 2022.
More than two-thirds of patients (67.2%) reported at least moderate fatigue, while 21.8% reported severe fatigue, Dr. Pena reported.
In addition, 41.3% reported at least moderate sleep disturbances, while 8% of patients reported severe sleep disturbances, including insomnia, “which may impair quality of life,” Dr. Pena said.
Obesity, mood disorders, and Black race emerged as contributors to problems with sleep and fatigue after COVID.
Notably, after adjusting for demographics, Black race conferred threefold higher odds of moderate to severe sleep disturbances.
“We don’t know why this is, and one of our next steps is to better understand race-specific determinants of sleep disturbances after COVID and create targeted interventions,” Dr. Pena said.
How long after COVID the fatigue and sleep problems last “remains uncertain,” Dr. Pena acknowledged. However, in her clinical experience with therapy, patients’ sleep and fatigue may improve after 6 or 8 months.
Ruth Benca, MD, PhD, cochair of the Alliance for Sleep, is not surprised by the Cleveland Clinic findings.
“Sleep disturbances and fatigue are part of the sequelae of COVID,” Dr. Benca, who was not involved in the study, said in an interview.
“We know that people who have had COVID have more trouble sleeping afterwards. There is the COVID insomnia created in all of us just out of our worries, fears, isolation, and stress. And then there’s an actual impact of having the infection itself on worsening sleep,” said Dr. Benca, with Wake Forest University and Atrium Health Wake Forest Baptist, both in Winston-Salem, N.C.
The study had no specific funding. The authors have disclosed no relevant financial relationships. Dr. Benca is a consultant for Idorsia Pharmaceuticals.
A version of this article first appeared on Medscape.com.
FROM SLEEP 2022
Gastroenterologists’ income up 12%, most happy with career pick
Gastroenterologists, like many other physicians, fared better financially in 2021 than during the height of the pandemic in 2020, according to the 2022 Medscape Gastroenterology Compensation Report.
Gastroenterologists’ average annual income rose from $406,000 in 2020 to $453,000 in 2021 – an increase of 12% over the prior year, second only to otolaryngologists (+13%).
“Compensation for most physicians is trending back up as demand for physicians accelerates,” says James Taylor, group president and chief operating officer of AMN Healthcare’s Physician & Leadership Solutions. “The market for physicians has done a complete 180 over just 7 or 8 months.”
In terms of 2021 income gains, gastroenterologists finished toward the top of the 29+ specialties surveyed by Medscape. The average bonus gastroenterologists earned was also higher in 2021 than in 2020 ($74,000 vs. $60,000).
Competition, side gigs
This year, Medscape asked gastroenterologists how competition affects their income; 16% cited nonphysician practitioners as a source of competition (same as physicians overall).
Eight percent cited telemedicine as a source of competition; 5% cited “minute clinics” and other walk-in clinics in pharmacies. Roughly three-quarters said their income is not affected by competition from these sources.
About 30% of gastroenterologists added responsibilities to their medical workload. A few even have side jobs outside of medicine.
However, gastroenterologists are somewhat less likely to take on extra work than other specialties (36%).
“Physicians are fortunate to have a huge array of potential side gigs available to them,” notes Sylvie Stacy, MD, MPH, author of 50 Nonclinical Careers for Physicians. “Supplemental income that pays well is not difficult to find.” She says most who do take on side jobs are motivated to fund early retirement or desire greater financial independence. They also have high levels of student debt to pay off.
Getting paid well is one thing; feeling adequately paid can be another. Gastroenterologists landed toward the middle (53%) of all physicians in terms of feeling fairly compensated for their work. Neurologists were the least (42%), while public health and preventive medicine providers (72%) were most apt to feel fairly compensated.
Challenges and rewards
The challenges of working during the pandemic and the overall changing tone of medicine prompted some physicians to leave the profession, while disenchanting many others.
This year, a smaller percentage of gastroenterologists said they would enter medicine again, compared with last year (75% vs. 81%).
Yet most gastroenterologists surveyed this year said they would choose their specialty again (95%), which is similar to last year (93%). Family physicians and internists would be less willing than most other physicians to repeat their choice.
Gastroenterologists spend an average 14.3 hours each week handling paperwork and administration, placing them among the middle third of all physicians. This year, the average for physicians overall was about 15.5 hours per week.
Most gastroenterologists (73%) plan to continue taking Medicare and/or Medicaid patients. However, that rate is smaller than in last year’s report (80%).
Compared with last year, about the same number of gastroenterologists say they won’t take new Medicaid patients (about 4% vs. 3%), while a somewhat higher percentage are undecided (about 22% vs. 16%). Overall, 70% of physicians said they plan to continue taking Medicare and/or Medicaid patients.
Nearly one-quarter (23%) of gastroenterologists indicated that they would drop low-paying insurers, but most would not because of business, ethical, or other reasons.
What is most rewarding about being a gastroenterologist? Being good at what they do/finding answers, diagnoses tops the list (31%), followed by relationships with and gratitude from patients (29%), making the world a better place/helping others (15%), and making good money at a job they like (11%). A few cited teaching (6%) and pride in their profession (5%)
The most challenging part of their job is having to follow so many rules and regulations (21%). Other challenges include trouble getting fair reimbursement (18%), dealing with difficult patients (17%), having to work long hours (14%), and working with electronic health record systems (10%).
A version of this article first appeared on Medscape.com.
Gastroenterologists, like many other physicians, fared better financially in 2021 than during the height of the pandemic in 2020, according to the 2022 Medscape Gastroenterology Compensation Report.
Gastroenterologists’ average annual income rose from $406,000 in 2020 to $453,000 in 2021 – an increase of 12% over the prior year, second only to otolaryngologists (+13%).
“Compensation for most physicians is trending back up as demand for physicians accelerates,” says James Taylor, group president and chief operating officer of AMN Healthcare’s Physician & Leadership Solutions. “The market for physicians has done a complete 180 over just 7 or 8 months.”
In terms of 2021 income gains, gastroenterologists finished toward the top of the 29+ specialties surveyed by Medscape. The average bonus gastroenterologists earned was also higher in 2021 than in 2020 ($74,000 vs. $60,000).
Competition, side gigs
This year, Medscape asked gastroenterologists how competition affects their income; 16% cited nonphysician practitioners as a source of competition (same as physicians overall).
Eight percent cited telemedicine as a source of competition; 5% cited “minute clinics” and other walk-in clinics in pharmacies. Roughly three-quarters said their income is not affected by competition from these sources.
About 30% of gastroenterologists added responsibilities to their medical workload. A few even have side jobs outside of medicine.
However, gastroenterologists are somewhat less likely to take on extra work than other specialties (36%).
“Physicians are fortunate to have a huge array of potential side gigs available to them,” notes Sylvie Stacy, MD, MPH, author of 50 Nonclinical Careers for Physicians. “Supplemental income that pays well is not difficult to find.” She says most who do take on side jobs are motivated to fund early retirement or desire greater financial independence. They also have high levels of student debt to pay off.
Getting paid well is one thing; feeling adequately paid can be another. Gastroenterologists landed toward the middle (53%) of all physicians in terms of feeling fairly compensated for their work. Neurologists were the least (42%), while public health and preventive medicine providers (72%) were most apt to feel fairly compensated.
Challenges and rewards
The challenges of working during the pandemic and the overall changing tone of medicine prompted some physicians to leave the profession, while disenchanting many others.
This year, a smaller percentage of gastroenterologists said they would enter medicine again, compared with last year (75% vs. 81%).
Yet most gastroenterologists surveyed this year said they would choose their specialty again (95%), which is similar to last year (93%). Family physicians and internists would be less willing than most other physicians to repeat their choice.
Gastroenterologists spend an average 14.3 hours each week handling paperwork and administration, placing them among the middle third of all physicians. This year, the average for physicians overall was about 15.5 hours per week.
Most gastroenterologists (73%) plan to continue taking Medicare and/or Medicaid patients. However, that rate is smaller than in last year’s report (80%).
Compared with last year, about the same number of gastroenterologists say they won’t take new Medicaid patients (about 4% vs. 3%), while a somewhat higher percentage are undecided (about 22% vs. 16%). Overall, 70% of physicians said they plan to continue taking Medicare and/or Medicaid patients.
Nearly one-quarter (23%) of gastroenterologists indicated that they would drop low-paying insurers, but most would not because of business, ethical, or other reasons.
What is most rewarding about being a gastroenterologist? Being good at what they do/finding answers, diagnoses tops the list (31%), followed by relationships with and gratitude from patients (29%), making the world a better place/helping others (15%), and making good money at a job they like (11%). A few cited teaching (6%) and pride in their profession (5%)
The most challenging part of their job is having to follow so many rules and regulations (21%). Other challenges include trouble getting fair reimbursement (18%), dealing with difficult patients (17%), having to work long hours (14%), and working with electronic health record systems (10%).
A version of this article first appeared on Medscape.com.
Gastroenterologists, like many other physicians, fared better financially in 2021 than during the height of the pandemic in 2020, according to the 2022 Medscape Gastroenterology Compensation Report.
Gastroenterologists’ average annual income rose from $406,000 in 2020 to $453,000 in 2021 – an increase of 12% over the prior year, second only to otolaryngologists (+13%).
“Compensation for most physicians is trending back up as demand for physicians accelerates,” says James Taylor, group president and chief operating officer of AMN Healthcare’s Physician & Leadership Solutions. “The market for physicians has done a complete 180 over just 7 or 8 months.”
In terms of 2021 income gains, gastroenterologists finished toward the top of the 29+ specialties surveyed by Medscape. The average bonus gastroenterologists earned was also higher in 2021 than in 2020 ($74,000 vs. $60,000).
Competition, side gigs
This year, Medscape asked gastroenterologists how competition affects their income; 16% cited nonphysician practitioners as a source of competition (same as physicians overall).
Eight percent cited telemedicine as a source of competition; 5% cited “minute clinics” and other walk-in clinics in pharmacies. Roughly three-quarters said their income is not affected by competition from these sources.
About 30% of gastroenterologists added responsibilities to their medical workload. A few even have side jobs outside of medicine.
However, gastroenterologists are somewhat less likely to take on extra work than other specialties (36%).
“Physicians are fortunate to have a huge array of potential side gigs available to them,” notes Sylvie Stacy, MD, MPH, author of 50 Nonclinical Careers for Physicians. “Supplemental income that pays well is not difficult to find.” She says most who do take on side jobs are motivated to fund early retirement or desire greater financial independence. They also have high levels of student debt to pay off.
Getting paid well is one thing; feeling adequately paid can be another. Gastroenterologists landed toward the middle (53%) of all physicians in terms of feeling fairly compensated for their work. Neurologists were the least (42%), while public health and preventive medicine providers (72%) were most apt to feel fairly compensated.
Challenges and rewards
The challenges of working during the pandemic and the overall changing tone of medicine prompted some physicians to leave the profession, while disenchanting many others.
This year, a smaller percentage of gastroenterologists said they would enter medicine again, compared with last year (75% vs. 81%).
Yet most gastroenterologists surveyed this year said they would choose their specialty again (95%), which is similar to last year (93%). Family physicians and internists would be less willing than most other physicians to repeat their choice.
Gastroenterologists spend an average 14.3 hours each week handling paperwork and administration, placing them among the middle third of all physicians. This year, the average for physicians overall was about 15.5 hours per week.
Most gastroenterologists (73%) plan to continue taking Medicare and/or Medicaid patients. However, that rate is smaller than in last year’s report (80%).
Compared with last year, about the same number of gastroenterologists say they won’t take new Medicaid patients (about 4% vs. 3%), while a somewhat higher percentage are undecided (about 22% vs. 16%). Overall, 70% of physicians said they plan to continue taking Medicare and/or Medicaid patients.
Nearly one-quarter (23%) of gastroenterologists indicated that they would drop low-paying insurers, but most would not because of business, ethical, or other reasons.
What is most rewarding about being a gastroenterologist? Being good at what they do/finding answers, diagnoses tops the list (31%), followed by relationships with and gratitude from patients (29%), making the world a better place/helping others (15%), and making good money at a job they like (11%). A few cited teaching (6%) and pride in their profession (5%)
The most challenging part of their job is having to follow so many rules and regulations (21%). Other challenges include trouble getting fair reimbursement (18%), dealing with difficult patients (17%), having to work long hours (14%), and working with electronic health record systems (10%).
A version of this article first appeared on Medscape.com.
Bariatric surgery cuts risk of developing and dying from cancer
A new study provides more evidence that the substantial weight loss achieved with bariatric surgery offers long-term protection against cancer.
The study found that adults with obesity who had bariatric surgery had a 32% lower risk of developing cancer and a 48% lower risk of dying from cancer, compared with peers who did not have the surgery.
“The magnitude of the benefit was very large and dose-dependent, with more weight loss associated with greater reduction in cancer risk,” lead investigator Ali Aminian, MD, director of the Bariatric & Metabolic Institute, Cleveland Clinic, told this news organization.
The study was published online in the Journal of the American Medical Association.
Best evidence to date
“We know that obesity is strongly linked with different types of cancers, but we didn’t know if losing a significant amount of weight can significantly decrease the risk of cancer,” Dr. Aminian explained.
The SPLENDID study involved 30,318 adults with obesity (median age, 46 years; 77% women; median body mass index, 45 kg/m2).
The 5,053 patients who underwent Roux-en-Y gastric bypass (66%) or sleeve gastrectomy (34%) were matched (1:5) to 25,265 patients who did not undergo bariatric surgery (nonsurgical control group).
At 10 years, patients who had bariatric surgery had lost 27.5 kg (60 pounds) compared with 2.7 kg (6 pounds) for peers who didn’t have the surgery, a difference of 19.2%.
During a median follow-up of 6.1 years, 96 patients in the bariatric surgery group and 780 patients in the nonsurgical control group developed an obesity-associated cancer (incidence rate of 3.0 vs. 4.6 events per 1,000 person-years).
At 10 years, the cumulative incidence of obesity-associated cancer was significantly lower in the bariatric surgery group (2.9% vs. 4.9%; absolute risk difference, 2.0%; 95% confidence interval [CI], 1.2%-2.7%; adjusted hazard ratio [HR], 0.68; 95% CI, 0.53-0.87; P = .002).
Most cancer types were less common in the bariatric surgery group. However, a comprehensive analysis of the impact of bariatric surgery on individual cancer types was not possible.
In the fully-adjusted Cox models, the association between bariatric surgery and individual cancer types was significant only for endometrial cancer (adjusted HR, 0.47; 95% CI, 0.27-0.83).
For the other individual cancers, there was a “trend or signal toward a reduction in their risk after the surgery,” Dr. Aminian said.
He noted that endometrial cancer has the strongest association with obesity, and patients who seek bariatric surgery are typically obese, middle-aged women.
“So, it was not surprising that we had more cases of endometrial cancer than other types of cancer,” he said.
The SPLENDID study also showed a significant reduction in cancer-related mortality at 10 years in patients with vs. without bariatric surgery (0.8% vs. 1.4%; adjusted HR, 0.52; 95% CI, 0.31-0.88; P = .01).
The benefits of bariatric surgery were evident in both women and men, younger and older patients, and Black and White patients, and were similarly observed after both gastric bypass and sleeve gastrectomy.
For the cancer protective effect, patients need to lose at least 20%-25% of their body weight, which is almost impossible with diet alone, Dr. Aminian said.
Obesity is “second only to tobacco” as a preventable cause of cancer in the United States, senior author Steven Nissen, MD, chief academic officer of the Heart, Vascular, and Thoracic Institute at Cleveland Clinic, said in a news release.
“This study provides the best possible evidence on the value of intentional weight loss to reduce cancer risk and mortality,” Dr. Nissen said.
Questions remain
In an accompanying editorial, Anita P. Courcoulas, MD, of the University of Pittsburgh Medical Center, said future studies should look at potential factors that influence the association between bariatric surgery and reduced cancer risk, with an eye toward individualizing treatment and figuring out who will benefit the most.
“It is likely that cancer risk reduction after bariatric surgery varies by sex, age, race and ethnicity, type of bariatric surgery, alcohol and smoking status, cancer site, diabetes status, body mass index, and other factors,” Dr. Courcoulas pointed out.
“In addition, there is a need to understand the specific biological mechanisms of effect responsible for the observed change in cancer risk because these mechanisms have not been clearly investigated and elucidated in humans,” she said.
“If this association is further validated, it would extend the benefits of bariatric surgery to another important area of long-term health and prevention. This additional information could then further guide for whom bariatric surgery is most beneficial,” Dr. Courcoulas concluded.
The study had no specific funding. Dr. Aminian reported receiving grants and speaking honoraria from Medtronic. Dr. Nissen reported receiving grants from Novartis, Eli Lilly, AbbVie, Silence Therapeutics, AstraZeneca, Esperion Therapeutics, Amgen, and Bristol Myers Squibb. A complete list of author disclosures is available with the original article. Dr. Courcoulas had no relevant disclosures.
A version of this article first appeared on Medscape.com.
A new study provides more evidence that the substantial weight loss achieved with bariatric surgery offers long-term protection against cancer.
The study found that adults with obesity who had bariatric surgery had a 32% lower risk of developing cancer and a 48% lower risk of dying from cancer, compared with peers who did not have the surgery.
“The magnitude of the benefit was very large and dose-dependent, with more weight loss associated with greater reduction in cancer risk,” lead investigator Ali Aminian, MD, director of the Bariatric & Metabolic Institute, Cleveland Clinic, told this news organization.
The study was published online in the Journal of the American Medical Association.
Best evidence to date
“We know that obesity is strongly linked with different types of cancers, but we didn’t know if losing a significant amount of weight can significantly decrease the risk of cancer,” Dr. Aminian explained.
The SPLENDID study involved 30,318 adults with obesity (median age, 46 years; 77% women; median body mass index, 45 kg/m2).
The 5,053 patients who underwent Roux-en-Y gastric bypass (66%) or sleeve gastrectomy (34%) were matched (1:5) to 25,265 patients who did not undergo bariatric surgery (nonsurgical control group).
At 10 years, patients who had bariatric surgery had lost 27.5 kg (60 pounds) compared with 2.7 kg (6 pounds) for peers who didn’t have the surgery, a difference of 19.2%.
During a median follow-up of 6.1 years, 96 patients in the bariatric surgery group and 780 patients in the nonsurgical control group developed an obesity-associated cancer (incidence rate of 3.0 vs. 4.6 events per 1,000 person-years).
At 10 years, the cumulative incidence of obesity-associated cancer was significantly lower in the bariatric surgery group (2.9% vs. 4.9%; absolute risk difference, 2.0%; 95% confidence interval [CI], 1.2%-2.7%; adjusted hazard ratio [HR], 0.68; 95% CI, 0.53-0.87; P = .002).
Most cancer types were less common in the bariatric surgery group. However, a comprehensive analysis of the impact of bariatric surgery on individual cancer types was not possible.
In the fully-adjusted Cox models, the association between bariatric surgery and individual cancer types was significant only for endometrial cancer (adjusted HR, 0.47; 95% CI, 0.27-0.83).
For the other individual cancers, there was a “trend or signal toward a reduction in their risk after the surgery,” Dr. Aminian said.
He noted that endometrial cancer has the strongest association with obesity, and patients who seek bariatric surgery are typically obese, middle-aged women.
“So, it was not surprising that we had more cases of endometrial cancer than other types of cancer,” he said.
The SPLENDID study also showed a significant reduction in cancer-related mortality at 10 years in patients with vs. without bariatric surgery (0.8% vs. 1.4%; adjusted HR, 0.52; 95% CI, 0.31-0.88; P = .01).
The benefits of bariatric surgery were evident in both women and men, younger and older patients, and Black and White patients, and were similarly observed after both gastric bypass and sleeve gastrectomy.
For the cancer protective effect, patients need to lose at least 20%-25% of their body weight, which is almost impossible with diet alone, Dr. Aminian said.
Obesity is “second only to tobacco” as a preventable cause of cancer in the United States, senior author Steven Nissen, MD, chief academic officer of the Heart, Vascular, and Thoracic Institute at Cleveland Clinic, said in a news release.
“This study provides the best possible evidence on the value of intentional weight loss to reduce cancer risk and mortality,” Dr. Nissen said.
Questions remain
In an accompanying editorial, Anita P. Courcoulas, MD, of the University of Pittsburgh Medical Center, said future studies should look at potential factors that influence the association between bariatric surgery and reduced cancer risk, with an eye toward individualizing treatment and figuring out who will benefit the most.
“It is likely that cancer risk reduction after bariatric surgery varies by sex, age, race and ethnicity, type of bariatric surgery, alcohol and smoking status, cancer site, diabetes status, body mass index, and other factors,” Dr. Courcoulas pointed out.
“In addition, there is a need to understand the specific biological mechanisms of effect responsible for the observed change in cancer risk because these mechanisms have not been clearly investigated and elucidated in humans,” she said.
“If this association is further validated, it would extend the benefits of bariatric surgery to another important area of long-term health and prevention. This additional information could then further guide for whom bariatric surgery is most beneficial,” Dr. Courcoulas concluded.
The study had no specific funding. Dr. Aminian reported receiving grants and speaking honoraria from Medtronic. Dr. Nissen reported receiving grants from Novartis, Eli Lilly, AbbVie, Silence Therapeutics, AstraZeneca, Esperion Therapeutics, Amgen, and Bristol Myers Squibb. A complete list of author disclosures is available with the original article. Dr. Courcoulas had no relevant disclosures.
A version of this article first appeared on Medscape.com.
A new study provides more evidence that the substantial weight loss achieved with bariatric surgery offers long-term protection against cancer.
The study found that adults with obesity who had bariatric surgery had a 32% lower risk of developing cancer and a 48% lower risk of dying from cancer, compared with peers who did not have the surgery.
“The magnitude of the benefit was very large and dose-dependent, with more weight loss associated with greater reduction in cancer risk,” lead investigator Ali Aminian, MD, director of the Bariatric & Metabolic Institute, Cleveland Clinic, told this news organization.
The study was published online in the Journal of the American Medical Association.
Best evidence to date
“We know that obesity is strongly linked with different types of cancers, but we didn’t know if losing a significant amount of weight can significantly decrease the risk of cancer,” Dr. Aminian explained.
The SPLENDID study involved 30,318 adults with obesity (median age, 46 years; 77% women; median body mass index, 45 kg/m2).
The 5,053 patients who underwent Roux-en-Y gastric bypass (66%) or sleeve gastrectomy (34%) were matched (1:5) to 25,265 patients who did not undergo bariatric surgery (nonsurgical control group).
At 10 years, patients who had bariatric surgery had lost 27.5 kg (60 pounds) compared with 2.7 kg (6 pounds) for peers who didn’t have the surgery, a difference of 19.2%.
During a median follow-up of 6.1 years, 96 patients in the bariatric surgery group and 780 patients in the nonsurgical control group developed an obesity-associated cancer (incidence rate of 3.0 vs. 4.6 events per 1,000 person-years).
At 10 years, the cumulative incidence of obesity-associated cancer was significantly lower in the bariatric surgery group (2.9% vs. 4.9%; absolute risk difference, 2.0%; 95% confidence interval [CI], 1.2%-2.7%; adjusted hazard ratio [HR], 0.68; 95% CI, 0.53-0.87; P = .002).
Most cancer types were less common in the bariatric surgery group. However, a comprehensive analysis of the impact of bariatric surgery on individual cancer types was not possible.
In the fully-adjusted Cox models, the association between bariatric surgery and individual cancer types was significant only for endometrial cancer (adjusted HR, 0.47; 95% CI, 0.27-0.83).
For the other individual cancers, there was a “trend or signal toward a reduction in their risk after the surgery,” Dr. Aminian said.
He noted that endometrial cancer has the strongest association with obesity, and patients who seek bariatric surgery are typically obese, middle-aged women.
“So, it was not surprising that we had more cases of endometrial cancer than other types of cancer,” he said.
The SPLENDID study also showed a significant reduction in cancer-related mortality at 10 years in patients with vs. without bariatric surgery (0.8% vs. 1.4%; adjusted HR, 0.52; 95% CI, 0.31-0.88; P = .01).
The benefits of bariatric surgery were evident in both women and men, younger and older patients, and Black and White patients, and were similarly observed after both gastric bypass and sleeve gastrectomy.
For the cancer protective effect, patients need to lose at least 20%-25% of their body weight, which is almost impossible with diet alone, Dr. Aminian said.
Obesity is “second only to tobacco” as a preventable cause of cancer in the United States, senior author Steven Nissen, MD, chief academic officer of the Heart, Vascular, and Thoracic Institute at Cleveland Clinic, said in a news release.
“This study provides the best possible evidence on the value of intentional weight loss to reduce cancer risk and mortality,” Dr. Nissen said.
Questions remain
In an accompanying editorial, Anita P. Courcoulas, MD, of the University of Pittsburgh Medical Center, said future studies should look at potential factors that influence the association between bariatric surgery and reduced cancer risk, with an eye toward individualizing treatment and figuring out who will benefit the most.
“It is likely that cancer risk reduction after bariatric surgery varies by sex, age, race and ethnicity, type of bariatric surgery, alcohol and smoking status, cancer site, diabetes status, body mass index, and other factors,” Dr. Courcoulas pointed out.
“In addition, there is a need to understand the specific biological mechanisms of effect responsible for the observed change in cancer risk because these mechanisms have not been clearly investigated and elucidated in humans,” she said.
“If this association is further validated, it would extend the benefits of bariatric surgery to another important area of long-term health and prevention. This additional information could then further guide for whom bariatric surgery is most beneficial,” Dr. Courcoulas concluded.
The study had no specific funding. Dr. Aminian reported receiving grants and speaking honoraria from Medtronic. Dr. Nissen reported receiving grants from Novartis, Eli Lilly, AbbVie, Silence Therapeutics, AstraZeneca, Esperion Therapeutics, Amgen, and Bristol Myers Squibb. A complete list of author disclosures is available with the original article. Dr. Courcoulas had no relevant disclosures.
A version of this article first appeared on Medscape.com.
Woman who faked cancer gets 5 years in prison
A California woman who pretended to have cancer and received more than $100,000 in charitable donations from hundreds of people has been sentenced to 5 years in prison.
Amanda Christine Riley pleaded guilty to one count of wire fraud for soliciting donations from people through various social media sites to help pay for cancer treatments that she never received or needed, according to the U.S. Department of Justice.
In total, the government identified 349 individuals and entities who made contributions totaling $105,513. Ms. Riley was sentenced to 60 months in prison on May 3.
Ms. Riley is hardly the first person to fake a cancer diagnosis for money. In fact, the phenomenon of faking illness online now occurs so often that researchers have given it a name: “Munchausen by internet.” However, few appear to be penalized with prison time.
In this case, the scam began in 2012, when Ms. Riley falsely claimed to have been diagnosed with Hodgkin’s lymphoma. She used Facebook, Instagram, Twitter, and a blog to document her imaginary condition and “aggressively” solicit donations to cover her supposed medical expenses, the DOJ said.
Instead, Ms. Riley used the donations to pay living expenses.
According to the DOJ, Ms. Riley went to “great lengths to maintain her deception.” She shaved her head to appear to be undergoing chemotherapy, faked her medical records, forged physicians’ letters and medical certifications, and convinced family members to back up her false claims.
Ms. Riley’s scheme continued for 7 years, until 2019, when her deception was uncovered by an investigation of the Internal Revenue Service and the San Jose Police Department.
Ms. Riley was charged in July 2020 and pleaded guilty in October 2021.
In addition to serving 5 years in prison, Ms. Riley must pay back the $105,513 and undergo 3 years of supervision after her release.
A version of this article first appeared on Medscape.com.
A California woman who pretended to have cancer and received more than $100,000 in charitable donations from hundreds of people has been sentenced to 5 years in prison.
Amanda Christine Riley pleaded guilty to one count of wire fraud for soliciting donations from people through various social media sites to help pay for cancer treatments that she never received or needed, according to the U.S. Department of Justice.
In total, the government identified 349 individuals and entities who made contributions totaling $105,513. Ms. Riley was sentenced to 60 months in prison on May 3.
Ms. Riley is hardly the first person to fake a cancer diagnosis for money. In fact, the phenomenon of faking illness online now occurs so often that researchers have given it a name: “Munchausen by internet.” However, few appear to be penalized with prison time.
In this case, the scam began in 2012, when Ms. Riley falsely claimed to have been diagnosed with Hodgkin’s lymphoma. She used Facebook, Instagram, Twitter, and a blog to document her imaginary condition and “aggressively” solicit donations to cover her supposed medical expenses, the DOJ said.
Instead, Ms. Riley used the donations to pay living expenses.
According to the DOJ, Ms. Riley went to “great lengths to maintain her deception.” She shaved her head to appear to be undergoing chemotherapy, faked her medical records, forged physicians’ letters and medical certifications, and convinced family members to back up her false claims.
Ms. Riley’s scheme continued for 7 years, until 2019, when her deception was uncovered by an investigation of the Internal Revenue Service and the San Jose Police Department.
Ms. Riley was charged in July 2020 and pleaded guilty in October 2021.
In addition to serving 5 years in prison, Ms. Riley must pay back the $105,513 and undergo 3 years of supervision after her release.
A version of this article first appeared on Medscape.com.
A California woman who pretended to have cancer and received more than $100,000 in charitable donations from hundreds of people has been sentenced to 5 years in prison.
Amanda Christine Riley pleaded guilty to one count of wire fraud for soliciting donations from people through various social media sites to help pay for cancer treatments that she never received or needed, according to the U.S. Department of Justice.
In total, the government identified 349 individuals and entities who made contributions totaling $105,513. Ms. Riley was sentenced to 60 months in prison on May 3.
Ms. Riley is hardly the first person to fake a cancer diagnosis for money. In fact, the phenomenon of faking illness online now occurs so often that researchers have given it a name: “Munchausen by internet.” However, few appear to be penalized with prison time.
In this case, the scam began in 2012, when Ms. Riley falsely claimed to have been diagnosed with Hodgkin’s lymphoma. She used Facebook, Instagram, Twitter, and a blog to document her imaginary condition and “aggressively” solicit donations to cover her supposed medical expenses, the DOJ said.
Instead, Ms. Riley used the donations to pay living expenses.
According to the DOJ, Ms. Riley went to “great lengths to maintain her deception.” She shaved her head to appear to be undergoing chemotherapy, faked her medical records, forged physicians’ letters and medical certifications, and convinced family members to back up her false claims.
Ms. Riley’s scheme continued for 7 years, until 2019, when her deception was uncovered by an investigation of the Internal Revenue Service and the San Jose Police Department.
Ms. Riley was charged in July 2020 and pleaded guilty in October 2021.
In addition to serving 5 years in prison, Ms. Riley must pay back the $105,513 and undergo 3 years of supervision after her release.
A version of this article first appeared on Medscape.com.
High rates of med student burnout during COVID
NEW ORLEANS –
Researchers surveyed 613 medical students representing all years of a medical program during the last week of the Spring semester of 2021.
Based on the Maslach Burnout Inventory-Student Survey (MBI-SS), more than half (54%) of the students had symptoms of burnout.
Eighty percent of students scored high on emotional exhaustion, 57% scored high on cynicism, and 36% scored low on academic effectiveness.
Compared with male medical students, female medical students were more apt to exhibit signs of burnout (60% vs. 44%), emotional exhaustion (80% vs. 73%), and cynicism (62% vs. 49%).
After adjusting for associated factors, female medical students were significantly more likely to suffer from burnout than male students (odds ratio, 1.90; 95% confidence interval, 1.34-2.70; P < .001).
Smoking was also linked to higher likelihood of burnout among medical students (OR, 2.12; 95% CI, 1.18-3.81; P < .05). The death of a family member from COVID-19 also put medical students at heightened risk for burnout (OR, 1.60; 95% CI, 1.08-2.36; P < .05).
The survey results were presented at the American Psychiatric Association (APA) Annual Meeting.
The findings point to the need to study burnout prevalence in universities and develop strategies to promote the mental health of future physicians, presenter Sofia Jezzini-Martínez, fourth-year medical student, Autonomous University of Nuevo Leon, Monterrey, Mexico, wrote in her conference abstract.
In related research presented at the APA meeting, researchers surveyed second-, third-, and fourth-year medical students from California during the pandemic.
Roughly 80% exhibited symptoms of anxiety and 68% exhibited depressive symptoms, of whom about 18% also reported having thoughts of suicide.
Yet only about half of the medical students exhibiting anxiety or depressive symptoms sought help from a mental health professional, and 20% reported using substances to cope with stress.
“Given that the pandemic is ongoing, we hope to draw attention to mental health needs of medical students and influence medical schools to direct appropriate and timely resources to this group,” presenter Sarthak Angal, MD, psychiatry resident, Kaiser Permanente San Jose Medical Center, California, wrote in his conference abstract.
Managing expectations
Weighing in on medical student burnout, Ihuoma Njoku, MD, department of psychiatry and neurobehavioral sciences, University of Virginia, Charlottesville, noted that, “particularly for women in multiple fields, including medicine, there’s a lot of burden placed on them.”
“Women are pulled in a lot of different directions and have increased demands, which may help explain their higher rate of burnout,” Dr. Njoku commented.
She noted that these surveys were conducted during the COVID-19 pandemic, “a period when students’ education experience was a lot different than what they expected and maybe what they wanted.”
Dr. Njoku noted that the challenges of the pandemic are particularly hard on fourth-year medical students.
“A big part of fourth year is applying to residency, and many were doing virtual interviews for residency. That makes it hard to really get an appreciation of the place you will spend the next three to eight years of your life,” she told this news organization.
A version of this article first appeared on Medscape.com.
NEW ORLEANS –
Researchers surveyed 613 medical students representing all years of a medical program during the last week of the Spring semester of 2021.
Based on the Maslach Burnout Inventory-Student Survey (MBI-SS), more than half (54%) of the students had symptoms of burnout.
Eighty percent of students scored high on emotional exhaustion, 57% scored high on cynicism, and 36% scored low on academic effectiveness.
Compared with male medical students, female medical students were more apt to exhibit signs of burnout (60% vs. 44%), emotional exhaustion (80% vs. 73%), and cynicism (62% vs. 49%).
After adjusting for associated factors, female medical students were significantly more likely to suffer from burnout than male students (odds ratio, 1.90; 95% confidence interval, 1.34-2.70; P < .001).
Smoking was also linked to higher likelihood of burnout among medical students (OR, 2.12; 95% CI, 1.18-3.81; P < .05). The death of a family member from COVID-19 also put medical students at heightened risk for burnout (OR, 1.60; 95% CI, 1.08-2.36; P < .05).
The survey results were presented at the American Psychiatric Association (APA) Annual Meeting.
The findings point to the need to study burnout prevalence in universities and develop strategies to promote the mental health of future physicians, presenter Sofia Jezzini-Martínez, fourth-year medical student, Autonomous University of Nuevo Leon, Monterrey, Mexico, wrote in her conference abstract.
In related research presented at the APA meeting, researchers surveyed second-, third-, and fourth-year medical students from California during the pandemic.
Roughly 80% exhibited symptoms of anxiety and 68% exhibited depressive symptoms, of whom about 18% also reported having thoughts of suicide.
Yet only about half of the medical students exhibiting anxiety or depressive symptoms sought help from a mental health professional, and 20% reported using substances to cope with stress.
“Given that the pandemic is ongoing, we hope to draw attention to mental health needs of medical students and influence medical schools to direct appropriate and timely resources to this group,” presenter Sarthak Angal, MD, psychiatry resident, Kaiser Permanente San Jose Medical Center, California, wrote in his conference abstract.
Managing expectations
Weighing in on medical student burnout, Ihuoma Njoku, MD, department of psychiatry and neurobehavioral sciences, University of Virginia, Charlottesville, noted that, “particularly for women in multiple fields, including medicine, there’s a lot of burden placed on them.”
“Women are pulled in a lot of different directions and have increased demands, which may help explain their higher rate of burnout,” Dr. Njoku commented.
She noted that these surveys were conducted during the COVID-19 pandemic, “a period when students’ education experience was a lot different than what they expected and maybe what they wanted.”
Dr. Njoku noted that the challenges of the pandemic are particularly hard on fourth-year medical students.
“A big part of fourth year is applying to residency, and many were doing virtual interviews for residency. That makes it hard to really get an appreciation of the place you will spend the next three to eight years of your life,” she told this news organization.
A version of this article first appeared on Medscape.com.
NEW ORLEANS –
Researchers surveyed 613 medical students representing all years of a medical program during the last week of the Spring semester of 2021.
Based on the Maslach Burnout Inventory-Student Survey (MBI-SS), more than half (54%) of the students had symptoms of burnout.
Eighty percent of students scored high on emotional exhaustion, 57% scored high on cynicism, and 36% scored low on academic effectiveness.
Compared with male medical students, female medical students were more apt to exhibit signs of burnout (60% vs. 44%), emotional exhaustion (80% vs. 73%), and cynicism (62% vs. 49%).
After adjusting for associated factors, female medical students were significantly more likely to suffer from burnout than male students (odds ratio, 1.90; 95% confidence interval, 1.34-2.70; P < .001).
Smoking was also linked to higher likelihood of burnout among medical students (OR, 2.12; 95% CI, 1.18-3.81; P < .05). The death of a family member from COVID-19 also put medical students at heightened risk for burnout (OR, 1.60; 95% CI, 1.08-2.36; P < .05).
The survey results were presented at the American Psychiatric Association (APA) Annual Meeting.
The findings point to the need to study burnout prevalence in universities and develop strategies to promote the mental health of future physicians, presenter Sofia Jezzini-Martínez, fourth-year medical student, Autonomous University of Nuevo Leon, Monterrey, Mexico, wrote in her conference abstract.
In related research presented at the APA meeting, researchers surveyed second-, third-, and fourth-year medical students from California during the pandemic.
Roughly 80% exhibited symptoms of anxiety and 68% exhibited depressive symptoms, of whom about 18% also reported having thoughts of suicide.
Yet only about half of the medical students exhibiting anxiety or depressive symptoms sought help from a mental health professional, and 20% reported using substances to cope with stress.
“Given that the pandemic is ongoing, we hope to draw attention to mental health needs of medical students and influence medical schools to direct appropriate and timely resources to this group,” presenter Sarthak Angal, MD, psychiatry resident, Kaiser Permanente San Jose Medical Center, California, wrote in his conference abstract.
Managing expectations
Weighing in on medical student burnout, Ihuoma Njoku, MD, department of psychiatry and neurobehavioral sciences, University of Virginia, Charlottesville, noted that, “particularly for women in multiple fields, including medicine, there’s a lot of burden placed on them.”
“Women are pulled in a lot of different directions and have increased demands, which may help explain their higher rate of burnout,” Dr. Njoku commented.
She noted that these surveys were conducted during the COVID-19 pandemic, “a period when students’ education experience was a lot different than what they expected and maybe what they wanted.”
Dr. Njoku noted that the challenges of the pandemic are particularly hard on fourth-year medical students.
“A big part of fourth year is applying to residency, and many were doing virtual interviews for residency. That makes it hard to really get an appreciation of the place you will spend the next three to eight years of your life,” she told this news organization.
A version of this article first appeared on Medscape.com.
FROM APA 2022
FDA expands indication for spinal muscular atrophy drug
As previously reported, the FDA first approved oral risdiplam for SMA in children older than age 2 years in 2020.
The FDA expanded the indication for risdiplam to include babies younger than 2 months old because of interim safety and efficacy data from the ongoing RAINBOWFISH study. It includes 25 babies from birth to 6 weeks of age at first dose, all of whom have genetically diagnosed SMA but are not yet presenting with symptoms.
After 12 months of risdiplam treatment, the majority of presymptomatic infants with SMA reached key motor milestones, Genentech said in a news release.
Of the six babies with two or three copies of the SMN2 gene, all were able to sit after 1 year of active treatment, roughly two-thirds could stand, and half could walk independently.
All babies were alive at 12 months without permanent ventilation.
“The approval of Evrysdi for presymptomatic babies is particularly important, as early treatment of SMA, before symptoms start to arise, can help babies to achieve motor milestones,” Richard Finkel, MD, principal investigator of the trial, said in the release.
“With the inclusion of SMA in newborn screening programs, this approval provides the opportunity to start treating at home with Evrysdi soon after the diagnosis is confirmed,” added Dr. Finkel, who is director of the experimental neuroscience program, St. Jude Children’s Research Hospital, Memphis.
From newborns to older adults?
SMA is a rare and often fatal genetic disease that causes muscle weakness and progressive loss of movement.
SMA, which affects about 1 in 10,000 babies, is caused by a mutation in the survival motor neuron 1 (SMN1) gene. The gene encodes the SMN protein, which is critical for the maintenance and function of motor neurons.
Risdiplam is an orally administered, centrally and peripherally distributed small molecule that modulates survival motor neuron 2 (SMN2) premessenger RNA splicing to increase SMN protein levels.
As part of the label extension, the prescribing information for risdiplam has also been updated to include 2-year pooled data from parts 1 and 2 of the FIREFISH study, which demonstrated long-term efficacy and safety in symptomatic infants with Type 1 SMA, the company noted.
“Because of its efficacy in multiple settings, Evrysdi is now available for people with SMA, from presymptomatic newborns to older adults,” Levi Garraway, MD, PhD, chief medical officer and head of global product development at Genentech, said in the release.
“We are proud of this achievement, which has the potential to make a real difference to those living with SMA and their caregivers,” Dr. Garraway added.
A version of this article first appeared on Medscape.com.
As previously reported, the FDA first approved oral risdiplam for SMA in children older than age 2 years in 2020.
The FDA expanded the indication for risdiplam to include babies younger than 2 months old because of interim safety and efficacy data from the ongoing RAINBOWFISH study. It includes 25 babies from birth to 6 weeks of age at first dose, all of whom have genetically diagnosed SMA but are not yet presenting with symptoms.
After 12 months of risdiplam treatment, the majority of presymptomatic infants with SMA reached key motor milestones, Genentech said in a news release.
Of the six babies with two or three copies of the SMN2 gene, all were able to sit after 1 year of active treatment, roughly two-thirds could stand, and half could walk independently.
All babies were alive at 12 months without permanent ventilation.
“The approval of Evrysdi for presymptomatic babies is particularly important, as early treatment of SMA, before symptoms start to arise, can help babies to achieve motor milestones,” Richard Finkel, MD, principal investigator of the trial, said in the release.
“With the inclusion of SMA in newborn screening programs, this approval provides the opportunity to start treating at home with Evrysdi soon after the diagnosis is confirmed,” added Dr. Finkel, who is director of the experimental neuroscience program, St. Jude Children’s Research Hospital, Memphis.
From newborns to older adults?
SMA is a rare and often fatal genetic disease that causes muscle weakness and progressive loss of movement.
SMA, which affects about 1 in 10,000 babies, is caused by a mutation in the survival motor neuron 1 (SMN1) gene. The gene encodes the SMN protein, which is critical for the maintenance and function of motor neurons.
Risdiplam is an orally administered, centrally and peripherally distributed small molecule that modulates survival motor neuron 2 (SMN2) premessenger RNA splicing to increase SMN protein levels.
As part of the label extension, the prescribing information for risdiplam has also been updated to include 2-year pooled data from parts 1 and 2 of the FIREFISH study, which demonstrated long-term efficacy and safety in symptomatic infants with Type 1 SMA, the company noted.
“Because of its efficacy in multiple settings, Evrysdi is now available for people with SMA, from presymptomatic newborns to older adults,” Levi Garraway, MD, PhD, chief medical officer and head of global product development at Genentech, said in the release.
“We are proud of this achievement, which has the potential to make a real difference to those living with SMA and their caregivers,” Dr. Garraway added.
A version of this article first appeared on Medscape.com.
As previously reported, the FDA first approved oral risdiplam for SMA in children older than age 2 years in 2020.
The FDA expanded the indication for risdiplam to include babies younger than 2 months old because of interim safety and efficacy data from the ongoing RAINBOWFISH study. It includes 25 babies from birth to 6 weeks of age at first dose, all of whom have genetically diagnosed SMA but are not yet presenting with symptoms.
After 12 months of risdiplam treatment, the majority of presymptomatic infants with SMA reached key motor milestones, Genentech said in a news release.
Of the six babies with two or three copies of the SMN2 gene, all were able to sit after 1 year of active treatment, roughly two-thirds could stand, and half could walk independently.
All babies were alive at 12 months without permanent ventilation.
“The approval of Evrysdi for presymptomatic babies is particularly important, as early treatment of SMA, before symptoms start to arise, can help babies to achieve motor milestones,” Richard Finkel, MD, principal investigator of the trial, said in the release.
“With the inclusion of SMA in newborn screening programs, this approval provides the opportunity to start treating at home with Evrysdi soon after the diagnosis is confirmed,” added Dr. Finkel, who is director of the experimental neuroscience program, St. Jude Children’s Research Hospital, Memphis.
From newborns to older adults?
SMA is a rare and often fatal genetic disease that causes muscle weakness and progressive loss of movement.
SMA, which affects about 1 in 10,000 babies, is caused by a mutation in the survival motor neuron 1 (SMN1) gene. The gene encodes the SMN protein, which is critical for the maintenance and function of motor neurons.
Risdiplam is an orally administered, centrally and peripherally distributed small molecule that modulates survival motor neuron 2 (SMN2) premessenger RNA splicing to increase SMN protein levels.
As part of the label extension, the prescribing information for risdiplam has also been updated to include 2-year pooled data from parts 1 and 2 of the FIREFISH study, which demonstrated long-term efficacy and safety in symptomatic infants with Type 1 SMA, the company noted.
“Because of its efficacy in multiple settings, Evrysdi is now available for people with SMA, from presymptomatic newborns to older adults,” Levi Garraway, MD, PhD, chief medical officer and head of global product development at Genentech, said in the release.
“We are proud of this achievement, which has the potential to make a real difference to those living with SMA and their caregivers,” Dr. Garraway added.
A version of this article first appeared on Medscape.com.
Telepsychiatry helped maintain standard of schizophrenia care during COVID
, new survey data show.
“Mental health centers rose to the challenge and did what they needed to do for their patients,” study investigator Dawn Velligan, PhD, University of Texas Health Science Center at San Antonio, told this news organization.
“Some decided to put patients on longer-acting injectable formulations. Some centers gave injections outside to make people feel safer,” Dr. Velligan said.
She added that other patients who might not have had transportation, or were too afraid to come in, were switched to oral medications. However, “switching to orals isn’t something that should be done lightly. I would only want patients to switch to orals as a last resort, but you do what you have to do,” Dr. Velligan said.
The findings were presented at the annual meeting of the American Psychiatric Association.
No going back?
When COVID hit, many mental health clinics closed for in-person visits. “This was unprecedented and we wanted to understand how clinics adapted their services and clinical management of patients with schizophrenia” on LAIs, Dr. Velligan said.
She and her colleagues surveyed 35 mental health clinics, with one respondent at each clinic, between October and November 2020.
All 35 clinics reported using telepsychiatry; 15 had been using telepsychiatry before the pandemic, while 20 (57%) began using it after COVID hit.
Across outpatient visit types, telepsychiatry use for noninjection visits rose from 12%-15% before the pandemic to 45%-69% after the pandemic.
In addition, patients were more apt to keep their telehealth visit. The frequency of appointment “no shows” and/or cancellations for telepsychiatry visits decreased by roughly one-third after the pandemic, compared with before the pandemic.
For patients with schizophrenia treated with LAIs, the frequency of telepsychiatry visits increased in 46% of the clinics during the pandemic.
For these patients, management options included switching patients from LAIs to oral antipsychotics in 34% of clinics and switching patients to LAIs with longer injection intervals in 31% of clinics.
Chief barriers to telepsychiatry visits were low reimbursement rate and lack of access to technology/reliable Internet.
Nearly all respondents reported being satisfied with the use of telepsychiatry to support patients with schizophrenia, whether treated with LAIs (94%) or with oral antipsychotics (97%).
Sixty percent of respondents reported no change in medication adherence for patients treated with LAIs since the start of the pandemic, while less than half (43%) reported no change in adherence to oral antipsychotics.
Most respondents (69%) felt that telepsychiatry visits would very likely continue to be used in combination with in-person office visits after the pandemic.
“Telemedicine is here to stay,” Dr. Velligan said.
Moving to a ‘hybrid universe’
Hector Colon-Rivera, MD, University of Pittsburgh Medical Center and president of the APA’s Hispanic Caucus, agrees.
Commenting on the findings, he noted that, because of shifts in care brought on by COVID, psychiatrists had to adopt telemedicine practices. As a result, many “now feel more comfortable” with telehealth visits for medication management and psychotherapy, said Dr. Colon-Rivera, who was not involved with the research.
He added this study is important because it shows that even patients with severe mental illness can be successfully managed with telepsychiatry, and with good adherence.
“Especially for patients with schizophrenia who have access issues, telepsychiatry is really helpful,” Dr. Colon-Rivera said.
“Telepsychiatry is becoming standard. Most clinics are moving to the hybrid universe now by having a telemedicine component and also seeing patients in person. Even places like emergency rooms and psychiatrists who do consults on medical floors are using telepsychiatry as an option,” he added.
Study funding was provided by Alkermes. Dr. Velligan has reported financial relationships with Alkermes, Otsuka, Janssen, and Lyndra. Dr. Colon-Rivera has reported no relevant financial relationships.
A version of this article first appeared on Medscape.com.
, new survey data show.
“Mental health centers rose to the challenge and did what they needed to do for their patients,” study investigator Dawn Velligan, PhD, University of Texas Health Science Center at San Antonio, told this news organization.
“Some decided to put patients on longer-acting injectable formulations. Some centers gave injections outside to make people feel safer,” Dr. Velligan said.
She added that other patients who might not have had transportation, or were too afraid to come in, were switched to oral medications. However, “switching to orals isn’t something that should be done lightly. I would only want patients to switch to orals as a last resort, but you do what you have to do,” Dr. Velligan said.
The findings were presented at the annual meeting of the American Psychiatric Association.
No going back?
When COVID hit, many mental health clinics closed for in-person visits. “This was unprecedented and we wanted to understand how clinics adapted their services and clinical management of patients with schizophrenia” on LAIs, Dr. Velligan said.
She and her colleagues surveyed 35 mental health clinics, with one respondent at each clinic, between October and November 2020.
All 35 clinics reported using telepsychiatry; 15 had been using telepsychiatry before the pandemic, while 20 (57%) began using it after COVID hit.
Across outpatient visit types, telepsychiatry use for noninjection visits rose from 12%-15% before the pandemic to 45%-69% after the pandemic.
In addition, patients were more apt to keep their telehealth visit. The frequency of appointment “no shows” and/or cancellations for telepsychiatry visits decreased by roughly one-third after the pandemic, compared with before the pandemic.
For patients with schizophrenia treated with LAIs, the frequency of telepsychiatry visits increased in 46% of the clinics during the pandemic.
For these patients, management options included switching patients from LAIs to oral antipsychotics in 34% of clinics and switching patients to LAIs with longer injection intervals in 31% of clinics.
Chief barriers to telepsychiatry visits were low reimbursement rate and lack of access to technology/reliable Internet.
Nearly all respondents reported being satisfied with the use of telepsychiatry to support patients with schizophrenia, whether treated with LAIs (94%) or with oral antipsychotics (97%).
Sixty percent of respondents reported no change in medication adherence for patients treated with LAIs since the start of the pandemic, while less than half (43%) reported no change in adherence to oral antipsychotics.
Most respondents (69%) felt that telepsychiatry visits would very likely continue to be used in combination with in-person office visits after the pandemic.
“Telemedicine is here to stay,” Dr. Velligan said.
Moving to a ‘hybrid universe’
Hector Colon-Rivera, MD, University of Pittsburgh Medical Center and president of the APA’s Hispanic Caucus, agrees.
Commenting on the findings, he noted that, because of shifts in care brought on by COVID, psychiatrists had to adopt telemedicine practices. As a result, many “now feel more comfortable” with telehealth visits for medication management and psychotherapy, said Dr. Colon-Rivera, who was not involved with the research.
He added this study is important because it shows that even patients with severe mental illness can be successfully managed with telepsychiatry, and with good adherence.
“Especially for patients with schizophrenia who have access issues, telepsychiatry is really helpful,” Dr. Colon-Rivera said.
“Telepsychiatry is becoming standard. Most clinics are moving to the hybrid universe now by having a telemedicine component and also seeing patients in person. Even places like emergency rooms and psychiatrists who do consults on medical floors are using telepsychiatry as an option,” he added.
Study funding was provided by Alkermes. Dr. Velligan has reported financial relationships with Alkermes, Otsuka, Janssen, and Lyndra. Dr. Colon-Rivera has reported no relevant financial relationships.
A version of this article first appeared on Medscape.com.
, new survey data show.
“Mental health centers rose to the challenge and did what they needed to do for their patients,” study investigator Dawn Velligan, PhD, University of Texas Health Science Center at San Antonio, told this news organization.
“Some decided to put patients on longer-acting injectable formulations. Some centers gave injections outside to make people feel safer,” Dr. Velligan said.
She added that other patients who might not have had transportation, or were too afraid to come in, were switched to oral medications. However, “switching to orals isn’t something that should be done lightly. I would only want patients to switch to orals as a last resort, but you do what you have to do,” Dr. Velligan said.
The findings were presented at the annual meeting of the American Psychiatric Association.
No going back?
When COVID hit, many mental health clinics closed for in-person visits. “This was unprecedented and we wanted to understand how clinics adapted their services and clinical management of patients with schizophrenia” on LAIs, Dr. Velligan said.
She and her colleagues surveyed 35 mental health clinics, with one respondent at each clinic, between October and November 2020.
All 35 clinics reported using telepsychiatry; 15 had been using telepsychiatry before the pandemic, while 20 (57%) began using it after COVID hit.
Across outpatient visit types, telepsychiatry use for noninjection visits rose from 12%-15% before the pandemic to 45%-69% after the pandemic.
In addition, patients were more apt to keep their telehealth visit. The frequency of appointment “no shows” and/or cancellations for telepsychiatry visits decreased by roughly one-third after the pandemic, compared with before the pandemic.
For patients with schizophrenia treated with LAIs, the frequency of telepsychiatry visits increased in 46% of the clinics during the pandemic.
For these patients, management options included switching patients from LAIs to oral antipsychotics in 34% of clinics and switching patients to LAIs with longer injection intervals in 31% of clinics.
Chief barriers to telepsychiatry visits were low reimbursement rate and lack of access to technology/reliable Internet.
Nearly all respondents reported being satisfied with the use of telepsychiatry to support patients with schizophrenia, whether treated with LAIs (94%) or with oral antipsychotics (97%).
Sixty percent of respondents reported no change in medication adherence for patients treated with LAIs since the start of the pandemic, while less than half (43%) reported no change in adherence to oral antipsychotics.
Most respondents (69%) felt that telepsychiatry visits would very likely continue to be used in combination with in-person office visits after the pandemic.
“Telemedicine is here to stay,” Dr. Velligan said.
Moving to a ‘hybrid universe’
Hector Colon-Rivera, MD, University of Pittsburgh Medical Center and president of the APA’s Hispanic Caucus, agrees.
Commenting on the findings, he noted that, because of shifts in care brought on by COVID, psychiatrists had to adopt telemedicine practices. As a result, many “now feel more comfortable” with telehealth visits for medication management and psychotherapy, said Dr. Colon-Rivera, who was not involved with the research.
He added this study is important because it shows that even patients with severe mental illness can be successfully managed with telepsychiatry, and with good adherence.
“Especially for patients with schizophrenia who have access issues, telepsychiatry is really helpful,” Dr. Colon-Rivera said.
“Telepsychiatry is becoming standard. Most clinics are moving to the hybrid universe now by having a telemedicine component and also seeing patients in person. Even places like emergency rooms and psychiatrists who do consults on medical floors are using telepsychiatry as an option,” he added.
Study funding was provided by Alkermes. Dr. Velligan has reported financial relationships with Alkermes, Otsuka, Janssen, and Lyndra. Dr. Colon-Rivera has reported no relevant financial relationships.
A version of this article first appeared on Medscape.com.
FROM APA 2022
Most COVID long-haulers suffer long-term debilitating neurologic symptoms
Most COVID-19 long-haulers continue to have brain fog, fatigue, and compromised quality of life more than a year after the initial infection, results from the most extensive follow-up to date of a group of long COVID patients show.
Most patients continue to experience debilitating neurologic symptoms an average of 15 months from symptom onset, Igor Koralnik, MD, who oversees the Neuro COVID-19 Clinic at Northwestern Medicine in Chicago, said during a press briefing.
Surprisingly, in some cases, new symptoms appear that didn’t exist before, including variation of heart rate and blood pressure, and gastrointestinal symptoms, indicating there may be a late appearance in dysfunction of the autonomic nervous system in those patients, Dr. Koralnik said.
The study was published online in Annals of Clinical and Translational Neurology.
Evolving symptoms
The investigators evaluated the evolution of neurologic symptoms in 52 adults who had mild COVID-19 symptoms and were not admitted to the hospital.
Their mean age was 43 years, 73% were women and 77% had received a COVID-19 vaccine. These patients have now been followed for between 11 and 18 months since their initial infection.
Overall, between first and follow-up evaluations, there was no significant change in the frequency of most neurologic symptoms, including brain fog (81% vs. 71%), numbness/tingling (69% vs. 65%), headache (67% vs. 54%), dizziness (50% vs. 54%), blurred vision (34% vs. 44%), tinnitus (33% vs. 42%), and fatigue (87% vs. 81%).
The only neurologic symptoms that decreased over time were loss of taste (63% vs. 27%) and smell (58% vs. 21%).
Conversely, heart rate and blood pressure variation (35% vs. 56%) and gastrointestinal symptoms (27% vs. 48%; P = .04) increased at follow-up evaluations.
Patients reported subjective improvements in their recovery, cognitive function and fatigue, but quality of life measures remained lower than the average population of the United States.
There was a neutral effect of COVID vaccination on long COVID symptoms – it didn’t cure long COVID or make long COVID worse, which is a reason given by some long-haulers for not getting vaccinated, Dr. Koralnik told the briefing.
Therefore, “we continue to encourage our patients to get vaccinated and boosted according to the Centers for Disease Control and Prevention recommendation,” he said.
Escape from the ‘pit of despair’
To date, the Northwestern Medicine Neuro COVID-19 Clinic has treated nearly 1,400 COVID long-haulers from across the United States.
Emily Caffee, a physical therapist from Wheaton, Ill., is one of them.
Speaking at the briefing, the 36-year-old described her saga and roller coaster of recovering from long COVID in three acts: her initial infection, followed by a descent into a pit of physical and emotional despair, followed by her eventual escape from that pit more than two years later.
Following a fairly mild case of COVID, Ms. Caffee said worsening neurologic symptoms forced her to take medical leave from her very physical and cognitively demanding job.
Ms. Caffee said she experienced crushing fatigue and brain fog, as well as rapid heart rate and blood pressure changes going from sitting to standing position.
She went from being a competitive athlete to someone who could barely get off the couch or empty the dishwasher.
With the ongoing help of her medical team, she slowly returned to daily activities and eventually to work on a limited basis.
Today, Ms. Caffee says she’s 90%-95% better but still she has some lingering symptoms and does not yet feel like her pre-COVID self.
It’s been a very slow climb out of the pit, Ms. Caffee said.
This study has no specific funding. The authors disclosed no relevant conflicts of interest.
A version of this article first appeared on Medscape.com.
Most COVID-19 long-haulers continue to have brain fog, fatigue, and compromised quality of life more than a year after the initial infection, results from the most extensive follow-up to date of a group of long COVID patients show.
Most patients continue to experience debilitating neurologic symptoms an average of 15 months from symptom onset, Igor Koralnik, MD, who oversees the Neuro COVID-19 Clinic at Northwestern Medicine in Chicago, said during a press briefing.
Surprisingly, in some cases, new symptoms appear that didn’t exist before, including variation of heart rate and blood pressure, and gastrointestinal symptoms, indicating there may be a late appearance in dysfunction of the autonomic nervous system in those patients, Dr. Koralnik said.
The study was published online in Annals of Clinical and Translational Neurology.
Evolving symptoms
The investigators evaluated the evolution of neurologic symptoms in 52 adults who had mild COVID-19 symptoms and were not admitted to the hospital.
Their mean age was 43 years, 73% were women and 77% had received a COVID-19 vaccine. These patients have now been followed for between 11 and 18 months since their initial infection.
Overall, between first and follow-up evaluations, there was no significant change in the frequency of most neurologic symptoms, including brain fog (81% vs. 71%), numbness/tingling (69% vs. 65%), headache (67% vs. 54%), dizziness (50% vs. 54%), blurred vision (34% vs. 44%), tinnitus (33% vs. 42%), and fatigue (87% vs. 81%).
The only neurologic symptoms that decreased over time were loss of taste (63% vs. 27%) and smell (58% vs. 21%).
Conversely, heart rate and blood pressure variation (35% vs. 56%) and gastrointestinal symptoms (27% vs. 48%; P = .04) increased at follow-up evaluations.
Patients reported subjective improvements in their recovery, cognitive function and fatigue, but quality of life measures remained lower than the average population of the United States.
There was a neutral effect of COVID vaccination on long COVID symptoms – it didn’t cure long COVID or make long COVID worse, which is a reason given by some long-haulers for not getting vaccinated, Dr. Koralnik told the briefing.
Therefore, “we continue to encourage our patients to get vaccinated and boosted according to the Centers for Disease Control and Prevention recommendation,” he said.
Escape from the ‘pit of despair’
To date, the Northwestern Medicine Neuro COVID-19 Clinic has treated nearly 1,400 COVID long-haulers from across the United States.
Emily Caffee, a physical therapist from Wheaton, Ill., is one of them.
Speaking at the briefing, the 36-year-old described her saga and roller coaster of recovering from long COVID in three acts: her initial infection, followed by a descent into a pit of physical and emotional despair, followed by her eventual escape from that pit more than two years later.
Following a fairly mild case of COVID, Ms. Caffee said worsening neurologic symptoms forced her to take medical leave from her very physical and cognitively demanding job.
Ms. Caffee said she experienced crushing fatigue and brain fog, as well as rapid heart rate and blood pressure changes going from sitting to standing position.
She went from being a competitive athlete to someone who could barely get off the couch or empty the dishwasher.
With the ongoing help of her medical team, she slowly returned to daily activities and eventually to work on a limited basis.
Today, Ms. Caffee says she’s 90%-95% better but still she has some lingering symptoms and does not yet feel like her pre-COVID self.
It’s been a very slow climb out of the pit, Ms. Caffee said.
This study has no specific funding. The authors disclosed no relevant conflicts of interest.
A version of this article first appeared on Medscape.com.
Most COVID-19 long-haulers continue to have brain fog, fatigue, and compromised quality of life more than a year after the initial infection, results from the most extensive follow-up to date of a group of long COVID patients show.
Most patients continue to experience debilitating neurologic symptoms an average of 15 months from symptom onset, Igor Koralnik, MD, who oversees the Neuro COVID-19 Clinic at Northwestern Medicine in Chicago, said during a press briefing.
Surprisingly, in some cases, new symptoms appear that didn’t exist before, including variation of heart rate and blood pressure, and gastrointestinal symptoms, indicating there may be a late appearance in dysfunction of the autonomic nervous system in those patients, Dr. Koralnik said.
The study was published online in Annals of Clinical and Translational Neurology.
Evolving symptoms
The investigators evaluated the evolution of neurologic symptoms in 52 adults who had mild COVID-19 symptoms and were not admitted to the hospital.
Their mean age was 43 years, 73% were women and 77% had received a COVID-19 vaccine. These patients have now been followed for between 11 and 18 months since their initial infection.
Overall, between first and follow-up evaluations, there was no significant change in the frequency of most neurologic symptoms, including brain fog (81% vs. 71%), numbness/tingling (69% vs. 65%), headache (67% vs. 54%), dizziness (50% vs. 54%), blurred vision (34% vs. 44%), tinnitus (33% vs. 42%), and fatigue (87% vs. 81%).
The only neurologic symptoms that decreased over time were loss of taste (63% vs. 27%) and smell (58% vs. 21%).
Conversely, heart rate and blood pressure variation (35% vs. 56%) and gastrointestinal symptoms (27% vs. 48%; P = .04) increased at follow-up evaluations.
Patients reported subjective improvements in their recovery, cognitive function and fatigue, but quality of life measures remained lower than the average population of the United States.
There was a neutral effect of COVID vaccination on long COVID symptoms – it didn’t cure long COVID or make long COVID worse, which is a reason given by some long-haulers for not getting vaccinated, Dr. Koralnik told the briefing.
Therefore, “we continue to encourage our patients to get vaccinated and boosted according to the Centers for Disease Control and Prevention recommendation,” he said.
Escape from the ‘pit of despair’
To date, the Northwestern Medicine Neuro COVID-19 Clinic has treated nearly 1,400 COVID long-haulers from across the United States.
Emily Caffee, a physical therapist from Wheaton, Ill., is one of them.
Speaking at the briefing, the 36-year-old described her saga and roller coaster of recovering from long COVID in three acts: her initial infection, followed by a descent into a pit of physical and emotional despair, followed by her eventual escape from that pit more than two years later.
Following a fairly mild case of COVID, Ms. Caffee said worsening neurologic symptoms forced her to take medical leave from her very physical and cognitively demanding job.
Ms. Caffee said she experienced crushing fatigue and brain fog, as well as rapid heart rate and blood pressure changes going from sitting to standing position.
She went from being a competitive athlete to someone who could barely get off the couch or empty the dishwasher.
With the ongoing help of her medical team, she slowly returned to daily activities and eventually to work on a limited basis.
Today, Ms. Caffee says she’s 90%-95% better but still she has some lingering symptoms and does not yet feel like her pre-COVID self.
It’s been a very slow climb out of the pit, Ms. Caffee said.
This study has no specific funding. The authors disclosed no relevant conflicts of interest.
A version of this article first appeared on Medscape.com.
FROM ANNALS OF CLINICAL AND TRANSLATIONAL NEUROLOGY
APA targets structural racism, offers solutions
, released to coincide with the annual meeting of the American Psychiatric Association.
The hope is this special issue will “motivate clinicians, educators, and researchers to take actions that will make a difference,” Ned H. Kalin, MD, AJP editor-in-chief, wrotes in an editor’s note.
“We cannot overestimate the impact of structural racism from the standpoint of its consequences related to mental health issues and mental health care,” Dr. Kalin said during an APA press briefing.
“This is one of our highest priorities, if not our highest priority,” he noted. The journal is the “voice of American and international psychiatry” and is a “great vehicle” for moving the field forward, he added.
Articles in the issue highlight “new directions to understand and eliminate mental health disparities [through a] multidimensional lens,” wrote Crystal L. Barksdale, PhD, health scientist administrator and program director with the National Institute on Minority Health and Health Disparities. Dr. Barksdale was guest editor for the issue.
A new agenda for change
In one article, Margarita Alegría, PhD, chief of the disparities research unit at Massachusetts General Hospital, Boston, and colleagues, wrote that the Biden Administration’s new budget offers the opportunity to redesign mental health research and service delivery in marginalized communities.
Given the rising mental health crisis in the U.S., the FY22 budget includes $1.6 billion for the community mental health services block grant program, which is more than double the money allocated in FY21.
Dr. Alegría and colleagues describe several interventions that have “sound evidence” of improving mental health or related outcomes among people of color in the U.S. within 5 years – by addressing social determinants of health.
They include universal school meal programs, community-based interventions delivered by paraprofessionals in after-school recreational programs, individual placement and support for employment, mental health literacy programs, senior centers offering health promotion activities, and a chronic disease self-management program.
Dr. Alegría noted that reducing structural racism and mental health disparities requires multilevel structural solutions and action by multiple stakeholders. In essence, “it takes a village,” she said.
A national conversation
Another article highlighted at the press briefing focuses on structural racism as it relates to youth suicide prevention.
Studies have shown the risk for suicide is higher earlier in life for youth of color. Suicide rates peak in adolescence and young adulthood for youth of color; for White populations, the peak happens in middle age and later life, noted lead author Kiara Alvarez, PhD, research scientist with Mass General’s disparities research unit.
However, there are well documented mental health service disparities where youth of color experiencing suicidal thoughts and behaviors have lower rates of access to needed services. They also have delays in access compared with their White peers, Dr. Alvarez said.
The authors propose a framework to address structural racism and mental health disparities as it relates to youth suicide prevention, with a focus on systems that are “preventive, rather than reactive; restorative, rather than punitive; and community-driven, rather than externally imposed.
“Ultimately, only structural solutions can dismantle structural racism,” they wrote.
The special issue of AJP aligns with the theme of this year’s APA meeting, which is the social determinants of mental health.
“Mental health has clearly become part of the national conversation. This has given us the opportunity to discuss how factors outside of the office and hospitals can impact the lives of many with mental illness and substance use disorder,” APA President Vivian B. Pender, MD, said during a preconference press briefing.
“These factors may include where you live, the air you breathe, how you’re educated, exposure to violence, and the impact of racism. These social determinants have become especially relevant to good mental health,” Dr. Pender said.
The research was supported by grants from the National Institute of Mental Health, the National Institute on Minority Health and Health Disparities, the National Institute of Drug Abuse, the National Institute of Alcohol Abuse and Alcoholism, and the National Institute of Child Health and Human Development. Dr. Kalin, Dr. Barksdale, Dr. Alegría, Dr. Alvarez, and Dr. Pender have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
, released to coincide with the annual meeting of the American Psychiatric Association.
The hope is this special issue will “motivate clinicians, educators, and researchers to take actions that will make a difference,” Ned H. Kalin, MD, AJP editor-in-chief, wrotes in an editor’s note.
“We cannot overestimate the impact of structural racism from the standpoint of its consequences related to mental health issues and mental health care,” Dr. Kalin said during an APA press briefing.
“This is one of our highest priorities, if not our highest priority,” he noted. The journal is the “voice of American and international psychiatry” and is a “great vehicle” for moving the field forward, he added.
Articles in the issue highlight “new directions to understand and eliminate mental health disparities [through a] multidimensional lens,” wrote Crystal L. Barksdale, PhD, health scientist administrator and program director with the National Institute on Minority Health and Health Disparities. Dr. Barksdale was guest editor for the issue.
A new agenda for change
In one article, Margarita Alegría, PhD, chief of the disparities research unit at Massachusetts General Hospital, Boston, and colleagues, wrote that the Biden Administration’s new budget offers the opportunity to redesign mental health research and service delivery in marginalized communities.
Given the rising mental health crisis in the U.S., the FY22 budget includes $1.6 billion for the community mental health services block grant program, which is more than double the money allocated in FY21.
Dr. Alegría and colleagues describe several interventions that have “sound evidence” of improving mental health or related outcomes among people of color in the U.S. within 5 years – by addressing social determinants of health.
They include universal school meal programs, community-based interventions delivered by paraprofessionals in after-school recreational programs, individual placement and support for employment, mental health literacy programs, senior centers offering health promotion activities, and a chronic disease self-management program.
Dr. Alegría noted that reducing structural racism and mental health disparities requires multilevel structural solutions and action by multiple stakeholders. In essence, “it takes a village,” she said.
A national conversation
Another article highlighted at the press briefing focuses on structural racism as it relates to youth suicide prevention.
Studies have shown the risk for suicide is higher earlier in life for youth of color. Suicide rates peak in adolescence and young adulthood for youth of color; for White populations, the peak happens in middle age and later life, noted lead author Kiara Alvarez, PhD, research scientist with Mass General’s disparities research unit.
However, there are well documented mental health service disparities where youth of color experiencing suicidal thoughts and behaviors have lower rates of access to needed services. They also have delays in access compared with their White peers, Dr. Alvarez said.
The authors propose a framework to address structural racism and mental health disparities as it relates to youth suicide prevention, with a focus on systems that are “preventive, rather than reactive; restorative, rather than punitive; and community-driven, rather than externally imposed.
“Ultimately, only structural solutions can dismantle structural racism,” they wrote.
The special issue of AJP aligns with the theme of this year’s APA meeting, which is the social determinants of mental health.
“Mental health has clearly become part of the national conversation. This has given us the opportunity to discuss how factors outside of the office and hospitals can impact the lives of many with mental illness and substance use disorder,” APA President Vivian B. Pender, MD, said during a preconference press briefing.
“These factors may include where you live, the air you breathe, how you’re educated, exposure to violence, and the impact of racism. These social determinants have become especially relevant to good mental health,” Dr. Pender said.
The research was supported by grants from the National Institute of Mental Health, the National Institute on Minority Health and Health Disparities, the National Institute of Drug Abuse, the National Institute of Alcohol Abuse and Alcoholism, and the National Institute of Child Health and Human Development. Dr. Kalin, Dr. Barksdale, Dr. Alegría, Dr. Alvarez, and Dr. Pender have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
, released to coincide with the annual meeting of the American Psychiatric Association.
The hope is this special issue will “motivate clinicians, educators, and researchers to take actions that will make a difference,” Ned H. Kalin, MD, AJP editor-in-chief, wrotes in an editor’s note.
“We cannot overestimate the impact of structural racism from the standpoint of its consequences related to mental health issues and mental health care,” Dr. Kalin said during an APA press briefing.
“This is one of our highest priorities, if not our highest priority,” he noted. The journal is the “voice of American and international psychiatry” and is a “great vehicle” for moving the field forward, he added.
Articles in the issue highlight “new directions to understand and eliminate mental health disparities [through a] multidimensional lens,” wrote Crystal L. Barksdale, PhD, health scientist administrator and program director with the National Institute on Minority Health and Health Disparities. Dr. Barksdale was guest editor for the issue.
A new agenda for change
In one article, Margarita Alegría, PhD, chief of the disparities research unit at Massachusetts General Hospital, Boston, and colleagues, wrote that the Biden Administration’s new budget offers the opportunity to redesign mental health research and service delivery in marginalized communities.
Given the rising mental health crisis in the U.S., the FY22 budget includes $1.6 billion for the community mental health services block grant program, which is more than double the money allocated in FY21.
Dr. Alegría and colleagues describe several interventions that have “sound evidence” of improving mental health or related outcomes among people of color in the U.S. within 5 years – by addressing social determinants of health.
They include universal school meal programs, community-based interventions delivered by paraprofessionals in after-school recreational programs, individual placement and support for employment, mental health literacy programs, senior centers offering health promotion activities, and a chronic disease self-management program.
Dr. Alegría noted that reducing structural racism and mental health disparities requires multilevel structural solutions and action by multiple stakeholders. In essence, “it takes a village,” she said.
A national conversation
Another article highlighted at the press briefing focuses on structural racism as it relates to youth suicide prevention.
Studies have shown the risk for suicide is higher earlier in life for youth of color. Suicide rates peak in adolescence and young adulthood for youth of color; for White populations, the peak happens in middle age and later life, noted lead author Kiara Alvarez, PhD, research scientist with Mass General’s disparities research unit.
However, there are well documented mental health service disparities where youth of color experiencing suicidal thoughts and behaviors have lower rates of access to needed services. They also have delays in access compared with their White peers, Dr. Alvarez said.
The authors propose a framework to address structural racism and mental health disparities as it relates to youth suicide prevention, with a focus on systems that are “preventive, rather than reactive; restorative, rather than punitive; and community-driven, rather than externally imposed.
“Ultimately, only structural solutions can dismantle structural racism,” they wrote.
The special issue of AJP aligns with the theme of this year’s APA meeting, which is the social determinants of mental health.
“Mental health has clearly become part of the national conversation. This has given us the opportunity to discuss how factors outside of the office and hospitals can impact the lives of many with mental illness and substance use disorder,” APA President Vivian B. Pender, MD, said during a preconference press briefing.
“These factors may include where you live, the air you breathe, how you’re educated, exposure to violence, and the impact of racism. These social determinants have become especially relevant to good mental health,” Dr. Pender said.
The research was supported by grants from the National Institute of Mental Health, the National Institute on Minority Health and Health Disparities, the National Institute of Drug Abuse, the National Institute of Alcohol Abuse and Alcoholism, and the National Institute of Child Health and Human Development. Dr. Kalin, Dr. Barksdale, Dr. Alegría, Dr. Alvarez, and Dr. Pender have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Multiple mental health woes? Blame it on genetics
Investigators conducted a genetic analysis of 11 major psychiatric disorders, including schizophrenia and bipolar disorder.
“Our findings confirm that high comorbidity across some disorders in part reflects overlapping pathways of genetic risk,” lead author Andrew Grotzinger, PhD, department of psychology and neuroscience, University of Colorado at Boulder, said in a press release.
The results could lead to the development of treatments that address multiple psychiatric disorders at once and help reshape the way diagnoses are established, the researchers note.
The findings were published online in Nature Genetics.
Common genetic patterns
Using the massive UK Biobank and the Psychiatric Genomics Consortium, the researchers applied novel statistical genetic methods to identify common patterns across 11 major psychiatric disorders: schizophrenia, bipolar disorder, major depressive disorder, anxiety disorder, anorexia nervosa, obsessive-compulsive disorder (OCD), Tourette syndrome, post traumatic stress disorder, problematic alcohol use, attention deficit hyperactive disorder, and autism.
The average total sample size per disorder was 156,771 participants, with a range of 9,725 to 802,939 participants.
In all, the investigators identified 152 genetic variants shared across multiple disorders, including those already known to influence certain types of brain cells.
For example, they found that 70% of the genetic signal associated with schizophrenia was also associated with bipolar disorder.
Results also showed that anorexia nervosa and OCD have a strong, shared genetic architecture and that individuals with a genetic predisposition to low body mass index also tend to have a genetic predisposition to these two disorders.
Not surprisingly, the researchers note, there was a large genetic overlap between anxiety disorder and major depressive disorder.
They also observed that psychiatric disorders that tend to cluster together also tend to share genes that influence how and when individuals are physically active during the day.
For example, patients with internalizing disorders such as anxiety and depression tend to have a genetic architecture associated with low movement throughout the day. On the other hand, those with OCD and anorexia tend to have genes associated with higher movement throughout the day.
“When you think about it, it makes sense,” said Dr. Grotzinger. Depressed individuals often experience fatigue or low energy while those with compulsive disorders may have a tough time sitting still, he noted.
One treatment for multiple disorders?
“Collectively, these results offer key insights into the shared and disorder-specific mechanisms of genetic risk for psychiatric disease,” the investigators write.
Their research is also a first step toward developing therapies that can address multiple disorders with one treatment, they add.
“People are more likely today to be prescribed multiple medications intended to treat multiple diagnoses, and in some instances those medicines can have side effects,” Dr. Grotzinger said.
“By identifying what is shared across these issues, we can hopefully come up with ways to target them in a different way that doesn’t require four separate pills or four separate psychotherapy interventions,” he added.
Dr. Grotzinger noted that, for now, the knowledge that genetics are underlying their disorders may provide comfort to some patients.
“It’s important for people to know that they didn’t just get a terrible roll of the dice in life – that they are not facing multiple different issues but rather one set of risk factors bleeding into them all,” he said.
This research had no commercial funding. Dr. Grotzinger reported no relevant disclosures.
A version of this article first appeared on Medscape.com.
Investigators conducted a genetic analysis of 11 major psychiatric disorders, including schizophrenia and bipolar disorder.
“Our findings confirm that high comorbidity across some disorders in part reflects overlapping pathways of genetic risk,” lead author Andrew Grotzinger, PhD, department of psychology and neuroscience, University of Colorado at Boulder, said in a press release.
The results could lead to the development of treatments that address multiple psychiatric disorders at once and help reshape the way diagnoses are established, the researchers note.
The findings were published online in Nature Genetics.
Common genetic patterns
Using the massive UK Biobank and the Psychiatric Genomics Consortium, the researchers applied novel statistical genetic methods to identify common patterns across 11 major psychiatric disorders: schizophrenia, bipolar disorder, major depressive disorder, anxiety disorder, anorexia nervosa, obsessive-compulsive disorder (OCD), Tourette syndrome, post traumatic stress disorder, problematic alcohol use, attention deficit hyperactive disorder, and autism.
The average total sample size per disorder was 156,771 participants, with a range of 9,725 to 802,939 participants.
In all, the investigators identified 152 genetic variants shared across multiple disorders, including those already known to influence certain types of brain cells.
For example, they found that 70% of the genetic signal associated with schizophrenia was also associated with bipolar disorder.
Results also showed that anorexia nervosa and OCD have a strong, shared genetic architecture and that individuals with a genetic predisposition to low body mass index also tend to have a genetic predisposition to these two disorders.
Not surprisingly, the researchers note, there was a large genetic overlap between anxiety disorder and major depressive disorder.
They also observed that psychiatric disorders that tend to cluster together also tend to share genes that influence how and when individuals are physically active during the day.
For example, patients with internalizing disorders such as anxiety and depression tend to have a genetic architecture associated with low movement throughout the day. On the other hand, those with OCD and anorexia tend to have genes associated with higher movement throughout the day.
“When you think about it, it makes sense,” said Dr. Grotzinger. Depressed individuals often experience fatigue or low energy while those with compulsive disorders may have a tough time sitting still, he noted.
One treatment for multiple disorders?
“Collectively, these results offer key insights into the shared and disorder-specific mechanisms of genetic risk for psychiatric disease,” the investigators write.
Their research is also a first step toward developing therapies that can address multiple disorders with one treatment, they add.
“People are more likely today to be prescribed multiple medications intended to treat multiple diagnoses, and in some instances those medicines can have side effects,” Dr. Grotzinger said.
“By identifying what is shared across these issues, we can hopefully come up with ways to target them in a different way that doesn’t require four separate pills or four separate psychotherapy interventions,” he added.
Dr. Grotzinger noted that, for now, the knowledge that genetics are underlying their disorders may provide comfort to some patients.
“It’s important for people to know that they didn’t just get a terrible roll of the dice in life – that they are not facing multiple different issues but rather one set of risk factors bleeding into them all,” he said.
This research had no commercial funding. Dr. Grotzinger reported no relevant disclosures.
A version of this article first appeared on Medscape.com.
Investigators conducted a genetic analysis of 11 major psychiatric disorders, including schizophrenia and bipolar disorder.
“Our findings confirm that high comorbidity across some disorders in part reflects overlapping pathways of genetic risk,” lead author Andrew Grotzinger, PhD, department of psychology and neuroscience, University of Colorado at Boulder, said in a press release.
The results could lead to the development of treatments that address multiple psychiatric disorders at once and help reshape the way diagnoses are established, the researchers note.
The findings were published online in Nature Genetics.
Common genetic patterns
Using the massive UK Biobank and the Psychiatric Genomics Consortium, the researchers applied novel statistical genetic methods to identify common patterns across 11 major psychiatric disorders: schizophrenia, bipolar disorder, major depressive disorder, anxiety disorder, anorexia nervosa, obsessive-compulsive disorder (OCD), Tourette syndrome, post traumatic stress disorder, problematic alcohol use, attention deficit hyperactive disorder, and autism.
The average total sample size per disorder was 156,771 participants, with a range of 9,725 to 802,939 participants.
In all, the investigators identified 152 genetic variants shared across multiple disorders, including those already known to influence certain types of brain cells.
For example, they found that 70% of the genetic signal associated with schizophrenia was also associated with bipolar disorder.
Results also showed that anorexia nervosa and OCD have a strong, shared genetic architecture and that individuals with a genetic predisposition to low body mass index also tend to have a genetic predisposition to these two disorders.
Not surprisingly, the researchers note, there was a large genetic overlap between anxiety disorder and major depressive disorder.
They also observed that psychiatric disorders that tend to cluster together also tend to share genes that influence how and when individuals are physically active during the day.
For example, patients with internalizing disorders such as anxiety and depression tend to have a genetic architecture associated with low movement throughout the day. On the other hand, those with OCD and anorexia tend to have genes associated with higher movement throughout the day.
“When you think about it, it makes sense,” said Dr. Grotzinger. Depressed individuals often experience fatigue or low energy while those with compulsive disorders may have a tough time sitting still, he noted.
One treatment for multiple disorders?
“Collectively, these results offer key insights into the shared and disorder-specific mechanisms of genetic risk for psychiatric disease,” the investigators write.
Their research is also a first step toward developing therapies that can address multiple disorders with one treatment, they add.
“People are more likely today to be prescribed multiple medications intended to treat multiple diagnoses, and in some instances those medicines can have side effects,” Dr. Grotzinger said.
“By identifying what is shared across these issues, we can hopefully come up with ways to target them in a different way that doesn’t require four separate pills or four separate psychotherapy interventions,” he added.
Dr. Grotzinger noted that, for now, the knowledge that genetics are underlying their disorders may provide comfort to some patients.
“It’s important for people to know that they didn’t just get a terrible roll of the dice in life – that they are not facing multiple different issues but rather one set of risk factors bleeding into them all,” he said.
This research had no commercial funding. Dr. Grotzinger reported no relevant disclosures.
A version of this article first appeared on Medscape.com.
FROM NATURE GENETICS