geoffrey modest medical blogs

There was an important article on Portugal's approach to a huge opiate problem: they decriminalized all drugs there in 2001, and this has been associated with a dramatic drops in overdoses, HIV and hepatitis infections, and drug-related crime (see https://www.theguardian.com/news/2017/dec/05/portugals-radical-drugs-policy-is-working-why-hasnt-the-world-copied-it ). A few details: -- The rates of HIV infection in Portugal had become the highest in the European Union. The all-time high was in 2000, with 104.2 cases per million population, decreasing to 4.2 cases per million in 2015 (!!!) -- Rather than being arrested, people with a personal supply of drugs were given a warning, a small fine, or were told to appear before a local commission composed of a doctor, lawyer, and social worker, with emphasis on treatment/harm reduction/support services -- “Portugal’s policy rests on three pillars: one, that there’s no such thing as a soft ...

A few recent articles highlighted the continuing problem in the US with opioid prescriptions. This blog will deal with a study showing much higher prescribing of opioids overall by dentists in the US vs England, and much stronger ones at that (see   opioid scripts by dentists jamaintmed2018  in dropbox, or  doi:10.1001/jamanetworkopen.2019.4303 ). another blog tomorrow.... Details: -- cross-sectional study of prescriptions for opioids dispensed from outpatient pharmacies in healthcare settings in 2016, by dentists in the US and England     -- the US data source was the IQVIA LRx database, which captures 85% of all outpatient prescriptions, including people commercially insured, Medicare, Medicaid, and cash payment (but not the VA)     -- the English data are from the NHS Digital Prescription Cost Analysis database, but were only available for England and not the whole UK Results: -- US dentist...

A recent study looked at the 5 year incidence of recurrent VTE in men and women who stopped anticoagulants after an unprovoked VTE and had negative d-dimer both before stopping therapy and one month afterwards. This is a follow-up to their 2. 2 year results (see prior article eval/blog: https://gmodestmedblogs.blogspot.com/2015/01/stopping-anticoagulation-after-first-dvt.html ), confirming that the incidence of recurrence was very high in men, lower in women, and quite low in those women who were on estrogens and stopped them (see dvt normal d-dimer not help jthrombhem2019 in dropbox, or DOI: 10.1111/jth.144). Details: -- 410 patients in the initial prospective interventional cohort study, who had 3 to 7 months of oral anticoagulants (OACs) with INR goal of 2.0-3.0; d-dimer was negative on therapy and still negative one month subsequently. -- Women who had a VTE while on estrogen therapy were eligible if they stopped estrogen therapy -- mean age 51, BMI 31, duration o...

As an addendum to the prior blog on atorvastatin improving renal function (see  http://gmodestmedblogs.blogspot.com/2019/05/atorvastatin-retards-renal-function.html ), a recent study came out suggesting that statins decrease the risk of dementia following a concussion (see concussion statin dec dementia jamaneuro2019 in dropbox, or doi:10.1001/jamaneurol.2019.1148). Details: -- population-based study in Ontario Canada from 1993 to 2013, then continued until March 2016 for follow-up -- older adults diagnosed with a concussion, excluding severe cases resulting in hospitalization and those with a prior diagnosis of dementia or delirium -- they measured the long-term incidence of dementia, comparing those who had a statin prescription written within 90 days of the concussion vs not [this is a simple database linkage, so no information about why they were on a statin] -- 28,815 patients were diagnosed as having a concussion -- median age 76 (30% were >80 yo), 61% female, socio...