Key clinical point: Occurrence of headache is not associated with subsequent sleep period characterized by shorter sleep duration, higher sleep disruption, or poorer sleep quality in adults with episodic migraine.

Major finding: The average nightly objective sleep duration, efficiency, and wake after sleep onset (WASO) were 7.3±1.2 hours, 89.5%±3.3%, and 44.8±17.0 minutes, respectively. Objective sleep duration was 7.3 (95% confidence interval, 1.5-13.0) minutes longer on nights after a headache day vs. nights on headache-free days. Actigraphically assessed sleep efficiency and WASO did not differ on nights after headache days vs. headache-free days.

Study details: A prospective cohort study of 98 adults (mean age, 35 years, with an average of five migraine headaches/month) with episodic migraine who provided 4,406 days of data; actigraphic sleep data were assessed for six weeks.

Disclosures: This study was funded by grants from the National Institute of Neurological Disorders and Stroke and the American Sleep Medicine Foundation and received financial contributions from Harvard University and its affiliated academic healthcare centers. Dr. Bertisch reported receiving research support from Merck, Sharpe & Dohme, ApniMed and Lockheed Martin and served as a consultant for Verily.

Citation: Vgontzas A et al. Sleep. 2020 Jan 13. doi: 10.1093/sleep/zsaa001.

Key clinical point: Occurrence of headache is not associated with subsequent sleep period characterized by shorter sleep duration, higher sleep disruption, or poorer sleep quality in adults with episodic migraine.

Major finding: The average nightly objective sleep duration, efficiency, and wake after sleep onset (WASO) were 7.3±1.2 hours, 89.5%±3.3%, and 44.8±17.0 minutes, respectively. Objective sleep duration was 7.3 (95% confidence interval, 1.5-13.0) minutes longer on nights after a headache day vs. nights on headache-free days. Actigraphically assessed sleep efficiency and WASO did not differ on nights after headache days vs. headache-free days.

Study details: A prospective cohort study of 98 adults (mean age, 35 years, with an average of five migraine headaches/month) with episodic migraine who provided 4,406 days of data; actigraphic sleep data were assessed for six weeks.

Disclosures: This study was funded by grants from the National Institute of Neurological Disorders and Stroke and the American Sleep Medicine Foundation and received financial contributions from Harvard University and its affiliated academic healthcare centers. Dr. Bertisch reported receiving research support from Merck, Sharpe & Dohme, ApniMed and Lockheed Martin and served as a consultant for Verily.

Citation: Vgontzas A et al. Sleep. 2020 Jan 13. doi: 10.1093/sleep/zsaa001.

Key clinical point: Occurrence of headache is not associated with subsequent sleep period characterized by shorter sleep duration, higher sleep disruption, or poorer sleep quality in adults with episodic migraine.

Major finding: The average nightly objective sleep duration, efficiency, and wake after sleep onset (WASO) were 7.3±1.2 hours, 89.5%±3.3%, and 44.8±17.0 minutes, respectively. Objective sleep duration was 7.3 (95% confidence interval, 1.5-13.0) minutes longer on nights after a headache day vs. nights on headache-free days. Actigraphically assessed sleep efficiency and WASO did not differ on nights after headache days vs. headache-free days.

Study details: A prospective cohort study of 98 adults (mean age, 35 years, with an average of five migraine headaches/month) with episodic migraine who provided 4,406 days of data; actigraphic sleep data were assessed for six weeks.

Disclosures: This study was funded by grants from the National Institute of Neurological Disorders and Stroke and the American Sleep Medicine Foundation and received financial contributions from Harvard University and its affiliated academic healthcare centers. Dr. Bertisch reported receiving research support from Merck, Sharpe & Dohme, ApniMed and Lockheed Martin and served as a consultant for Verily.

Citation: Vgontzas A et al. Sleep. 2020 Jan 13. doi: 10.1093/sleep/zsaa001.

Key clinical point: In patients with migraine, flunarizine (Fz)-induced parkinsonism (FIP) is associated with older age, history of comorbidities, exposure to high dose of Fz, and longer duration of exposure to Fz.

Major finding: In patients aged 45-64 years and 65 years or older, FIP risk was 3.18 and 4.89 times, respectively, higher in the Fz-treated group than in the controls. Compared with control group, the risk for FIP in those with comorbidities, annual cumulative Fz dose ≥445 mg, and Fz use for ≥60 days was 4.54-, 7.69-, and 8.49-fold, respectively, higher than in the control group.

Study details: A population-based study used data from Taiwan’s National Health Insurance Research Database and included 6,470 patients with migraine who were divided into two groups, based on their exposure (n=3,235) or non-exposure to Fz (n=3,235).

Disclosures: This study was supported by grants from the Taiwan Ministry of Health and Welfare Clinical Trial Center; China Medical University Hospital; Academia Sinica Stroke Biosignature Project; MOST Clinical Trial Consortium for Stroke; Tseng-Lien Lin Foundation, Taichung, Taiwan; and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The authors declared no conflict of interest.

Citation: Lin W et al. Front Pharmacol. 2019 Dec 19. doi: 10.3389/fphar.2019.01495.

Key clinical point: In patients with migraine, flunarizine (Fz)-induced parkinsonism (FIP) is associated with older age, history of comorbidities, exposure to high dose of Fz, and longer duration of exposure to Fz.

Major finding: In patients aged 45-64 years and 65 years or older, FIP risk was 3.18 and 4.89 times, respectively, higher in the Fz-treated group than in the controls. Compared with control group, the risk for FIP in those with comorbidities, annual cumulative Fz dose ≥445 mg, and Fz use for ≥60 days was 4.54-, 7.69-, and 8.49-fold, respectively, higher than in the control group.

Study details: A population-based study used data from Taiwan’s National Health Insurance Research Database and included 6,470 patients with migraine who were divided into two groups, based on their exposure (n=3,235) or non-exposure to Fz (n=3,235).

Disclosures: This study was supported by grants from the Taiwan Ministry of Health and Welfare Clinical Trial Center; China Medical University Hospital; Academia Sinica Stroke Biosignature Project; MOST Clinical Trial Consortium for Stroke; Tseng-Lien Lin Foundation, Taichung, Taiwan; and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The authors declared no conflict of interest.

Citation: Lin W et al. Front Pharmacol. 2019 Dec 19. doi: 10.3389/fphar.2019.01495.

Key clinical point: In patients with migraine, flunarizine (Fz)-induced parkinsonism (FIP) is associated with older age, history of comorbidities, exposure to high dose of Fz, and longer duration of exposure to Fz.

Major finding: In patients aged 45-64 years and 65 years or older, FIP risk was 3.18 and 4.89 times, respectively, higher in the Fz-treated group than in the controls. Compared with control group, the risk for FIP in those with comorbidities, annual cumulative Fz dose ≥445 mg, and Fz use for ≥60 days was 4.54-, 7.69-, and 8.49-fold, respectively, higher than in the control group.

Study details: A population-based study used data from Taiwan’s National Health Insurance Research Database and included 6,470 patients with migraine who were divided into two groups, based on their exposure (n=3,235) or non-exposure to Fz (n=3,235).

Disclosures: This study was supported by grants from the Taiwan Ministry of Health and Welfare Clinical Trial Center; China Medical University Hospital; Academia Sinica Stroke Biosignature Project; MOST Clinical Trial Consortium for Stroke; Tseng-Lien Lin Foundation, Taichung, Taiwan; and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The authors declared no conflict of interest.

Citation: Lin W et al. Front Pharmacol. 2019 Dec 19. doi: 10.3389/fphar.2019.01495.

Key clinical point: Vitamin D3 supplementation might improve headache characteristics and protect against inflammation in migraine.

Major finding: Analysis of covariance adjusted for baseline values and confounders showed that vitamin D3 supplemented group had significantly lower headache days, attacks frequency, duration and severity, and reduced analgesics consumption compared with the placebo group
(P less than 0.05). Patients receiving vitamin D3 had a significant reduction in inducible nitric oxide synthase
(P=0.001) and serum levels of interleukin-6 (P=0.055) compared with placebo.

Study details: Study of 80 patients with episodic migraine randomly assigned to a daily dose of vitamin D3 2,000 IU (50 μg) or placebo for 12 weeks.

Disclosures: The study was supported by Tehran University of Medical Sciences & health Services grant. The authors declared no conflict of interest.

Citation: Ghorbani Z et al. Neurol Sci. 2020 Jan 2. doi: 10.1007/s10072-019-04220-8. 

Key clinical point: Vitamin D3 supplementation might improve headache characteristics and protect against inflammation in migraine.

Major finding: Analysis of covariance adjusted for baseline values and confounders showed that vitamin D3 supplemented group had significantly lower headache days, attacks frequency, duration and severity, and reduced analgesics consumption compared with the placebo group
(P less than 0.05). Patients receiving vitamin D3 had a significant reduction in inducible nitric oxide synthase
(P=0.001) and serum levels of interleukin-6 (P=0.055) compared with placebo.

Study details: Study of 80 patients with episodic migraine randomly assigned to a daily dose of vitamin D3 2,000 IU (50 μg) or placebo for 12 weeks.

Disclosures: The study was supported by Tehran University of Medical Sciences & health Services grant. The authors declared no conflict of interest.

Citation: Ghorbani Z et al. Neurol Sci. 2020 Jan 2. doi: 10.1007/s10072-019-04220-8. 

Key clinical point: Vitamin D3 supplementation might improve headache characteristics and protect against inflammation in migraine.

Major finding: Analysis of covariance adjusted for baseline values and confounders showed that vitamin D3 supplemented group had significantly lower headache days, attacks frequency, duration and severity, and reduced analgesics consumption compared with the placebo group
(P less than 0.05). Patients receiving vitamin D3 had a significant reduction in inducible nitric oxide synthase
(P=0.001) and serum levels of interleukin-6 (P=0.055) compared with placebo.

Study details: Study of 80 patients with episodic migraine randomly assigned to a daily dose of vitamin D3 2,000 IU (50 μg) or placebo for 12 weeks.

Disclosures: The study was supported by Tehran University of Medical Sciences & health Services grant. The authors declared no conflict of interest.

Citation: Ghorbani Z et al. Neurol Sci. 2020 Jan 2. doi: 10.1007/s10072-019-04220-8. 

Key clinical point: Sleep fragmentation (defined by low sleep efficiency) is associated with a higher risk of migraine onset on day 1; short sleep duration and low sleep quality are not temporally associated with migraine.

Major finding: Low sleep efficiency was associated with 39% higher odds of headache on day 1. Sleep duration ≤6.5 hours and poor sleep quality were not associated with migraine onset on the day immediately following the sleep period (day 0) and the following day (day 1).

Study details: The data were obtained from a prospective study of 98 adults with episodic migraine.

Disclosures: This study was funded by grants from the National Institute of Neurologic Disorders and Stroke and the American Sleep Medicine Foundation; received financial contributions from Harvard University and its affiliated academic healthcare centers. Dr. Bertisch reported receiving research support from Merck, Sharpe & Dohme and Lockheed Martin and served as a consultant for Verily.

Citation: Bertisch SM et al. Neurology. 2019 Dec 16. doi: 10.1212/WNL.0000000000008740.

Key clinical point: Sleep fragmentation (defined by low sleep efficiency) is associated with a higher risk of migraine onset on day 1; short sleep duration and low sleep quality are not temporally associated with migraine.

Major finding: Low sleep efficiency was associated with 39% higher odds of headache on day 1. Sleep duration ≤6.5 hours and poor sleep quality were not associated with migraine onset on the day immediately following the sleep period (day 0) and the following day (day 1).

Study details: The data were obtained from a prospective study of 98 adults with episodic migraine.

Disclosures: This study was funded by grants from the National Institute of Neurologic Disorders and Stroke and the American Sleep Medicine Foundation; received financial contributions from Harvard University and its affiliated academic healthcare centers. Dr. Bertisch reported receiving research support from Merck, Sharpe & Dohme and Lockheed Martin and served as a consultant for Verily.

Citation: Bertisch SM et al. Neurology. 2019 Dec 16. doi: 10.1212/WNL.0000000000008740.

Key clinical point: Sleep fragmentation (defined by low sleep efficiency) is associated with a higher risk of migraine onset on day 1; short sleep duration and low sleep quality are not temporally associated with migraine.

Major finding: Low sleep efficiency was associated with 39% higher odds of headache on day 1. Sleep duration ≤6.5 hours and poor sleep quality were not associated with migraine onset on the day immediately following the sleep period (day 0) and the following day (day 1).

Study details: The data were obtained from a prospective study of 98 adults with episodic migraine.

Disclosures: This study was funded by grants from the National Institute of Neurologic Disorders and Stroke and the American Sleep Medicine Foundation; received financial contributions from Harvard University and its affiliated academic healthcare centers. Dr. Bertisch reported receiving research support from Merck, Sharpe & Dohme and Lockheed Martin and served as a consultant for Verily.

Citation: Bertisch SM et al. Neurology. 2019 Dec 16. doi: 10.1212/WNL.0000000000008740.

Key clinical point: Pregnant women with a history of migraine are at an increased risk of adverse outcomes, including preeclampsia (PE) and low birth weight (LBW).

Major finding: Women with migraine had a higher risk for PE (odds ratio, 2.07; 95% confidence interval, 1.51-2.85) and LBW (odds ratio, 1.18; 95% confidence interval, 1.03-1.34) compared with women without migraine. No significant association was observed between the history of migraine and preterm birth or small for gestational age.

Study details: A systematic review and meta-analysis of 14 studies.

Disclosures: Authors declared no conflict of interest.

Citation: Aukes AM et al. Obstet Gynecol Surv. 2019 Dec. doi: 10.1097/OGX.0000000000000738. 

Key clinical point: Pregnant women with a history of migraine are at an increased risk of adverse outcomes, including preeclampsia (PE) and low birth weight (LBW).

Major finding: Women with migraine had a higher risk for PE (odds ratio, 2.07; 95% confidence interval, 1.51-2.85) and LBW (odds ratio, 1.18; 95% confidence interval, 1.03-1.34) compared with women without migraine. No significant association was observed between the history of migraine and preterm birth or small for gestational age.

Study details: A systematic review and meta-analysis of 14 studies.

Disclosures: Authors declared no conflict of interest.

Citation: Aukes AM et al. Obstet Gynecol Surv. 2019 Dec. doi: 10.1097/OGX.0000000000000738. 

Key clinical point: Pregnant women with a history of migraine are at an increased risk of adverse outcomes, including preeclampsia (PE) and low birth weight (LBW).

Major finding: Women with migraine had a higher risk for PE (odds ratio, 2.07; 95% confidence interval, 1.51-2.85) and LBW (odds ratio, 1.18; 95% confidence interval, 1.03-1.34) compared with women without migraine. No significant association was observed between the history of migraine and preterm birth or small for gestational age.

Study details: A systematic review and meta-analysis of 14 studies.

Disclosures: Authors declared no conflict of interest.

Citation: Aukes AM et al. Obstet Gynecol Surv. 2019 Dec. doi: 10.1097/OGX.0000000000000738. 

Among patients with hepatitis B virus (HBV) infection who are not receiving antiviral therapy, surface antigen titers and alanine aminotransferase (ALT) levels may independently predict spontaneous seroconversion, based on a recent case-control study.

Patients with hepatitis B surface antigen (HBsAg) titers less than 1,000 IU/mL were significantly more likely to spontaneously seroconvert, reported principal author Sammy Saab, MD, of the University of California, Los Angeles, and colleagues.

While the predictive value of HBsAg titers has been demonstrated for patients undergoing antiviral therapy, data are limited for spontaneous seroconversion, the investigators wrote in Journal of Clinical Gastroenterology.

To learn more about this scenario, the investigators reviewed medical records from 2,126 patients who visited a large community practice in the Los Angeles area between 2014 and 2019. Cases were defined by HBV infection with seroconversion, whereas matched controls were defined by HBV without seroconversion. A variety of demographic and clinical data were also evaluated, including age, ethnicity, sex, HBsAg titer, ALT, HBV DNA, total cholesterol, presence of fatty liver, and other factors.

The investigators identified 167 patients with HBV who were not on antiviral therapy. Of these, 14 underwent seroconversion, and were matched with 70 patients who did not seroconvert. All patients were of Asian descent, most were women, and none had cirrhosis.

Across all demographic and clinical parameters, the two factors that significantly differed between cases and controls were ALT and HBsAg titer. The mean ALT for patients who seroconverted was 17.6 U/L, versus 25.1 U/L in those who did not undergo seroconversion (P less than .01). Similarly, mean titer was lower in the seroconversion group (459.8 vs. 782.0 IU/mL; P = .01).

The investigators noted that seroconversion was more common among patients with an HBsAg titer level less than 1,000 IU/mL. Specifically, 79% of patients who seroconverted had a titer less than 1,000 IU/mL, compared with just 16% of patients who did not seroconvert (P = .001).

HBV DNA levels were not predictive of seroconversion, the investigators noted, which aligns with most, but not all, previous research.

The investigators reported no disclosures.

SOURCE: Wu CF et al. J Clin Gastroenterol. 2020 Feb 11. doi: 10.1097/MCG.0000000000001324.

Among patients with hepatitis B virus (HBV) infection who are not receiving antiviral therapy, surface antigen titers and alanine aminotransferase (ALT) levels may independently predict spontaneous seroconversion, based on a recent case-control study.

Patients with hepatitis B surface antigen (HBsAg) titers less than 1,000 IU/mL were significantly more likely to spontaneously seroconvert, reported principal author Sammy Saab, MD, of the University of California, Los Angeles, and colleagues.

While the predictive value of HBsAg titers has been demonstrated for patients undergoing antiviral therapy, data are limited for spontaneous seroconversion, the investigators wrote in Journal of Clinical Gastroenterology.

To learn more about this scenario, the investigators reviewed medical records from 2,126 patients who visited a large community practice in the Los Angeles area between 2014 and 2019. Cases were defined by HBV infection with seroconversion, whereas matched controls were defined by HBV without seroconversion. A variety of demographic and clinical data were also evaluated, including age, ethnicity, sex, HBsAg titer, ALT, HBV DNA, total cholesterol, presence of fatty liver, and other factors.

The investigators identified 167 patients with HBV who were not on antiviral therapy. Of these, 14 underwent seroconversion, and were matched with 70 patients who did not seroconvert. All patients were of Asian descent, most were women, and none had cirrhosis.

Across all demographic and clinical parameters, the two factors that significantly differed between cases and controls were ALT and HBsAg titer. The mean ALT for patients who seroconverted was 17.6 U/L, versus 25.1 U/L in those who did not undergo seroconversion (P less than .01). Similarly, mean titer was lower in the seroconversion group (459.8 vs. 782.0 IU/mL; P = .01).

The investigators noted that seroconversion was more common among patients with an HBsAg titer level less than 1,000 IU/mL. Specifically, 79% of patients who seroconverted had a titer less than 1,000 IU/mL, compared with just 16% of patients who did not seroconvert (P = .001).

HBV DNA levels were not predictive of seroconversion, the investigators noted, which aligns with most, but not all, previous research.

The investigators reported no disclosures.

SOURCE: Wu CF et al. J Clin Gastroenterol. 2020 Feb 11. doi: 10.1097/MCG.0000000000001324.

Among patients with hepatitis B virus (HBV) infection who are not receiving antiviral therapy, surface antigen titers and alanine aminotransferase (ALT) levels may independently predict spontaneous seroconversion, based on a recent case-control study.

Patients with hepatitis B surface antigen (HBsAg) titers less than 1,000 IU/mL were significantly more likely to spontaneously seroconvert, reported principal author Sammy Saab, MD, of the University of California, Los Angeles, and colleagues.

While the predictive value of HBsAg titers has been demonstrated for patients undergoing antiviral therapy, data are limited for spontaneous seroconversion, the investigators wrote in Journal of Clinical Gastroenterology.

To learn more about this scenario, the investigators reviewed medical records from 2,126 patients who visited a large community practice in the Los Angeles area between 2014 and 2019. Cases were defined by HBV infection with seroconversion, whereas matched controls were defined by HBV without seroconversion. A variety of demographic and clinical data were also evaluated, including age, ethnicity, sex, HBsAg titer, ALT, HBV DNA, total cholesterol, presence of fatty liver, and other factors.

The investigators identified 167 patients with HBV who were not on antiviral therapy. Of these, 14 underwent seroconversion, and were matched with 70 patients who did not seroconvert. All patients were of Asian descent, most were women, and none had cirrhosis.

Across all demographic and clinical parameters, the two factors that significantly differed between cases and controls were ALT and HBsAg titer. The mean ALT for patients who seroconverted was 17.6 U/L, versus 25.1 U/L in those who did not undergo seroconversion (P less than .01). Similarly, mean titer was lower in the seroconversion group (459.8 vs. 782.0 IU/mL; P = .01).

The investigators noted that seroconversion was more common among patients with an HBsAg titer level less than 1,000 IU/mL. Specifically, 79% of patients who seroconverted had a titer less than 1,000 IU/mL, compared with just 16% of patients who did not seroconvert (P = .001).

HBV DNA levels were not predictive of seroconversion, the investigators noted, which aligns with most, but not all, previous research.

The investigators reported no disclosures.

SOURCE: Wu CF et al. J Clin Gastroenterol. 2020 Feb 11. doi: 10.1097/MCG.0000000000001324.

Key clinical point: Patients with migraine are likely to have metacognitive deficits.

Major finding: Patients with migraine performed worse on measures of metacognitive functions, including accuracy score (P = .012), global monitoring (P = .015), monetary gains (P = .022), and control sensitivity (P = .027) compared with control participants.

Study details: An Italian study evaluated the metacognitive abilities of 64 patients with chronic and episodic migraine and 29 healthy control participants.

Disclosures: The authors declared no conflicts of interest.

Citation: Zucca M et al. J Clin Neurosci. 2020 Jan 5. doi: 10.1016/j.jocn.2019.12.048.

Key clinical point: Patients with migraine are likely to have metacognitive deficits.

Major finding: Patients with migraine performed worse on measures of metacognitive functions, including accuracy score (P = .012), global monitoring (P = .015), monetary gains (P = .022), and control sensitivity (P = .027) compared with control participants.

Study details: An Italian study evaluated the metacognitive abilities of 64 patients with chronic and episodic migraine and 29 healthy control participants.

Disclosures: The authors declared no conflicts of interest.

Citation: Zucca M et al. J Clin Neurosci. 2020 Jan 5. doi: 10.1016/j.jocn.2019.12.048.

Key clinical point: Patients with migraine are likely to have metacognitive deficits.

Major finding: Patients with migraine performed worse on measures of metacognitive functions, including accuracy score (P = .012), global monitoring (P = .015), monetary gains (P = .022), and control sensitivity (P = .027) compared with control participants.

Study details: An Italian study evaluated the metacognitive abilities of 64 patients with chronic and episodic migraine and 29 healthy control participants.

Disclosures: The authors declared no conflicts of interest.

Citation: Zucca M et al. J Clin Neurosci. 2020 Jan 5. doi: 10.1016/j.jocn.2019.12.048.

Infectious disease physicians are more than twice as likely to be happy outside of work than in the office, according to Medscape’s 2020 Lifestyle, Happiness, and Burnout Report.

About 25% of infectious disease physicians reported that they were very happy in the office, compared with dermatologists, who had the highest rate of in-office happiness at 41%, according to the Medscape report. The out-of-office happiness rate rose to 52% for ID physicians, compared with the top spot of rheumatologists, who reported a 60% happiness rate.

The burnout rate for ID physicians was 46%, compared with 41% for physicians overall, with 12% of ID physicians reporting that they were both burned out and depressed. Having too many bureaucratic tasks was the most commonly reported reason for ID physician burnout at 49%, followed by a lack of respect from colleagues at 46% and spending too much time at work at 43%.

ID physicians most commonly dealt with burnout by talking with friends/family (49%), exercising (48%), and isolating themselves from others (43%). In addition, 52% of ID physicians reported taking 3-4 weeks of vacation, compared with 44% of all physicians, with 33% of ID physicians saying that they took less than 3 weeks’ vacation.

About 14% of ID physicians reported that they’d contemplated suicide, with 0% reporting that they’d attempted it; 80% reported that they’d never thought about it. About 54% said they weren’t considering seeking professional help for symptoms of burnout or depression, 13% said they’d used therapy in the past but weren’t currently looking, 7% said they were planning on seeking help, and 17% said they were currently seeking help.

The Medscape survey was conducted from June 25 to Sept. 19, 2019, and involved 15,181 physicians.

lfranki@mdedge.com

Infectious disease physicians are more than twice as likely to be happy outside of work than in the office, according to Medscape’s 2020 Lifestyle, Happiness, and Burnout Report.

About 25% of infectious disease physicians reported that they were very happy in the office, compared with dermatologists, who had the highest rate of in-office happiness at 41%, according to the Medscape report. The out-of-office happiness rate rose to 52% for ID physicians, compared with the top spot of rheumatologists, who reported a 60% happiness rate.

The burnout rate for ID physicians was 46%, compared with 41% for physicians overall, with 12% of ID physicians reporting that they were both burned out and depressed. Having too many bureaucratic tasks was the most commonly reported reason for ID physician burnout at 49%, followed by a lack of respect from colleagues at 46% and spending too much time at work at 43%.

ID physicians most commonly dealt with burnout by talking with friends/family (49%), exercising (48%), and isolating themselves from others (43%). In addition, 52% of ID physicians reported taking 3-4 weeks of vacation, compared with 44% of all physicians, with 33% of ID physicians saying that they took less than 3 weeks’ vacation.

About 14% of ID physicians reported that they’d contemplated suicide, with 0% reporting that they’d attempted it; 80% reported that they’d never thought about it. About 54% said they weren’t considering seeking professional help for symptoms of burnout or depression, 13% said they’d used therapy in the past but weren’t currently looking, 7% said they were planning on seeking help, and 17% said they were currently seeking help.

The Medscape survey was conducted from June 25 to Sept. 19, 2019, and involved 15,181 physicians.

lfranki@mdedge.com

Infectious disease physicians are more than twice as likely to be happy outside of work than in the office, according to Medscape’s 2020 Lifestyle, Happiness, and Burnout Report.

About 25% of infectious disease physicians reported that they were very happy in the office, compared with dermatologists, who had the highest rate of in-office happiness at 41%, according to the Medscape report. The out-of-office happiness rate rose to 52% for ID physicians, compared with the top spot of rheumatologists, who reported a 60% happiness rate.

The burnout rate for ID physicians was 46%, compared with 41% for physicians overall, with 12% of ID physicians reporting that they were both burned out and depressed. Having too many bureaucratic tasks was the most commonly reported reason for ID physician burnout at 49%, followed by a lack of respect from colleagues at 46% and spending too much time at work at 43%.

ID physicians most commonly dealt with burnout by talking with friends/family (49%), exercising (48%), and isolating themselves from others (43%). In addition, 52% of ID physicians reported taking 3-4 weeks of vacation, compared with 44% of all physicians, with 33% of ID physicians saying that they took less than 3 weeks’ vacation.

About 14% of ID physicians reported that they’d contemplated suicide, with 0% reporting that they’d attempted it; 80% reported that they’d never thought about it. About 54% said they weren’t considering seeking professional help for symptoms of burnout or depression, 13% said they’d used therapy in the past but weren’t currently looking, 7% said they were planning on seeking help, and 17% said they were currently seeking help.

The Medscape survey was conducted from June 25 to Sept. 19, 2019, and involved 15,181 physicians.

lfranki@mdedge.com

A higher lifetime number of sexual partners was associated with a greater risk of being diagnosed with cancer in older adults, according to a recent study.

Additionally, among women, having had more lifetime partners was linked to higher odds of reporting a limiting long-standing condition.

Igor Grabovac, MD, of the Medical University of Vienna, and colleagues reported these results in BMJ Sexual & Reproductive Health.

The exploratory analysis included 2,537 men and 3,185 women, aged 50 years and older, who were a part of the English Longitudinal Study of Ageing. The mean age of study subjects was 64 years in men and 65 years in women, and most were either married or cohabitating.

Researchers collected data on sexual history using a self-administered questionnaire, which privately recorded the lifetime number of sexual partners among study participants. Data on other health outcomes, such as limiting long-standing illness and cancer diagnoses, were also self-reported.

Among male participants, 28.5% reported a history of 0-1 lifetime sexual partners, 29.0% had 2-4 partners, 20.2% had 5-9 partners, and 22.2% had 10 or more partners. The respective measures in women were 40.8%, 35.5%, 15.8%, and 7.8%.

Among all participants, a greater number of sexual partners was associated with being single, younger age, and being in the least or greatest brackets of household income.

The researchers found that, compared with having 0-1 sexual partners, a lifetime history of 10 or more sexual partners was associated with a greater risk of reported cancer in both men (odds ratio, 1.69; P = .047) and women (OR, 1.91; P = .038).

In addition, women with a lifetime history of 10 or more sexual partners had greater odds of reporting a limiting long-standing condition (OR, 1.64; P = .007).

“We observed no statistically significant association between number of lifetime sexual partners and self-rated health, CHD [coronary heart disease], or stroke in either sex, or with limiting long-standing illness in men,” the researchers explained.

They acknowledged that a key limitation of the study was the self-reported nature of the data. As a result, further studies are required to establish causality.

“Sexual history may be a relevant clinical indicator for cancer risk in older patients,” they concluded.

No funding sources were reported. The authors reported having no conflicts of interest.
 

SOURCE: Grabovac I et al. BMJ Sex Reprod Health. 2020 Feb 13. doi: 10.1136/bmjsrh-2019-200352.

A higher lifetime number of sexual partners was associated with a greater risk of being diagnosed with cancer in older adults, according to a recent study.

Additionally, among women, having had more lifetime partners was linked to higher odds of reporting a limiting long-standing condition.

Igor Grabovac, MD, of the Medical University of Vienna, and colleagues reported these results in BMJ Sexual & Reproductive Health.

The exploratory analysis included 2,537 men and 3,185 women, aged 50 years and older, who were a part of the English Longitudinal Study of Ageing. The mean age of study subjects was 64 years in men and 65 years in women, and most were either married or cohabitating.

Researchers collected data on sexual history using a self-administered questionnaire, which privately recorded the lifetime number of sexual partners among study participants. Data on other health outcomes, such as limiting long-standing illness and cancer diagnoses, were also self-reported.

Among male participants, 28.5% reported a history of 0-1 lifetime sexual partners, 29.0% had 2-4 partners, 20.2% had 5-9 partners, and 22.2% had 10 or more partners. The respective measures in women were 40.8%, 35.5%, 15.8%, and 7.8%.

Among all participants, a greater number of sexual partners was associated with being single, younger age, and being in the least or greatest brackets of household income.

The researchers found that, compared with having 0-1 sexual partners, a lifetime history of 10 or more sexual partners was associated with a greater risk of reported cancer in both men (odds ratio, 1.69; P = .047) and women (OR, 1.91; P = .038).

In addition, women with a lifetime history of 10 or more sexual partners had greater odds of reporting a limiting long-standing condition (OR, 1.64; P = .007).

“We observed no statistically significant association between number of lifetime sexual partners and self-rated health, CHD [coronary heart disease], or stroke in either sex, or with limiting long-standing illness in men,” the researchers explained.

They acknowledged that a key limitation of the study was the self-reported nature of the data. As a result, further studies are required to establish causality.

“Sexual history may be a relevant clinical indicator for cancer risk in older patients,” they concluded.

No funding sources were reported. The authors reported having no conflicts of interest.
 

SOURCE: Grabovac I et al. BMJ Sex Reprod Health. 2020 Feb 13. doi: 10.1136/bmjsrh-2019-200352.

A higher lifetime number of sexual partners was associated with a greater risk of being diagnosed with cancer in older adults, according to a recent study.

Additionally, among women, having had more lifetime partners was linked to higher odds of reporting a limiting long-standing condition.

Igor Grabovac, MD, of the Medical University of Vienna, and colleagues reported these results in BMJ Sexual & Reproductive Health.

The exploratory analysis included 2,537 men and 3,185 women, aged 50 years and older, who were a part of the English Longitudinal Study of Ageing. The mean age of study subjects was 64 years in men and 65 years in women, and most were either married or cohabitating.

Researchers collected data on sexual history using a self-administered questionnaire, which privately recorded the lifetime number of sexual partners among study participants. Data on other health outcomes, such as limiting long-standing illness and cancer diagnoses, were also self-reported.

Among male participants, 28.5% reported a history of 0-1 lifetime sexual partners, 29.0% had 2-4 partners, 20.2% had 5-9 partners, and 22.2% had 10 or more partners. The respective measures in women were 40.8%, 35.5%, 15.8%, and 7.8%.

Among all participants, a greater number of sexual partners was associated with being single, younger age, and being in the least or greatest brackets of household income.

The researchers found that, compared with having 0-1 sexual partners, a lifetime history of 10 or more sexual partners was associated with a greater risk of reported cancer in both men (odds ratio, 1.69; P = .047) and women (OR, 1.91; P = .038).

In addition, women with a lifetime history of 10 or more sexual partners had greater odds of reporting a limiting long-standing condition (OR, 1.64; P = .007).

“We observed no statistically significant association between number of lifetime sexual partners and self-rated health, CHD [coronary heart disease], or stroke in either sex, or with limiting long-standing illness in men,” the researchers explained.

They acknowledged that a key limitation of the study was the self-reported nature of the data. As a result, further studies are required to establish causality.

“Sexual history may be a relevant clinical indicator for cancer risk in older patients,” they concluded.

No funding sources were reported. The authors reported having no conflicts of interest.
 

SOURCE: Grabovac I et al. BMJ Sex Reprod Health. 2020 Feb 13. doi: 10.1136/bmjsrh-2019-200352.

Among women with a history of gestational diabetes, a longer period of breastfeeding was associated with a lower probability of going on to develop type 2 diabetes, as well as a more favorable glucose metabolic biomarker profile. Women who breastfed for 2 years or longer had a 27% lower risk than that of those who did not breastfeed at all, even after adjustment for age, ethnicity, family history of diabetes, parity, age at first birth, smoking, diet quality, physical activity, and prepregnancy body mass index, according to findings published in Diabetes Care.

It remains to be seen if the association is causal, and if so, what mechanisms might connect breastfeeding duration to risk for type 2 diabetes, wrote study leaders Sylvia Ley, PhD, of Tulane University School of Public Health and Tropical Medicine, New Orleans, and the Harvard T.H. Chan School of Public Health, Boston, and Cuilin Zhang, MD, PhD, of the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md., and colleagues.

“It’s really nice to see this consistency and the long-term association being borne out in a very large sample of women with gestational diabetes,” Erica P. Gunderson, PhD, said in an interview about the study. Dr. Gunderson has conducted similar studies of her own, including one published in 2018 that showed an independent association between lactation and reduced diabetes risk in women (JAMA Intern Med. 2018;178:328-37). That analysis showed no sign that the presence of gestational diabetes affected the reduction of diabetes risk associated with lactation.

Dr. Gunderson noted that pregnancy is a hyperlipidemic state, with triglyceride levels sometimes doubling, likely in response to the need to support the placenta and the growing fetus. Lactation may help restore lipid levels to the prepregnancy state by redirecting lipids to breast milk. She and others are working to produce more direct evidence of metabolic changes in the postpartum period associated with lactation. “That’s where we don’t have much mechanistic evidence right now,” said Dr. Gunderson, a senior research scientist and epidemiologist at Kaiser Permanente Northern California, Oakland.

Gestational diabetes occurs in an estimated 5%-9% of pregnancies in the United States, and women who experience this complication are at greater risk of developing type 2 diabetes in the future. Findings from other studies have shown that longer lactation periods are associated with lowered risk of future type 2 disease (JAMA. 2005;294:2601-10).

In the latest study, the researchers included 4,372 women with a history of gestational diabetes, identified through the Nurses’ Health Study II. Participants were excluded if they had a history of cancer, cardiovascular disease, or multiple-birth pregnancy before the pregnancy during which they were diagnosed with gestational diabetes. In all, 873 women developed type 2 diabetes over 87,411 person-years of follow-up. The median age at gestational diabetes diagnosis was 31.8 years, and 49.8 years for diagnoses of type 2 diabetes.

After adjustment, the researchers found a steadying decline of risk for type 2 diabetes with increasing length of lactation: for up to 6 months of lactation, the hazard ratio was 1.05 (95% confidence interval, 0.82-1.34); for 6-12 months, the HR was 0.91 (95% CI, 0.71-1.15); 12-24 months, 0.84 (95% CI, 0.67-1.06); more than 24 months, 0.73 (95% CI, 0.57-0.93; P for trend = .004). Age, parity, primipara, prepregnancy body mass index, and age had no statistically significant effect modification on the association.

At a follow-up blood collection taken at median age of 58.2 years and 26.3 years after the gestational-diabetes index pregnancy, the researchers found associations between longer breastfeeding (greater than 24 months vs. 0 months) and lower hemoglobin A_1c percentage (5.58 vs. 5.68; P for trend = .04), lower insulin levels (53.1 vs. 64.7 pmol/L; P for trend = .02), and lower C-peptide levels (3.42 vs. 3.88 ng/mL; P for trend = .02).

The study was supported by the National Institutes of Health. Dr. Ley was supported by a National Institute of General Medical Sciences grant from the NIH. None of the study authors reported any conflicts of interest, and neither did Dr. Gunderson.

SOURCE: Ley S et al. Diabetes Care. 2020 Feb 10. doi: 10.2337/dc19-2237.

Among women with a history of gestational diabetes, a longer period of breastfeeding was associated with a lower probability of going on to develop type 2 diabetes, as well as a more favorable glucose metabolic biomarker profile. Women who breastfed for 2 years or longer had a 27% lower risk than that of those who did not breastfeed at all, even after adjustment for age, ethnicity, family history of diabetes, parity, age at first birth, smoking, diet quality, physical activity, and prepregnancy body mass index, according to findings published in Diabetes Care.

It remains to be seen if the association is causal, and if so, what mechanisms might connect breastfeeding duration to risk for type 2 diabetes, wrote study leaders Sylvia Ley, PhD, of Tulane University School of Public Health and Tropical Medicine, New Orleans, and the Harvard T.H. Chan School of Public Health, Boston, and Cuilin Zhang, MD, PhD, of the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md., and colleagues.

“It’s really nice to see this consistency and the long-term association being borne out in a very large sample of women with gestational diabetes,” Erica P. Gunderson, PhD, said in an interview about the study. Dr. Gunderson has conducted similar studies of her own, including one published in 2018 that showed an independent association between lactation and reduced diabetes risk in women (JAMA Intern Med. 2018;178:328-37). That analysis showed no sign that the presence of gestational diabetes affected the reduction of diabetes risk associated with lactation.

Dr. Gunderson noted that pregnancy is a hyperlipidemic state, with triglyceride levels sometimes doubling, likely in response to the need to support the placenta and the growing fetus. Lactation may help restore lipid levels to the prepregnancy state by redirecting lipids to breast milk. She and others are working to produce more direct evidence of metabolic changes in the postpartum period associated with lactation. “That’s where we don’t have much mechanistic evidence right now,” said Dr. Gunderson, a senior research scientist and epidemiologist at Kaiser Permanente Northern California, Oakland.

Gestational diabetes occurs in an estimated 5%-9% of pregnancies in the United States, and women who experience this complication are at greater risk of developing type 2 diabetes in the future. Findings from other studies have shown that longer lactation periods are associated with lowered risk of future type 2 disease (JAMA. 2005;294:2601-10).

In the latest study, the researchers included 4,372 women with a history of gestational diabetes, identified through the Nurses’ Health Study II. Participants were excluded if they had a history of cancer, cardiovascular disease, or multiple-birth pregnancy before the pregnancy during which they were diagnosed with gestational diabetes. In all, 873 women developed type 2 diabetes over 87,411 person-years of follow-up. The median age at gestational diabetes diagnosis was 31.8 years, and 49.8 years for diagnoses of type 2 diabetes.

After adjustment, the researchers found a steadying decline of risk for type 2 diabetes with increasing length of lactation: for up to 6 months of lactation, the hazard ratio was 1.05 (95% confidence interval, 0.82-1.34); for 6-12 months, the HR was 0.91 (95% CI, 0.71-1.15); 12-24 months, 0.84 (95% CI, 0.67-1.06); more than 24 months, 0.73 (95% CI, 0.57-0.93; P for trend = .004). Age, parity, primipara, prepregnancy body mass index, and age had no statistically significant effect modification on the association.

At a follow-up blood collection taken at median age of 58.2 years and 26.3 years after the gestational-diabetes index pregnancy, the researchers found associations between longer breastfeeding (greater than 24 months vs. 0 months) and lower hemoglobin A_1c percentage (5.58 vs. 5.68; P for trend = .04), lower insulin levels (53.1 vs. 64.7 pmol/L; P for trend = .02), and lower C-peptide levels (3.42 vs. 3.88 ng/mL; P for trend = .02).

The study was supported by the National Institutes of Health. Dr. Ley was supported by a National Institute of General Medical Sciences grant from the NIH. None of the study authors reported any conflicts of interest, and neither did Dr. Gunderson.

SOURCE: Ley S et al. Diabetes Care. 2020 Feb 10. doi: 10.2337/dc19-2237.

Among women with a history of gestational diabetes, a longer period of breastfeeding was associated with a lower probability of going on to develop type 2 diabetes, as well as a more favorable glucose metabolic biomarker profile. Women who breastfed for 2 years or longer had a 27% lower risk than that of those who did not breastfeed at all, even after adjustment for age, ethnicity, family history of diabetes, parity, age at first birth, smoking, diet quality, physical activity, and prepregnancy body mass index, according to findings published in Diabetes Care.

It remains to be seen if the association is causal, and if so, what mechanisms might connect breastfeeding duration to risk for type 2 diabetes, wrote study leaders Sylvia Ley, PhD, of Tulane University School of Public Health and Tropical Medicine, New Orleans, and the Harvard T.H. Chan School of Public Health, Boston, and Cuilin Zhang, MD, PhD, of the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md., and colleagues.

“It’s really nice to see this consistency and the long-term association being borne out in a very large sample of women with gestational diabetes,” Erica P. Gunderson, PhD, said in an interview about the study. Dr. Gunderson has conducted similar studies of her own, including one published in 2018 that showed an independent association between lactation and reduced diabetes risk in women (JAMA Intern Med. 2018;178:328-37). That analysis showed no sign that the presence of gestational diabetes affected the reduction of diabetes risk associated with lactation.

Dr. Gunderson noted that pregnancy is a hyperlipidemic state, with triglyceride levels sometimes doubling, likely in response to the need to support the placenta and the growing fetus. Lactation may help restore lipid levels to the prepregnancy state by redirecting lipids to breast milk. She and others are working to produce more direct evidence of metabolic changes in the postpartum period associated with lactation. “That’s where we don’t have much mechanistic evidence right now,” said Dr. Gunderson, a senior research scientist and epidemiologist at Kaiser Permanente Northern California, Oakland.

Gestational diabetes occurs in an estimated 5%-9% of pregnancies in the United States, and women who experience this complication are at greater risk of developing type 2 diabetes in the future. Findings from other studies have shown that longer lactation periods are associated with lowered risk of future type 2 disease (JAMA. 2005;294:2601-10).

In the latest study, the researchers included 4,372 women with a history of gestational diabetes, identified through the Nurses’ Health Study II. Participants were excluded if they had a history of cancer, cardiovascular disease, or multiple-birth pregnancy before the pregnancy during which they were diagnosed with gestational diabetes. In all, 873 women developed type 2 diabetes over 87,411 person-years of follow-up. The median age at gestational diabetes diagnosis was 31.8 years, and 49.8 years for diagnoses of type 2 diabetes.

After adjustment, the researchers found a steadying decline of risk for type 2 diabetes with increasing length of lactation: for up to 6 months of lactation, the hazard ratio was 1.05 (95% confidence interval, 0.82-1.34); for 6-12 months, the HR was 0.91 (95% CI, 0.71-1.15); 12-24 months, 0.84 (95% CI, 0.67-1.06); more than 24 months, 0.73 (95% CI, 0.57-0.93; P for trend = .004). Age, parity, primipara, prepregnancy body mass index, and age had no statistically significant effect modification on the association.

At a follow-up blood collection taken at median age of 58.2 years and 26.3 years after the gestational-diabetes index pregnancy, the researchers found associations between longer breastfeeding (greater than 24 months vs. 0 months) and lower hemoglobin A_1c percentage (5.58 vs. 5.68; P for trend = .04), lower insulin levels (53.1 vs. 64.7 pmol/L; P for trend = .02), and lower C-peptide levels (3.42 vs. 3.88 ng/mL; P for trend = .02).

The study was supported by the National Institutes of Health. Dr. Ley was supported by a National Institute of General Medical Sciences grant from the NIH. None of the study authors reported any conflicts of interest, and neither did Dr. Gunderson.

SOURCE: Ley S et al. Diabetes Care. 2020 Feb 10. doi: 10.2337/dc19-2237.