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Content 7


The Doctor and the Pharmacist

Radio Show Articles:
January 12, 2013

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Short-Term Correction of Vitamin D Deficiency in Healthy Young Women
Low Total-Fat Intake Is Associated with Lower Weight, Body-Mass Index, and Waist Circumference
Streamlining Clostridium difficile Diagnosis with Swabs
Testosterone Replacement Among Patients with Erectile Dysfunction
Should Patients' Weight Affect the Choice of Antihypertensive Therapy?
Person-to-Person Spread of Acute Gastroenteritis
Hypertension Drug Combo plus NSAIDs Associated with Risk for Acute Kidney Injury
Not Pneumonia? Hold the Antibiotics!
Preeclampsia and Parity: Is Having More Than One Child Good for Your Heart?
How Susceptible Is Helicobacter pylori to Antibiotics in Europe?
Overweight Seems Associated with Lower All-Cause Mortality, Meta-Analysis Finds
A Few Medical Schools Offering 3-Year Degrees
One in Eight U.S. Adolescents Has Considered Suicide
New Norovirus Strain Spreads Worldwide
Americans Living Shorter, Sicker Lives Than People in Other Wealthy Nations
Binge Drinking Is Common in Women and Girls

MM: It's fine to look for increased muscle strength in young people who have increased their vitamin D intake but don't forget the other benefits of D3 such as immune function, bone density, cognition and a host of other long term benefits. Unfortunately, the vitamin D level that these women reached of´ " nearly 30" , was still insufficient. In my opinion, optimal blood levels of 25 (OH) D should be in the 60-80ng/ml range.
J Clin Endocrinol Metab 2012 Dec; 97:4709
Short-Term Correction of Vitamin D Deficiency in Healthy Young Women
Supplementation raised 25-hydroxyvitamin D levels substantially, but with no physical benefits.
These days, some clinicians check vitamin D levels even in healthy young adults, despite a lack of evidence that screening for vitamin D deficiency confers benefit in this age group. In a placebo-controlled trial in India, 173 healthy young women (mean age, 22) with vitamin D deficiency (mean 25-hydroxyvitamin D [25(OH)D] level, 9 ng/mL) were randomized to four groups: Vitamin D3 alone, calcium alone, both, or neither. The vitamin D3 dose was 60,000 IU weekly for 2 months, then twice monthly for 4 months. The elemental calcium dose was 500 mg twice daily. The researchers were particularly interested in whether supplementation would improve muscle strength (as occurs in some older patients).
At 6 months, mean 25(OH)D levels had risen to nearly 30 ng/mL, and parathyroid hormone levels fell in both vitamin D supplement groups. Neither 1,25-dihydroxyvitamin D levels (which were normal at baseline) nor calcium levels changed significantly. Handgrip strength, finger pinch strength, 6-minute walk performance, and health-related quality of life did not improve significantly in any group.
Comment: Vitamin D supplementation did not yield noticeable short-term physical benefits in healthy young women with low 25(OH)D levels. Whether identifying and treating such women is beneficial in the long term remains unknown.
Allan S. Brett, MD Published in Journal Watch General Medicine January 3, 2013
Citation(s): Goswami R et al. Skeletal muscle strength in young Asian Indian females after vitamin D and calcium supplementation: A double-blind randomized controlled clinical trial. J Clin Endocrinol Metab 2012 Dec; 97:4709.
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MM: It's not a surprise that lower fat intake will reflect a lower body weight. Unfortunately people tend to focus too much on low fat and substitute the fat with sugars and other high glycemic carbohydrates. This is doing themselves a disservice at these carbohydrates are detrimental to their weight and also to their insulin resistance that can lead to type 2 diabetes and other related metabolic syndrome conditions. The key is to eat a balanced, complete diet that stays away from artificial foods and additives. This will provide the long term benefits that reflect on both their weight and overall health.
BMJ 2012 Dec 6; 345:e7666
Low Total-Fat Intake Is Associated with Lower Weight, Body-Mass Index, and Waist Circumference
A meta-analysis backs up observations about fat intake.
Surprisingly, the relation between fat intake and body weight is unclear. In a World Health Organization–sponsored meta-analysis of randomized trials and cohort studies, investigators determined the effect of reducing total-fat intake on body weight in people who did not intend to lose weight (e.g., studies to lower cardiovascular risk).
Thirty-three randomized trials (duration, 0.5–8.1 years; 74,000 participants) were included in the meta-analysis. The mean final weight of participants randomized to low-fat diets (most allowed ≤30% fat intake) was 1.6 kg lower than that of participants randomized to usual-fat diets — a significant difference. Greater reductions in fat intake and lower fat intake at baseline were associated with greater weight loss. Participants who were randomized to low-fat diets also had significantly lower final mean body-mass index (BMI; by 0.5 kg/m2) and waist circumference (by 0.3 cm) than did those randomized to usual-fat diets. The cohort studies yielded similar results. Finally, low-fat diets also had salutary effects on lipids and blood pressure.
Comment: In this meta-analysis, low total-fat intake was associated with lower weight, BMI, and waist circumference in people who did not intend to lose weight. On average, the improvements were modest, but many participants likely achieved clinically important responses. These results have public health implications and support the authors' claim that attempts should be made to reduce total-fat intake in populations where mean total-fat intake is ≥30% of energy. Clinicians should remain steadfast in recommending the same for their individual patients.
Paul S. Mueller, MD, MPH, FACP  Published in Journal Watch General Medicine January 3, 2013
Citation(s): Hooper L et al. Effect of reducing total fat intake on body weight: Systematic review and meta-analysis of randomised controlled trials and cohort studies. BMJ 2012 Dec 6; 345:e7666.
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Clin Infect Dis 2012 Dec 1; 55:1527
Streamlining Clostridium difficile Diagnosis with Swabs
A small study suggests that analyzing stool-stained swabs might obviate the need for collecting stool samples.
Prompt diagnosis and treatment of Clostridium difficile infection (CDI) often are complicated by the most mundane of difficulties: obtaining adequate stool specimens. Hospitalized patients with severe infections might have ileus and produce no stool, or they might be too confused to cooperate. Outpatients might not be able to produce or deliver samples on demand.
At a single Cleveland hospital, researchers evaluated the performance of the far more user-friendly swab in diagnosing CDI among 139 consecutive inpatients with diarrhea. Swabs and stool specimens from each patient were sent to the same hospital laboratory, where both were evaluated with commercial polymerase chain reaction (PCR) assays; swabs also were cultured for toxigenic C. difficile, and a subset were evaluated with commercial enzyme-linked immunosorbent assays (ELISAs) to detect glutamate dehydrogenase (an initial screening test for CDI).
With PCR testing, swabs were negative for all 116 patients with negative stool results (specificity, 100%) and were positive for 22 of 23 patients with positive stool results (sensitivity, 96%). Glutamate dehydrogenase testing yielded sensitivity and specificity similar to those obtained with PCR.
Comment: Stool collection is a major headache for doctors and nurses, and patients don't like it much either. All are likely to cheer the prospect of streamlining CDI diagnosis with swabs. But unfortunately, use of swabs would most likely complicate matters in the lab, as these authors note: The number of submitted specimens undoubtedly would increase substantially, with a sizeable fraction from patients without true diarrhea and low pretest probability of disease. Thus, unfortunately, the excellent performance characteristics seen in this study are unlikely to be achieved in everyday use.
Abigail Zuger, MD Published in Journal Watch General Medicine January 3, 2013
Citation(s): Kundrapu S et al. Utility of perirectal swab specimens for diagnosis of Clostridium difficile infection. Clin Infect Dis 2012 Dec 1; 55:1527.
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MM: Let us not forget the benefits of testosterone beyond erectile dysfunction. Testosterone is responsible for muscle tone, bone density, cognitive function, mental clarity, improved balance leading to fewer fractures related to falls, the ability to enjoy life (joie de vive) and a host of related benefits. The most visible benefit may be the easiest to measure but is not necessarily the most important thing to consider.
Ann Intern Med 2102 Nov 20; 157:681
Testosterone Replacement Among Patients with Erectile Dysfunction
Function improved with sildenafil, with or without testosterone replacement.
Not infrequently, middle-aged and older men with erectile dysfunction (ED) have low testosterone levels. Treatment with a selective phosphodiesterase type 5 inhibitor (such as sildenafil) is considered first-line therapy in such men, but whether testosterone replacement provides additional benefit remains uncertain. In this randomized, double-blind, placebo-controlled trial, 140 participants (age range, 40–70) with ED and low testosterone levels (total testosterone, <330 ng/dL or free testosterone, <50 pg/mL) were treated initially with sildenafil and then were randomized to 14 weeks of daily transdermal testosterone (dose titrated from 5 to 15 g) or placebo.
During a run-in phase in which sildenafil doses were optimized, mean testosterone levels rose from about 250 ng/dL to about 350 ng/dL in both groups. After randomization, men who received testosterone showed a further increase in testosterone levels, whereas those in the placebo arm did not exhibit higher levels (649 ng/dL vs. 347 ng/dL). Sildenafil was associated with significant improvement in erectile function; addition of testosterone failed to improve function further.
Comment: The rise in testosterone levels after sildenafil treatment was a surprise to me. The authors discuss potential mechanisms, such as activation of steroidogenic proteins, but the precise process remains uncertain. Nonetheless, the authors appropriately conclude that, among men with low testosterone levels, sildenafil plus testosterone is not superior to sildenafil alone and testosterone replacement should not be used routinely in such patients.
Jamaluddin Moloo, MD, MPH  Published in Journal Watch General Medicine January 2, 2013
Citation(s): Spitzer M et al. Effect of testosterone replacement on response to sildenafil citrate in men with erectile dysfunction: A parallel, randomized trial. Ann Intern Med 2102 Nov 20; 157:681.
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Lancet 2012 Dec 6
Should Patients' Weight Affect the Choice of Antihypertensive Therapy?
In a subanalysis of ACCOMPLISH trial data, overweight or obesity was associated with improved survival in one treatment arm, but not the other.
The obesity paradox suggests that obesity is protective in high-risk hypertensive patients (Am J Med 2007; 120:863). In this prespecified subanalysis from the industry-sponsored ACCOMPLISH trial (JW Cardiol Dec 3 2008), investigators examined whether body weight affects outcomes of antihypertensive therapy. Participants randomized to a single-pill combination of either benazepril and hydrochlorothiazide or benazepril and amlodipine were stratified according to body-mass index (BMI) as follows: obese (BMI, ≥30; n=5709), overweight (BMI, ≥25 to <30; n=4157), or normal weight (BMI, <25; n=1616). The primary endpoint was cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke, adjusted for age, sex, diabetes, previous cardiovascular events, stroke, and chronic kidney disease.
In the hydrochlorothiazide group, incidence of the primary endpoint (per 1000 patient-years) was 30.7 in normal-weight, 21.9 in overweight, and 18.2 in obese patients (P=0·003). In the amlodipine group, the primary endpoint did not differ significantly among the three BMI groups (18.2, 16.9, and 16.5 per 1000 person-years, respectively). In obese patients, event rates were similar in the hydrochlorothiazide and amlodipine groups, but they were significantly lower with amlodipine than with hydrochlorothiazide in overweight patients (hazard ratio, 0·76; 95% confidence interval, 0·59–0·94; P=0·037) and in normal-weight patients (HR, 0·57; 95% CI, 0·39–0·84; P=0·004).
Comment: In this substudy, an angiotensin-converting–enzyme (ACE) inhibitor plus a thiazide diuretic was less effective in normal-weight than in obese patients, whereas an ACE inhibitor plus a calcium-channel blocker was uniformly effective regardless of body weight. However, this is just one study, and stratification by body-mass index occurred after randomization. An obesity-related disparity in outcomes with different antihypertensive therapies must be replicated in future studies before we begin making treatment decisions based on body weight.
JoAnne M. Foody, MD Published in Journal Watch Cardiology January 9, 2013
Citation(s):Weber MA et al. Effects of body size and hypertension treatments on cardiovascular event rates: Subanalysis of the ACCOMPLISH randomised controlled trial. Lancet 2012 Dec 6; [e-pub ahead of print].
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MM: This info brings to mind the work of British physician, Andrew Wakefield , who espoused the premise that measles and other viruses could be transmitted via aerosolization of fecal matter by merely flushing a toilet with the seat up. Its always interesting how a simple action or lack of action may exhibit a much farther reaching result than anticipated. In this instance, it might be a good idea to add to the general hygiene practices the simple one of closing the commode prior to flushing. Simple but possibly quite effective.
MMWR Surveill Summ 2012 Dec 14; 61:1
Person-to-Person Spread of Acute Gastroenteritis
Data from a relatively new national surveillance system reveal that many outbreaks of acute gastroenteritis are spread person to person.
About 179 million episodes of acute gastroenteritis (AGE) occur each year in the U.S. Data on water- and food-borne AGE outbreaks have been collected for decades. Starting in 2009, the CDC established the Web-based, voluntary National Outbreak Reporting System (NORS) to support the reporting of all AGE outbreaks, including those transmitted by direct person-to-person (P-to-P) contact.
NORS received reports of 2259 P-to-P AGE outbreaks in 2009–2010 (81,491 cases, 1339 hospitalizations, 136 deaths). Among the 1419 outbreaks (63%) with at least one suspected or confirmed etiology, norovirus was implicated most often (56% of all reported outbreaks), followed by Shigella (4%) and "other/multiple etiologies" including Salmonella, rotavirus, and Shiga toxin–producing Escherichia coli. Vomiting (especially with norovirus infection) and diarrhea were the most common symptoms; bloody stools were often indicative of bacterial etiology.
Outbreaks involved a mean of 36 cases (range, 2 to 394), with the numbers highest for norovirus outbreaks. The most common settings were long-term care facilities, childcare centers, schools, and hospitals; adults aged ≥50 accounted for 54% of cases. Norovirus outbreaks — and outbreaks of unknown etiology — occurred most commonly during the winter, whereas Shigella outbreaks occurred most often during the summer.
Comment: The authors note that, because of the newness and voluntary nature of NORS, AGE outbreaks are likely underestimated. Clinicians — especially those who treat patients from long-term care facilities and childcare centers — should familiarize themselves with and use NORS. Disease spread can be minimized by meticulous hand hygiene and case isolation. The preponderance of norovirus infection should make one think twice before prescribing antimicrobial therapy for wintertime AGE.
Stephen G. Baum, MD  Published in Journal Watch Infectious Diseases January 9, 2013
Citation(s): Centers for Disease Control and Prevention (CDC). Outbreaks of acute gastroenteritis transmitted by person-to-person contact — United States, 2009–2010. MMWR Surveill Summ 2012 Dec 14; 61:1.
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Hypertension Drug Combo plus NSAIDs Associated with Risk for Acute Kidney Injury
By Joe Elia
Common antihypertensive agents are associated with increased risk for kidney injury when used concurrently with NSAIDs, according to a BMJ article.
Using U.K. national databases, researchers followed half a million patients who were prescribed antihypertensives over a mean of roughly 6 years. The incidence of kidney injury in the entire cohort was 7 per 10,000 person-years. Patients receiving "triple therapy" (an NSAID plus a diuretic plus either an angiotensin-converting–enzyme inhibitor or angiotensin-receptor blocker) had a 31% increased risk for hospitalization for acute kidney injury, relative to those not taking NSAIDs. "Double therapy" (an NSAID plus either a diuretic, ACE inhibitor, or ARB) was not associated with increased risk.
Editorialists note that the confidence interval around the double therapy estimate was wide, and thus the evidence for the absence of risk was not strong. The study's authors urge caution, especially early in the course of treatment when risk seems highest and patients may be taking NSAIDs for arthritis or flu-like syndromes.
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Lancet Infect Dis 2012 Dec 19
Not Pneumonia? Hold the Antibiotics!
In a large randomized study involving adults with acute uncomplicated lower respiratory tract infections, amoxicillin showed little benefit and slight harm.
Respiratory infections are a common reason for prescribing antibiotics. To assess the benefits and risks of amoxicillin treatment for acute uncomplicated lower respiratory tract infections (LRTIs), researchers conducted a placebo-controlled trial in primary care practices in 12 European countries.
Adults aged ≥18 with LRTIs in whom pneumonia was not suspected were randomized to receive 1 g of amoxicillin three times daily or a placebo that was identical in appearance, taste, and texture. Participants completed a daily symptom diary; research staff also telephoned participants during the follow-up period. Baseline characteristics were similar between the amoxicillin and placebo groups (n=1038 and 1023, respectively); overall, 28.9% were aged ≥60, and 15.0% had chronic obstructive pulmonary disease or asthma.
More than 90% of participants in each group reported taking the study drug for ≥5 days. The median duration of symptoms rated moderately bad or worse did not differ significantly between groups: 6 days (amoxicillin) versus 7 (placebo). Results were similar between participants aged ≥60 and those who were younger. New or worsening symptoms were less likely in the amoxicillin group than in the placebo group (15.9% vs. 19.3%; P=0.043), but adverse events (nausea, rash, diarrhea) were more common in the amoxicillin group. One amoxicillin-group patient had documented anaphylaxis. Two patients in the placebo group and one in the amoxicillin group required hospitalization, but no study-related deaths occurred.
Comment: This large multicenter trial of primary care ambulatory patients suggests slight benefit — and some harm — from amoxicillin treatment of uncomplicated LRTIs. An editorialist discusses whether other objective measures, such as procalcitonin concentration, might be useful in helping to identify those who are likely to benefit from antibiotic treatment.
Mary E. Wilson, MD  Published in Journal Watch Infectious Diseases January 9, 2013
Citation(s): Little P et al. Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: A 12-country, randomised, placebo-controlled trial. Lancet Infect Dis 2012 Dec 19; [e-pub ahead of print].
Schuetz P. Antibiotics for non-pneumonic respiratory-tract infections. Lancet Infect Dis 2012 Dec 19; [e-pub ahead of print].
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BMJ 2012 Nov 27; 345:e7677
Preeclampsia and Parity: Is Having More Than One Child Good for Your Heart?
Risk for cardiovascular death was highest for women with histories of preterm preeclampsia and just one child.
Later in life, women with hypertensive disorders of pregnancy have excess risk for death from cardiovascular disease. Primiparous women are also at heightened risk. Norwegian investigators used national birth and death registries to determine whether risk for cardiovascular death is greater for women with a history of preeclampsia and just one child, compared with risk associated with either factor alone.
Of 836,147 women with first singleton births who were followed between 1967 and 2002, 4% had diagnosed preeclampsia and 16% had only one child. Overall, 0.5% of women died of cardiovascular disease during follow-up. Women who had preeclampsia in their first pregnancies had greater likelihood of death from cardiovascular disease than those without preeclampsia (adjusted hazard ratio, 1.9). Excess risk for cardiovascular death was greater (aHR, 3.7) for women with preterm preeclampsia (generally, a more severe presentation) and still greater (aHR, 9.4) among primiparas with preterm preeclampsia.
Comment: These findings demonstrate that women with preterm preeclampsia are at particular risk for cardiovascular disease later in life, especially if they have only one child. A causal relation between primiparity and cardiovascular health is unlikely to explain the association entirely. Rather, women with severe disease might be more likely than other women to be advised against future pregnancies, to not desire another pregnancy, or to fail to conceive again. Nonetheless, the notion of pregnancy as a physiologic "stress test" has gained traction. Given that women with pregnancy-related morbidity are at risk for later health problems, women's health providers should incorporate obstetric history into screening protocols. Although having a complicated first pregnancy and no other children could merely be a proxy for other comorbidities, women who fill these criteria may be ones to watch most closely.
Allison Bryant, MD, MPH  Published in Journal Watch Women's Health January 3, 2013
Citation(s): Skjaerven R et al. Cardiovascular mortality after pre-eclampsia in one child mothers: Prospective, population based cohort study. BMJ 2012 Nov 27; 345:e7677.
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Gut 2013 Jan; 62:34
How Susceptible Is Helicobacter pylori to Antibiotics in Europe?
Less than it used to be (particularly for clarithromycin and levofloxacin), but in varying degrees by region and drug
The effectiveness of empiric treatment regimens for Helicobacter pylori infection is decreasing as antibiotic resistance to the organism increases. Recent data support the conclusion that selecting the best therapy will require knowledge of antibiotic resistance rates by geographic area (JW Gastroenterol Dec 14 2012).
To estimate antibiotic resistance rates in Europe, investigators analyzed bacterial cultures from the gastric biopsies of 2204 patients with untreated H. pylori infection that were prospectively collected between April 2008 and June 2009 in 18 countries. They then assessed whether resistance rates were associated with outpatient drug use between 2001 and 2008.
In adults, overall resistance rates were 17.5% for clarithromycin, 14.1% for levofloxacin, and 34.9% for metronidazole. Resistance rates for clarithromycin and levofloxacin were <10% in Northern Europe but >20% in most of Western/Central and Southern Europe. Based on 2005 data from 17 countries, use of outpatient quinolones was associated with levofloxacin resistance (P=0.001), and use of long-acting macrolides was associated with clarithromycin resistance (P=0.04). The association between total macrolide use and clarithromycin resistance was not statistically significant (P=0.06).
The authors note that rapid increases in resistance to both clarithromycin in Europe overall — from 9.9% in 1998 (Eur J Clin Microbiol Infect Dis 2001; 20:820) to 17.5% in 2008/2009 — and to levofloxacin in several European countries now preclude their use as empiric first-line therapy for H. pylori infection without susceptibility testing. Also, knowledge of antibiotic consumption in a region might be used to predict sensitivity of H. pylori to quinolones and macrolides, particularly where diagnostic infrastructure is lacking.
Comment: These findings provide strong evidence to support the regular collection and use of regional data on antibiotic resistance, antibiotic use, or both to guide H. pylori therapy.
David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)  Published in Journal Watch Gastroenterology December 14, 2012
Citation(s): Megraud F et al. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut 2013 Jan; 62:34.
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Overweight Seems Associated with Lower All-Cause Mortality, Meta-Analysis Finds
Being overweight is associated with lower all-cause mortality than being normal weight, according to a JAMA meta-analysis, but editorialists are cautious in their interpretation.
Researchers examined BMI and its relation to mortality in nearly 100 studies, altogether including 2.9 million people. People with higher levels of obesity (that is, with BMIs of 35 and above) had higher hazard ratios for all-cause mortality than those of normal weight (BMIs between 18.5 and 25).
However, BMIs between 25 and 30 were associated with a significantly lower risk (hazard ratio, 0.94) than normal weight, and BMIs of 30 to 35 did not show higher risks.
Editorialists say the reduced risk seen in overweight people could be an artifact, since the lower end of the normal BMI range has been found to confer a higher risk of mortality than the upper end of normal. They conclude: "Establishing BMI is only the first step toward a more comprehensive risk evaluation."
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A Few Medical Schools Offering 3-Year Degrees
New York University and a handful of other medical schools are starting to offer 3-year degrees to select students, the New York Times reports.
The pilot programs are designed to save students a year of tuition and may help alleviate the coming shortfall of primary care physicians. NYU officials say that they can shave a year off medical school by getting rid of redundancies in the science curriculum, shifting clinical training earlier, and adding summer classes. Three-year students will also save a year's tuition expenses ($50,000 at NYU).
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One in Eight U.S. Adolescents Has Considered Suicide
By Kelly Young
One in eight U.S. teens has seriously considered suicide, and one in 25 has attempted it, according to a study in JAMA Psychiatry (formerly known as Archives of General Psychiatry).
Nearly 6500 adolescents (aged 13 to 18) were surveyed about their lifetime history of suicidal behaviors and mental disorders. Among the findings:

Asked to comment, Barbara Geller of Journal Watch Psychiatry wrote: "Because most suicidal teenagers were in treatment, the need for developing effective prevention and intervention is pronounced. Until then, families may benefit from education about the need for vigilance and for sensible precautions such as gun-free homes."
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New Norovirus Strain Spreads Worldwide
By Cara Adler
A new strain of norovirus from Australia may account for the worldwide increase in norovirus activity since late 2012, U.K. health officials announced Wednesday.
The variant — called Sydney 2012 — has become the dominant norovirus strain in the U.K., according to results of genetic testing reported in a Eurosurveillance paper. This variant was first identified in Australia in March 2012 and has since also been seen in Europe, New Zealand, Japan, and the U.S. In the U.K., norovirus infections are 63% higher this season than during the same period last year.
Health officials note that this strain does not cause more severe illness than other strains and that methods for managing outbreaks, primarily handwashing, remain the same.
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Americans Living Shorter, Sicker Lives Than People in Other Wealthy Nations
By Kelly Young
Americans are leading sicker lives than residents of 16 other wealthy nations, and the disparity exists at all ages, according to a report by the Institute of Medicine and the National Research Council.
The U.S. hovers near the bottom of the list of countries in nine areas, among them: infant mortality and low birth weight, injuries and homicides, teenage pregnancies and sexually transmitted infections.
Even Americans with health insurance, higher educations, and healthy behaviors seem to be sicker than their counterparts in other countries, the report notes.
It's not all bad news. The U.S. ranked relatively favorably in the following areas: mortality for those older than 75, stroke and cancer mortality, management of blood pressure and cholesterol, and smoking rates.
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Binge Drinking Is Common in Women and Girls
By Cara Adler
Some one in five high-school girls and one in eight women in the U.S. binge drink, according to an MMWR study.
Using data from the 2011 Behavioral Risk Factor Surveillance System, researchers found that 12.5% of adult women reported binge drinking (i.e., having four or more alcoholic drinks on an occasion in the past 30 days), and those who binge drank did so an average of three times per month and consumed six drinks per episode. Binge drinking decreased with age and increased with household income.
Among high school girls participating in the national Youth Risk Behavior Survey, the prevalence of binge drinking (having five or more alcoholic drinks in a row) was 19.8%. Binge drinking was most common among Hispanic and non-Hispanic white girls and increased with age. More than half of girls who reported current alcohol use were binge drinkers.
The authors note that the study does not include people living on college campuses and military bases.

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