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5 November 2013 Annals of Internal Medicine Tip Sheet

Below is information about articles being published in the September 17 issue of 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.

1. Women who adhere to Mediterranean-type diet in midlife have greater physical and mental function in old age

Women who follow a healthy diet during middle age have approximately 40 percent greater odds of surviving past the age of 70 with no chronic illnesses and no physical or cognitive impairment, according to a study published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/0003-4819-159-9-201311050-00004). As life expectancy increases, maintaining health and well-being into older age becomes a major challenge. Habits in midlife may affect how people age. Researchers reviewed dietary data ascertained by survey for 10,670 women who were in their late 50s and early 60s at the time of the questionnaire. The same women provided information on health approximately 15 years later. The researchers found that women who adhered to a Mediterranean or similar type diet had greater health and well-being in older age. Healthy agers ate more plant foods, whole grains, and fish or long-chain Omega-3 PUFAs; limited alcohol intake; and ate less red and processed meats. Healthy agers were differentiated from usual agers by four specific health domains. The healthy agers were free from 11 chronic diseases, had no impairment in cognition, no physical disabilities, and had intact mental health.

2. Home test for strep could save hundreds of thousands of doctor visits a year

A new home score for calculating a patientís risk for strep throat is nearly as accurate as lab tests and could make doctorís visits for sore throat unnecessary, according to a study published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/0003-4819-159-9-201311050-00001). Most cases of sore throat are caused by a virus rather than bacteria, and therefore will resolve on their own without antibiotics and without causing further problems. It is recommended that patients who visit their physician for sore throat have a lab test to determine whether the infection is viral or bacterial. However, patients at low risk for strep may not need a lab test. Researchers developed a scoring system to identify low-risk patients who would not need a doctor visit. The score was based on the patientís personal health information and an assessment of recent strep incidence in the local population. Researchers found that their new scoring system was accurate, and could help clinicians and patients estimate the likelihood of disease before a clinical encounter and help steer these patients to timely, appropriate care when needed. The author of an accompanying editorial cautions that this home score algorithm has several shortcomings. Among them, the age range is too broad (strep is rare in persons over the age of 50) and it assumes even prevalence of strep across communities. The author of a second editorial doubts the cost-savings potential of the new algorithm. The editorialist points out that a clinical evaluation that eliminates testing for patients at low risk, and the use of generic antibiotics for those who need them, could improve treatment and decrease costs.

3. Opioid overdose prevention programs could save lives of recently released prisoners

Drug interventions specifically targeted to recently released prisoners could help prevent opioid overdose deaths, especially among women, according to a study in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/0003-4819-159-9-201311050-00005). Studies have shown that former prisoners are at increased risk for death from drug overdose during the postrelease period. Over the past decade, efforts have been made to improve prisoner reentry. During the same timeframe, opioid prescriptions have reached an all-time high. Currently, opioids are the most commonly prescribed class of medications in the United States and overdose is now the leading cause of accidental death. Researchers studied records for 76,208 persons released from prison in Washington State from 1999 to 2009 to see how the rising trend in opioid use and abuse has affected postrelease mortality. They found that overdose was the leading cause of death among former prisoners and that opioids were involved in approximately 15 percent of all deaths. Compared to their male counterparts, women were at higher risk for overdose and death due to opioids. The researchers suggest that efforts to reduce drug overdose, including that from pharmaceutical opioids, should involve interventions for released prisoners.