1. Low physical fitness and obesity during teen years linked to disability later in life
Being physically fit was an important marker of health, regardless of BMI
Video available: B-roll and soundbites from obesity specialist, Christina Wee, MD, are available to view and download at http://www.dssimon.com/MM/ACP-disability.
Abstract: http://annals.org/aim/article/doi/10.7326/M18-1861
URLs go live when the embargo lifts
Low physical fitness, obesity, and a combination of the two are strongly associated with chronic disability later in life due to a wide range of diseases and causes. A study of more than 1 million Swedish men is published in Annals of Internal Medicine.
In many countries, disability pensions are granted to working-aged persons who are likely to never work full-time again because of a chronic disease or injury diagnosed by a physician. In addition to serving as an important indicator of chronic disease, disability pensions are associated with high societal costs, both clinically and economically. Thus, identification of early and potentially modifiable risk factors for later disability is of great public health importance.
In the largest study of its kind, researchers from Karolinska Institute, Sweden, and University of Granada, Spain lead a study assessing cardiorespiratory fitness and weight for more than 1 million men between the ages of 16 and 19 and then followed them to see who would later receive a medical disability pension. Over a median follow-up of 28.3 years, the data showed that low cardiorespiratory fitness was strongly associated with later receipt of a disability pension due to all causes. Obesity was also associated with a risk for disability, with the greatest risks observed for severe/morbid obesity. However, the researchers noted that compared with being unfit, being moderately or highly fit was associated with reduced risk for disability, regardless of body mass index. According to the researchers, these findings suggest that being physically fit is an important indicator of health irrespectively of body weight.
Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Pontus Henriksson, PhD, please contact him directly at pontus.henriksson@ki.se.
2. Facebook's suicide prevention efforts raise concerns about using consumer data for medical research
Abstract: http://annals.org/aim/article/doi/10.7326/M19-0366
URLs go live when the embargo lifts
Facebook's innovative suicide prevention algorithm may help to identify users who are at risk for self-harm, yet the approach raises concerns about ethics and transparency when using consumer data in this manner, which some would classify as research. A commentary on this issue is published in Annals of Internal Medicine.
Recently, Facebook began using an algorithm that assesses an individual's risk for suicide based on interactions on the social platform. If a user is deemed at risk, the company calls local emergency services. While Facebook has offered some details on its algorithms, less is known about the credentials of its Community Operations who review the data or about the outcomes of its approximately 3,500 notifications to local emergency services so far.
Authors of a commentary from Beth Israel Deaconess Medical Center/Harvard Medical School argue that more transparency is needed for this effort, as they believe it is medical research. While Facebook does not claim that its suicide efforts are research, it has conducted experiments on users before and denied it was doing so. The authors suggest that Facebook's efforts need to be subject to the rules and principles of research. Considering the amount of personal medical and mental health information Facebook accumulates in determining whether a person is at risk of suicide, the public health system they activate through calling emergency services, and the need to ensure equal access and efficacy for all, the scope of the research seems more fitting for public health departments than to a publicly traded company.
Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, John Torous, MD, please contact Jacqueline Mitchell at jsmitche@bidmc.harvard.edu.
3. Case suggests melanoma as a possible diagnosis for patients with autoimmune encephalitis
Abstract: http://annals.org/aim/article/doi/10.7326/L18-0593
URL goes live when the embargo lifts
An unusual case suggests melanoma as a possible diagnosis for patients with autoimmune encephalitis. The case report is published in Annals of Internal Medicine.
The receptor for a-amino-3hdroxy-5methyl-4-isoxazolepropionic acid (AMPA) is a glutamate receptor that mediates synaptic transmission in the central nervous system. Antibodies against the AMPA receptor are found in encephalitis associated with lung, breast, and thymus tumors, but had never had been seen with melanoma.
Clinicians from Mayo Clinic; Rochester, Minnesota saw a 61-year-old woman for symptoms of autoimmune encephalitis. A cerebrospinal fluid analysis showed anti-AMPA receptor antibodies and a positron emission tomography-computed tomography (PET-CT) scan confirmed active lymph nodes in the patient's left cervical and axillary regions. The patient had no skin lesions and the origin of the tumor was not clear, but further testing confirmed a diagnosis of melanoma. Her mental status was poor due to the encephalitis, so the clinicians treated her with a BRAF inhibitor (vemurafenib) and an MEK inhibitor (cobimetinib). She did not improve in 2 weeks, but improved 2 weeks later at home in hospice care on continued treatment. She also started on a regimen of methylprednisolone and intravenous immunoglobulin. After 3 months, a PET-CT scan found no recurrence of melanoma and a neurologic evaluation reveled excellent clinical recover from the encephalitis. She remained cancer-free at 9 months.
According to the authors, this case suggests that clinicians should consider melanoma as a possible diagnosis for patients with anti-AMPA receptor encephalitis because some patients with this disease can respond exceedingly well to appropriate therapy.
Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Ali Daneshmand, MD, MPH, please contact the Mayo Clinic newsroom at newsbureau@mayo.edu or 507-284-5005.
Also New in this issue:
Ominous Reversal of Health Gains in the United States: Time to Rethink Research Priorities?
K.M. Venkat Narayan, MD; Shivani A. Patel, PhD; Solveig A. Cunningham, PhD; and James Curran, MD
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M18-3653
Selective Use of Coronary Artery Calcium Testing for Shared Decision Making: Guideline Endorsed and Ready for Prime Time
Rhanderson Cardoso, MD; Khurram Nasir, MD, MPH, MSc; Roger S. Blumenthal, MD; and Michael J. Blaha, MD, MPH
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M18-3675
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Journal
Annals of Internal Medicine