AHRQ Data: Mastectomies Increased 36% From 2005 to 2013
Although breast cancer rates remained constant between 2005 and 2013, the rate of women undergoing mastectomies increased 36%, including a more than tripling of double mastectomies, according to new Agency for Healthcare Research and Quality (AHRQ) data. Both single and double mastectomies are increasingly performed as outpatient procedures, and the overall proportion of mastectomies performed in hospital-based ambulatory surgery settings reached 45% in 2013. "This brief highlights changing patterns of care for breast cancer and the need for further evidence about the effects of choices women are making on their health, well-being and safety," said AHRQ Director Richard Kronick, PhD. "More women are opting for mastectomies, particularly preventive double mastectomies, and more of those surgeries are being done as outpatient procedures." Choosing a mastectomy rather than breast-conserving treatment, or electing to undergo a double mastectomy rather than single mastectomy, may be based on physician advice, fear of cancer recurrence, or desire for cosmetic symmetry. The choice may also be influenced by a family history of breast cancer, or mutations in the BRCA1 and BRCA2 gene. AHRQ's analysis shows a twofold increase in double mastectomies for women who don't have cancer, although the number of women making this choice remains low. Find more data on the topic in "Trends in Bilateral and Unilateral Mastectomies in Hospital Inpatient and Ambulatory Settings, 2005-2013," a statistical brief from AHRQ's Healthcare Cost and Utilization Project.
AHRQ Stats: Control of Diabetes
The rate of hospital admissions for uncontrolled diabetes without complications fell from about 28% in 2001 to 17% in 2012. Admissions fell across all racial and ethnic groups, but rates remained higher for blacks and Hispanics and lower for Asians/Pacific Islanders compared with whites. (Source: Agency for Healthcare Research and Quality, 2014 National Healthcare Quality and Disparities Report, Chartbook on Effective Treatment.)
Restoring Microbes in Infants Born by Cesarean Section
Babies delivered via the birth canal acquire a microbial community that resembles that of their mother's vagina. Babies born by cesarean section tend to acquire a microbial community that more closely resembles that of their mother's skin. The microbiota acquired by a newborn are thought to be essential for the development of a healthy immune system and metabolism.
A research team led by Dr. Maria Dominguez-Bello at NYU Langone Medical Center and Dr. Jose C. Clemente at Icahn School of Medicine in Mount Sinai, New York, set out to determine whether they could alter the microbiota of babies born by C-section by exposing them to maternal vaginal fluids at birth. The study was funded in part by NIH's National Institute of Diabetes and Digestive and Kidney Diseases. Eighteen healthy mothers participated in the small pilot study. Seven delivered vaginally. Of the 11 who delivered by scheduled C-section, 4 elected to have their newborns swabbed. For the procedure, a sterile gauze pad was incubated in the mother's birth canal an hour before the C-section. The newborn was then swabbed with the gauze within the first 1-3 minutes after birth, starting with the mouth, then the face, and then the rest of the body. All women who participated in the microbial transfer were first tested to ensure they didn't have any viral infections or sexually transmitted diseases. All mothers received standard treatment, including preventive prenatal antibiotics when necessary.
The infants and mothers were later swabbed for bacterial DNA analysis at six time points up to 30 days after birth. More than 1,500 samples were collected from areas that included the mouth, forehead, arm, foot, anal region of the baby, and vaginal region of the mother.
The researchers found that the microbiomes (all of the DNA, or genomes, of all of the microbes) of the C-section-delivered infants exposed to vaginal fluids resembled those of vaginally delivered infants, especially during the first week of life. Their gut, mouth, and skin bacterial communities during the first 30 days of life were enriched in vaginal bacteria. These bacteria were underrepresented in the C-section-delivered infants who weren't swabbed with vaginal fluids. "This study has allowed us to demonstrate the feasibility of bacterial restoration in a small cohort, but we do not know yet whether this procedure alone is sufficient to restore the health benefits associated with vaginal delivery," Clemente says.
Marijuana Use Disorder Is Common and Often Untreated
Marijuana use disorder is common in the United States; is often associated with other substance use disorders, behavioral problems, and disability; and goes largely untreated, according to a new study conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the NIH. The analysis found that 2.5% of adults-nearly 6 million people-experienced marijuana use disorder in the past year, whereas 6.3% had met the diagnostic criteria for the disorder at some point in their lives. A report of the study, led by Bridget Grant, PhD, of the NIAAA Laboratory of Epidemiology and Biometry, appeared in the American Journal of Psychiatry. Dr. Grant and her team found the percentage of Americans who reported using marijuana in the past year more than doubled between 2001-2002 and 2012-2013, and the increase in marijuana use disorders during that time was nearly as large. Consistent with previous findings, the new data showed that marijuana use disorder is about twice as common among men than women, and that younger age-groups are much more likely to experience the disorder than people age 45 and over. The risk for onset of the disorder was found to peak during late adolescence and among people in their early 20s, with remission occurring within 3 to 4 years. Also in keeping with previous findings, the new study found that past year and lifetime marijuana use disorders were strongly and consistently associated with other substance use and mental health disorders.