Public Release: 

Army personnel most at risk for violent suicide

American College of Physicians

1. Among active duty military, Army personnel most at risk for violent suicide

Firearms the most common cause of suicide death across all branches of service
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A study of rates and predictors of suicide among active duty enlisted service members found that Army personnel were most at risk for violent suicide. Firearms were determined to be the primary cause of suicide death across all branches of service. The findings are published in Annals of Internal Medicine.

Suicide is a leading cause of death worldwide and a growing concern among those serving in the U.S. military, where overall suicide rates almost doubled between 2001 and 2011. Understanding suicide trends among military units and the nonclinical factors associated with chosen suicide methods may help to improve suicide prevention strategies.

Researchers studied a U.S. military suicide data repository to calculate suicide rates for all active duty enlisted U.S. military personnel in each branch of the military from 2005 to 2011. The authors also looked at methods of suicide to identify those at risk for firearm-specific suicide. The data showed that suicide rates were highest among army personnel. Among suicides with a known cause of death, 62 percent were attributed to firearms. In addition, the results suggest that among army personnel or marines who committed suicide, those with infantry or special operations job classifications were more likely than those in noninfantry positions to use a firearm to commit suicide. According to the authors, these findings may help to guide efforts to prevent self-harm within the military.

Note: For an embargoed PDF, please contact Cara Graeff. For an interview with the lead author, Dr. Andrew Anglemyer, please contact Dale Kuska at or Lieutenant Commander (LCDR) Gregory Flores at

2. TAVI may reduce mortality rates better than surgery for aortic stenosis

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Compared with surgical aortic valve replacement (SAVR), transcatheter aortic valve implantation (TAVI) may have better early and midterm outcomes for patients with severe aortic stenosis, including reduced early myocardial infarction and all-cause mortality. A systematic evidence review and meta-analysis is published in Annals of Internal Medicine.

In recent years, TAVI has become preferred alternative to surgical valve replacement for patients at high surgical risk. Currently, interest is increasing in comparative studies of TAVI and SAVR in patients at low or intermediate surgical risk. In one recent trial, TAVI was not found to be superior to SAVR for reducing all-cause mortality, stroke, or myocardial infarction at one year. Another trial in patients at intermediate risk showed no statistically significant differences between TAVI and SAVR for reducing death or stroke at two years.

Given several recent studies, extended follow-up of previous studies, and some conflicting results, researchers conducted an updated meta-analysis comparing clinical outcomes, including short- and mid-term mortality, of adult patients with severe aortic stenosis undergoing either TAVI or SAVI. The data showed that TAVI may have similar or reduced early and midterm all-cause mortality outcomes in patients with high and low to intermediate surgical risk. Transfemoral TAVI seemed to provide a clear mortality benefit over SAVR. TAVI was also associated with significantly less myocardial infarction, major bleeding, acute kidney injury, and new-onset atrial fibrillation. However, SAVR significantly reduced pacemaker implantation, vascular complications, and paravalvular leak. According to the researchers, these results consolidate the role of TAVI as an alternative to SAVR for adults with severe aortic stenosis.

Note: For an embargoed PDF, please contact Cara Graeff. For an interview with the lead author Giovanni Esposito MD, PhD, please contact him directly at or +39 0817463075.

3. To treat or not to treat? Guidelines and physician opinions vary on treating subclinical hypothyroidism

Annals of Internal Medicine and Beth Israel Deaconess Medical Center go "Beyond the Guidelines" to discuss whether or not to treat subclinical hypothyroidism
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Should a patient be treated for subclinical hypothyroidism? Two experts debate the topic in a multicomponent educational article being published in Annals of Internal Medicine.

Currently, clinical guidelines differ on whether or not patients should be screened for thyroid dysfunction or treated for subclinical hypothyroidism. An evidence review for the USPSTF found adequate evidence that treating subclinical hypothyroidism did not provide clinically meaningful improvements in several measures of health or quality-of-life. Evidence was inadequate to determine whether screening for thyroid dysfunction reduced cardiovascular disease or related morbidity and mortality. Therefore, their guidelines do not recommend screening for thyroid dysfunction in asymptomatic adults or treating hypothyroidism. Separate guidelines from the American Association of Clinical Endocrinologists and the American Thyroid Association are more aggressive. They say that subclinical hypothyroidism adversely affects cardiovascular outcomes and thus merits case-finding in patients with certain clinical conditions or characteristics.

In this Beyond the Guidelines article, two physicians with differing opinions weigh the benefits and harms of treating a patient with subclinical hypothyroidism. Their debate is presented in a question and answer format, and includes video interviews with the patient and physicians. All Beyond the Guidelines papers are based on the Department of Medicine Grand Rounds at Beth Israel Deaconess Medical Center in Boston. Each session focuses on care of a patient who "falls between the cracks" in available evidence and for whom the optimal clinical management is unclear. Such situations include those in which a guideline finds evidence insufficient to make a recommendation, a patient does not fit criteria mapped out in recommendations, or different organizations provide conflicting recommendations. A list of topics is available at

Note: The URLs, including video link, will be live when the embargo lifts. For an embargoed PDF, please contact Cara Graeff. To interview the lead author, please contact Lizzie Williamson at or 617-632-8217.

4. Annals Graphic Medicine feature paints vivid picture of life with OCD

Free content:
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The author of an Annals Graphic Medicine feature entitled A Brief Anatomy of My Anxiety: The OCD Variety, uses compelling visuals to describe what life is like living with OCD. Annals Graphic Medicine uses the creativity of the graphic novel format to address medically relevant topics. These free features are often poignant and thought-provoking. A complete list of topics is available at

Note: For an embargoed PDF, please contact Cara Graeff. Dr. William Doane can be contacted directly at or on his cell at 513-461-1395.


Also new in this issue:

Control of an Outbreak of Middle East Respiratory Syndrome in a Tertiary Hospital in Korea
Ga Eun Park, MD; Jae-Hoon Ko, MD; Kyong Ran Peck, MD, PhD; Ji Yeon Lee, MD; Ji Yong Lee, MD; Sun Young Cho, MD; Young Eun Ha, MD; Cheol-In Kang, MD, PhD; Ji-Man Kang, MD; Yae-Jean Kim, MD, PhD; Hee Jae Huh, MD, PhD; Chang-Seok Ki, MD, PhD; Nam Yong Lee, MD, PhD; Jun Haeng Lee, MD, PhD; Ik Joon Jo, MD, PhD; Byeong-Ho Jeong, MD; Gee Young Suh, MD, PhD; Jinkyeong Park, MD; Chi Ryang Chung, MD, PhD; Jae-Hoon Song, MD, PhD; and Doo Ryeon Chung, MD, PhD
Original Research

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