M. Alexander Otto

DENVER – Parents who smoke are more likely to ban smoking at home if they have a child younger than age 10 years, if they don’t allow smoking in the car, if there’s just one or two smokers in their house, and if only the father smokes, according to a survey study presented at the annual meeting of the Pediatric Academic Societies.

The findings "suggest opportunities for intervention with smoking households. Some things that come to mind are [if you are caring for] a child who is on the younger side, maybe you’ll have increased traction for [advocating] a smoke-free home. Maybe you want to work on [encouraging a] smoke-free car and smoke-free home synergistically" because the two seem to correlate, said senior author Dr. Jonathan P. Winickoff of the department of pediatrics at Massachusetts General Hospital and Harvard Medical School, both in Boston.

Because homes are where children are most exposed to secondhand smoke, he and his colleagues wanted to see what factors were associated with a home-smoking ban in order to help clinicians know where to focus their efforts.

"We thought that if we could identify what some of these associated factors were, it might give us some clues about how best to intervene," Dr. Winickoff said.

They surveyed 661 smoking parents in seven pediatric practices. Half were white, 22% were black, 18% Hispanic, and 10% other. About half reported that "no one is allowed to smoke anywhere in the house," and that no one had smoked at home in the past 3 months.

Odds ratios in the study were all statistically significant. For example, if there was a child younger than age 5 years at home, the adjusted OR for a smoke-free home was 3.17; for a child aged 6-10 years old, the OR was 2.01. The OR for a smoke-free home was 2.21 if there was just one or two smokers living in the house, and 2.45 if only the father smoked. If parents banned smoking in the car, the OR for a smoke-free home was 4.13.

Other factors made a home-smoking ban less likely. If parents came to the practice for a sick-child visit, the adjusted OR for a smoke-free home was 0.46, which makes sense, Dr. Winickoff said, because smoking parents are more likely to have sicker children.

Being on Medicaid rather than private insurance also made a smoke-free home less likely (OR, 0.46), as did being black (OR, 0.47) or having a parent who smoked more than 10 cigarettes per day (OR, 0.46).

However, because the results were based on parents’ self-reports, they may have underestimated the exposure of children to smoking in the home. "Who wants to admit to their [infant’s] being exposed to secondhand smoke?" Dr. Winickoff asked.

Dr. Winickoff said he had no relevant financial disclosures. The study was funded by the National Cancer Institute, the National Institute on Drug Abuse, the Agency for Healthcare Research and Quality, and the American Academy of Pediatrics.

DENVER – Parents who smoke are more likely to ban smoking at home if they have a child younger than age 10 years, if they don’t allow smoking in the car, if there’s just one or two smokers in their house, and if only the father smokes, according to a survey study presented at the annual meeting of the Pediatric Academic Societies.

The findings "suggest opportunities for intervention with smoking households. Some things that come to mind are [if you are caring for] a child who is on the younger side, maybe you’ll have increased traction for [advocating] a smoke-free home. Maybe you want to work on [encouraging a] smoke-free car and smoke-free home synergistically" because the two seem to correlate, said senior author Dr. Jonathan P. Winickoff of the department of pediatrics at Massachusetts General Hospital and Harvard Medical School, both in Boston.

Because homes are where children are most exposed to secondhand smoke, he and his colleagues wanted to see what factors were associated with a home-smoking ban in order to help clinicians know where to focus their efforts.

"We thought that if we could identify what some of these associated factors were, it might give us some clues about how best to intervene," Dr. Winickoff said.

They surveyed 661 smoking parents in seven pediatric practices. Half were white, 22% were black, 18% Hispanic, and 10% other. About half reported that "no one is allowed to smoke anywhere in the house," and that no one had smoked at home in the past 3 months.

Odds ratios in the study were all statistically significant. For example, if there was a child younger than age 5 years at home, the adjusted OR for a smoke-free home was 3.17; for a child aged 6-10 years old, the OR was 2.01. The OR for a smoke-free home was 2.21 if there was just one or two smokers living in the house, and 2.45 if only the father smoked. If parents banned smoking in the car, the OR for a smoke-free home was 4.13.

Other factors made a home-smoking ban less likely. If parents came to the practice for a sick-child visit, the adjusted OR for a smoke-free home was 0.46, which makes sense, Dr. Winickoff said, because smoking parents are more likely to have sicker children.

Being on Medicaid rather than private insurance also made a smoke-free home less likely (OR, 0.46), as did being black (OR, 0.47) or having a parent who smoked more than 10 cigarettes per day (OR, 0.46).

However, because the results were based on parents’ self-reports, they may have underestimated the exposure of children to smoking in the home. "Who wants to admit to their [infant’s] being exposed to secondhand smoke?" Dr. Winickoff asked.

Dr. Winickoff said he had no relevant financial disclosures. The study was funded by the National Cancer Institute, the National Institute on Drug Abuse, the Agency for Healthcare Research and Quality, and the American Academy of Pediatrics.

DENVER – Parents who smoke are more likely to ban smoking at home if they have a child younger than age 10 years, if they don’t allow smoking in the car, if there’s just one or two smokers in their house, and if only the father smokes, according to a survey study presented at the annual meeting of the Pediatric Academic Societies.

The findings "suggest opportunities for intervention with smoking households. Some things that come to mind are [if you are caring for] a child who is on the younger side, maybe you’ll have increased traction for [advocating] a smoke-free home. Maybe you want to work on [encouraging a] smoke-free car and smoke-free home synergistically" because the two seem to correlate, said senior author Dr. Jonathan P. Winickoff of the department of pediatrics at Massachusetts General Hospital and Harvard Medical School, both in Boston.

Because homes are where children are most exposed to secondhand smoke, he and his colleagues wanted to see what factors were associated with a home-smoking ban in order to help clinicians know where to focus their efforts.

"We thought that if we could identify what some of these associated factors were, it might give us some clues about how best to intervene," Dr. Winickoff said.

They surveyed 661 smoking parents in seven pediatric practices. Half were white, 22% were black, 18% Hispanic, and 10% other. About half reported that "no one is allowed to smoke anywhere in the house," and that no one had smoked at home in the past 3 months.

Odds ratios in the study were all statistically significant. For example, if there was a child younger than age 5 years at home, the adjusted OR for a smoke-free home was 3.17; for a child aged 6-10 years old, the OR was 2.01. The OR for a smoke-free home was 2.21 if there was just one or two smokers living in the house, and 2.45 if only the father smoked. If parents banned smoking in the car, the OR for a smoke-free home was 4.13.

Other factors made a home-smoking ban less likely. If parents came to the practice for a sick-child visit, the adjusted OR for a smoke-free home was 0.46, which makes sense, Dr. Winickoff said, because smoking parents are more likely to have sicker children.

Being on Medicaid rather than private insurance also made a smoke-free home less likely (OR, 0.46), as did being black (OR, 0.47) or having a parent who smoked more than 10 cigarettes per day (OR, 0.46).

However, because the results were based on parents’ self-reports, they may have underestimated the exposure of children to smoking in the home. "Who wants to admit to their [infant’s] being exposed to secondhand smoke?" Dr. Winickoff asked.

Dr. Winickoff said he had no relevant financial disclosures. The study was funded by the National Cancer Institute, the National Institute on Drug Abuse, the Agency for Healthcare Research and Quality, and the American Academy of Pediatrics.

SEATTLE – Patients having heart attacks are more likely to die if their nearest emergency department is temporarily refusing new patients, according to a study that linked heart attack outcomes to hospital diversion logs in four California counties, and that was presented at the annual research meeting of AcademyHealth.

Acute MI death rates are about 3% higher if the closest ED is on 12 or more hours of diversion on the day of the heart attack.

Treatment delays could be the reason, but patients in the study were typically accepted by another ED within a mile. Another possible explanation is that diverted patients were less likely to end up at EDs with readily available and potentially lifesaving catheterization labs, said lead investigator Yu-Chu Shen, Ph.D., an economist at the Naval Postgraduate School in Monterey, Calif.

She and her colleague found a nonsignificant trend toward increased mortality for diversion periods shorter than 12 hours, as well as "an increase of 0.2 percentage points for every hour increase in diversion. This is the first multisite, multicounty study that really quantifies the association" between diversion and acute MI mortality "on a large scale," Dr. Shen said.

The findings are based on Medicare claims data for 11,625 acute MI patients in Los Angeles, San Francisco, San Mateo, and Santa Clara counties who were treated in 2000-2005 at about 150 EDs. The researchers compared mortality outcomes when patients were able to be treated at the nearest ED vs. outcomes when their nearest ED was on diversion, typically because there were no inpatient beds available for new admissions or the catheterization lab was full.

The approximately 3%, statistically significant increase in death rates when hospitals were on 12 or more hours of diversion held true across 30- and 90-day mortality, as well as 9- and 12-month mortality.

For instance, 15% of the 3,541 patients who were able to be admitted to their nearest ED died within 30 days of their heart attack; 19% of the 2,060 whose nearest ED was on 12 or more hours of diversion died within a month, which translated to a regression-adjusted increase of 3.24% (95% confidence interval, 0.60-5.88).

Similarly, when patients’ nearest EDs were accepting new patients, 87% were admitted to a hospital with a catheterization lab; when the nearest hospital was on at least 12 hours of diversion, the number fell to 78%, Dr. Shen said (JAMA 2011;305:2440-7).

The message for physicians is to "do everything you can to keep [the ED] open," said Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas, Dallas.

"Hospitals have different thresholds for closing. Some close at the drop of a hat; others wait until they absolutely" have no choice. "Everybody [seems to have] their own criteria, but it’s really in the patient\'s best interest for hospitals to do everything possible to stay open," said Dr. Livingston, also a contributing editor at JAMA, which published the study online ahead of print to coincide with Dr. Shen’s presentation.

"We chose to publish [the study] because we think it’s an important observation. This shows a broad spectrum of hospitals in different kinds of environments with the same problem. That suggests it is a truly systemic problem, and not just a problem of one particular facility or region," which has been suggested in the past, he said.

And it’s a problem with no easy solutions, he and Dr. Shen agreed, because diversion touches on issues of resource allocation, hospital design, health care markets, competition, and other matters.

But in the short term, there "may need to be criteria that we all agree on for what makes you close. We all ought to agree that those thresholds should be really high," Dr. Livingston said.

To mitigate the adverse health outcomes associated with hospitals on diversion, "the key is increasing flow through emergency departments by moving patients who have been admitted to the hospital out of the [ED] to inpatient areas," Dr. Sandra Schneider said in a statement. A task force of emergency physicians also recommended that hospitals discharge most hospital patients before noon to make more inpatient beds available to emergency patients, and that hospitals make an effort to schedule elective and surgical cases more evenly throughout the week. Dr. Schneider is president of the American College of Emergency Physicians.

Dr. Shen said she has no disclosures. Dr. Livingston said he is a consultant for Texas Instruments. The study was funded by the Robert Wood Johnson Foundation, the National Institutes of Health, and the University of California, San Francisco.

SEATTLE – Patients having heart attacks are more likely to die if their nearest emergency department is temporarily refusing new patients, according to a study that linked heart attack outcomes to hospital diversion logs in four California counties, and that was presented at the annual research meeting of AcademyHealth.

Acute MI death rates are about 3% higher if the closest ED is on 12 or more hours of diversion on the day of the heart attack.

Treatment delays could be the reason, but patients in the study were typically accepted by another ED within a mile. Another possible explanation is that diverted patients were less likely to end up at EDs with readily available and potentially lifesaving catheterization labs, said lead investigator Yu-Chu Shen, Ph.D., an economist at the Naval Postgraduate School in Monterey, Calif.

She and her colleague found a nonsignificant trend toward increased mortality for diversion periods shorter than 12 hours, as well as "an increase of 0.2 percentage points for every hour increase in diversion. This is the first multisite, multicounty study that really quantifies the association" between diversion and acute MI mortality "on a large scale," Dr. Shen said.

The findings are based on Medicare claims data for 11,625 acute MI patients in Los Angeles, San Francisco, San Mateo, and Santa Clara counties who were treated in 2000-2005 at about 150 EDs. The researchers compared mortality outcomes when patients were able to be treated at the nearest ED vs. outcomes when their nearest ED was on diversion, typically because there were no inpatient beds available for new admissions or the catheterization lab was full.

The approximately 3%, statistically significant increase in death rates when hospitals were on 12 or more hours of diversion held true across 30- and 90-day mortality, as well as 9- and 12-month mortality.

For instance, 15% of the 3,541 patients who were able to be admitted to their nearest ED died within 30 days of their heart attack; 19% of the 2,060 whose nearest ED was on 12 or more hours of diversion died within a month, which translated to a regression-adjusted increase of 3.24% (95% confidence interval, 0.60-5.88).

Similarly, when patients’ nearest EDs were accepting new patients, 87% were admitted to a hospital with a catheterization lab; when the nearest hospital was on at least 12 hours of diversion, the number fell to 78%, Dr. Shen said (JAMA 2011;305:2440-7).

The message for physicians is to "do everything you can to keep [the ED] open," said Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas, Dallas.

"Hospitals have different thresholds for closing. Some close at the drop of a hat; others wait until they absolutely" have no choice. "Everybody [seems to have] their own criteria, but it’s really in the patient\'s best interest for hospitals to do everything possible to stay open," said Dr. Livingston, also a contributing editor at JAMA, which published the study online ahead of print to coincide with Dr. Shen’s presentation.

"We chose to publish [the study] because we think it’s an important observation. This shows a broad spectrum of hospitals in different kinds of environments with the same problem. That suggests it is a truly systemic problem, and not just a problem of one particular facility or region," which has been suggested in the past, he said.

And it’s a problem with no easy solutions, he and Dr. Shen agreed, because diversion touches on issues of resource allocation, hospital design, health care markets, competition, and other matters.

But in the short term, there "may need to be criteria that we all agree on for what makes you close. We all ought to agree that those thresholds should be really high," Dr. Livingston said.

To mitigate the adverse health outcomes associated with hospitals on diversion, "the key is increasing flow through emergency departments by moving patients who have been admitted to the hospital out of the [ED] to inpatient areas," Dr. Sandra Schneider said in a statement. A task force of emergency physicians also recommended that hospitals discharge most hospital patients before noon to make more inpatient beds available to emergency patients, and that hospitals make an effort to schedule elective and surgical cases more evenly throughout the week. Dr. Schneider is president of the American College of Emergency Physicians.

Dr. Shen said she has no disclosures. Dr. Livingston said he is a consultant for Texas Instruments. The study was funded by the Robert Wood Johnson Foundation, the National Institutes of Health, and the University of California, San Francisco.

SEATTLE – Patients having heart attacks are more likely to die if their nearest emergency department is temporarily refusing new patients, according to a study that linked heart attack outcomes to hospital diversion logs in four California counties, and that was presented at the annual research meeting of AcademyHealth.

Acute MI death rates are about 3% higher if the closest ED is on 12 or more hours of diversion on the day of the heart attack.

Treatment delays could be the reason, but patients in the study were typically accepted by another ED within a mile. Another possible explanation is that diverted patients were less likely to end up at EDs with readily available and potentially lifesaving catheterization labs, said lead investigator Yu-Chu Shen, Ph.D., an economist at the Naval Postgraduate School in Monterey, Calif.

She and her colleague found a nonsignificant trend toward increased mortality for diversion periods shorter than 12 hours, as well as "an increase of 0.2 percentage points for every hour increase in diversion. This is the first multisite, multicounty study that really quantifies the association" between diversion and acute MI mortality "on a large scale," Dr. Shen said.

The findings are based on Medicare claims data for 11,625 acute MI patients in Los Angeles, San Francisco, San Mateo, and Santa Clara counties who were treated in 2000-2005 at about 150 EDs. The researchers compared mortality outcomes when patients were able to be treated at the nearest ED vs. outcomes when their nearest ED was on diversion, typically because there were no inpatient beds available for new admissions or the catheterization lab was full.

The approximately 3%, statistically significant increase in death rates when hospitals were on 12 or more hours of diversion held true across 30- and 90-day mortality, as well as 9- and 12-month mortality.

For instance, 15% of the 3,541 patients who were able to be admitted to their nearest ED died within 30 days of their heart attack; 19% of the 2,060 whose nearest ED was on 12 or more hours of diversion died within a month, which translated to a regression-adjusted increase of 3.24% (95% confidence interval, 0.60-5.88).

Similarly, when patients’ nearest EDs were accepting new patients, 87% were admitted to a hospital with a catheterization lab; when the nearest hospital was on at least 12 hours of diversion, the number fell to 78%, Dr. Shen said (JAMA 2011;305:2440-7).

The message for physicians is to "do everything you can to keep [the ED] open," said Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas, Dallas.

"Hospitals have different thresholds for closing. Some close at the drop of a hat; others wait until they absolutely" have no choice. "Everybody [seems to have] their own criteria, but it’s really in the patient\'s best interest for hospitals to do everything possible to stay open," said Dr. Livingston, also a contributing editor at JAMA, which published the study online ahead of print to coincide with Dr. Shen’s presentation.

"We chose to publish [the study] because we think it’s an important observation. This shows a broad spectrum of hospitals in different kinds of environments with the same problem. That suggests it is a truly systemic problem, and not just a problem of one particular facility or region," which has been suggested in the past, he said.

And it’s a problem with no easy solutions, he and Dr. Shen agreed, because diversion touches on issues of resource allocation, hospital design, health care markets, competition, and other matters.

But in the short term, there "may need to be criteria that we all agree on for what makes you close. We all ought to agree that those thresholds should be really high," Dr. Livingston said.

To mitigate the adverse health outcomes associated with hospitals on diversion, "the key is increasing flow through emergency departments by moving patients who have been admitted to the hospital out of the [ED] to inpatient areas," Dr. Sandra Schneider said in a statement. A task force of emergency physicians also recommended that hospitals discharge most hospital patients before noon to make more inpatient beds available to emergency patients, and that hospitals make an effort to schedule elective and surgical cases more evenly throughout the week. Dr. Schneider is president of the American College of Emergency Physicians.

Dr. Shen said she has no disclosures. Dr. Livingston said he is a consultant for Texas Instruments. The study was funded by the Robert Wood Johnson Foundation, the National Institutes of Health, and the University of California, San Francisco.

SEATTLE – Patients having heart attacks are more likely to die if their nearest emergency department is temporarily refusing new patients, according to a study that linked heart attack outcomes to hospital diversion logs in four California counties, and that was presented at the annual research meeting of AcademyHealth.

Acute MI death rates are about 3% higher if the closest ED is on 12 or more hours of diversion on the day of the heart attack.

Treatment delays could be the reason, but patients in the study were typically accepted by another ED within a mile. Another possible explanation is that diverted patients were less likely to end up at EDs with readily available and potentially lifesaving catheterization labs, said lead investigator Yu-Chu Shen, Ph.D., an economist at the Naval Postgraduate School in Monterey, Calif.

She and her colleague found a nonsignificant trend toward increased mortality for diversion periods shorter than 12 hours, as well as "an increase of 0.2 percentage points for every hour increase in diversion. This is the first multisite, multicounty study that really quantifies the association" between diversion and acute MI mortality "on a large scale," Dr. Shen said.

The findings are based on Medicare claims data for 11,625 acute MI patients in Los Angeles, San Francisco, San Mateo, and Santa Clara counties who were treated in 2000-2005 at about 150 EDs. The researchers compared mortality outcomes when patients were able to be treated at the nearest ED vs. outcomes when their nearest ED was on diversion, typically because there were no inpatient beds available for new admissions or the catheterization lab was full.

The approximately 3%, statistically significant increase in death rates when hospitals were on 12 or more hours of diversion held true across 30- and 90-day mortality, as well as 9- and 12-month mortality.

For instance, 15% of the 3,541 patients who were able to be admitted to their nearest ED died within 30 days of their heart attack; 19% of the 2,060 whose nearest ED was on 12 or more hours of diversion died within a month, which translated to a regression-adjusted increase of 3.24% (95% confidence interval, 0.60-5.88).

Similarly, when patients’ nearest EDs were accepting new patients, 87% were admitted to a hospital with a catheterization lab; when the nearest hospital was on at least 12 hours of diversion, the number fell to 78%, Dr. Shen said (JAMA 2011;305:2440-7).

The message for physicians is to "do everything you can to keep [the ED] open," said Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas, Dallas.

"Hospitals have different thresholds for closing. Some close at the drop of a hat; others wait until they absolutely" have no choice. "Everybody [seems to have] their own criteria, but it’s really in the patient\'s best interest for hospitals to do everything possible to stay open," said Dr. Livingston, also a contributing editor at JAMA, which published the study online ahead of print to coincide with Dr. Shen’s presentation.

"We chose to publish [the study] because we think it’s an important observation. This shows a broad spectrum of hospitals in different kinds of environments with the same problem. That suggests it is a truly systemic problem, and not just a problem of one particular facility or region," which has been suggested in the past, he said.

And it’s a problem with no easy solutions, he and Dr. Shen agreed, because diversion touches on issues of resource allocation, hospital design, health care markets, competition, and other matters.

But in the short term, there "may need to be criteria that we all agree on for what makes you close. We all ought to agree that those thresholds should be really high," Dr. Livingston said.

To mitigate the adverse health outcomes associated with hospitals on diversion, "the key is increasing flow through emergency departments by moving patients who have been admitted to the hospital out of the [ED] to inpatient areas," Dr. Sandra Schneider said in a statement. A task force of emergency physicians also recommended that hospitals discharge most hospital patients before noon to make more inpatient beds available to emergency patients, and that hospitals make an effort to schedule elective and surgical cases more evenly throughout the week. Dr. Schneider is president of the American College of Emergency Physicians.

Dr. Shen said she has no disclosures. Dr. Livingston said he is a consultant for Texas Instruments. The study was funded by the Robert Wood Johnson Foundation, the National Institutes of Health, and the University of California, San Francisco.

SEATTLE – Patients having heart attacks are more likely to die if their nearest emergency department is temporarily refusing new patients, according to a study that linked heart attack outcomes to hospital diversion logs in four California counties, and that was presented at the annual research meeting of AcademyHealth.

Acute MI death rates are about 3% higher if the closest ED is on 12 or more hours of diversion on the day of the heart attack.

Treatment delays could be the reason, but patients in the study were typically accepted by another ED within a mile. Another possible explanation is that diverted patients were less likely to end up at EDs with readily available and potentially lifesaving catheterization labs, said lead investigator Yu-Chu Shen, Ph.D., an economist at the Naval Postgraduate School in Monterey, Calif.

She and her colleague found a nonsignificant trend toward increased mortality for diversion periods shorter than 12 hours, as well as "an increase of 0.2 percentage points for every hour increase in diversion. This is the first multisite, multicounty study that really quantifies the association" between diversion and acute MI mortality "on a large scale," Dr. Shen said.

The findings are based on Medicare claims data for 11,625 acute MI patients in Los Angeles, San Francisco, San Mateo, and Santa Clara counties who were treated in 2000-2005 at about 150 EDs. The researchers compared mortality outcomes when patients were able to be treated at the nearest ED vs. outcomes when their nearest ED was on diversion, typically because there were no inpatient beds available for new admissions or the catheterization lab was full.

The approximately 3%, statistically significant increase in death rates when hospitals were on 12 or more hours of diversion held true across 30- and 90-day mortality, as well as 9- and 12-month mortality.

For instance, 15% of the 3,541 patients who were able to be admitted to their nearest ED died within 30 days of their heart attack; 19% of the 2,060 whose nearest ED was on 12 or more hours of diversion died within a month, which translated to a regression-adjusted increase of 3.24% (95% confidence interval, 0.60-5.88).

Similarly, when patients’ nearest EDs were accepting new patients, 87% were admitted to a hospital with a catheterization lab; when the nearest hospital was on at least 12 hours of diversion, the number fell to 78%, Dr. Shen said (JAMA 2011;305:2440-7).

The message for physicians is to "do everything you can to keep [the ED] open," said Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas, Dallas.

"Hospitals have different thresholds for closing. Some close at the drop of a hat; others wait until they absolutely" have no choice. "Everybody [seems to have] their own criteria, but it’s really in the patient\'s best interest for hospitals to do everything possible to stay open," said Dr. Livingston, also a contributing editor at JAMA, which published the study online ahead of print to coincide with Dr. Shen’s presentation.

"We chose to publish [the study] because we think it’s an important observation. This shows a broad spectrum of hospitals in different kinds of environments with the same problem. That suggests it is a truly systemic problem, and not just a problem of one particular facility or region," which has been suggested in the past, he said.

And it’s a problem with no easy solutions, he and Dr. Shen agreed, because diversion touches on issues of resource allocation, hospital design, health care markets, competition, and other matters.

But in the short term, there "may need to be criteria that we all agree on for what makes you close. We all ought to agree that those thresholds should be really high," Dr. Livingston said.

To mitigate the adverse health outcomes associated with hospitals on diversion, "the key is increasing flow through emergency departments by moving patients who have been admitted to the hospital out of the [ED] to inpatient areas," Dr. Sandra Schneider said in a statement. A task force of emergency physicians also recommended that hospitals discharge most hospital patients before noon to make more inpatient beds available to emergency patients, and that hospitals make an effort to schedule elective and surgical cases more evenly throughout the week. Dr. Schneider is president of the American College of Emergency Physicians.

Dr. Shen said she has no disclosures. Dr. Livingston said he is a consultant for Texas Instruments. The study was funded by the Robert Wood Johnson Foundation, the National Institutes of Health, and the University of California, San Francisco.

SEATTLE – Patients having heart attacks are more likely to die if their nearest emergency department is temporarily refusing new patients, according to a study that linked heart attack outcomes to hospital diversion logs in four California counties, and that was presented at the annual research meeting of AcademyHealth.

Acute MI death rates are about 3% higher if the closest ED is on 12 or more hours of diversion on the day of the heart attack.

Treatment delays could be the reason, but patients in the study were typically accepted by another ED within a mile. Another possible explanation is that diverted patients were less likely to end up at EDs with readily available and potentially lifesaving catheterization labs, said lead investigator Yu-Chu Shen, Ph.D., an economist at the Naval Postgraduate School in Monterey, Calif.

She and her colleague found a nonsignificant trend toward increased mortality for diversion periods shorter than 12 hours, as well as "an increase of 0.2 percentage points for every hour increase in diversion. This is the first multisite, multicounty study that really quantifies the association" between diversion and acute MI mortality "on a large scale," Dr. Shen said.

The findings are based on Medicare claims data for 11,625 acute MI patients in Los Angeles, San Francisco, San Mateo, and Santa Clara counties who were treated in 2000-2005 at about 150 EDs. The researchers compared mortality outcomes when patients were able to be treated at the nearest ED vs. outcomes when their nearest ED was on diversion, typically because there were no inpatient beds available for new admissions or the catheterization lab was full.

The approximately 3%, statistically significant increase in death rates when hospitals were on 12 or more hours of diversion held true across 30- and 90-day mortality, as well as 9- and 12-month mortality.

For instance, 15% of the 3,541 patients who were able to be admitted to their nearest ED died within 30 days of their heart attack; 19% of the 2,060 whose nearest ED was on 12 or more hours of diversion died within a month, which translated to a regression-adjusted increase of 3.24% (95% confidence interval, 0.60-5.88).

Similarly, when patients’ nearest EDs were accepting new patients, 87% were admitted to a hospital with a catheterization lab; when the nearest hospital was on at least 12 hours of diversion, the number fell to 78%, Dr. Shen said (JAMA 2011;305:2440-7).

The message for physicians is to "do everything you can to keep [the ED] open," said Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas, Dallas.

"Hospitals have different thresholds for closing. Some close at the drop of a hat; others wait until they absolutely" have no choice. "Everybody [seems to have] their own criteria, but it’s really in the patient\'s best interest for hospitals to do everything possible to stay open," said Dr. Livingston, also a contributing editor at JAMA, which published the study online ahead of print to coincide with Dr. Shen’s presentation.

"We chose to publish [the study] because we think it’s an important observation. This shows a broad spectrum of hospitals in different kinds of environments with the same problem. That suggests it is a truly systemic problem, and not just a problem of one particular facility or region," which has been suggested in the past, he said.

And it’s a problem with no easy solutions, he and Dr. Shen agreed, because diversion touches on issues of resource allocation, hospital design, health care markets, competition, and other matters.

But in the short term, there "may need to be criteria that we all agree on for what makes you close. We all ought to agree that those thresholds should be really high," Dr. Livingston said.

To mitigate the adverse health outcomes associated with hospitals on diversion, "the key is increasing flow through emergency departments by moving patients who have been admitted to the hospital out of the [ED] to inpatient areas," Dr. Sandra Schneider said in a statement. A task force of emergency physicians also recommended that hospitals discharge most hospital patients before noon to make more inpatient beds available to emergency patients, and that hospitals make an effort to schedule elective and surgical cases more evenly throughout the week. Dr. Schneider is president of the American College of Emergency Physicians.

Dr. Shen said she has no disclosures. Dr. Livingston said he is a consultant for Texas Instruments. The study was funded by the Robert Wood Johnson Foundation, the National Institutes of Health, and the University of California, San Francisco.

HONOLULU – Deployment of a parent in Afghanistan or Iraq increases the risk of a child’s hospitalization for mental health problems by about 10%, compared with other children in military families, according to a study from the Uniformed Services University of the Health Sciences in Bethesda, Md.

"The longer you are deployed, the more chance of a hospitalization for [your] child," said Dr. Jeffrey Millegan, a disaster and preventive psychiatry fellow at the university and a lieutenant commander in the Navy.

Children with past psychiatric problems are at greatest risk, followed by those with civilian mothers who have their own psychiatric issues. "If the civilian mother has more psychiatric problems during the deployment, that leads to worse outcomes in the child," he said at the annual meeting of the American Psychiatric Association.

Pediatricians and primary care providers should keep the findings in mind when dealing with children from military families.

"Be aware of the fact that these kids may be more vulnerable while [a] parent is deployed," Dr. Millegan said. Ask questions during routine visits about how things are going at home and how kids are dealing with having a parent away, he recommends If problems are identified during routine visits, take the kids to outpatient psychiatric care before they turn into issues that require hospitalization, he added.

To arrive at the findings, he and his colleagues linked the medical records of 377,565 children aged 9-17 years to their parents’ service records from fiscal years 2007-2009. In all, 32% of children and adolescents had a parent who deployed to Afghanistan or Iraq. Psychiatric hospitalizations were identified by ICD-9 codes.

The patients’ mean age was 12.5 years; half were boys, and most had married parents. The mean age of the deployed parent was 38 years; more than 90% were fathers away for a median of 11 months.

The adjusted odds ratio for hospitalization of a child with a deployed parent was 1.10, and 1.12 for deployments longer than 6 months, both findings statistically significant. Hospitalizations lasted about a month on average.

Typically, families do poorly at the start of a deployment, get into a groove toward the middle, and face another tough readjustment as the deployment comes to an end, Dr. Millegan said.

It can be especially hard on adolescents already struggling with boundary and transition issues. "Eleven months is a very significant length of time during a period when a lot of big developmental things are going on," he said.

In addition to paying extra attention to children’s psychological states, it’s also important to keep a close eye on family dynamics during deployment. "Be in tune with the mother and other people in the family," he said. "Everybody affects everybody else. They are all intertwined."

Dr. Millegan said he has no disclosures. The study received no outside funding.

HONOLULU – Deployment of a parent in Afghanistan or Iraq increases the risk of a child’s hospitalization for mental health problems by about 10%, compared with other children in military families, according to a study from the Uniformed Services University of the Health Sciences in Bethesda, Md.

"The longer you are deployed, the more chance of a hospitalization for [your] child," said Dr. Jeffrey Millegan, a disaster and preventive psychiatry fellow at the university and a lieutenant commander in the Navy.

Children with past psychiatric problems are at greatest risk, followed by those with civilian mothers who have their own psychiatric issues. "If the civilian mother has more psychiatric problems during the deployment, that leads to worse outcomes in the child," he said at the annual meeting of the American Psychiatric Association.

Pediatricians and primary care providers should keep the findings in mind when dealing with children from military families.

"Be aware of the fact that these kids may be more vulnerable while [a] parent is deployed," Dr. Millegan said. Ask questions during routine visits about how things are going at home and how kids are dealing with having a parent away, he recommends If problems are identified during routine visits, take the kids to outpatient psychiatric care before they turn into issues that require hospitalization, he added.

To arrive at the findings, he and his colleagues linked the medical records of 377,565 children aged 9-17 years to their parents’ service records from fiscal years 2007-2009. In all, 32% of children and adolescents had a parent who deployed to Afghanistan or Iraq. Psychiatric hospitalizations were identified by ICD-9 codes.

The patients’ mean age was 12.5 years; half were boys, and most had married parents. The mean age of the deployed parent was 38 years; more than 90% were fathers away for a median of 11 months.

The adjusted odds ratio for hospitalization of a child with a deployed parent was 1.10, and 1.12 for deployments longer than 6 months, both findings statistically significant. Hospitalizations lasted about a month on average.

Typically, families do poorly at the start of a deployment, get into a groove toward the middle, and face another tough readjustment as the deployment comes to an end, Dr. Millegan said.

It can be especially hard on adolescents already struggling with boundary and transition issues. "Eleven months is a very significant length of time during a period when a lot of big developmental things are going on," he said.

In addition to paying extra attention to children’s psychological states, it’s also important to keep a close eye on family dynamics during deployment. "Be in tune with the mother and other people in the family," he said. "Everybody affects everybody else. They are all intertwined."

Dr. Millegan said he has no disclosures. The study received no outside funding.

HONOLULU – Deployment of a parent in Afghanistan or Iraq increases the risk of a child’s hospitalization for mental health problems by about 10%, compared with other children in military families, according to a study from the Uniformed Services University of the Health Sciences in Bethesda, Md.

"The longer you are deployed, the more chance of a hospitalization for [your] child," said Dr. Jeffrey Millegan, a disaster and preventive psychiatry fellow at the university and a lieutenant commander in the Navy.

Children with past psychiatric problems are at greatest risk, followed by those with civilian mothers who have their own psychiatric issues. "If the civilian mother has more psychiatric problems during the deployment, that leads to worse outcomes in the child," he said at the annual meeting of the American Psychiatric Association.

Pediatricians and primary care providers should keep the findings in mind when dealing with children from military families.

"Be aware of the fact that these kids may be more vulnerable while [a] parent is deployed," Dr. Millegan said. Ask questions during routine visits about how things are going at home and how kids are dealing with having a parent away, he recommends If problems are identified during routine visits, take the kids to outpatient psychiatric care before they turn into issues that require hospitalization, he added.

To arrive at the findings, he and his colleagues linked the medical records of 377,565 children aged 9-17 years to their parents’ service records from fiscal years 2007-2009. In all, 32% of children and adolescents had a parent who deployed to Afghanistan or Iraq. Psychiatric hospitalizations were identified by ICD-9 codes.

The patients’ mean age was 12.5 years; half were boys, and most had married parents. The mean age of the deployed parent was 38 years; more than 90% were fathers away for a median of 11 months.

The adjusted odds ratio for hospitalization of a child with a deployed parent was 1.10, and 1.12 for deployments longer than 6 months, both findings statistically significant. Hospitalizations lasted about a month on average.

Typically, families do poorly at the start of a deployment, get into a groove toward the middle, and face another tough readjustment as the deployment comes to an end, Dr. Millegan said.

It can be especially hard on adolescents already struggling with boundary and transition issues. "Eleven months is a very significant length of time during a period when a lot of big developmental things are going on," he said.

In addition to paying extra attention to children’s psychological states, it’s also important to keep a close eye on family dynamics during deployment. "Be in tune with the mother and other people in the family," he said. "Everybody affects everybody else. They are all intertwined."

Dr. Millegan said he has no disclosures. The study received no outside funding.

HONOLULU – Deployment of a parent in Afghanistan or Iraq increases the risk of a child’s hospitalization for mental health problems by about 10%, compared with other children in military families, according to a study from the Uniformed Services University of the Health Sciences in Bethesda, Md.

"The longer you are deployed, the more chance of a hospitalization for [your] child," said Dr. Jeffrey Millegan, a disaster and preventive psychiatry fellow at the university and a lieutenant commander in the Navy.

Children with past psychiatric problems are at greatest risk, followed by those with civilian mothers who have their own psychiatric issues. "If the civilian mother has more psychiatric problems during the deployment, that leads to worse outcomes in the child," he said at the annual meeting of the American Psychiatric Association.

Pediatricians and primary care providers should keep the findings in mind when dealing with children from military families.

"Be aware of the fact that these kids may be more vulnerable while [a] parent is deployed," Dr. Millegan said. Ask questions during routine visits about how things are going at home and how kids are dealing with having a parent away, he recommends If problems are identified during routine visits, take the kids to outpatient psychiatric care before they turn into issues that require hospitalization, he added.

To arrive at the findings, he and his colleagues linked the medical records of 377,565 children aged 9-17 years to their parents’ service records from fiscal years 2007-2009. In all, 32% of children and adolescents had a parent who deployed to Afghanistan or Iraq. Psychiatric hospitalizations were identified by ICD-9 codes.

The patients’ mean age was 12.5 years; half were boys, and most had married parents. The mean age of the deployed parent was 38 years; more than 90% were fathers away for a median of 11 months.

The adjusted odds ratio for hospitalization of a child with a deployed parent was 1.10, and 1.12 for deployments longer than 6 months, both findings statistically significant. Hospitalizations lasted about a month on average.

Typically, families do poorly at the start of a deployment, get into a groove toward the middle, and face another tough readjustment as the deployment comes to an end, Dr. Millegan said.

It can be especially hard on adolescents already struggling with boundary and transition issues. "Eleven months is a very significant length of time during a period when a lot of big developmental things are going on," he said.

In addition to paying extra attention to children’s psychological states, it’s also important to keep a close eye on family dynamics during deployment. "Be in tune with the mother and other people in the family," he said. "Everybody affects everybody else. They are all intertwined."

Dr. Millegan said he has no disclosures. The study received no outside funding.

HONOLULU – Deployment of a parent in Afghanistan or Iraq increases the risk of a child’s hospitalization for mental health problems by about 10%, compared with other children in military families, according to a study from the Uniformed Services University of the Health Sciences in Bethesda, Md.

"The longer you are deployed, the more chance of a hospitalization for [your] child," said Dr. Jeffrey Millegan, a disaster and preventive psychiatry fellow at the university and a lieutenant commander in the Navy.

Children with past psychiatric problems are at greatest risk, followed by those with civilian mothers who have their own psychiatric issues. "If the civilian mother has more psychiatric problems during the deployment, that leads to worse outcomes in the child," he said at the annual meeting of the American Psychiatric Association.

Pediatricians and primary care providers should keep the findings in mind when dealing with children from military families.

"Be aware of the fact that these kids may be more vulnerable while [a] parent is deployed," Dr. Millegan said. Ask questions during routine visits about how things are going at home and how kids are dealing with having a parent away, he recommends If problems are identified during routine visits, take the kids to outpatient psychiatric care before they turn into issues that require hospitalization, he added.

To arrive at the findings, he and his colleagues linked the medical records of 377,565 children aged 9-17 years to their parents’ service records from fiscal years 2007-2009. In all, 32% of children and adolescents had a parent who deployed to Afghanistan or Iraq. Psychiatric hospitalizations were identified by ICD-9 codes.

The patients’ mean age was 12.5 years; half were boys, and most had married parents. The mean age of the deployed parent was 38 years; more than 90% were fathers away for a median of 11 months.

The adjusted odds ratio for hospitalization of a child with a deployed parent was 1.10, and 1.12 for deployments longer than 6 months, both findings statistically significant. Hospitalizations lasted about a month on average.

Typically, families do poorly at the start of a deployment, get into a groove toward the middle, and face another tough readjustment as the deployment comes to an end, Dr. Millegan said.

It can be especially hard on adolescents already struggling with boundary and transition issues. "Eleven months is a very significant length of time during a period when a lot of big developmental things are going on," he said.

In addition to paying extra attention to children’s psychological states, it’s also important to keep a close eye on family dynamics during deployment. "Be in tune with the mother and other people in the family," he said. "Everybody affects everybody else. They are all intertwined."

Dr. Millegan said he has no disclosures. The study received no outside funding.

HONOLULU – Deployment of a parent in Afghanistan or Iraq increases the risk of a child’s hospitalization for mental health problems by about 10%, compared with other children in military families, according to a study from the Uniformed Services University of the Health Sciences in Bethesda, Md.

"The longer you are deployed, the more chance of a hospitalization for [your] child," said Dr. Jeffrey Millegan, a disaster and preventive psychiatry fellow at the university and a lieutenant commander in the Navy.

Children with past psychiatric problems are at greatest risk, followed by those with civilian mothers who have their own psychiatric issues. "If the civilian mother has more psychiatric problems during the deployment, that leads to worse outcomes in the child," he said at the annual meeting of the American Psychiatric Association.

Pediatricians and primary care providers should keep the findings in mind when dealing with children from military families.

"Be aware of the fact that these kids may be more vulnerable while [a] parent is deployed," Dr. Millegan said. Ask questions during routine visits about how things are going at home and how kids are dealing with having a parent away, he recommends If problems are identified during routine visits, take the kids to outpatient psychiatric care before they turn into issues that require hospitalization, he added.

To arrive at the findings, he and his colleagues linked the medical records of 377,565 children aged 9-17 years to their parents’ service records from fiscal years 2007-2009. In all, 32% of children and adolescents had a parent who deployed to Afghanistan or Iraq. Psychiatric hospitalizations were identified by ICD-9 codes.

The patients’ mean age was 12.5 years; half were boys, and most had married parents. The mean age of the deployed parent was 38 years; more than 90% were fathers away for a median of 11 months.

The adjusted odds ratio for hospitalization of a child with a deployed parent was 1.10, and 1.12 for deployments longer than 6 months, both findings statistically significant. Hospitalizations lasted about a month on average.

Typically, families do poorly at the start of a deployment, get into a groove toward the middle, and face another tough readjustment as the deployment comes to an end, Dr. Millegan said.

It can be especially hard on adolescents already struggling with boundary and transition issues. "Eleven months is a very significant length of time during a period when a lot of big developmental things are going on," he said.

In addition to paying extra attention to children’s psychological states, it’s also important to keep a close eye on family dynamics during deployment. "Be in tune with the mother and other people in the family," he said. "Everybody affects everybody else. They are all intertwined."

Dr. Millegan said he has no disclosures. The study received no outside funding.

SEATTLE – Gastric bypass did not extend the lives of older, severely obese patients in a Department of Veterans Affairs Study.

Though bariatric surgery is often assumed to extend lives, "physicians should advise patients such as those examined here that there is no survival benefit at nearly 7 years, and the longer-term survival benefit is still unknown," said lead author Matthew L. Maciejewski, Ph.D., of Duke University, Durham, N.C., and an investigator at the Center for Health Services Research in Primary Care at the Durham VA Medical Center at the annual research meeting of AcademyHealth.

He and his colleagues compared 850 VA Roux-en-Y gastric bypass patients with 41,244 nonsurgical controls. The operations were conducted between 2000 and 2006. The average age in the bypass group was 50 years and average body mass index was 47 kg/m²; 74% were men. The average age in the control group was 55 years and average BMI was 42 kg/m²; 92% were men.

At first glance, bypass patients appeared to do better after a mean follow-up of 6.7 years. Although 6.8% had died after 6 years, for instance, 15.2% had died in the control group (hazard ratio, 0.64; 95% confidence interval, 0.51-0.80).

The apparent advantage, however, diminished after covariate adjustment (HR 0.80; 95% CI 0.63-0.99), and vanished when patients were propensity matched one to one with the most similar controls based on age, sex, race, marital status, BMI, diagnosis related groups (DRG), and other factors (HR, 0.83; 95% CI, 0.61-1.14). When the investigators further adjusted for the start time, the advantage disappeared (HR, 0.94, 95% CI, 0.64-1.39).

In short, "the use of bariatric surgery, compared with usual care, was not associated with decreased mortality," Dr. Maciejewski and his colleagues concluded (JAMA 2011 June 12 [doi:10.1001/jama.2011.817]).

The results mean "you should not select people [for surgery] thinking they are going to live longer. If someone comes to you and says, ‘I want bariatric surgery because it’s going to improve my longevity,’ the answer is ‘no.’ There’s no study that definitively shows that might even be the case," said coauthor Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas Southwestern Medical School at Dallas.

Selection instead should be based on immediate concerns. Out-of-control diabetes, a patient too big to get around, sleep apnea, failing joints, and other weight-related problems make "surgery a reasonable option," said Dr. Livingston, who’s been performing bariatric surgeries since 1993.

The findings contradict previous studies suggesting a survival benefit for bariatric surgery, but those studies were largely of younger women with inherently lower obesity-related mortality risks, or foreign studies that don’t translate well to the United States, he said.

In contrast, the veterans in the study – older, obese, and comorbid – "die at a very high rate, so we expected [surgery to demonstrate] a big benefit in a short amount of time. The belief is if you take people that are really sick with diabetes, hypertension, and sleep apnea, and get a lot of weight off them, they live longer. We didn’t see it. This is the first study to show that doesn’t actually happen," he said.

The researchers have previously shown that bariatric surgery did not cut the health care costs of their cohort within 3 years (Med. Care 2010;48:989-98).

Dr. Maciejewski is paid consultant to Takeda Pharmaceuticals and Novartis and owns stock in Amgen. Dr. Livingston is a paid consultant to Texas Instruments. The study was funded by the Department of Veterans Affairs.

SEATTLE – Gastric bypass did not extend the lives of older, severely obese patients in a Department of Veterans Affairs Study.

Though bariatric surgery is often assumed to extend lives, "physicians should advise patients such as those examined here that there is no survival benefit at nearly 7 years, and the longer-term survival benefit is still unknown," said lead author Matthew L. Maciejewski, Ph.D., of Duke University, Durham, N.C., and an investigator at the Center for Health Services Research in Primary Care at the Durham VA Medical Center at the annual research meeting of AcademyHealth.

He and his colleagues compared 850 VA Roux-en-Y gastric bypass patients with 41,244 nonsurgical controls. The operations were conducted between 2000 and 2006. The average age in the bypass group was 50 years and average body mass index was 47 kg/m²; 74% were men. The average age in the control group was 55 years and average BMI was 42 kg/m²; 92% were men.

At first glance, bypass patients appeared to do better after a mean follow-up of 6.7 years. Although 6.8% had died after 6 years, for instance, 15.2% had died in the control group (hazard ratio, 0.64; 95% confidence interval, 0.51-0.80).

The apparent advantage, however, diminished after covariate adjustment (HR 0.80; 95% CI 0.63-0.99), and vanished when patients were propensity matched one to one with the most similar controls based on age, sex, race, marital status, BMI, diagnosis related groups (DRG), and other factors (HR, 0.83; 95% CI, 0.61-1.14). When the investigators further adjusted for the start time, the advantage disappeared (HR, 0.94, 95% CI, 0.64-1.39).

In short, "the use of bariatric surgery, compared with usual care, was not associated with decreased mortality," Dr. Maciejewski and his colleagues concluded (JAMA 2011 June 12 [doi:10.1001/jama.2011.817]).

The results mean "you should not select people [for surgery] thinking they are going to live longer. If someone comes to you and says, ‘I want bariatric surgery because it’s going to improve my longevity,’ the answer is ‘no.’ There’s no study that definitively shows that might even be the case," said coauthor Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas Southwestern Medical School at Dallas.

Selection instead should be based on immediate concerns. Out-of-control diabetes, a patient too big to get around, sleep apnea, failing joints, and other weight-related problems make "surgery a reasonable option," said Dr. Livingston, who’s been performing bariatric surgeries since 1993.

The findings contradict previous studies suggesting a survival benefit for bariatric surgery, but those studies were largely of younger women with inherently lower obesity-related mortality risks, or foreign studies that don’t translate well to the United States, he said.

In contrast, the veterans in the study – older, obese, and comorbid – "die at a very high rate, so we expected [surgery to demonstrate] a big benefit in a short amount of time. The belief is if you take people that are really sick with diabetes, hypertension, and sleep apnea, and get a lot of weight off them, they live longer. We didn’t see it. This is the first study to show that doesn’t actually happen," he said.

The researchers have previously shown that bariatric surgery did not cut the health care costs of their cohort within 3 years (Med. Care 2010;48:989-98).

Dr. Maciejewski is paid consultant to Takeda Pharmaceuticals and Novartis and owns stock in Amgen. Dr. Livingston is a paid consultant to Texas Instruments. The study was funded by the Department of Veterans Affairs.

SEATTLE – Gastric bypass did not extend the lives of older, severely obese patients in a Department of Veterans Affairs Study.

Though bariatric surgery is often assumed to extend lives, "physicians should advise patients such as those examined here that there is no survival benefit at nearly 7 years, and the longer-term survival benefit is still unknown," said lead author Matthew L. Maciejewski, Ph.D., of Duke University, Durham, N.C., and an investigator at the Center for Health Services Research in Primary Care at the Durham VA Medical Center at the annual research meeting of AcademyHealth.

He and his colleagues compared 850 VA Roux-en-Y gastric bypass patients with 41,244 nonsurgical controls. The operations were conducted between 2000 and 2006. The average age in the bypass group was 50 years and average body mass index was 47 kg/m²; 74% were men. The average age in the control group was 55 years and average BMI was 42 kg/m²; 92% were men.

At first glance, bypass patients appeared to do better after a mean follow-up of 6.7 years. Although 6.8% had died after 6 years, for instance, 15.2% had died in the control group (hazard ratio, 0.64; 95% confidence interval, 0.51-0.80).

The apparent advantage, however, diminished after covariate adjustment (HR 0.80; 95% CI 0.63-0.99), and vanished when patients were propensity matched one to one with the most similar controls based on age, sex, race, marital status, BMI, diagnosis related groups (DRG), and other factors (HR, 0.83; 95% CI, 0.61-1.14). When the investigators further adjusted for the start time, the advantage disappeared (HR, 0.94, 95% CI, 0.64-1.39).

In short, "the use of bariatric surgery, compared with usual care, was not associated with decreased mortality," Dr. Maciejewski and his colleagues concluded (JAMA 2011 June 12 [doi:10.1001/jama.2011.817]).

The results mean "you should not select people [for surgery] thinking they are going to live longer. If someone comes to you and says, ‘I want bariatric surgery because it’s going to improve my longevity,’ the answer is ‘no.’ There’s no study that definitively shows that might even be the case," said coauthor Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas Southwestern Medical School at Dallas.

Selection instead should be based on immediate concerns. Out-of-control diabetes, a patient too big to get around, sleep apnea, failing joints, and other weight-related problems make "surgery a reasonable option," said Dr. Livingston, who’s been performing bariatric surgeries since 1993.

The findings contradict previous studies suggesting a survival benefit for bariatric surgery, but those studies were largely of younger women with inherently lower obesity-related mortality risks, or foreign studies that don’t translate well to the United States, he said.

In contrast, the veterans in the study – older, obese, and comorbid – "die at a very high rate, so we expected [surgery to demonstrate] a big benefit in a short amount of time. The belief is if you take people that are really sick with diabetes, hypertension, and sleep apnea, and get a lot of weight off them, they live longer. We didn’t see it. This is the first study to show that doesn’t actually happen," he said.

The researchers have previously shown that bariatric surgery did not cut the health care costs of their cohort within 3 years (Med. Care 2010;48:989-98).

Dr. Maciejewski is paid consultant to Takeda Pharmaceuticals and Novartis and owns stock in Amgen. Dr. Livingston is a paid consultant to Texas Instruments. The study was funded by the Department of Veterans Affairs.

SEATTLE – Gastric bypass did not extend the lives of older, severely obese patients in a Department of Veterans Affairs Study.

Though bariatric surgery is often assumed to extend lives, "physicians should advise patients such as those examined here that there is no survival benefit at nearly 7 years, and the longer-term survival benefit is still unknown," said lead author Matthew L. Maciejewski, Ph.D., of Duke University, Durham, N.C., and an investigator at the Center for Health Services Research in Primary Care at the Durham VA Medical Center at the annual research meeting of AcademyHealth.

He and his colleagues compared 850 VA Roux-en-Y gastric bypass patients with 41,244 nonsurgical controls. The operations were conducted between 2000 and 2006. The average age in the bypass group was 50 years and average body mass index was 47 kg/m²; 74% were men. The average age in the control group was 55 years and average BMI was 42 kg/m²; 92% were men.

At first glance, bypass patients appeared to do better after a mean follow-up of 6.7 years. Although 6.8% had died after 6 years, for instance, 15.2% had died in the control group (hazard ratio, 0.64; 95% confidence interval, 0.51-0.80).

The apparent advantage, however, diminished after covariate adjustment (HR 0.80; 95% CI 0.63-0.99), and vanished when patients were propensity matched one to one with the most similar controls based on age, sex, race, marital status, BMI, diagnosis related groups (DRG), and other factors (HR, 0.83; 95% CI, 0.61-1.14). When the investigators further adjusted for the start time, the advantage disappeared (HR, 0.94, 95% CI, 0.64-1.39).

In short, "the use of bariatric surgery, compared with usual care, was not associated with decreased mortality," Dr. Maciejewski and his colleagues concluded (JAMA 2011 June 12 [doi:10.1001/jama.2011.817]).

The results mean "you should not select people [for surgery] thinking they are going to live longer. If someone comes to you and says, ‘I want bariatric surgery because it’s going to improve my longevity,’ the answer is ‘no.’ There’s no study that definitively shows that might even be the case," said coauthor Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas Southwestern Medical School at Dallas.

Selection instead should be based on immediate concerns. Out-of-control diabetes, a patient too big to get around, sleep apnea, failing joints, and other weight-related problems make "surgery a reasonable option," said Dr. Livingston, who’s been performing bariatric surgeries since 1993.

The findings contradict previous studies suggesting a survival benefit for bariatric surgery, but those studies were largely of younger women with inherently lower obesity-related mortality risks, or foreign studies that don’t translate well to the United States, he said.

In contrast, the veterans in the study – older, obese, and comorbid – "die at a very high rate, so we expected [surgery to demonstrate] a big benefit in a short amount of time. The belief is if you take people that are really sick with diabetes, hypertension, and sleep apnea, and get a lot of weight off them, they live longer. We didn’t see it. This is the first study to show that doesn’t actually happen," he said.

The researchers have previously shown that bariatric surgery did not cut the health care costs of their cohort within 3 years (Med. Care 2010;48:989-98).

Dr. Maciejewski is paid consultant to Takeda Pharmaceuticals and Novartis and owns stock in Amgen. Dr. Livingston is a paid consultant to Texas Instruments. The study was funded by the Department of Veterans Affairs.

SEATTLE – Gastric bypass did not extend the lives of older, severely obese patients in a Department of Veterans Affairs Study.

Though bariatric surgery is often assumed to extend lives, "physicians should advise patients such as those examined here that there is no survival benefit at nearly 7 years, and the longer-term survival benefit is still unknown," said lead author Matthew L. Maciejewski, Ph.D., of Duke University, Durham, N.C., and an investigator at the Center for Health Services Research in Primary Care at the Durham VA Medical Center at the annual research meeting of AcademyHealth.

He and his colleagues compared 850 VA Roux-en-Y gastric bypass patients with 41,244 nonsurgical controls. The operations were conducted between 2000 and 2006. The average age in the bypass group was 50 years and average body mass index was 47 kg/m²; 74% were men. The average age in the control group was 55 years and average BMI was 42 kg/m²; 92% were men.

At first glance, bypass patients appeared to do better after a mean follow-up of 6.7 years. Although 6.8% had died after 6 years, for instance, 15.2% had died in the control group (hazard ratio, 0.64; 95% confidence interval, 0.51-0.80).

The apparent advantage, however, diminished after covariate adjustment (HR 0.80; 95% CI 0.63-0.99), and vanished when patients were propensity matched one to one with the most similar controls based on age, sex, race, marital status, BMI, diagnosis related groups (DRG), and other factors (HR, 0.83; 95% CI, 0.61-1.14). When the investigators further adjusted for the start time, the advantage disappeared (HR, 0.94, 95% CI, 0.64-1.39).

In short, "the use of bariatric surgery, compared with usual care, was not associated with decreased mortality," Dr. Maciejewski and his colleagues concluded (JAMA 2011 June 12 [doi:10.1001/jama.2011.817]).

The results mean "you should not select people [for surgery] thinking they are going to live longer. If someone comes to you and says, ‘I want bariatric surgery because it’s going to improve my longevity,’ the answer is ‘no.’ There’s no study that definitively shows that might even be the case," said coauthor Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas Southwestern Medical School at Dallas.

Selection instead should be based on immediate concerns. Out-of-control diabetes, a patient too big to get around, sleep apnea, failing joints, and other weight-related problems make "surgery a reasonable option," said Dr. Livingston, who’s been performing bariatric surgeries since 1993.

The findings contradict previous studies suggesting a survival benefit for bariatric surgery, but those studies were largely of younger women with inherently lower obesity-related mortality risks, or foreign studies that don’t translate well to the United States, he said.

In contrast, the veterans in the study – older, obese, and comorbid – "die at a very high rate, so we expected [surgery to demonstrate] a big benefit in a short amount of time. The belief is if you take people that are really sick with diabetes, hypertension, and sleep apnea, and get a lot of weight off them, they live longer. We didn’t see it. This is the first study to show that doesn’t actually happen," he said.

The researchers have previously shown that bariatric surgery did not cut the health care costs of their cohort within 3 years (Med. Care 2010;48:989-98).

Dr. Maciejewski is paid consultant to Takeda Pharmaceuticals and Novartis and owns stock in Amgen. Dr. Livingston is a paid consultant to Texas Instruments. The study was funded by the Department of Veterans Affairs.

SEATTLE – Gastric bypass did not extend the lives of older, severely obese patients in a Department of Veterans Affairs Study.

Though bariatric surgery is often assumed to extend lives, "physicians should advise patients such as those examined here that there is no survival benefit at nearly 7 years, and the longer-term survival benefit is still unknown," said lead author Matthew L. Maciejewski, Ph.D., of Duke University, Durham, N.C., and an investigator at the Center for Health Services Research in Primary Care at the Durham VA Medical Center at the annual research meeting of AcademyHealth.

He and his colleagues compared 850 VA Roux-en-Y gastric bypass patients with 41,244 nonsurgical controls. The operations were conducted between 2000 and 2006. The average age in the bypass group was 50 years and average body mass index was 47 kg/m²; 74% were men. The average age in the control group was 55 years and average BMI was 42 kg/m²; 92% were men.

At first glance, bypass patients appeared to do better after a mean follow-up of 6.7 years. Although 6.8% had died after 6 years, for instance, 15.2% had died in the control group (hazard ratio, 0.64; 95% confidence interval, 0.51-0.80).

The apparent advantage, however, diminished after covariate adjustment (HR 0.80; 95% CI 0.63-0.99), and vanished when patients were propensity matched one to one with the most similar controls based on age, sex, race, marital status, BMI, diagnosis related groups (DRG), and other factors (HR, 0.83; 95% CI, 0.61-1.14). When the investigators further adjusted for the start time, the advantage disappeared (HR, 0.94, 95% CI, 0.64-1.39).

In short, "the use of bariatric surgery, compared with usual care, was not associated with decreased mortality," Dr. Maciejewski and his colleagues concluded (JAMA 2011 June 12 [doi:10.1001/jama.2011.817]).

The results mean "you should not select people [for surgery] thinking they are going to live longer. If someone comes to you and says, ‘I want bariatric surgery because it’s going to improve my longevity,’ the answer is ‘no.’ There’s no study that definitively shows that might even be the case," said coauthor Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas Southwestern Medical School at Dallas.

Selection instead should be based on immediate concerns. Out-of-control diabetes, a patient too big to get around, sleep apnea, failing joints, and other weight-related problems make "surgery a reasonable option," said Dr. Livingston, who’s been performing bariatric surgeries since 1993.

The findings contradict previous studies suggesting a survival benefit for bariatric surgery, but those studies were largely of younger women with inherently lower obesity-related mortality risks, or foreign studies that don’t translate well to the United States, he said.

In contrast, the veterans in the study – older, obese, and comorbid – "die at a very high rate, so we expected [surgery to demonstrate] a big benefit in a short amount of time. The belief is if you take people that are really sick with diabetes, hypertension, and sleep apnea, and get a lot of weight off them, they live longer. We didn’t see it. This is the first study to show that doesn’t actually happen," he said.

The researchers have previously shown that bariatric surgery did not cut the health care costs of their cohort within 3 years (Med. Care 2010;48:989-98).

Dr. Maciejewski is paid consultant to Takeda Pharmaceuticals and Novartis and owns stock in Amgen. Dr. Livingston is a paid consultant to Texas Instruments. The study was funded by the Department of Veterans Affairs.

SEATTLE – Gastric bypass did not extend the lives of older, severely obese patients in a Department of Veterans Affairs Study.

Though bariatric surgery is often assumed to extend lives, "physicians should advise patients such as those examined here that there is no survival benefit at nearly 7 years, and the longer-term survival benefit is still unknown," said lead author Matthew L. Maciejewski, Ph.D., of Duke University, Durham, N.C., and an investigator at the Center for Health Services Research in Primary Care at the Durham VA Medical Center at the annual research meeting of AcademyHealth.

He and his colleagues compared 850 VA Roux-en-Y gastric bypass patients with 41,244 nonsurgical controls. The operations were conducted between 2000 and 2006. The average age in the bypass group was 50 years and average body mass index was 47 kg/m²; 74% were men. The average age in the control group was 55 years and average BMI was 42 kg/m²; 92% were men.

At first glance, bypass patients appeared to do better after a mean follow-up of 6.7 years. Although 6.8% had died after 6 years, for instance, 15.2% had died in the control group (hazard ratio, 0.64; 95% confidence interval, 0.51-0.80).

The apparent advantage, however, diminished after covariate adjustment (HR 0.80; 95% CI 0.63-0.99), and vanished when patients were propensity matched one to one with the most similar controls based on age, sex, race, marital status, BMI, diagnosis related groups (DRG), and other factors (HR, 0.83; 95% CI, 0.61-1.14). When the investigators further adjusted for the start time, the advantage disappeared (HR, 0.94, 95% CI, 0.64-1.39).

In short, "the use of bariatric surgery, compared with usual care, was not associated with decreased mortality," Dr. Maciejewski and his colleagues concluded (JAMA 2011 June 12 [doi:10.1001/jama.2011.817]).

The results mean "you should not select people [for surgery] thinking they are going to live longer. If someone comes to you and says, ‘I want bariatric surgery because it’s going to improve my longevity,’ the answer is ‘no.’ There’s no study that definitively shows that might even be the case," said coauthor Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas Southwestern Medical School at Dallas.

Selection instead should be based on immediate concerns. Out-of-control diabetes, a patient too big to get around, sleep apnea, failing joints, and other weight-related problems make "surgery a reasonable option," said Dr. Livingston, who’s been performing bariatric surgeries since 1993.

The findings contradict previous studies suggesting a survival benefit for bariatric surgery, but those studies were largely of younger women with inherently lower obesity-related mortality risks, or foreign studies that don’t translate well to the United States, he said.

In contrast, the veterans in the study – older, obese, and comorbid – "die at a very high rate, so we expected [surgery to demonstrate] a big benefit in a short amount of time. The belief is if you take people that are really sick with diabetes, hypertension, and sleep apnea, and get a lot of weight off them, they live longer. We didn’t see it. This is the first study to show that doesn’t actually happen," he said.

The researchers have previously shown that bariatric surgery did not cut the health care costs of their cohort within 3 years (Med. Care 2010;48:989-98).

Dr. Maciejewski is paid consultant to Takeda Pharmaceuticals and Novartis and owns stock in Amgen. Dr. Livingston is a paid consultant to Texas Instruments. The study was funded by the Department of Veterans Affairs.

SEATTLE – Gastric bypass did not extend the lives of older, severely obese patients in a Department of Veterans Affairs Study.

Though bariatric surgery is often assumed to extend lives, "physicians should advise patients such as those examined here that there is no survival benefit at nearly 7 years, and the longer-term survival benefit is still unknown," said lead author Matthew L. Maciejewski, Ph.D., of Duke University, Durham, N.C., and an investigator at the Center for Health Services Research in Primary Care at the Durham VA Medical Center at the annual research meeting of AcademyHealth.

He and his colleagues compared 850 VA Roux-en-Y gastric bypass patients with 41,244 nonsurgical controls. The operations were conducted between 2000 and 2006. The average age in the bypass group was 50 years and average body mass index was 47 kg/m²; 74% were men. The average age in the control group was 55 years and average BMI was 42 kg/m²; 92% were men.

At first glance, bypass patients appeared to do better after a mean follow-up of 6.7 years. Although 6.8% had died after 6 years, for instance, 15.2% had died in the control group (hazard ratio, 0.64; 95% confidence interval, 0.51-0.80).

The apparent advantage, however, diminished after covariate adjustment (HR 0.80; 95% CI 0.63-0.99), and vanished when patients were propensity matched one to one with the most similar controls based on age, sex, race, marital status, BMI, diagnosis related groups (DRG), and other factors (HR, 0.83; 95% CI, 0.61-1.14). When the investigators further adjusted for the start time, the advantage disappeared (HR, 0.94, 95% CI, 0.64-1.39).

In short, "the use of bariatric surgery, compared with usual care, was not associated with decreased mortality," Dr. Maciejewski and his colleagues concluded (JAMA 2011 June 12 [doi:10.1001/jama.2011.817]).

The results mean "you should not select people [for surgery] thinking they are going to live longer. If someone comes to you and says, ‘I want bariatric surgery because it’s going to improve my longevity,’ the answer is ‘no.’ There’s no study that definitively shows that might even be the case," said coauthor Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas Southwestern Medical School at Dallas.

Selection instead should be based on immediate concerns. Out-of-control diabetes, a patient too big to get around, sleep apnea, failing joints, and other weight-related problems make "surgery a reasonable option," said Dr. Livingston, who’s been performing bariatric surgeries since 1993.

The findings contradict previous studies suggesting a survival benefit for bariatric surgery, but those studies were largely of younger women with inherently lower obesity-related mortality risks, or foreign studies that don’t translate well to the United States, he said.

In contrast, the veterans in the study – older, obese, and comorbid – "die at a very high rate, so we expected [surgery to demonstrate] a big benefit in a short amount of time. The belief is if you take people that are really sick with diabetes, hypertension, and sleep apnea, and get a lot of weight off them, they live longer. We didn’t see it. This is the first study to show that doesn’t actually happen," he said.

The researchers have previously shown that bariatric surgery did not cut the health care costs of their cohort within 3 years (Med. Care 2010;48:989-98).

Dr. Maciejewski is paid consultant to Takeda Pharmaceuticals and Novartis and owns stock in Amgen. Dr. Livingston is a paid consultant to Texas Instruments. The study was funded by the Department of Veterans Affairs.

SEATTLE – Gastric bypass did not extend the lives of older, severely obese patients in a Department of Veterans Affairs Study.

Though bariatric surgery is often assumed to extend lives, "physicians should advise patients such as those examined here that there is no survival benefit at nearly 7 years, and the longer-term survival benefit is still unknown," said lead author Matthew L. Maciejewski, Ph.D., of Duke University, Durham, N.C., and an investigator at the Center for Health Services Research in Primary Care at the Durham VA Medical Center at the annual research meeting of AcademyHealth.

He and his colleagues compared 850 VA Roux-en-Y gastric bypass patients with 41,244 nonsurgical controls. The operations were conducted between 2000 and 2006. The average age in the bypass group was 50 years and average body mass index was 47 kg/m²; 74% were men. The average age in the control group was 55 years and average BMI was 42 kg/m²; 92% were men.

At first glance, bypass patients appeared to do better after a mean follow-up of 6.7 years. Although 6.8% had died after 6 years, for instance, 15.2% had died in the control group (hazard ratio, 0.64; 95% confidence interval, 0.51-0.80).

The apparent advantage, however, diminished after covariate adjustment (HR 0.80; 95% CI 0.63-0.99), and vanished when patients were propensity matched one to one with the most similar controls based on age, sex, race, marital status, BMI, diagnosis related groups (DRG), and other factors (HR, 0.83; 95% CI, 0.61-1.14). When the investigators further adjusted for the start time, the advantage disappeared (HR, 0.94, 95% CI, 0.64-1.39).

In short, "the use of bariatric surgery, compared with usual care, was not associated with decreased mortality," Dr. Maciejewski and his colleagues concluded (JAMA 2011 June 12 [doi:10.1001/jama.2011.817]).

The results mean "you should not select people [for surgery] thinking they are going to live longer. If someone comes to you and says, ‘I want bariatric surgery because it’s going to improve my longevity,’ the answer is ‘no.’ There’s no study that definitively shows that might even be the case," said coauthor Dr. Edward Livingston, chairman of the GI and endocrine surgery division at the University of Texas Southwestern Medical School at Dallas.

Selection instead should be based on immediate concerns. Out-of-control diabetes, a patient too big to get around, sleep apnea, failing joints, and other weight-related problems make "surgery a reasonable option," said Dr. Livingston, who’s been performing bariatric surgeries since 1993.

The findings contradict previous studies suggesting a survival benefit for bariatric surgery, but those studies were largely of younger women with inherently lower obesity-related mortality risks, or foreign studies that don’t translate well to the United States, he said.

In contrast, the veterans in the study – older, obese, and comorbid – "die at a very high rate, so we expected [surgery to demonstrate] a big benefit in a short amount of time. The belief is if you take people that are really sick with diabetes, hypertension, and sleep apnea, and get a lot of weight off them, they live longer. We didn’t see it. This is the first study to show that doesn’t actually happen," he said.

The researchers have previously shown that bariatric surgery did not cut the health care costs of their cohort within 3 years (Med. Care 2010;48:989-98).

Dr. Maciejewski is paid consultant to Takeda Pharmaceuticals and Novartis and owns stock in Amgen. Dr. Livingston is a paid consultant to Texas Instruments. The study was funded by the Department of Veterans Affairs.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.