Aimee Simone, Assistant Editor

Those who fear they will lose their jobs have an increased risk of developing incident asthma.

Stress over potential job loss could lead to adult-onset asthma, the results of a German study suggest.

Previous research deemed perceived job insecurity a risk factor for lifestyle behaviors related to poor health outcomes, including smoking, obesity, and physiological stress. The current study, published online September 22, 2014, in the 

Journal of Epidemiology and Community Health

, analyzed the relationship between job insecurity and incident asthma in Germany following the economic recession in 2008, when perceptions of job insecurity increased dramatically.

The study relied on data from the more than 7000 participants of the 2009 and 2011 German Socio-Economic Panel, which included individuals who were employed and did not have asthma in 2009. Participants rated the likelihood that they would lose their jobs within the next 2 years in 10% increments on a scale of 0% to 100%.

Respondents who rated the probability of job loss above 50% were considered to have high job insecurity. Then, in 2011, the participants were asked if they had ever been diagnosed with asthma.

Those with high job insecurity were younger, had lower levels of education and monthly income, and were more likely to be single than those with no or low job insecurity. In addition, those with high job insecurity were more likely to smoke and have physician-diagnosed depression, and were less likely to engage in regular exercise or have permanent contracts.

Overall, 105 new cases of adult-onset asthma occurred from 2009 to 2011. After adjusting for lifestyle, demographic, and other factors, the results indicated that the risk of developing incident asthma increased by 24% for every 25% increase in the perceived threat of job loss. Additionally, participants who reported high job insecurity had a 60% increased risk of asthma compared with those who had no or low job insecurity.

Although the study was the first to establish a relationship between fears of job loss and incident asthma, the findings were consistent with previous research.

“This is consistent with epidemiological studies, which have shown that psychological stress and, in particular, work-related stress may be risk factors for new-onset asthma,” the study authors wrote. “Our findings also provide a possible explanation for the increased prevalence of respiratory symptoms during the recent economic crisis in the United Kingdom.”

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Job Loss Fears May Raise Asthma Risk

In this age group, such hospitalizations surged 104% between 2005 and 2011.

The number of emergency department visits resulting from drug-related suicide attempts more than doubled between 2005 and 2011, according to 2 reports from the Substance Abuse and Mental Health Services Administration (SAMHSA). The reports, released on August 7, 2014, found such visits have especially increased among middle-aged adults.

The combined findings of the studies were based on data from SAMHSA’s 2005-2011 Drug Abuse Warning Network reports.

Among patients aged 12 years and older, emergency department visits for drug-related suicide attempts increased 51% in that 6-year period, from 151,477 visits in 2005 to 228,277 visits in 2011. Among patients aged 18 to 29 years, such visits increased by 58%, from 47,512 in 2005 to 75,068 in 2011.

Surprisingly, the greatest increase in emergency department visits for drug-related suicide attempts was observed among patients aged 45 to 64 years. In this age group, visits surged 104%, from 28,802 in 2005 to 58,775 in 2011. In addition, patients aged 45 to 64 accounted for 26% of all emergency department visits for drug-related suicide attempts in 2011, up from 19% in 2005.

According to the second report, which analyzed visits among patients aged 45 to 64, 96% of those visits in 2011 involved prescription and OTC medications, with anti-anxiety and insomnia medications involved in 48%, pain relievers in 29%, and antidepressants in 22%. The percentage of visits that involved narcotic pain relievers increased 148% from 2005 to 2011, while those involving benzodiazepines increased 120% in the same period.

The data also indicated an increase in emergency department visits for drug-related suicide attempts involving alcohol. Overall, visits involving alcohol doubled from 10,813 in 2005 to 22,763 in 2011, and those involving alcohol combined with prescription and OTC medications significantly increased by 122%. Visits involving illicit drugs, however, did not significantly increase over the study period, and such drugs were rarely reported as the only type of drug used.

The report also found 22% of patients had no evidence of follow-up care in 2011; however, this percentage was not statistically different from 2005.

Although suicide attempts increased the most among middle-aged adults, most suicide prevention programs and initiatives are aimed to help teenagers, young adults, and the elderly, the report noted.

“This increase in suicide attempts (and suicide death) among middle-aged adults underscores the importance of understanding risk factors for suicide in this age group to ensure that targeted preventive interventions are implemented,” the authors of the study wrote.

More Middle-Aged Adults Hospitalized for Drug-Related Suicide Attempts

In 2012 alone, US health care providers wrote 82.5 opioid and 37.6 benzodiazepine prescriptions per 100 persons.

In the United States, 46 people die each day from prescription painkiller overdoses, according to a research published in a recent Morbidity and Mortality Weekly Report from the US Centers for Disease Control and Prevention (CDC).

To evaluate prescribing practices for opioid pain relievers and benzodiazepines across the country, CDC researchers analyzed prescribing data from IMS Health's National Prescription Audit. 

Overall, they found health care providers wrote 259 million prescriptions for painkillers in 2012, providing 82.5 opioid and 37.6 benzodiazepine prescriptions per 100 persons in the United States. According to the CDC researchers, extended-release/long-acting (ER/LA) opioids accounted for 12.5% of the total estimated amount of opioid prescriptions written nationwide in 2012, while high-dose opioids accounted for 5.1%.

Prescribing rates, however, varied significantly by state. Both opioid and benzodiazepine prescribing rates were higher in the South compared to other regions. Alabama, Tennessee, and West Virginia were the top 3 prescribing states for both opioid painkillers and benzodiazepines. In fact, prescribing rates for both opioids and benzodizapines were 2 or more standard deviations above the national average for these 3 states. For instance, the prescribing rate for all opioid types in Alabama was 2.7 times the rate in Hawaii.

The Northeast, however, had the highest prescribing rates for high-dose and ER/LA opioids. In this region, 17.8% of all opioids prescribed were ER/LA formulations, and prescribing rates for this type of painkiller were 2 or more standard deviations above the average in Maine and Delaware. For high-dose opioids, Delaware, Tennessee, and Nevada had prescribing rates at least 2 standard deviations above the mean.

Although the researchers did not know what factors influenced the regional variations, they suggested the health issues of each state were most likely not different enough to cause such wide disparities in prescribing.

“One possible explanation for the results of this study is the lack of consensus among health care providers on whether and how to use [opioid pain relievers] for chronic noncancer pain,” the 

According to the CDC researchers, the high opioid prescribing rates observed in some states suggest a need to identify and modify prescribing practices that might not balance patient care and safety appropriately. The researchers recommended that developing guidelines for prescribing opioids and other controlled substances might help to align local prescribing rates with current best practices. Reducing prescribing, however, will require education for patients and prescribers, in addition to careful consideration of all available treatment options.

“Patients in all states deserve access to safe and effective, evidence-based medical care, and prescribers should carefully consider the balance between risks and benefits in any pharmacotherapy,” the authors concluded.

Opioids, Benzodiazepines Overprescribed Across the United States

Obese patients who underwent surgery or took medications to lose weight were more satisfied with their results than those who made lifestyle changes. 

Nearly 60% of obese patients are not taking any action to lose weight, according to the results of a recent analysis of the 2012 National Health and Wellness Survey conducted by Eisai Inc and Kantar Health. The study, presented on June 21, 2014, at the 16th International Congress of Endocrinology and the Endocrine Society’s 96th Annual Meeting and Expo in Chicago, also found that among obese individuals who did attempt to lose weight, those who underwent surgery or took prescription medications were more satisfied with their weight loss than those who made lifestyle modifications.

Researchers of the study analyzed the weight-loss satisfaction of 22,927 obese adults and 19,121 obese adults who had at least 1 related comorbidity including type 2 diabetes, hypertension, or dyslipidemia. Patients were categorized as having undergone a weight-loss surgery or using a prescription for weight loss or using self-modifications such as diet, exercise, weight management programs, and over-the-counter medications and supplements to lose weight. Overall satisfaction with current weight-loss methods was analyzed on a scale from 1 (extremely dissatisfied) to 7 (extremely satisfied).

Of the 22,927 obese patients included in the analysis, 58.4% were not attempting to lose weight. This result suggests “the need for more education on obesity awareness/prevention,” the authors of the study noted.

Only 2.3% of patients used surgery or prescription medications to lose weight, while 39.3% were in the self-modification group. The results indicated that patients who used surgery or medications were significantly more satisfied with their weight-loss methods than those who made lifestyle changes. Among obese patients who had weight-loss surgery or took medications, 39.3% reported being extremely or very satisfied, compared with just 20.2% of modification patients. Similar results were observed among obese and overweight patients with comorbidities; 44.4% of patients in the surgery and prescription group were extremely or very satisfied, compared with 19.7% among those in the modification group. Treatment satisfaction did not significantly vary between patients using a prescription and those who had surgery.

“This finding may mean that diet and exercise alone just don’t work for a lot of people,” said lead investigator Z. Jason Wang, PhD, director of Health Economics and Outcomes at Eisai in Woodcliff Lake, NJ, in a press release. “Drug treatment and bariatric surgical procedures should be considered an integral part of weight management for eligible patients to achieve better treatment satisfaction, which may in turn help patients achieve and maintain better long-term weight loss.”

Obese patients who underwent surgery or took medications to lose weight were more satisfied with their results than those who made lifestyle changes.

Weight-Loss Surgery, Prescriptions More Satisfying for Obese Patients

Of college students who used medications to aid study during final exams, 33% obtained the drugs without a doctor’s prescription.

Nearly one-third of college students turn to prescription drugs during final exam time, and an increasing number of them are ordering the drugs from the Internet without a prescription, according to the results of a recent poll.

The poll, now in its second year, was conducted by Zogby Analytics on behalf of the Digital Citizens Alliance, a coalition whose mission is to improve safety and reduce crime on the Internet. A total of 311 current and recently graduated college students completed an online survey from May 1 to May 13, 2014.

Of the students surveyed, 72% said that sharing prescription medications with friends was somewhat or very common among college students. Overall, 32% of students surveyed said they or their friends had taken prescription medications as study aids during final exams. Among those who had used medications, 33% obtained the drugs without a physician’s prescription. Both the percentage of students who used prescription drugs and the percentage of those who obtained them without a prescription were slightly increased compared with the results from the 2013 poll. Men were more likely to use medications to help them study than women; approximately 38% of men reported using prescription drugs, compared with 26% of women.

In addition, 31% of students said they or a friend had shared a legally prescribed medication with someone else, an 8% increase from last year. Students residing in the southern part of the United States were more likely to share prescriptions than those from other regions, the survey found.

A greater percentage of students also reported obtaining prescription medications through the internet this year. Approximately 28% of respondents said they or a friend had ordered drugs online without a prescription, up 13% from 2013.

"We know that there are 19.7 million college students from the 2011 Census. Perhaps more than 5 million are using the Internet to obtain prescription medication to help cope with finals and other high pressure situations," said Adam Benson, Deputy Executive Director of the Digital Citizens Alliance in a press release. "Last year's survey showed there was a large number of students making these purchases. To see an increase like this is a sign that both Universities and parents need to ask some new questions of students."

Of college students who used medications to aid study during final exams, 33% obtained the drugs without a doctor's prescription.

More Stressed College Students Ordering Medications Online

The number of measles cases reported to the Centers for Disease Control and Prevention during the first 5 months of 2014 is the highest reported for that period since 1994.

From January 1, 2014, to May 23, 2014, 288 cases of measles were reported in the United States, according to a 

 in the June 6, 2014, issue of the Centers for Disease Control and Prevention’s 

. This is the largest number of cases reported in 20 years, and almost all of them have been associated with international travel by unvaccinated people.

The Centers for Disease Control and Prevention evaluated measles cases reported by states and found that the number of cases reported for 2014 so far surpasses the highest reported yearly total of cases since measles elimination was declared in 2000. This is also the greatest number of cases that have been reported during the first 5 months of a year since 1994. Patients with measles have ranged in age from 2 weeks to 65 years and 52% were aged 20 years and older. Of the 288 patients, 43 (15%) were hospitalized and no deaths have been reported. Cases have been reported in 18 states and New York City, with most occurring in Ohio (138), California (60), and New York City (26).

Of cases this year, 97% were associated with importations from at least 18 countries. A total of 45 direct importations were reported, 49% of which were in patients returning from the Philippines. Other importations were associated with travel from countries belonging to the World Health Organization Western Pacific, South-East Asia, European, Americas, and Eastern Mediterranean regions.  

The report also found that 15 outbreaks accounted for 79% of reported measles cases, including the largest outbreak reported in the country since elimination. The ongoing outbreak has been associated with 138 cases so far, occurring mostly among unvaccinated Amish communities in Ohio.

A majority of all cases (69%) occurred among unvaccinated patients and 20% were reported among patients with unknown vaccination status. Among unvaccinated patients who contracted measles, 85% refused vaccinations for religious, philosophical, or personal reasons.

Although measles elimination has been maintained and vaccine coverage is high, the report suggests that importations and outbreaks among unvaccinated communities still pose a threat.

“[C]overage varies at the local level, and unvaccinated children tend to cluster geographically, increasing the risk for outbreaks,” the report notes. “Thus, maintaining high measles vaccination coverage is critical to prevent large measles outbreaks in the United States.”

Health care professionals should remind patients traveling internationally about the increased risk for measles and encourage vaccination, the report suggests. The measles, mumps, and rubella (MMR) vaccine is recommended for all children, with the first dose given at age 12 to 15 months and a second dose at age 4 to 6 years. Children and adolescents who have not received 2 appropriately spaced doses are recommended to receive catch-up vaccination. Adults are recommended to receive at least 1 dose of the MMR vaccine, and health care personnel, college students, and international travelers should receive 2 appropriately spaced doses.