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Harvard Commentaries
35320
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


What Your Doctor Is Reading What Your Doctor Is Reading
 

Update From the Medical Journals: March 2013


March 29, 2013

By Mary Pickett M.D.

Harvard Medical School

What's the latest news in the medical journals this month? Find out what your doctor is reading.

Nearly One-Third of Children with ADHD Grow Up to Have ADHD as Adults

Attention deficit hyperactivity disorder (ADHD) is a common diagnosis for kids. If you have ADHD as a kid, how likely are you to still have symptoms from ADHD as an adult? A study, published online March 4 by the journal Pediatrics, looked at this question. Researchers followed 232 children with ADHD through adulthood. Twenty-nine percent of them reported persisting symptoms (such as attention or concentration difficulties, or impulsiveness). More than half also had another mental health diagnosis in adulthood — like depression or another psychiatric concern.

These results are useful. However, we need to be careful about how we interpret them. This study might exaggerate how likely ADHD is to persist. In the 1980s, ADHD was a less common diagnosis than it is now. Children who were diagnosed during that time are likely to have had particularly severe symptoms. So it's possible that these children would continue to show symptoms long term. Also, being part of a study may make the participants very aware of their ADHD, and more likely to attribute attention lapses or other problems as adults to ADHD.

Medication such as methylphenidate (Ritalin) helps some people with adult ADHD to function better. If you had ADHD symptoms when you were a child, even if they were not diagnosed, you are at risk for adult ADHD. If you have trouble functioning at work or in school as an adult, it may be helpful to talk this over with your doctor. If you did not have ADHD symptoms as a child, doctors agree, you are very unlikely to have adult ADHD. And you are unlikely to benefit from ADHD medications.

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Expert Group Discourages C-Sections Other Than for Medical Reasons

Most C-sections are done for medical reasons. But in recent years, some pregnant women have decided ahead of time to have a C-section when ther is no medical reason. In the past several years, 2.5% of all U.S. births were "maternal-request cesareans." Why would a woman ask for a C-section if she did not need one? Some of these women fear childbirth pain. Some think they will recover faster with a C-section. And some think they will be less likely to have urine leakage or problems with sexual function later.

The American College of Obstetricians and Gynecologists (ACOG) released a statement March 21 saying that maternal-request cesareans are not safer than vaginal deliveries. And they do not help women avoid complications from delivery. This influential expert group is also on record as strongly recommending vaginal birth unless there is a medical reason for a C-section. In light of this, we can expect that maternal-request cesareans will no longer be as common in the future. The full ACOG recommendation will appear in the April issue of Obstetrics & Gynecology.

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Some Women with Extra Breast-Cancer Risk Can Get Mammograms Every Other Year

Mammograms are recommended for women between ages 50 and 75. Doctors used to recommend women get one every year. In 2009 the U.S. Preventive Services Task Force (USPSTF) recommended that women at average risk for breast cancer could go two years between mammograms. But should women at higher than average risk for breast cancer get more frequent mammograms? At the time, the USPSTF said more research was needed to answer that question.

Now a group of researchers has found that, for at least some women at above-average risk for breast cancer, a mammogram every 2 years seems to be enough. JAMA Internal Medicine published their study online March 18. The researchers reviewed the records of 934,098 women who had mammograms; 11,474 of them were diagnosed with breast cancer. The study found that there was no greater chance of a woman developing breast cancer in an advanced stage (too far along to be easily treated) if mammograms were done every 2 years instead of every year. This was true even for women who used estrogen hormone replacement therapy for longer than 5 years, and women whose mammograms showed dense breast tissue. (Each of these things is known to increase a woman's risk for breast cancer.)

Some women choose to begin mammogram screening at age 40 instead of age 50. Researchers are not convinced that this is worthwhile. In this study, yearly mammograms appeared to lower the risk for having advanced-stage cancer among women who began screening early and whose early mammograms showed dense breasts.

The strongest risks for breast cancer are having a previous history of breast cancer, having a gene that is known to promote breast cancer (a BRCA gene) or having several close family members with the disease. The study did not look at these risks. For women who have these risks, doctors typically recommend mammograms every year.

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More News in Brief

  • Sleeping Pills Lead to Hip Fractures In Nursing Home Residents. Nursing home residents who take sleep medicines have a 66% higher risk of hip fracture than non-users of sleeping pills. This was the finding from a study that monitored insurance claims among 15,528 patients with hip fractures who were long-term residents of nursing homes.

    The study included residents who were 50 years or older. Zolpidem (Ambien), eszopiclone (Lunesta), zoleplon (Sonata), ramelteon (Rozerem) and trazodone were among the medications included in this study. Benzodiazepines, such as diazepam (Valium), were not included in the study because they have already been associated with a strong risk for falls. This is one reason they are poor choices for sleeping pills. The study was published online March 4 by JAMA Internal Medicine.

  • Atrial Fibrillation Increases Risk for Memory Loss. Atrial fibrillation is a very common heart rhythm disorder. People with this condition have an increased risk for stroke. According to new research that was reported by the Annals of Internal Medicine on March 5, atrial fibrillation also raises the risk for memory loss and dementia, even when stroke is not involved. The risk for dementia was increased by about a third compared with people who did not have atrial fibrillation.

    This finding will definitely affect future research about atrial fibrillation, and may eventually lead doctors to treat atrial fibrillation more aggressively. There are risks to taking drugs that control heart rhythm. There are also risks from invasive procedures, such as "ablation." This procedure burns areas of heart muscle to stop atrial fibrillation from occurring. Because of these risks, many people choose not to get these aggressive treatments. Instead, they limit their treatments to a medication that keeps their heart rate slow and to a blood thinner. Research in the future will need to study whether treatments that block atrial fibrillation can protect against memory loss.

  • Torn Meniscus Does as Well with Physical Therapy as with Surgery. An article in the New England Journal of Medicine compared surgery to physical therapy to treat a torn meniscus muscle in the knee. Researchers studied 351 people. Half of them got surgery and half got physical therapy. Both groups had similar pain scores and similar improvements in their function six months and one year after treatment. The group that did physical therapy completed nine sessions with a physical therapist. They also had exercises to do at home. Given these results, it makes sense for most people with a torn meniscus to choose physical therapy. It is less expensive and less risky than surgery.

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Mary Pickett, M.D. is an Associate professor at Oregon Health & Science University where she is a primary care doctor for adults. She supervises and educates residents in the field of Internal Medicine, for outpatient and hospital care. She is a Lecturer for Harvard Medical School and a Senior Medical Editor for Harvard Health Publications.

 

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