Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.
A survey of high-achieving young physician-researchers shows pronounced gender differences in domestic activities among those married with children, according to an article being published in Annals of Internal Medicine. It is known that female physician-researchers do not achieve career success at the same rate as men. Could differences in nonprofessional responsibilities explain some of the gap? Researchers surveyed 1,055 physician-researchers who were recipients of National Institute of Health research K08 and K28 awards (highly selective grants made to early-career researchers) and had active academic affiliation at the time of the survey to investigate the division of domestic labor and professional activities (research\, teaching, and patient care) by gender. Among the physicians who were married, the men were almost four times more likely to have a spouse who either did not work or worked only part-time. Among married physicians with children, men reported working seven hours longer and spending 12 fewer hours on parenting and domestic tasks each week than women. Women in partnered relationships with children were also substantially more likely to take time off to care for children when there was a disruption in usual childcare. The study authors express concern that the medical profession may be particularly resistant to policy and cultural changes necessary to ensure the success of women. The authors of an accompanying editorial – both highly-motivated physician-researchers who also care for families – are neither surprised nor worried by the findings. They suggest that division of time may be more likely driven by preferences. Female physicians may choose research because it is intellectually challenging, but it also affords flexibility. They suggest that awareness that successful academic careers do not follow a singular trajectory and may have distinct phases. “There is no need to do it all, all at once, right now,” they write.
Single-patient, or n-of-1, trials may be a useful method for determining which patients are experiencing true statin-related discomfort and which patients may be able to continue therapy, according to an article being published in Annals of Internal Medicine. Statins are recommended to reduce risk for heart disease, stroke, and other cardiovascular problems. Myalgia (muscle pain or discomfort) is a common complaint among patients taking statins and a common reason for discontinuation of therapy. However, it can be difficult to determine whether statins are the cause of patient discomfort. Researchers conducted a proof-of-concept study to assess the feasibility and potential value of n-of-1 trials in patients with statin-related myalgia. The investigators hypothesized that such trials would provide objective proof in some patients that their symptoms were (or were not) statin-related. Patients who had discontinued statin use due to myalgia were randomly assigned to statin therapy or placebo, up to three times each, for up to three weeks (adequate time period for myalgia to develop). Neither the physician nor the patient knew whether the statin or placebo was taken. Patient self-reporting revealed no clinically significant differences in myalgia or other pain measures in any of the n-of-1 trials or in the combined results across trials. Most patients resumed statin treatment after reviewing the results of their trial, which resulted in lower LDL-C levels 10 months later.
A survey of U.S. households conducted between 2003 and 2010 revealed that approximately 2.7 million US residents are infected with chronic hepatitis C virus (HCV). This figure marks a decrease by about 500,000 cases identified by a similar analysis conducted between 1999 and 2000. The findings are being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M13-1133). Chronic HCV infection is an important public health issue because those who are infected are at high risk for liver disease and other chronic illnesses. Treatment can cure the disease and decrease risk for death, yet many persons infected with HCV do not know they have it. Currently, more people in the U.S. die from HCV than from HIV infection. Knowledge of the number of persons with HCV infection is critical for public health and policy planning. Investigators conducted a nationally representative household survey to estimate the prevalence of HCV and to identify risk factors for infection. They found that the estimated prevalence of chronic HCV infection in the U.S. is about 2.7 million, a decrease of about 500,000 cases since the previous survey. This decrease could be attributed from deaths due to the disease. Risk factors are essentially unchanged from previous periods (injection drug use, having a blood transfusion before 1992). Because only about one half of infected persons report having at least one of these risk factors, risk-based screening may not be the best way to identify chronically ill persons. Baby boomers are six times more likely than other adults to be infected, so the Centers for Disease Control and Prevention recommend a one-time screening for all persons born between 1945 and 1965. The authors write that information from this survey will help to inform the design of programs for HCV screening and linking patients to care and treatment.