I have learned a few things in my almost half-century of hurtling through space with all of you on this fragile blue-green rock. My most recent enlightenment is that the universe has a way of flipping our certitude on its head. Mental acrobatics requires flexibility, requiring us to bend so we don’t break.

On July 1, Minnesota began allowing clinicians to certify patients for “intractable pain” as a qualifying condition for the Minnesota Medical Cannabis Program. Recall that medical marijuana is a Schedule I drug, and we cannot prescribe it. These programs are set up in such a way that the only role a clinician plays is to certify patients with qualifying conditions. This allows a patient to pay a registration fee and visit a cannabis patient center, where a pharmacist will recommend cannabis dose and type.

Months before this, I was waxing professorial about our lack of certainty about dosing and efficacy of medical marijuana. Then I met a 30-year-old with chronic back pain.

She had been evaluated by every subspecialist. This patient was taking and failing supertherapeutic doses of NSAIDs, acetaminophen, and gabapentin. No more surgical options existed. She had been removed from opioid contracts for aberrant behavior. She had had a hysterectomy for severe bleeding. She was in pain and asking for help.

She relates to you that street marijuana has helped with the pain, but she is worried about being arrested and losing her job. Do we put her on another opioid contract? Do we throw up our hands in defeat, apologize, and show her the door?

Serendipitously, I ran across a study evaluating the relationship between cannabis use over a 20-year period and health conditions. The study by Madeline Meier, Ph.D., and her colleagues evaluated 1,037 New Zealanders followed into their late 30s. Laboratory measures were available, and tobacco use was determined (JAMA Psychiatry. 2016 Jul 1;73[7]:731-40).

Cannabis was associated with poorer periodontal health, but with no other health conditions in early midlife. In contrast, tobacco use was associated with significant adverse health consequences in multiple domains.

This study looked at smoked cannabis. In contrast, the cannabis that my patient would take is an oil, negating any potential respiratory health issues from by-products of burning. Furthermore, products with higher concentrations of or consisting exclusively of cannabidiol can be selected. Cannabidiol is proposed to possess health benefits and is not psychoactive.

As the opioid crisis rages, solutions are not readily presenting themselves. Will we be on the wrong side of medical history by providing patients with chronic pain access to medical marijuana? Perhaps we can avoid, at least for a short time, the all-too inevitable outcome of chronic pain patients in their 30s: ever-increasing opioid doses with the same amount of pain, frequent emergency department visits, a fractured patient-physician relationship, and drug overdose.

For our patients’ sake, I hope we can bend before we break.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author and do not necessarily represent the views and opinions of the Mayo Clinic. The opinions expressed in this article should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Dr. Ebbert has no relevant financial disclosures about this article.

I have learned a few things in my almost half-century of hurtling through space with all of you on this fragile blue-green rock. My most recent enlightenment is that the universe has a way of flipping our certitude on its head. Mental acrobatics requires flexibility, requiring us to bend so we don’t break.

On July 1, Minnesota began allowing clinicians to certify patients for “intractable pain” as a qualifying condition for the Minnesota Medical Cannabis Program. Recall that medical marijuana is a Schedule I drug, and we cannot prescribe it. These programs are set up in such a way that the only role a clinician plays is to certify patients with qualifying conditions. This allows a patient to pay a registration fee and visit a cannabis patient center, where a pharmacist will recommend cannabis dose and type.

Months before this, I was waxing professorial about our lack of certainty about dosing and efficacy of medical marijuana. Then I met a 30-year-old with chronic back pain.

She had been evaluated by every subspecialist. This patient was taking and failing supertherapeutic doses of NSAIDs, acetaminophen, and gabapentin. No more surgical options existed. She had been removed from opioid contracts for aberrant behavior. She had had a hysterectomy for severe bleeding. She was in pain and asking for help.

She relates to you that street marijuana has helped with the pain, but she is worried about being arrested and losing her job. Do we put her on another opioid contract? Do we throw up our hands in defeat, apologize, and show her the door?

Serendipitously, I ran across a study evaluating the relationship between cannabis use over a 20-year period and health conditions. The study by Madeline Meier, Ph.D., and her colleagues evaluated 1,037 New Zealanders followed into their late 30s. Laboratory measures were available, and tobacco use was determined (JAMA Psychiatry. 2016 Jul 1;73[7]:731-40).

Cannabis was associated with poorer periodontal health, but with no other health conditions in early midlife. In contrast, tobacco use was associated with significant adverse health consequences in multiple domains.

This study looked at smoked cannabis. In contrast, the cannabis that my patient would take is an oil, negating any potential respiratory health issues from by-products of burning. Furthermore, products with higher concentrations of or consisting exclusively of cannabidiol can be selected. Cannabidiol is proposed to possess health benefits and is not psychoactive.

As the opioid crisis rages, solutions are not readily presenting themselves. Will we be on the wrong side of medical history by providing patients with chronic pain access to medical marijuana? Perhaps we can avoid, at least for a short time, the all-too inevitable outcome of chronic pain patients in their 30s: ever-increasing opioid doses with the same amount of pain, frequent emergency department visits, a fractured patient-physician relationship, and drug overdose.

For our patients’ sake, I hope we can bend before we break.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author and do not necessarily represent the views and opinions of the Mayo Clinic. The opinions expressed in this article should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Dr. Ebbert has no relevant financial disclosures about this article.

I have learned a few things in my almost half-century of hurtling through space with all of you on this fragile blue-green rock. My most recent enlightenment is that the universe has a way of flipping our certitude on its head. Mental acrobatics requires flexibility, requiring us to bend so we don’t break.

On July 1, Minnesota began allowing clinicians to certify patients for “intractable pain” as a qualifying condition for the Minnesota Medical Cannabis Program. Recall that medical marijuana is a Schedule I drug, and we cannot prescribe it. These programs are set up in such a way that the only role a clinician plays is to certify patients with qualifying conditions. This allows a patient to pay a registration fee and visit a cannabis patient center, where a pharmacist will recommend cannabis dose and type.

Months before this, I was waxing professorial about our lack of certainty about dosing and efficacy of medical marijuana. Then I met a 30-year-old with chronic back pain.

She had been evaluated by every subspecialist. This patient was taking and failing supertherapeutic doses of NSAIDs, acetaminophen, and gabapentin. No more surgical options existed. She had been removed from opioid contracts for aberrant behavior. She had had a hysterectomy for severe bleeding. She was in pain and asking for help.

She relates to you that street marijuana has helped with the pain, but she is worried about being arrested and losing her job. Do we put her on another opioid contract? Do we throw up our hands in defeat, apologize, and show her the door?

Serendipitously, I ran across a study evaluating the relationship between cannabis use over a 20-year period and health conditions. The study by Madeline Meier, Ph.D., and her colleagues evaluated 1,037 New Zealanders followed into their late 30s. Laboratory measures were available, and tobacco use was determined (JAMA Psychiatry. 2016 Jul 1;73[7]:731-40).

Cannabis was associated with poorer periodontal health, but with no other health conditions in early midlife. In contrast, tobacco use was associated with significant adverse health consequences in multiple domains.

This study looked at smoked cannabis. In contrast, the cannabis that my patient would take is an oil, negating any potential respiratory health issues from by-products of burning. Furthermore, products with higher concentrations of or consisting exclusively of cannabidiol can be selected. Cannabidiol is proposed to possess health benefits and is not psychoactive.

As the opioid crisis rages, solutions are not readily presenting themselves. Will we be on the wrong side of medical history by providing patients with chronic pain access to medical marijuana? Perhaps we can avoid, at least for a short time, the all-too inevitable outcome of chronic pain patients in their 30s: ever-increasing opioid doses with the same amount of pain, frequent emergency department visits, a fractured patient-physician relationship, and drug overdose.

For our patients’ sake, I hope we can bend before we break.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author and do not necessarily represent the views and opinions of the Mayo Clinic. The opinions expressed in this article should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Dr. Ebbert has no relevant financial disclosures about this article.

Radiographic vertebral fractures occur frequently in patients with ankylosing spondylitis, according to Dr. Fiona Maas and her associates.

At baseline, 59 (20%) of the 292 patients included in a prospective cohort study had radiographic vertebral fractures. During a 2-year follow-up period, 15 patients developed new fractures and 7 patients experienced an increase in severity of current fractures. A significant majority of fractures were defined as mild, and most were located in the mid-thoracic and thoracolumbar regions of the spine.

Fractures were more likely in patients who were older, had a higher body mass index, had smoked for long durations, had larger occiput-to-wall distances, had more spinal radiographic damage, and had lower hip bone mineral density (BMD). Patients who developed new fractures during the study period were older and had lower hip BMD. Incidence and prevalence of fractures was reduced in patients who were receiving nonsteroidal anti-inflammatory drugs (NSAIDs) at baseline.

“The influence of anti-inflammatory drugs (e.g. NSAIDs, TNF-alpha inhibitors), anti-osteoporotic treatment (e.g. calcium/vitamin D supplements, bisphosphonates), and lifestyle changes (e.g. smoking cessation, body weight control, physical exercise) on the development of vertebral fractures in AS should be further investigated in a large study population with long-term follow-up,” the investigators concluded.

Find the full study in Arthritis Care & Research (doi: 10.1002/acr.22980).

[email protected]

Radiographic vertebral fractures occur frequently in patients with ankylosing spondylitis, according to Dr. Fiona Maas and her associates.

At baseline, 59 (20%) of the 292 patients included in a prospective cohort study had radiographic vertebral fractures. During a 2-year follow-up period, 15 patients developed new fractures and 7 patients experienced an increase in severity of current fractures. A significant majority of fractures were defined as mild, and most were located in the mid-thoracic and thoracolumbar regions of the spine.

Fractures were more likely in patients who were older, had a higher body mass index, had smoked for long durations, had larger occiput-to-wall distances, had more spinal radiographic damage, and had lower hip bone mineral density (BMD). Patients who developed new fractures during the study period were older and had lower hip BMD. Incidence and prevalence of fractures was reduced in patients who were receiving nonsteroidal anti-inflammatory drugs (NSAIDs) at baseline.

“The influence of anti-inflammatory drugs (e.g. NSAIDs, TNF-alpha inhibitors), anti-osteoporotic treatment (e.g. calcium/vitamin D supplements, bisphosphonates), and lifestyle changes (e.g. smoking cessation, body weight control, physical exercise) on the development of vertebral fractures in AS should be further investigated in a large study population with long-term follow-up,” the investigators concluded.

Find the full study in Arthritis Care & Research (doi: 10.1002/acr.22980).

[email protected]

Radiographic vertebral fractures occur frequently in patients with ankylosing spondylitis, according to Dr. Fiona Maas and her associates.

At baseline, 59 (20%) of the 292 patients included in a prospective cohort study had radiographic vertebral fractures. During a 2-year follow-up period, 15 patients developed new fractures and 7 patients experienced an increase in severity of current fractures. A significant majority of fractures were defined as mild, and most were located in the mid-thoracic and thoracolumbar regions of the spine.

Fractures were more likely in patients who were older, had a higher body mass index, had smoked for long durations, had larger occiput-to-wall distances, had more spinal radiographic damage, and had lower hip bone mineral density (BMD). Patients who developed new fractures during the study period were older and had lower hip BMD. Incidence and prevalence of fractures was reduced in patients who were receiving nonsteroidal anti-inflammatory drugs (NSAIDs) at baseline.

“The influence of anti-inflammatory drugs (e.g. NSAIDs, TNF-alpha inhibitors), anti-osteoporotic treatment (e.g. calcium/vitamin D supplements, bisphosphonates), and lifestyle changes (e.g. smoking cessation, body weight control, physical exercise) on the development of vertebral fractures in AS should be further investigated in a large study population with long-term follow-up,” the investigators concluded.

Find the full study in Arthritis Care & Research (doi: 10.1002/acr.22980).

[email protected]

The influx of aging Baby Boomers into the ranks of the retired will reduce the ratio of workers available to pay for each Medicare part A beneficiary by 40% from 2000 to 2030, according to the 2016 report of the Medicare Trustees.

In 2015, there were 3.1 workers for each part A beneficiary, putting the United States in the middle of a projected drop from 4.0 workers per beneficiary in 2000 down to 2.4 in 2030. The Boomer-induced drop will largely be over by then, but the decline will continue until there are about 2.1 workers for each part A beneficiary by 2090, the report said.

“This reduction implies an increase in the [Medicare part A] cost rate of about 50% by 2090, relative to its current level, solely due to this demographic factor,” the trustees noted.

The projections are done using three sets – low-cost, intermediate, and high-cost – of economic and demographic assumptions. The figures presented here are from the intermediate assumption.

[email protected]

The influx of aging Baby Boomers into the ranks of the retired will reduce the ratio of workers available to pay for each Medicare part A beneficiary by 40% from 2000 to 2030, according to the 2016 report of the Medicare Trustees.

In 2015, there were 3.1 workers for each part A beneficiary, putting the United States in the middle of a projected drop from 4.0 workers per beneficiary in 2000 down to 2.4 in 2030. The Boomer-induced drop will largely be over by then, but the decline will continue until there are about 2.1 workers for each part A beneficiary by 2090, the report said.

“This reduction implies an increase in the [Medicare part A] cost rate of about 50% by 2090, relative to its current level, solely due to this demographic factor,” the trustees noted.

The projections are done using three sets – low-cost, intermediate, and high-cost – of economic and demographic assumptions. The figures presented here are from the intermediate assumption.

[email protected]

The influx of aging Baby Boomers into the ranks of the retired will reduce the ratio of workers available to pay for each Medicare part A beneficiary by 40% from 2000 to 2030, according to the 2016 report of the Medicare Trustees.

In 2015, there were 3.1 workers for each part A beneficiary, putting the United States in the middle of a projected drop from 4.0 workers per beneficiary in 2000 down to 2.4 in 2030. The Boomer-induced drop will largely be over by then, but the decline will continue until there are about 2.1 workers for each part A beneficiary by 2090, the report said.

“This reduction implies an increase in the [Medicare part A] cost rate of about 50% by 2090, relative to its current level, solely due to this demographic factor,” the trustees noted.

The projections are done using three sets – low-cost, intermediate, and high-cost – of economic and demographic assumptions. The figures presented here are from the intermediate assumption.

[email protected]

Donald Trump, the presumptive Republican Party nominee focused on the VA and veterans’ health issues in a speech Monday in Virginia Beach, Virginia. In the speech, Mr. Trump called for civil service reform, access to community care for all veterans regardless of Choice program eligibility, and more VA mental health care providers.

“It is the job of the next President to make America safe again, for everyone,” Mr. Trump said in a prepared speech. “That promise of protection must include taking care of every last veteran.”

Echoing the recent recommendations of the Commission on Care, Mr. Trump argued that access to care in the community should be guaranteed for all veterans. “We must extend this right to all veterans, not just those who can’t get an appointment in 30 days, or who live more than 40 miles from a VA hospital, which is the current policy.”

Hillary Clinton, the presumptive Democratic Party nominee, did not directly respond to Mr. Trump’s proposal or those of the Commission on Care. However she has previously stated that she opposes efforts to privatize veteran care. Mrs. Clinton has touted her role in increasing aid to families of veterans and active- duty service members and expanding coverage to include National Guard and reservists as a member of the Armed Services Committee.

Charging that the VA was “corrupt,” Mr. Trump vowed to begin an investigation immediately if he is elected president. “I will instruct my staff that if a valid complaint is not addressed, that the issue be brought directly to me,” he said. “I will pick up the phone and fix it myself if I have to.” The Republican candidate called for civil service reform so that the VA can more easily fire employees.

The Republican candidate’s remarks also drew on the pre-release of information from the VA’s research into suicide rates. Noting that the rate of veteran suicide is lower among patients in the VA system compared with the rate of those who do not use VA services, Mr. Trump called for expansion of mental health services at the VA. “A shocking 20 veterans are committing suicide each day, especially our older veterans,” Mr. Trump said. “This is a national tragedy. The evidence shows that if veterans are in the system, receiving care, they are much less likely to take their own lives than veterans outside the system. That is why we must increase the number of mental health care professionals inside the VA— while ensuring that veterans can access private mental health care as well.”

In his speech, Mr. Trump vowed to enact the following VA reform proposals:

1. I will appoint a Secretary of Veterans Affairs who will make it his or her personal mission to clean up the VA.

2. I am going to use every lawful authority to remove and discipline federal employees or managers who fail our veterans or breach the public trust.

3. I am going to ask Congress to pass legislation that ensures the Secretary of Veterans Affairs has the authority to remove or discipline any employee who risks the health, safety, or well-being of any veteran.

4. I am going to appoint a commission to investigate all the wrongdoing at the VA and then present those findings to Congress as the basis for bold legislative reform.

5. I am going to make sure the honest and dedicated people in the VA have their jobs protected and are put in line for promotions.

6. I will create a private White House Hotline that is answered by a real person 24 hours a day to ensure that no valid complaint about VA wrongdoing falls through the cracks.

7. We are going to stop giving bonuses to people for wasting money and start giving bonuses to people for improving service, saving lives, and cutting waste.

8. We are going to reform our visa programs to ensure American veterans are in the front, not back, of the line.

9 We are going to increase the number of mental health care professionals and increase outreach to veterans outside of the system.

10. We are going to ensure every veteran in America has the choice to seek care at the VA or to seek private medical care.

Donald Trump, the presumptive Republican Party nominee focused on the VA and veterans’ health issues in a speech Monday in Virginia Beach, Virginia. In the speech, Mr. Trump called for civil service reform, access to community care for all veterans regardless of Choice program eligibility, and more VA mental health care providers.

“It is the job of the next President to make America safe again, for everyone,” Mr. Trump said in a prepared speech. “That promise of protection must include taking care of every last veteran.”

Echoing the recent recommendations of the Commission on Care, Mr. Trump argued that access to care in the community should be guaranteed for all veterans. “We must extend this right to all veterans, not just those who can’t get an appointment in 30 days, or who live more than 40 miles from a VA hospital, which is the current policy.”

Hillary Clinton, the presumptive Democratic Party nominee, did not directly respond to Mr. Trump’s proposal or those of the Commission on Care. However she has previously stated that she opposes efforts to privatize veteran care. Mrs. Clinton has touted her role in increasing aid to families of veterans and active- duty service members and expanding coverage to include National Guard and reservists as a member of the Armed Services Committee.

Charging that the VA was “corrupt,” Mr. Trump vowed to begin an investigation immediately if he is elected president. “I will instruct my staff that if a valid complaint is not addressed, that the issue be brought directly to me,” he said. “I will pick up the phone and fix it myself if I have to.” The Republican candidate called for civil service reform so that the VA can more easily fire employees.

The Republican candidate’s remarks also drew on the pre-release of information from the VA’s research into suicide rates. Noting that the rate of veteran suicide is lower among patients in the VA system compared with the rate of those who do not use VA services, Mr. Trump called for expansion of mental health services at the VA. “A shocking 20 veterans are committing suicide each day, especially our older veterans,” Mr. Trump said. “This is a national tragedy. The evidence shows that if veterans are in the system, receiving care, they are much less likely to take their own lives than veterans outside the system. That is why we must increase the number of mental health care professionals inside the VA— while ensuring that veterans can access private mental health care as well.”

In his speech, Mr. Trump vowed to enact the following VA reform proposals:

1. I will appoint a Secretary of Veterans Affairs who will make it his or her personal mission to clean up the VA.

2. I am going to use every lawful authority to remove and discipline federal employees or managers who fail our veterans or breach the public trust.

3. I am going to ask Congress to pass legislation that ensures the Secretary of Veterans Affairs has the authority to remove or discipline any employee who risks the health, safety, or well-being of any veteran.

4. I am going to appoint a commission to investigate all the wrongdoing at the VA and then present those findings to Congress as the basis for bold legislative reform.

5. I am going to make sure the honest and dedicated people in the VA have their jobs protected and are put in line for promotions.

6. I will create a private White House Hotline that is answered by a real person 24 hours a day to ensure that no valid complaint about VA wrongdoing falls through the cracks.

7. We are going to stop giving bonuses to people for wasting money and start giving bonuses to people for improving service, saving lives, and cutting waste.

8. We are going to reform our visa programs to ensure American veterans are in the front, not back, of the line.

9 We are going to increase the number of mental health care professionals and increase outreach to veterans outside of the system.

10. We are going to ensure every veteran in America has the choice to seek care at the VA or to seek private medical care.

Donald Trump, the presumptive Republican Party nominee focused on the VA and veterans’ health issues in a speech Monday in Virginia Beach, Virginia. In the speech, Mr. Trump called for civil service reform, access to community care for all veterans regardless of Choice program eligibility, and more VA mental health care providers.

“It is the job of the next President to make America safe again, for everyone,” Mr. Trump said in a prepared speech. “That promise of protection must include taking care of every last veteran.”

Echoing the recent recommendations of the Commission on Care, Mr. Trump argued that access to care in the community should be guaranteed for all veterans. “We must extend this right to all veterans, not just those who can’t get an appointment in 30 days, or who live more than 40 miles from a VA hospital, which is the current policy.”

Hillary Clinton, the presumptive Democratic Party nominee, did not directly respond to Mr. Trump’s proposal or those of the Commission on Care. However she has previously stated that she opposes efforts to privatize veteran care. Mrs. Clinton has touted her role in increasing aid to families of veterans and active- duty service members and expanding coverage to include National Guard and reservists as a member of the Armed Services Committee.

Charging that the VA was “corrupt,” Mr. Trump vowed to begin an investigation immediately if he is elected president. “I will instruct my staff that if a valid complaint is not addressed, that the issue be brought directly to me,” he said. “I will pick up the phone and fix it myself if I have to.” The Republican candidate called for civil service reform so that the VA can more easily fire employees.

The Republican candidate’s remarks also drew on the pre-release of information from the VA’s research into suicide rates. Noting that the rate of veteran suicide is lower among patients in the VA system compared with the rate of those who do not use VA services, Mr. Trump called for expansion of mental health services at the VA. “A shocking 20 veterans are committing suicide each day, especially our older veterans,” Mr. Trump said. “This is a national tragedy. The evidence shows that if veterans are in the system, receiving care, they are much less likely to take their own lives than veterans outside the system. That is why we must increase the number of mental health care professionals inside the VA— while ensuring that veterans can access private mental health care as well.”

In his speech, Mr. Trump vowed to enact the following VA reform proposals:

1. I will appoint a Secretary of Veterans Affairs who will make it his or her personal mission to clean up the VA.

2. I am going to use every lawful authority to remove and discipline federal employees or managers who fail our veterans or breach the public trust.

3. I am going to ask Congress to pass legislation that ensures the Secretary of Veterans Affairs has the authority to remove or discipline any employee who risks the health, safety, or well-being of any veteran.

4. I am going to appoint a commission to investigate all the wrongdoing at the VA and then present those findings to Congress as the basis for bold legislative reform.

5. I am going to make sure the honest and dedicated people in the VA have their jobs protected and are put in line for promotions.

6. I will create a private White House Hotline that is answered by a real person 24 hours a day to ensure that no valid complaint about VA wrongdoing falls through the cracks.

7. We are going to stop giving bonuses to people for wasting money and start giving bonuses to people for improving service, saving lives, and cutting waste.

8. We are going to reform our visa programs to ensure American veterans are in the front, not back, of the line.

9 We are going to increase the number of mental health care professionals and increase outreach to veterans outside of the system.

10. We are going to ensure every veteran in America has the choice to seek care at the VA or to seek private medical care.

Prescription opioid use in HIV-positive individuals is underestimated, based on data from a 12-week study of medical and nonmedical prescription drug use in HIV patients attending a medical center and community clinic.

Of the 254 participants in the study, 43% reported medical use of prescription opioids, and 11% of the opioid use was reported as nonmedical.

Previous studies of prescription drug use in the HIV-positive population have mainly focused on nonmedical use, so “the existing research likely underestimates overall exposure of HIV-positive individuals to prescription medications,” wrote Abigail Norris Turner, PhD, of Ohio State University in Columbus, and her colleagues. Nonmedical use was defined as “using more medication than prescribed, using medication prescribed to someone else, or using medication for a purpose other than its prescribed use,” the researchers wrote.

The cross-sectional, self-administered survey involved data collection during July and August 2015 at a large, urban medical center (149 patients) and a community-based AIDS service organization (105 patients). Most of the study participants were male (91%), were identified as gay or bisexual (79%), and were at least 40 years old (61%).

Overall, 27% of the participants reported nonmedical use of any prescription drug during the previous year. Of these, 17% reported using one medication, 8% reported using two medications, and 2% reported using three or more medications. During the past month, 14% reported nonmedical use of a prescription drug, with 17% reporting one medication, 8% reporting two medications, and 2% reporting three or more medications. Reports of drug use were similar between the hospital group and clinic group.

The findings were limited by the cross-sectional nature of the study and the reliance on self-reports, the researchers noted; therefore, “we cannot make inferences about the causes and consequences of prescription medication use,” they said.

However, the results suggest that “it would be prudent for HIV providers to regularly review their opioid prescription practices to make sure they are appropriate; this review could also help identify patients at risk for opioid dependence and those who may benefit from referral to a pain medicine specialist or addiction medicine specialist,” they wrote.

The study was supported in part by the National Institutes of Health and the SOLAR Foundation Research Fund at the Ohio State University.

Read the full study here: AIDS Care 2016 Jun 20. doi: 10.1080/09540121.2016.1198746.

Prescription opioid use in HIV-positive individuals is underestimated, based on data from a 12-week study of medical and nonmedical prescription drug use in HIV patients attending a medical center and community clinic.

Of the 254 participants in the study, 43% reported medical use of prescription opioids, and 11% of the opioid use was reported as nonmedical.

Previous studies of prescription drug use in the HIV-positive population have mainly focused on nonmedical use, so “the existing research likely underestimates overall exposure of HIV-positive individuals to prescription medications,” wrote Abigail Norris Turner, PhD, of Ohio State University in Columbus, and her colleagues. Nonmedical use was defined as “using more medication than prescribed, using medication prescribed to someone else, or using medication for a purpose other than its prescribed use,” the researchers wrote.

The cross-sectional, self-administered survey involved data collection during July and August 2015 at a large, urban medical center (149 patients) and a community-based AIDS service organization (105 patients). Most of the study participants were male (91%), were identified as gay or bisexual (79%), and were at least 40 years old (61%).

Overall, 27% of the participants reported nonmedical use of any prescription drug during the previous year. Of these, 17% reported using one medication, 8% reported using two medications, and 2% reported using three or more medications. During the past month, 14% reported nonmedical use of a prescription drug, with 17% reporting one medication, 8% reporting two medications, and 2% reporting three or more medications. Reports of drug use were similar between the hospital group and clinic group.

The findings were limited by the cross-sectional nature of the study and the reliance on self-reports, the researchers noted; therefore, “we cannot make inferences about the causes and consequences of prescription medication use,” they said.

However, the results suggest that “it would be prudent for HIV providers to regularly review their opioid prescription practices to make sure they are appropriate; this review could also help identify patients at risk for opioid dependence and those who may benefit from referral to a pain medicine specialist or addiction medicine specialist,” they wrote.

The study was supported in part by the National Institutes of Health and the SOLAR Foundation Research Fund at the Ohio State University.

Read the full study here: AIDS Care 2016 Jun 20. doi: 10.1080/09540121.2016.1198746.

Prescription opioid use in HIV-positive individuals is underestimated, based on data from a 12-week study of medical and nonmedical prescription drug use in HIV patients attending a medical center and community clinic.

Of the 254 participants in the study, 43% reported medical use of prescription opioids, and 11% of the opioid use was reported as nonmedical.

Previous studies of prescription drug use in the HIV-positive population have mainly focused on nonmedical use, so “the existing research likely underestimates overall exposure of HIV-positive individuals to prescription medications,” wrote Abigail Norris Turner, PhD, of Ohio State University in Columbus, and her colleagues. Nonmedical use was defined as “using more medication than prescribed, using medication prescribed to someone else, or using medication for a purpose other than its prescribed use,” the researchers wrote.

The cross-sectional, self-administered survey involved data collection during July and August 2015 at a large, urban medical center (149 patients) and a community-based AIDS service organization (105 patients). Most of the study participants were male (91%), were identified as gay or bisexual (79%), and were at least 40 years old (61%).

Overall, 27% of the participants reported nonmedical use of any prescription drug during the previous year. Of these, 17% reported using one medication, 8% reported using two medications, and 2% reported using three or more medications. During the past month, 14% reported nonmedical use of a prescription drug, with 17% reporting one medication, 8% reporting two medications, and 2% reporting three or more medications. Reports of drug use were similar between the hospital group and clinic group.

The findings were limited by the cross-sectional nature of the study and the reliance on self-reports, the researchers noted; therefore, “we cannot make inferences about the causes and consequences of prescription medication use,” they said.

However, the results suggest that “it would be prudent for HIV providers to regularly review their opioid prescription practices to make sure they are appropriate; this review could also help identify patients at risk for opioid dependence and those who may benefit from referral to a pain medicine specialist or addiction medicine specialist,” they wrote.

The study was supported in part by the National Institutes of Health and the SOLAR Foundation Research Fund at the Ohio State University.

Read the full study here: AIDS Care 2016 Jun 20. doi: 10.1080/09540121.2016.1198746.

In a 26-0 vote, the Food and Drug Administration’s arthritis advisory committee recommended July 12 that the agency license an Amgen product as biosimilar to Humira (adalimumab) for seven distinct indications: rheumatoid arthritis, juvenile idiopathic arthritis (in patients at least 4 years old), psoriatic arthritis, ankylosing spondylitis, plaque psoriasis, adult Crohn’s disease, and adult ulcerative colitis.

Developing Story

In a 26-0 vote, the Food and Drug Administration’s arthritis advisory committee recommended July 12 that the agency license an Amgen product as biosimilar to Humira (adalimumab) for seven distinct indications: rheumatoid arthritis, juvenile idiopathic arthritis (in patients at least 4 years old), psoriatic arthritis, ankylosing spondylitis, plaque psoriasis, adult Crohn’s disease, and adult ulcerative colitis.

Developing Story

In a 26-0 vote, the Food and Drug Administration’s arthritis advisory committee recommended July 12 that the agency license an Amgen product as biosimilar to Humira (adalimumab) for seven distinct indications: rheumatoid arthritis, juvenile idiopathic arthritis (in patients at least 4 years old), psoriatic arthritis, ankylosing spondylitis, plaque psoriasis, adult Crohn’s disease, and adult ulcerative colitis.

Developing Story

Physicians wrote significantly fewer prescriptions for painkillers and other medications for elderly and disabled patients who had legal access to medical marijuana, a new study finds.

In fact, Medicare saved more than $165 million in 2013 on prescription drugs in the District of Columbia and 17 states that allowed cannabis to be used as medicine, researchers calculated. If every state in the nation legalized medical marijuana, the study forecast that the federal program would save more than $468 million a year on pharmaceuticals for disabled Americans and those 65 and older.

No health insurance, including Medicare, will reimburse for the cost of marijuana. Although medical cannabis is legal today in 25 states and the District of Columbia, federal law continues to prohibit its prescription in all circumstances.

The new study, published July 6 in Health Affairs, was the first to ask if there's any evidence that medical marijuana is being used as medicine, said senior author W. David Bradford in a phone interview. The answer is yes, said Bradford, a health economist and a professor at the University of Georgia in Athens.

"When states turned on medical marijuana laws, we did see a rather substantial turn away from FDA-approved medicine," he said.

Researchers analyzed Medicare data from 2010 through 2013 for drugs approved by the U.S. Food and Drug Administration (FDA) to treat nine ailments - from pain to depression and nausea - for which marijuana might be an alternative remedy.

They expected to see fewer prescriptions for FDA-approved drugs that might treat the same conditions as cannabis. Indeed, except for glaucoma, doctors wrote fewer prescriptions for all nine ailments after medical marijuana laws took effect, the study found.

The number of Medicare prescriptions significantly dropped for drugs that treat pain, depression, anxiety, nausea, psychoses, seizures and sleep disorders.

For pain, the annual number of daily doses prescribed per physician fell by more than 11 percent.

"The results show that marijuana might be beneficial with diverting people away from opioids," Bradford said.

A 2014 study found that opioid overdose death rates were on average nearly 25 percent lower in states where medical marijuana was legal compared to states where it remained illegal. Chronic or severe pain is considered a primary indicator for medical marijuana in most states where it is legal.

Nearly two million Americans either abused or were dependent on prescription opioids in 2014, according to the U.S. Centers for Disease Control and Prevention (CDC). Since 1999, more than 165,000 Americans have died from prescription opioid overdoses.

Addiction psychiatrist Dr. Kevin Hill questioned whether medical marijuana patients might in some cases be getting inferior or incorrect treatment, and if so, whether the resulting extra healthcare costs would overshadow the Medicare drug savings. Hill, a professor at Harvard Medical School in Boston, was not involved in the new study.

"Fewer opioid prescriptions in medical marijuana states might be a good thing, but I am concerned about the overall quality of care delivered in medical marijuana specialty clinics," he told Reuters Health in an email.

He criticized the implementation of medical marijuana laws in many states as often leading to "medical care that is of poor quality."

Part of the problem stems from a dearth of research into the efficacy of medical marijuana.

Although California became the first state to legalize medical marijuana in 1996, federal law enacted by Congress in 1970 continues to put cannabis in the same category as heroin, Schedule 1 of the Comprehensive Drug Abuse Prevention and Control Act, and finds it has no medicinal value. Consequently, research has been severely limited.

Sheigla Murphy, a medical sociologist who was not involved in the current study, praised it as a major contribution to the literature on the role of medical marijuana in older adults.

Murphy directs the Center for Substance Abuse Studies in San Francisco and has done prior research on marijuana and baby boomers. She said some older adults prefer marijuana to painkillers and sleeping pills.

"It fits with the problems of older age, problems with sleeping, depression, arthritis, worn-out body parts that begin to hurt. Marijuana can relieve these without the side effects of grogginess and worrying about addiction," she said.

"As we're trying to reduce the number of pain medications, I think marijuana would be a welcome addition to the pharmacopeia," she said. "The one thing we know is no one has ever died of it."

SOURCE: http://bit.ly/1lx2GBv

Health Affairs 2016.

Physicians wrote significantly fewer prescriptions for painkillers and other medications for elderly and disabled patients who had legal access to medical marijuana, a new study finds.

In fact, Medicare saved more than $165 million in 2013 on prescription drugs in the District of Columbia and 17 states that allowed cannabis to be used as medicine, researchers calculated. If every state in the nation legalized medical marijuana, the study forecast that the federal program would save more than $468 million a year on pharmaceuticals for disabled Americans and those 65 and older.

No health insurance, including Medicare, will reimburse for the cost of marijuana. Although medical cannabis is legal today in 25 states and the District of Columbia, federal law continues to prohibit its prescription in all circumstances.

The new study, published July 6 in Health Affairs, was the first to ask if there's any evidence that medical marijuana is being used as medicine, said senior author W. David Bradford in a phone interview. The answer is yes, said Bradford, a health economist and a professor at the University of Georgia in Athens.

"When states turned on medical marijuana laws, we did see a rather substantial turn away from FDA-approved medicine," he said.

Researchers analyzed Medicare data from 2010 through 2013 for drugs approved by the U.S. Food and Drug Administration (FDA) to treat nine ailments - from pain to depression and nausea - for which marijuana might be an alternative remedy.

They expected to see fewer prescriptions for FDA-approved drugs that might treat the same conditions as cannabis. Indeed, except for glaucoma, doctors wrote fewer prescriptions for all nine ailments after medical marijuana laws took effect, the study found.

The number of Medicare prescriptions significantly dropped for drugs that treat pain, depression, anxiety, nausea, psychoses, seizures and sleep disorders.

For pain, the annual number of daily doses prescribed per physician fell by more than 11 percent.

"The results show that marijuana might be beneficial with diverting people away from opioids," Bradford said.

A 2014 study found that opioid overdose death rates were on average nearly 25 percent lower in states where medical marijuana was legal compared to states where it remained illegal. Chronic or severe pain is considered a primary indicator for medical marijuana in most states where it is legal.

Nearly two million Americans either abused or were dependent on prescription opioids in 2014, according to the U.S. Centers for Disease Control and Prevention (CDC). Since 1999, more than 165,000 Americans have died from prescription opioid overdoses.

Addiction psychiatrist Dr. Kevin Hill questioned whether medical marijuana patients might in some cases be getting inferior or incorrect treatment, and if so, whether the resulting extra healthcare costs would overshadow the Medicare drug savings. Hill, a professor at Harvard Medical School in Boston, was not involved in the new study.

"Fewer opioid prescriptions in medical marijuana states might be a good thing, but I am concerned about the overall quality of care delivered in medical marijuana specialty clinics," he told Reuters Health in an email.

He criticized the implementation of medical marijuana laws in many states as often leading to "medical care that is of poor quality."

Part of the problem stems from a dearth of research into the efficacy of medical marijuana.

Although California became the first state to legalize medical marijuana in 1996, federal law enacted by Congress in 1970 continues to put cannabis in the same category as heroin, Schedule 1 of the Comprehensive Drug Abuse Prevention and Control Act, and finds it has no medicinal value. Consequently, research has been severely limited.

Sheigla Murphy, a medical sociologist who was not involved in the current study, praised it as a major contribution to the literature on the role of medical marijuana in older adults.

Murphy directs the Center for Substance Abuse Studies in San Francisco and has done prior research on marijuana and baby boomers. She said some older adults prefer marijuana to painkillers and sleeping pills.

"It fits with the problems of older age, problems with sleeping, depression, arthritis, worn-out body parts that begin to hurt. Marijuana can relieve these without the side effects of grogginess and worrying about addiction," she said.

"As we're trying to reduce the number of pain medications, I think marijuana would be a welcome addition to the pharmacopeia," she said. "The one thing we know is no one has ever died of it."

SOURCE: http://bit.ly/1lx2GBv

Health Affairs 2016.

Physicians wrote significantly fewer prescriptions for painkillers and other medications for elderly and disabled patients who had legal access to medical marijuana, a new study finds.

In fact, Medicare saved more than $165 million in 2013 on prescription drugs in the District of Columbia and 17 states that allowed cannabis to be used as medicine, researchers calculated. If every state in the nation legalized medical marijuana, the study forecast that the federal program would save more than $468 million a year on pharmaceuticals for disabled Americans and those 65 and older.

No health insurance, including Medicare, will reimburse for the cost of marijuana. Although medical cannabis is legal today in 25 states and the District of Columbia, federal law continues to prohibit its prescription in all circumstances.

The new study, published July 6 in Health Affairs, was the first to ask if there's any evidence that medical marijuana is being used as medicine, said senior author W. David Bradford in a phone interview. The answer is yes, said Bradford, a health economist and a professor at the University of Georgia in Athens.

"When states turned on medical marijuana laws, we did see a rather substantial turn away from FDA-approved medicine," he said.

Researchers analyzed Medicare data from 2010 through 2013 for drugs approved by the U.S. Food and Drug Administration (FDA) to treat nine ailments - from pain to depression and nausea - for which marijuana might be an alternative remedy.

They expected to see fewer prescriptions for FDA-approved drugs that might treat the same conditions as cannabis. Indeed, except for glaucoma, doctors wrote fewer prescriptions for all nine ailments after medical marijuana laws took effect, the study found.

The number of Medicare prescriptions significantly dropped for drugs that treat pain, depression, anxiety, nausea, psychoses, seizures and sleep disorders.

For pain, the annual number of daily doses prescribed per physician fell by more than 11 percent.

"The results show that marijuana might be beneficial with diverting people away from opioids," Bradford said.

A 2014 study found that opioid overdose death rates were on average nearly 25 percent lower in states where medical marijuana was legal compared to states where it remained illegal. Chronic or severe pain is considered a primary indicator for medical marijuana in most states where it is legal.

Nearly two million Americans either abused or were dependent on prescription opioids in 2014, according to the U.S. Centers for Disease Control and Prevention (CDC). Since 1999, more than 165,000 Americans have died from prescription opioid overdoses.

Addiction psychiatrist Dr. Kevin Hill questioned whether medical marijuana patients might in some cases be getting inferior or incorrect treatment, and if so, whether the resulting extra healthcare costs would overshadow the Medicare drug savings. Hill, a professor at Harvard Medical School in Boston, was not involved in the new study.

"Fewer opioid prescriptions in medical marijuana states might be a good thing, but I am concerned about the overall quality of care delivered in medical marijuana specialty clinics," he told Reuters Health in an email.

He criticized the implementation of medical marijuana laws in many states as often leading to "medical care that is of poor quality."

Part of the problem stems from a dearth of research into the efficacy of medical marijuana.

Although California became the first state to legalize medical marijuana in 1996, federal law enacted by Congress in 1970 continues to put cannabis in the same category as heroin, Schedule 1 of the Comprehensive Drug Abuse Prevention and Control Act, and finds it has no medicinal value. Consequently, research has been severely limited.

Sheigla Murphy, a medical sociologist who was not involved in the current study, praised it as a major contribution to the literature on the role of medical marijuana in older adults.

Murphy directs the Center for Substance Abuse Studies in San Francisco and has done prior research on marijuana and baby boomers. She said some older adults prefer marijuana to painkillers and sleeping pills.

"It fits with the problems of older age, problems with sleeping, depression, arthritis, worn-out body parts that begin to hurt. Marijuana can relieve these without the side effects of grogginess and worrying about addiction," she said.

"As we're trying to reduce the number of pain medications, I think marijuana would be a welcome addition to the pharmacopeia," she said. "The one thing we know is no one has ever died of it."

SOURCE: http://bit.ly/1lx2GBv

Health Affairs 2016.

DENVER – Sleep problems and their host of deleterious physical and psychosocial consequences are pervasive among the civilian female spouses of U.S. military service members, according to the first large study to examine the issue.

“Our findings suggest that if we’re trying to promote the resilience and adjustment of military spouses and their families – particularly in light of 14 years of protracted overseas combat, where many families are experiencing deployment – sleep might be a really important target,” Wendy M. Troxel, PhD, said while presenting the study results at the annual meeting of the Associated Professional Sleep Societies.

Bruce Jancin/Frontline Medical News

The study population consisted of a nationally representative group of 1,805 female civilian spouses of military service members. Forty-four percent reported short sleep duration, meaning 6 hours or less per night. Another 18% got 5 hours or less. The Centers for Disease Control and Prevention and the American Academy of Sleep Medicine recommend 7 hours or more, noted Dr. Troxel, senior behavioral and social scientist at RAND Corporation in Pittsburgh.

More than half (54%) of military spouses reported that their sleep problems contributed to daytime impairment, such as intolerance of their spouse or children, frequent crying, or suboptimal performance at work or chores. One-third of the spouses reported feeling daytime fatigue three or more times per week, and another 29% experienced daytime fatigue one or two days per week.

As has been observed in other studies, sleep problems in military spouses were associated with psychosocial impairment. In linear regression analyses, the spouses with poor sleep quality, daytime impairment, and/or fatigue had significantly more depressive symptoms on the Patient Health Questionnaire–8, lower marital satisfaction, and poor self-rated health. Women with shorter sleep duration had more depressive symptoms and poorer self-rated health, but not lower marital satisfaction.

The spouses of services members currently deployed in combat zones had significantly worse sleep quality as measured on the Pittsburgh Sleep Quality Index compared with spouses of previously or never-deployed service members. But for the other outcomes of interest – sleep duration, daytime impairment, and fatigue – there were no differences based upon deployment status.

“This shows that it’s not just about the stress of combat deployment, it’s also about the stresses of everyday military life. Military families experience a great deal of stress that could lead to sleep disturbances whether or not a service member has been deployed: frequent residential moves, very long and unpredictable work hours, demanding jobs, threatening training environments,” Dr. Troxel said. “I think we need to be thinking about sleep as an important health indicator of military families in general across the deployment cycle.”

The study results are a call to action, she added.

“These findings highlight the importance of targeted screening, prevention, and intervention methods for military spouses. And primary care is where most people present with sleep problems,” Dr. Troxel said.

There are formal screening instruments for sleep problems, but in her view they really need to be better validated for use in primary care before widespread adoption.

“Simply having providers ask three quick questions about their patients’ sleep and daytime function is a good, practical approach: How’s the quality of your sleep? How much do you sleep on average? Do you have enough energy during the daytime to get through your day-to-day functioning? That’s informative enough to indicate the utility of moving on to longer screening tools or to referral for evidence-based treatments,” she said.

Dr. Troxel noted successful intervention in sleep problems in civilian spouses is a priority for reasons beyond their personal well-being. “Civilian spouses are most often the primary caretakers for service members who return from war with either invisible mental health wounds or physical health wounds,” she said. “And we’re expecting to have need for a lot of caretakers.”

The RAND National Defense Research Institute, the Office of the Surgeon General, the U.S. Army, and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury funded the study.

[email protected]

DENVER – Sleep problems and their host of deleterious physical and psychosocial consequences are pervasive among the civilian female spouses of U.S. military service members, according to the first large study to examine the issue.

“Our findings suggest that if we’re trying to promote the resilience and adjustment of military spouses and their families – particularly in light of 14 years of protracted overseas combat, where many families are experiencing deployment – sleep might be a really important target,” Wendy M. Troxel, PhD, said while presenting the study results at the annual meeting of the Associated Professional Sleep Societies.

Bruce Jancin/Frontline Medical News

The study population consisted of a nationally representative group of 1,805 female civilian spouses of military service members. Forty-four percent reported short sleep duration, meaning 6 hours or less per night. Another 18% got 5 hours or less. The Centers for Disease Control and Prevention and the American Academy of Sleep Medicine recommend 7 hours or more, noted Dr. Troxel, senior behavioral and social scientist at RAND Corporation in Pittsburgh.

More than half (54%) of military spouses reported that their sleep problems contributed to daytime impairment, such as intolerance of their spouse or children, frequent crying, or suboptimal performance at work or chores. One-third of the spouses reported feeling daytime fatigue three or more times per week, and another 29% experienced daytime fatigue one or two days per week.

As has been observed in other studies, sleep problems in military spouses were associated with psychosocial impairment. In linear regression analyses, the spouses with poor sleep quality, daytime impairment, and/or fatigue had significantly more depressive symptoms on the Patient Health Questionnaire–8, lower marital satisfaction, and poor self-rated health. Women with shorter sleep duration had more depressive symptoms and poorer self-rated health, but not lower marital satisfaction.

The spouses of services members currently deployed in combat zones had significantly worse sleep quality as measured on the Pittsburgh Sleep Quality Index compared with spouses of previously or never-deployed service members. But for the other outcomes of interest – sleep duration, daytime impairment, and fatigue – there were no differences based upon deployment status.

“This shows that it’s not just about the stress of combat deployment, it’s also about the stresses of everyday military life. Military families experience a great deal of stress that could lead to sleep disturbances whether or not a service member has been deployed: frequent residential moves, very long and unpredictable work hours, demanding jobs, threatening training environments,” Dr. Troxel said. “I think we need to be thinking about sleep as an important health indicator of military families in general across the deployment cycle.”

The study results are a call to action, she added.

“These findings highlight the importance of targeted screening, prevention, and intervention methods for military spouses. And primary care is where most people present with sleep problems,” Dr. Troxel said.

There are formal screening instruments for sleep problems, but in her view they really need to be better validated for use in primary care before widespread adoption.

“Simply having providers ask three quick questions about their patients’ sleep and daytime function is a good, practical approach: How’s the quality of your sleep? How much do you sleep on average? Do you have enough energy during the daytime to get through your day-to-day functioning? That’s informative enough to indicate the utility of moving on to longer screening tools or to referral for evidence-based treatments,” she said.

Dr. Troxel noted successful intervention in sleep problems in civilian spouses is a priority for reasons beyond their personal well-being. “Civilian spouses are most often the primary caretakers for service members who return from war with either invisible mental health wounds or physical health wounds,” she said. “And we’re expecting to have need for a lot of caretakers.”

The RAND National Defense Research Institute, the Office of the Surgeon General, the U.S. Army, and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury funded the study.

[email protected]

DENVER – Sleep problems and their host of deleterious physical and psychosocial consequences are pervasive among the civilian female spouses of U.S. military service members, according to the first large study to examine the issue.

“Our findings suggest that if we’re trying to promote the resilience and adjustment of military spouses and their families – particularly in light of 14 years of protracted overseas combat, where many families are experiencing deployment – sleep might be a really important target,” Wendy M. Troxel, PhD, said while presenting the study results at the annual meeting of the Associated Professional Sleep Societies.

Bruce Jancin/Frontline Medical News

The study population consisted of a nationally representative group of 1,805 female civilian spouses of military service members. Forty-four percent reported short sleep duration, meaning 6 hours or less per night. Another 18% got 5 hours or less. The Centers for Disease Control and Prevention and the American Academy of Sleep Medicine recommend 7 hours or more, noted Dr. Troxel, senior behavioral and social scientist at RAND Corporation in Pittsburgh.

More than half (54%) of military spouses reported that their sleep problems contributed to daytime impairment, such as intolerance of their spouse or children, frequent crying, or suboptimal performance at work or chores. One-third of the spouses reported feeling daytime fatigue three or more times per week, and another 29% experienced daytime fatigue one or two days per week.

As has been observed in other studies, sleep problems in military spouses were associated with psychosocial impairment. In linear regression analyses, the spouses with poor sleep quality, daytime impairment, and/or fatigue had significantly more depressive symptoms on the Patient Health Questionnaire–8, lower marital satisfaction, and poor self-rated health. Women with shorter sleep duration had more depressive symptoms and poorer self-rated health, but not lower marital satisfaction.

The spouses of services members currently deployed in combat zones had significantly worse sleep quality as measured on the Pittsburgh Sleep Quality Index compared with spouses of previously or never-deployed service members. But for the other outcomes of interest – sleep duration, daytime impairment, and fatigue – there were no differences based upon deployment status.

“This shows that it’s not just about the stress of combat deployment, it’s also about the stresses of everyday military life. Military families experience a great deal of stress that could lead to sleep disturbances whether or not a service member has been deployed: frequent residential moves, very long and unpredictable work hours, demanding jobs, threatening training environments,” Dr. Troxel said. “I think we need to be thinking about sleep as an important health indicator of military families in general across the deployment cycle.”

The study results are a call to action, she added.

“These findings highlight the importance of targeted screening, prevention, and intervention methods for military spouses. And primary care is where most people present with sleep problems,” Dr. Troxel said.

There are formal screening instruments for sleep problems, but in her view they really need to be better validated for use in primary care before widespread adoption.

“Simply having providers ask three quick questions about their patients’ sleep and daytime function is a good, practical approach: How’s the quality of your sleep? How much do you sleep on average? Do you have enough energy during the daytime to get through your day-to-day functioning? That’s informative enough to indicate the utility of moving on to longer screening tools or to referral for evidence-based treatments,” she said.

Dr. Troxel noted successful intervention in sleep problems in civilian spouses is a priority for reasons beyond their personal well-being. “Civilian spouses are most often the primary caretakers for service members who return from war with either invisible mental health wounds or physical health wounds,” she said. “And we’re expecting to have need for a lot of caretakers.”

The RAND National Defense Research Institute, the Office of the Surgeon General, the U.S. Army, and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury funded the study.

[email protected]

The diagnosis

The colonoscopy disclosed an erythematous, ulcerated tumor with spontaneous bleeding in the ascending colon (Figure A). Noncontrast abdominal CT showed multiple hypoattenuating lesions in the liver. These lesions had central enhancement in the early arterial phase and progressive enhancement in the delayed phase (Figure B).

Angiosarcoma is a rare, malignant tumor arising from vascular endothelium. These tumors usually develop in skin and in the soft tissue of the head and neck region.1 Gastrointestinal angiosarcomas are rare with fewer than 20 cases reported in the literature.^1,2 Patients with colonic angiosarcoma usually present with abdominal pain, rectal bleeding, or a palpable abdominal mass.^1,2 On colonoscopy, the tumor has been described as a submucosal tumor^1,2or a hemorrhagic mass with spontaneous bleeding³, as in this case.

1. Lo, T.H., Tsai, M.S., Chen, T.A. Angiosarcoma of sigmoid colon with intraperitoneal bleeding: case report and literature review. Ann R Coll Surg Engl. 2011;93:e91-3.

2. El Chaar, M., McQuay, N. Jr. Sigmoid colon angiosarcoma with intraperitoneal bleeding and early metastasis. J Surg Educ. 2007;64: 54-6.

3. Cammarota, G., Schinzari, G., Larocca, L.M. et al. Duodenal metastasis from a primary angiosarcoma of the colon. Gastrointest Endosc. 2006;63:330.

The diagnosis

The colonoscopy disclosed an erythematous, ulcerated tumor with spontaneous bleeding in the ascending colon (Figure A). Noncontrast abdominal CT showed multiple hypoattenuating lesions in the liver. These lesions had central enhancement in the early arterial phase and progressive enhancement in the delayed phase (Figure B).

Angiosarcoma is a rare, malignant tumor arising from vascular endothelium. These tumors usually develop in skin and in the soft tissue of the head and neck region.1 Gastrointestinal angiosarcomas are rare with fewer than 20 cases reported in the literature.^1,2 Patients with colonic angiosarcoma usually present with abdominal pain, rectal bleeding, or a palpable abdominal mass.^1,2 On colonoscopy, the tumor has been described as a submucosal tumor^1,2or a hemorrhagic mass with spontaneous bleeding³, as in this case.

1. Lo, T.H., Tsai, M.S., Chen, T.A. Angiosarcoma of sigmoid colon with intraperitoneal bleeding: case report and literature review. Ann R Coll Surg Engl. 2011;93:e91-3.

2. El Chaar, M., McQuay, N. Jr. Sigmoid colon angiosarcoma with intraperitoneal bleeding and early metastasis. J Surg Educ. 2007;64: 54-6.

3. Cammarota, G., Schinzari, G., Larocca, L.M. et al. Duodenal metastasis from a primary angiosarcoma of the colon. Gastrointest Endosc. 2006;63:330.

The diagnosis

The colonoscopy disclosed an erythematous, ulcerated tumor with spontaneous bleeding in the ascending colon (Figure A). Noncontrast abdominal CT showed multiple hypoattenuating lesions in the liver. These lesions had central enhancement in the early arterial phase and progressive enhancement in the delayed phase (Figure B).

Angiosarcoma is a rare, malignant tumor arising from vascular endothelium. These tumors usually develop in skin and in the soft tissue of the head and neck region.1 Gastrointestinal angiosarcomas are rare with fewer than 20 cases reported in the literature.^1,2 Patients with colonic angiosarcoma usually present with abdominal pain, rectal bleeding, or a palpable abdominal mass.^1,2 On colonoscopy, the tumor has been described as a submucosal tumor^1,2or a hemorrhagic mass with spontaneous bleeding³, as in this case.

1. Lo, T.H., Tsai, M.S., Chen, T.A. Angiosarcoma of sigmoid colon with intraperitoneal bleeding: case report and literature review. Ann R Coll Surg Engl. 2011;93:e91-3.

2. El Chaar, M., McQuay, N. Jr. Sigmoid colon angiosarcoma with intraperitoneal bleeding and early metastasis. J Surg Educ. 2007;64: 54-6.

3. Cammarota, G., Schinzari, G., Larocca, L.M. et al. Duodenal metastasis from a primary angiosarcoma of the colon. Gastrointest Endosc. 2006;63:330.

Myth: Psoriasis is contagious

One of the challenges patients with psoriasis face is misinformation among their peers, especially about the cause of psoriasis. Results from a survey conducted in France (N=1005) regarding knowledge of psoriasis and perceptions toward psoriasis patients indicated that approximately 16.5% of respondents believed that psoriasis is contagious; 6.8% believed that the disease is related to personal hygiene and 3.2% believed that it affects more people with low personal hygiene (Halioua et al). Moreover, approximately 62.4% of respondents recognized a lack of information about psoriasis and 19.7% noted that they have misconceptions about the disease.

Another study from Poland on the feelings of stigmatization among psoriasis patients (N=102) found that 72 psoriasis patients reported that they felt other people think their skin disease is contagious; only 30 psoriasis patients indicated that they did not feel this way (Hrehorów et al).

These findings underscore the need for more information on psoriasis in the general public worldwide. It is important to spread the message that psoriasis is a chronic inflammatory disease of the immune system that affects approximately 7.5 million individuals in the United States. One cannot "catch" psoriasis; psoriasis starts or worsens because of a variety of triggers (eg, infections, injury to the skin, stress, cold weather, smoking, heavy alcohol consumption, certain medications). The National Institute of Arthritis and Musculoskeletal and Skin Diseases offers a simple but revealing explanation for the cause of psoriasis: "Normally, T cells help protect the body against infection and disease. In the case of psoriasis, T cells are put into action by mistake and become so active that they trigger other immune responses, which lead to inflammation and to rapid turnover of skin cells." Genetics may play a role in the development of psoriasis, along with environmental factors.

With several new therapies available, psoriasis has gained media attention. Dermatologists can circulate more information about the causes of psoriasis, which may work toward helping patients with psoriasis cope with the social impact of the condition.

Myth: Psoriasis is contagious

One of the challenges patients with psoriasis face is misinformation among their peers, especially about the cause of psoriasis. Results from a survey conducted in France (N=1005) regarding knowledge of psoriasis and perceptions toward psoriasis patients indicated that approximately 16.5% of respondents believed that psoriasis is contagious; 6.8% believed that the disease is related to personal hygiene and 3.2% believed that it affects more people with low personal hygiene (Halioua et al). Moreover, approximately 62.4% of respondents recognized a lack of information about psoriasis and 19.7% noted that they have misconceptions about the disease.

Another study from Poland on the feelings of stigmatization among psoriasis patients (N=102) found that 72 psoriasis patients reported that they felt other people think their skin disease is contagious; only 30 psoriasis patients indicated that they did not feel this way (Hrehorów et al).

These findings underscore the need for more information on psoriasis in the general public worldwide. It is important to spread the message that psoriasis is a chronic inflammatory disease of the immune system that affects approximately 7.5 million individuals in the United States. One cannot "catch" psoriasis; psoriasis starts or worsens because of a variety of triggers (eg, infections, injury to the skin, stress, cold weather, smoking, heavy alcohol consumption, certain medications). The National Institute of Arthritis and Musculoskeletal and Skin Diseases offers a simple but revealing explanation for the cause of psoriasis: "Normally, T cells help protect the body against infection and disease. In the case of psoriasis, T cells are put into action by mistake and become so active that they trigger other immune responses, which lead to inflammation and to rapid turnover of skin cells." Genetics may play a role in the development of psoriasis, along with environmental factors.

With several new therapies available, psoriasis has gained media attention. Dermatologists can circulate more information about the causes of psoriasis, which may work toward helping patients with psoriasis cope with the social impact of the condition.

Myth: Psoriasis is contagious

One of the challenges patients with psoriasis face is misinformation among their peers, especially about the cause of psoriasis. Results from a survey conducted in France (N=1005) regarding knowledge of psoriasis and perceptions toward psoriasis patients indicated that approximately 16.5% of respondents believed that psoriasis is contagious; 6.8% believed that the disease is related to personal hygiene and 3.2% believed that it affects more people with low personal hygiene (Halioua et al). Moreover, approximately 62.4% of respondents recognized a lack of information about psoriasis and 19.7% noted that they have misconceptions about the disease.

Another study from Poland on the feelings of stigmatization among psoriasis patients (N=102) found that 72 psoriasis patients reported that they felt other people think their skin disease is contagious; only 30 psoriasis patients indicated that they did not feel this way (Hrehorów et al).

These findings underscore the need for more information on psoriasis in the general public worldwide. It is important to spread the message that psoriasis is a chronic inflammatory disease of the immune system that affects approximately 7.5 million individuals in the United States. One cannot "catch" psoriasis; psoriasis starts or worsens because of a variety of triggers (eg, infections, injury to the skin, stress, cold weather, smoking, heavy alcohol consumption, certain medications). The National Institute of Arthritis and Musculoskeletal and Skin Diseases offers a simple but revealing explanation for the cause of psoriasis: "Normally, T cells help protect the body against infection and disease. In the case of psoriasis, T cells are put into action by mistake and become so active that they trigger other immune responses, which lead to inflammation and to rapid turnover of skin cells." Genetics may play a role in the development of psoriasis, along with environmental factors.

With several new therapies available, psoriasis has gained media attention. Dermatologists can circulate more information about the causes of psoriasis, which may work toward helping patients with psoriasis cope with the social impact of the condition.