geoffrey modest medical blogs

2 related articles were recently published by the CDC. 1. In the United State from 1991 to 2014 the birth rate among teens age 15 to 19 has  declined by a dramatic 61%  from 61.8 per 1000 to 24.2 per 1000,  with larger % decreases in ethnic/racial minorities   (see  http://www.cdc.gov/mmwr/volumes/65/wr/mm6516a1.htm?s_cid=mm6516a1_w  ).  However the birth rate remained approximately twice as high for Hispanic and non-Hispanic black teens compared to non-Hispanic white teens.  There are also significant geographic and socioeconomic disparities. See prior blog  http://gmodestmedblogs.blogspot.com/2016/05/dropping-teen-birthrates.html     for the full assessment . In brief: -- from 2006 to 2014, a 41% decline in birthrate overall, to 25.4 per 1000 female teens      -- Hispanic: decreasing to 39.8 per 1000, a 51% decrease from 77.4 per 1000      -- Black: decreasing to 37.0 per 1000, a 44% decrease, from 61.9 per 1000      -- white: decreasing to 18.0 per 1000, a 35%

A recent community-based study of chronic low back pain found that yoga was non-inferior to physical therapy for function and pain (s ee doi:10.7326/M16-2579 ). Details: -- 320 predominantly low income adults with nonspecific chronic low back pain were enrolled in a 12 week, single-blind, 3 group randomized trial, with a 40 week maintenance phase. -- Mean age 45, 60% female, 18% non-Hispanic white/58% non-Hispanic black/14% Hispanic, 32% earned college degree or higher, 45% currently employed, 60% with annual income less than $30,000, BMI 31, mean back pain intensity 7 (on scale of 11), RMDQ score 15 (score range 0 to 23, higher score means worse function), 70% on pain medications (52% NSAIDs/35% acetaminophen/20% opioids), comorbidities of hypertension 35%/neck pain 30%/pulmonary disorders 25%/diabetes 18%/depression 20%. [the Roland Morris Disability Questionnaire (RMDQ) of 15 and pain intensity score of 7 reflect moderate to severe pain] -- the study was done in an academ

​ 1. A recent study   f ound that Tai Chi was at least as good, and sometimes better, than physical therapy (PT) for patients with painful knee osteoarthritis, OA ( see   doi:10.7326/M15-2143 ). There have been some earlier studies finding efficacy of  Tai Chi  for knee osteoarthritis, rheumatoid arthritis, and fibromyalgia, by decreasing  pain  and improving physical and psychological health. The current study compared  T ai C hi  with PT. details: --204 people with symptomatic knee OA --mean age 60, 70% women,  53% white/35% black, BMI 33, duration of knee  pain  8 years, mostly moderate radiologic OA (Kellgren-Lawrence grade 2 in 38%, 3 in 37%), 50% hypertensive, 20% diabetic, mean WOMAC  pain  score (Western Ontario and McMaster Universities Osteoarthritis Index) 253 (range 0-500) --interventions (patients allowed to continue meds, including acetaminophen and NSAIDs):                 -- Tai Chi : 60 minute sessions 2x/week for 12 weeks.  Explanation of mind-body exercise theory and

A recent large-scale analysis from health insurance claims found that under one-quarter of adolescents and young adults with opioid use disorder (OUD) received either buprenorphine or naltrexone (see  opioids in youth low use bupren jamapeds2017  in the “chronic pain” folder in the dropbox, or doi:10.1001/jamapediatrics.2017.0745) Details : -- retrospective cohort study based on reviewed insurance claims of 9.7 million youth aged 13 to 25; they identified 20,822 with a diagnosis of OUD 2001 to 2014, and matched them with those receiving prescriptions for either buprenorphine or naltrexone within 6 months of the OUD diagnosis. They used the national commercial insurance database Optum, which has inpatient, outpatient, emergency dept and pharmacy claims from large commercial health insurer databases, with members in all 50 states. -- In those with OUD: 66% male, 82% non-Hispanic white/6% Hispanic/2% non-Hispanic black or Asian, mean age 21 at 1 st  diagnosis, 68% urban, neighbor

A recent systematic review and meta-analysis found that hospital antibiotic stewardship programs significantly reduced the incidence of infections and colonization with antibiotic- resistant  bacteria and C difficile infections (see  antibiotic resistance  dec  with stewardship lancetID2017  in  dropbox , or doi.org/10.1016/ S1473-3099(17)30344-4). Details: --32 studies  in a meta -analysis with 9,056,241 in-hospital patient days and 159 estimates of incidence ratios (IRs) of target infections --studies from 20 countries: US (5 studies), Japan (4), Germany (3), France (3). Most common design was before-after analyses --most frequent  stewardship   interventions:  audits in 59%, implementation of restrictive policies in 47%, co-implementation of stewardship programs with infection control measures (mostly hand hygiene) in 25% Results: --antibiotic stewardship programs  reduced  the incidence of and colonization with:     -- multi-drug resistant gram-negative bacteria: