Key clinical point: Mothers of children with MS are more likely to use mental health services before and after their child’s diagnosis with multiple sclerosis (MS) than mothers of children without MS.

Major finding: The prevalence of any physical condition and mood or anxiety disorder was higher in MS-mothers vs. non-MS-mothers. The odds of having any psychiatry visit was significantly increased in MS-mothers (odds ratio, 1.60; 95% confidence interval [CI], 1.10-2.31). The annual rate of psychiatry visits did not differ between MS-mothers and non-MS-mothers (rate ratio, 0.66; 95% CI, 0.33-1.30).

Study details: A population-based retrospective matched cohort study of 156 MS-mothers and 624 non-MS mothers.

Disclosures: This study was funded by the Multiple Sclerosis Scientific Research Foundation. Dr. Marrie received research funding from CIHR, Research Manitoba, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Foundation, Crohn’s and Colitis Canada, National Multiple Sclerosis Society, and CMSC and was supported by the Waugh Family Chair in Multiple Sclerosis.

Citation: Marrie RA et al. Neurology. 2020 Jan 9. doi: 10.1212/WNL.0000000000008871. 

Key clinical point: Mothers of children with MS are more likely to use mental health services before and after their child’s diagnosis with multiple sclerosis (MS) than mothers of children without MS.

Major finding: The prevalence of any physical condition and mood or anxiety disorder was higher in MS-mothers vs. non-MS-mothers. The odds of having any psychiatry visit was significantly increased in MS-mothers (odds ratio, 1.60; 95% confidence interval [CI], 1.10-2.31). The annual rate of psychiatry visits did not differ between MS-mothers and non-MS-mothers (rate ratio, 0.66; 95% CI, 0.33-1.30).

Study details: A population-based retrospective matched cohort study of 156 MS-mothers and 624 non-MS mothers.

Disclosures: This study was funded by the Multiple Sclerosis Scientific Research Foundation. Dr. Marrie received research funding from CIHR, Research Manitoba, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Foundation, Crohn’s and Colitis Canada, National Multiple Sclerosis Society, and CMSC and was supported by the Waugh Family Chair in Multiple Sclerosis.

Citation: Marrie RA et al. Neurology. 2020 Jan 9. doi: 10.1212/WNL.0000000000008871. 

Key clinical point: Mothers of children with MS are more likely to use mental health services before and after their child’s diagnosis with multiple sclerosis (MS) than mothers of children without MS.

Major finding: The prevalence of any physical condition and mood or anxiety disorder was higher in MS-mothers vs. non-MS-mothers. The odds of having any psychiatry visit was significantly increased in MS-mothers (odds ratio, 1.60; 95% confidence interval [CI], 1.10-2.31). The annual rate of psychiatry visits did not differ between MS-mothers and non-MS-mothers (rate ratio, 0.66; 95% CI, 0.33-1.30).

Study details: A population-based retrospective matched cohort study of 156 MS-mothers and 624 non-MS mothers.

Disclosures: This study was funded by the Multiple Sclerosis Scientific Research Foundation. Dr. Marrie received research funding from CIHR, Research Manitoba, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Foundation, Crohn’s and Colitis Canada, National Multiple Sclerosis Society, and CMSC and was supported by the Waugh Family Chair in Multiple Sclerosis.

Citation: Marrie RA et al. Neurology. 2020 Jan 9. doi: 10.1212/WNL.0000000000008871. 

Key clinical point: Vitamin D and body mass index (BMI) are independent causal risk factors for multiple sclerosis (MS) in adulthood and childhood.

Major finding: Genetically determined increased childhood BMI and adult BMI were associated with a 24% and 14% higher risk of MS, respectively. Each genetically determined unit increase in the natural-log-transformed vitamin D level was associated with a 43% reduction in the MS risk. 

Study details: A 2-sample Mendelian randomization study estimated the effect of BMI and vitamin D status on MS risk; associations of single-nucleotide polymorphisms with both the risk factors of interest were obtained from the relevant consortia.

Disclosures: This study was funded through a grant from the Barts Charity. The authors declared no conflicts of interest.

Citation: Jacobs BM et al. Neurol Neuroimmunol Neuroinflamm. 2020 Jan 14. doi: 10.1212/NXI.0000000000000662. 

Key clinical point: Vitamin D and body mass index (BMI) are independent causal risk factors for multiple sclerosis (MS) in adulthood and childhood.

Major finding: Genetically determined increased childhood BMI and adult BMI were associated with a 24% and 14% higher risk of MS, respectively. Each genetically determined unit increase in the natural-log-transformed vitamin D level was associated with a 43% reduction in the MS risk. 

Study details: A 2-sample Mendelian randomization study estimated the effect of BMI and vitamin D status on MS risk; associations of single-nucleotide polymorphisms with both the risk factors of interest were obtained from the relevant consortia.

Disclosures: This study was funded through a grant from the Barts Charity. The authors declared no conflicts of interest.

Citation: Jacobs BM et al. Neurol Neuroimmunol Neuroinflamm. 2020 Jan 14. doi: 10.1212/NXI.0000000000000662. 

Key clinical point: Vitamin D and body mass index (BMI) are independent causal risk factors for multiple sclerosis (MS) in adulthood and childhood.

Major finding: Genetically determined increased childhood BMI and adult BMI were associated with a 24% and 14% higher risk of MS, respectively. Each genetically determined unit increase in the natural-log-transformed vitamin D level was associated with a 43% reduction in the MS risk. 

Study details: A 2-sample Mendelian randomization study estimated the effect of BMI and vitamin D status on MS risk; associations of single-nucleotide polymorphisms with both the risk factors of interest were obtained from the relevant consortia.

Disclosures: This study was funded through a grant from the Barts Charity. The authors declared no conflicts of interest.

Citation: Jacobs BM et al. Neurol Neuroimmunol Neuroinflamm. 2020 Jan 14. doi: 10.1212/NXI.0000000000000662. 

Key clinical point: In patients with multiple sclerosis (MS) without good recovery after the initial relapse, initiating a disease-modifying therapy (DMT) immediately increases the likelihood of a benign disease course.

Major finding: Patients with good recovery and immediate DMT initiation and those with poor recovery and delayed DMT initiation had about 65% and 20% chance, respectively, of remaining at a minimal disability level (Expanded Disability Status Scale score of less than 2.5) by age 45 years.

Study details: An analysis of data from the phase 3 CHAMPS trial in clinically isolated syndrome (n=383) and 10-year follow-up EXTENSION trial.

Disclosures: This study was funded by an unrestricted grant to Dr. Kantarci from Biogen. Dr. Kantarci and Dr. Atkinson received salary support as part of the grant from Biogen. Dr. Castrillo-Viguera was employed by Biogen.

Citation: Kantarci OH et al. Neurol Neuroimmunol Neuroinflamm. 2019 Dec 17. doi: 10.1212/NXI.0000000000000653. 

Key clinical point: In patients with multiple sclerosis (MS) without good recovery after the initial relapse, initiating a disease-modifying therapy (DMT) immediately increases the likelihood of a benign disease course.

Major finding: Patients with good recovery and immediate DMT initiation and those with poor recovery and delayed DMT initiation had about 65% and 20% chance, respectively, of remaining at a minimal disability level (Expanded Disability Status Scale score of less than 2.5) by age 45 years.

Study details: An analysis of data from the phase 3 CHAMPS trial in clinically isolated syndrome (n=383) and 10-year follow-up EXTENSION trial.

Disclosures: This study was funded by an unrestricted grant to Dr. Kantarci from Biogen. Dr. Kantarci and Dr. Atkinson received salary support as part of the grant from Biogen. Dr. Castrillo-Viguera was employed by Biogen.

Citation: Kantarci OH et al. Neurol Neuroimmunol Neuroinflamm. 2019 Dec 17. doi: 10.1212/NXI.0000000000000653. 

Key clinical point: In patients with multiple sclerosis (MS) without good recovery after the initial relapse, initiating a disease-modifying therapy (DMT) immediately increases the likelihood of a benign disease course.

Major finding: Patients with good recovery and immediate DMT initiation and those with poor recovery and delayed DMT initiation had about 65% and 20% chance, respectively, of remaining at a minimal disability level (Expanded Disability Status Scale score of less than 2.5) by age 45 years.

Study details: An analysis of data from the phase 3 CHAMPS trial in clinically isolated syndrome (n=383) and 10-year follow-up EXTENSION trial.

Disclosures: This study was funded by an unrestricted grant to Dr. Kantarci from Biogen. Dr. Kantarci and Dr. Atkinson received salary support as part of the grant from Biogen. Dr. Castrillo-Viguera was employed by Biogen.

Citation: Kantarci OH et al. Neurol Neuroimmunol Neuroinflamm. 2019 Dec 17. doi: 10.1212/NXI.0000000000000653. 

Key clinical point: Phase 3 EVOLVE-MS-2 study demonstrates that diroximel fumarate (DRF) has an improved gastrointestinal (GI) tolerability profile compared with dimethyl fumarate (DMF) in patients with relapsing-remitting multiple sclerosis (MS).

Major finding: Patients treated with DRF self-reported 46% fewer days with an Individual Gastrointestinal Symptom and Impact Scale (IGISIS) symptom intensity score of ≥2 vs those treated with DMF (rate ratio, 0.54; 95% confidence interval, 0.39-0.75). The rates of GI adverse events (AEs) were lower with DRF than DMF (34.8% vs. 49.0%). DRF-treated patients had a lower discontinuation rate because of GI AEs (0.8% vs. 4.8%) and overall AEs (1.6% vs. 5.6%).

Study details: EVOLVE-MS-2 was a 5-week randomized trial that directly compared the GI tolerability of DRF 462 mg (n = 253) with that of DMF 240 mg (n = 249); primary endpoint was the number of days with an IGISIS intensity score of 2 or greater relative to exposure.

Disclosures: This study was funded by Alkermes Inc. and Biogen. The authors reported receiving grants and personal fees from multiple pharmaceutical companies.

Citation: Naismith RT et al. CNS Drugs. 2020 Jan 17. doi: 10.1007/s40263-020-00700-0. 

Key clinical point: Phase 3 EVOLVE-MS-2 study demonstrates that diroximel fumarate (DRF) has an improved gastrointestinal (GI) tolerability profile compared with dimethyl fumarate (DMF) in patients with relapsing-remitting multiple sclerosis (MS).

Major finding: Patients treated with DRF self-reported 46% fewer days with an Individual Gastrointestinal Symptom and Impact Scale (IGISIS) symptom intensity score of ≥2 vs those treated with DMF (rate ratio, 0.54; 95% confidence interval, 0.39-0.75). The rates of GI adverse events (AEs) were lower with DRF than DMF (34.8% vs. 49.0%). DRF-treated patients had a lower discontinuation rate because of GI AEs (0.8% vs. 4.8%) and overall AEs (1.6% vs. 5.6%).

Study details: EVOLVE-MS-2 was a 5-week randomized trial that directly compared the GI tolerability of DRF 462 mg (n = 253) with that of DMF 240 mg (n = 249); primary endpoint was the number of days with an IGISIS intensity score of 2 or greater relative to exposure.

Disclosures: This study was funded by Alkermes Inc. and Biogen. The authors reported receiving grants and personal fees from multiple pharmaceutical companies.

Citation: Naismith RT et al. CNS Drugs. 2020 Jan 17. doi: 10.1007/s40263-020-00700-0. 

Key clinical point: Phase 3 EVOLVE-MS-2 study demonstrates that diroximel fumarate (DRF) has an improved gastrointestinal (GI) tolerability profile compared with dimethyl fumarate (DMF) in patients with relapsing-remitting multiple sclerosis (MS).

Major finding: Patients treated with DRF self-reported 46% fewer days with an Individual Gastrointestinal Symptom and Impact Scale (IGISIS) symptom intensity score of ≥2 vs those treated with DMF (rate ratio, 0.54; 95% confidence interval, 0.39-0.75). The rates of GI adverse events (AEs) were lower with DRF than DMF (34.8% vs. 49.0%). DRF-treated patients had a lower discontinuation rate because of GI AEs (0.8% vs. 4.8%) and overall AEs (1.6% vs. 5.6%).

Study details: EVOLVE-MS-2 was a 5-week randomized trial that directly compared the GI tolerability of DRF 462 mg (n = 253) with that of DMF 240 mg (n = 249); primary endpoint was the number of days with an IGISIS intensity score of 2 or greater relative to exposure.

Disclosures: This study was funded by Alkermes Inc. and Biogen. The authors reported receiving grants and personal fees from multiple pharmaceutical companies.

Citation: Naismith RT et al. CNS Drugs. 2020 Jan 17. doi: 10.1007/s40263-020-00700-0. 

The dermMentors™ Resident of Distinction Award™ was presented to 5 dermatology residents at the 19th Annual Caribbean Dermatology Symposium, January 21–25, 2020, in Paradise Island, Bahamas. Recipients of the award include Rachel Giesey, DO, Case Western Reserve University, Cleveland, Ohio, and University Hospitals Cleveland Medical Center, Cleveland, Ohio; Janice Tiao, MD, Boston University Medical Center, Boston, Massachusetts; Jordan V. Wang, MD, MBE, MBA, Thomas Jefferson University, Philadelphia, Pennsylvania; Jacqueline D. Watchmaker, MD, Boston University School of Medicine, Boston, Massachusetts; and Jennifer E. Yeh, MD, PhD, Brigham and Women’s Hospital, Boston, Massachusetts. The residents presented their research during the general sessions on January 25, 2020.

The overall grand prize was awarded to Dr. Yeh for her research entitled, “Topical Imiquimod in Combination With Brachytherapy for Unresectable Cutaneous Melanoma Metastases.” Dr. Yeh presented the utility of combining topical imiquimod with brachytherapy for locoregional control of cutaneous metastases through the presentation of 3 patients with scalp melanoma initially treated with wide local excision who developed numerous cutaneous metastases. “While surgical excision is the first-line treatment of single, discrete cutaneous metastases, it may not be practical in patients with multiple foci of disease distributed over large areas, as seen in the 3 patients presented here who achieved complete resolution of their cutaneous metastatic burden with concurrent topical imiquimod and brachytherapy,” Dr. Yeh reported.

Presentations by the other residents included a study of the burden of common skin diseases in the Caribbean and the potential correlation with a country’s socioeconomic status (Dr. Giesey), a study of the use of doxycycline in patients with lichen planopilaris and frontal fibrosing alopecia (Dr. Tiao), a discussion of counterfeit medical devices and injectables as well as medical spas in dermatology (Dr. Wang), and a study of the most common reasons patients are dissatisfied with minimally and noninvasive cosmetic procedures (Dr. Watchmaker). Access all of the abstracts presented by the top residents here. 

The dermMentors™ Resident of Distinction Award™ recognizes top residents in dermatology. DermMentors.org and the dermMentors™ Resident of Distinction Award™ are sponsored by Beiersdorf Inc and administered by DermEd, Inc. The 2020 dermMentors™ Residents of Distinction™ presented new scientific research during the general sessions of the 19th Annual Caribbean Dermatology Symposium on January 25, 2020.

The dermMentors™ Resident of Distinction Award™ was presented to 5 dermatology residents at the 19th Annual Caribbean Dermatology Symposium, January 21–25, 2020, in Paradise Island, Bahamas. Recipients of the award include Rachel Giesey, DO, Case Western Reserve University, Cleveland, Ohio, and University Hospitals Cleveland Medical Center, Cleveland, Ohio; Janice Tiao, MD, Boston University Medical Center, Boston, Massachusetts; Jordan V. Wang, MD, MBE, MBA, Thomas Jefferson University, Philadelphia, Pennsylvania; Jacqueline D. Watchmaker, MD, Boston University School of Medicine, Boston, Massachusetts; and Jennifer E. Yeh, MD, PhD, Brigham and Women’s Hospital, Boston, Massachusetts. The residents presented their research during the general sessions on January 25, 2020.

The overall grand prize was awarded to Dr. Yeh for her research entitled, “Topical Imiquimod in Combination With Brachytherapy for Unresectable Cutaneous Melanoma Metastases.” Dr. Yeh presented the utility of combining topical imiquimod with brachytherapy for locoregional control of cutaneous metastases through the presentation of 3 patients with scalp melanoma initially treated with wide local excision who developed numerous cutaneous metastases. “While surgical excision is the first-line treatment of single, discrete cutaneous metastases, it may not be practical in patients with multiple foci of disease distributed over large areas, as seen in the 3 patients presented here who achieved complete resolution of their cutaneous metastatic burden with concurrent topical imiquimod and brachytherapy,” Dr. Yeh reported.

Presentations by the other residents included a study of the burden of common skin diseases in the Caribbean and the potential correlation with a country’s socioeconomic status (Dr. Giesey), a study of the use of doxycycline in patients with lichen planopilaris and frontal fibrosing alopecia (Dr. Tiao), a discussion of counterfeit medical devices and injectables as well as medical spas in dermatology (Dr. Wang), and a study of the most common reasons patients are dissatisfied with minimally and noninvasive cosmetic procedures (Dr. Watchmaker). Access all of the abstracts presented by the top residents here. 

The dermMentors™ Resident of Distinction Award™ recognizes top residents in dermatology. DermMentors.org and the dermMentors™ Resident of Distinction Award™ are sponsored by Beiersdorf Inc and administered by DermEd, Inc. The 2020 dermMentors™ Residents of Distinction™ presented new scientific research during the general sessions of the 19th Annual Caribbean Dermatology Symposium on January 25, 2020.

The dermMentors™ Resident of Distinction Award™ was presented to 5 dermatology residents at the 19th Annual Caribbean Dermatology Symposium, January 21–25, 2020, in Paradise Island, Bahamas. Recipients of the award include Rachel Giesey, DO, Case Western Reserve University, Cleveland, Ohio, and University Hospitals Cleveland Medical Center, Cleveland, Ohio; Janice Tiao, MD, Boston University Medical Center, Boston, Massachusetts; Jordan V. Wang, MD, MBE, MBA, Thomas Jefferson University, Philadelphia, Pennsylvania; Jacqueline D. Watchmaker, MD, Boston University School of Medicine, Boston, Massachusetts; and Jennifer E. Yeh, MD, PhD, Brigham and Women’s Hospital, Boston, Massachusetts. The residents presented their research during the general sessions on January 25, 2020.

The overall grand prize was awarded to Dr. Yeh for her research entitled, “Topical Imiquimod in Combination With Brachytherapy for Unresectable Cutaneous Melanoma Metastases.” Dr. Yeh presented the utility of combining topical imiquimod with brachytherapy for locoregional control of cutaneous metastases through the presentation of 3 patients with scalp melanoma initially treated with wide local excision who developed numerous cutaneous metastases. “While surgical excision is the first-line treatment of single, discrete cutaneous metastases, it may not be practical in patients with multiple foci of disease distributed over large areas, as seen in the 3 patients presented here who achieved complete resolution of their cutaneous metastatic burden with concurrent topical imiquimod and brachytherapy,” Dr. Yeh reported.

Presentations by the other residents included a study of the burden of common skin diseases in the Caribbean and the potential correlation with a country’s socioeconomic status (Dr. Giesey), a study of the use of doxycycline in patients with lichen planopilaris and frontal fibrosing alopecia (Dr. Tiao), a discussion of counterfeit medical devices and injectables as well as medical spas in dermatology (Dr. Wang), and a study of the most common reasons patients are dissatisfied with minimally and noninvasive cosmetic procedures (Dr. Watchmaker). Access all of the abstracts presented by the top residents here. 

The dermMentors™ Resident of Distinction Award™ recognizes top residents in dermatology. DermMentors.org and the dermMentors™ Resident of Distinction Award™ are sponsored by Beiersdorf Inc and administered by DermEd, Inc. The 2020 dermMentors™ Residents of Distinction™ presented new scientific research during the general sessions of the 19th Annual Caribbean Dermatology Symposium on January 25, 2020.

The Society of Hospital Medicine has announced that Eric Howell, MD, MHM, will become its next CEO effective July 1, 2020. Dr. Howell will replace Laurence Wellikson, MD, MHM, who helped to found the society, and has been its first and only CEO since 2000.

“On behalf of the SHM board of directors, we welcome Dr. Howell as the incoming CEO for our organization who, with the mission-driven commitment and dedication of SHM staff, will take SHM into the future,” said Danielle Scheurer, MD, MSRC, SFHM, president-elect of SHM and chair of the CEO search committee. “With his broad knowledge of hospital medicine and extensive volunteer leadership at SHM, Dr. Howell’s experience is a natural complement to SHM’s core mission.”

Dr. Howell has a long history with SHM and has a wealth of expertise in hospital medicine. Since July 2018, he has served as chief operating officer of SHM, leading senior management’s planning and defining organizational goals to drive extensive, sustainable growth. Dr. Howell has also served as the senior physician advisor to SHM’s Center for Quality Improvement, the society’s arm that conducts quality improvement programs for hospitalist teams, since 2015. He is a past president of SHM’s board of directors and currently serves as the course director for the SHM Leadership Academies.

“Having been involved with SHM in many capacities since first joining, I am truly honored to become SHM’s CEO,” Dr. Howell said. “I always tell everyone that my goal is to make the world a better place, and I know that SHM’s staff will be able to do just that through the development and deployment of a variety of products, tools, and services to help hospitalists improve patient care.”

In addition to serving in various capacities at SHM, Dr. Howell has been a professor of medicine in the department of medicine at Johns Hopkins University, Baltimore. He has held multiple titles within the Johns Hopkins medical institutions, including chief of the division of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, section chief of hospital medicine for Johns Hopkins Community Physicians, deputy director of hospital operations for the department of medicine at Johns Hopkins Bayview, and chief medical officer of operations at Johns Hopkins Bayview. Dr. Howell joined the Johns Hopkins Bayview hospitalist program in 2000, began the Howard County (Md.) General Hospital hospitalist program in 2010, and oversaw nearly 200 physicians and clinical staff providing patient care in three hospitals.

Dr. Howell received his electrical engineering degree from the University of Maryland, which has proven instrumental in his mastery of managing and implementing change in the hospital. His research has focused on the relationship between the emergency department and medicine floors, improving communication, throughput, and patient outcomes.

The search process was led by a CEO search committee, comprised of members of the SHM board of directors and assisted by the executive search firm Spencer Stuart. Launching a nationwide search, the firm identified candidates with the values and leadership qualities necessary to ensure the future growth of the organization.

“After a thorough search process, Dr. Eric Howell emerged as the right person to lead SHM,” said SHM board president Christopher Frost, MD, SFHM, “His experience in hospital medicine and his servant leadership style make him an ideal fit to lead SHM to even greater future success.”

In the coming weeks, the SHM board of directors will work with Dr. Howell and Dr. Wellikson on a smooth transition plan to have Dr. Howell assume the role on July 1, 2020.

The Society of Hospital Medicine has announced that Eric Howell, MD, MHM, will become its next CEO effective July 1, 2020. Dr. Howell will replace Laurence Wellikson, MD, MHM, who helped to found the society, and has been its first and only CEO since 2000.

“On behalf of the SHM board of directors, we welcome Dr. Howell as the incoming CEO for our organization who, with the mission-driven commitment and dedication of SHM staff, will take SHM into the future,” said Danielle Scheurer, MD, MSRC, SFHM, president-elect of SHM and chair of the CEO search committee. “With his broad knowledge of hospital medicine and extensive volunteer leadership at SHM, Dr. Howell’s experience is a natural complement to SHM’s core mission.”

Dr. Howell has a long history with SHM and has a wealth of expertise in hospital medicine. Since July 2018, he has served as chief operating officer of SHM, leading senior management’s planning and defining organizational goals to drive extensive, sustainable growth. Dr. Howell has also served as the senior physician advisor to SHM’s Center for Quality Improvement, the society’s arm that conducts quality improvement programs for hospitalist teams, since 2015. He is a past president of SHM’s board of directors and currently serves as the course director for the SHM Leadership Academies.

“Having been involved with SHM in many capacities since first joining, I am truly honored to become SHM’s CEO,” Dr. Howell said. “I always tell everyone that my goal is to make the world a better place, and I know that SHM’s staff will be able to do just that through the development and deployment of a variety of products, tools, and services to help hospitalists improve patient care.”

In addition to serving in various capacities at SHM, Dr. Howell has been a professor of medicine in the department of medicine at Johns Hopkins University, Baltimore. He has held multiple titles within the Johns Hopkins medical institutions, including chief of the division of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, section chief of hospital medicine for Johns Hopkins Community Physicians, deputy director of hospital operations for the department of medicine at Johns Hopkins Bayview, and chief medical officer of operations at Johns Hopkins Bayview. Dr. Howell joined the Johns Hopkins Bayview hospitalist program in 2000, began the Howard County (Md.) General Hospital hospitalist program in 2010, and oversaw nearly 200 physicians and clinical staff providing patient care in three hospitals.

Dr. Howell received his electrical engineering degree from the University of Maryland, which has proven instrumental in his mastery of managing and implementing change in the hospital. His research has focused on the relationship between the emergency department and medicine floors, improving communication, throughput, and patient outcomes.

The search process was led by a CEO search committee, comprised of members of the SHM board of directors and assisted by the executive search firm Spencer Stuart. Launching a nationwide search, the firm identified candidates with the values and leadership qualities necessary to ensure the future growth of the organization.

“After a thorough search process, Dr. Eric Howell emerged as the right person to lead SHM,” said SHM board president Christopher Frost, MD, SFHM, “His experience in hospital medicine and his servant leadership style make him an ideal fit to lead SHM to even greater future success.”

In the coming weeks, the SHM board of directors will work with Dr. Howell and Dr. Wellikson on a smooth transition plan to have Dr. Howell assume the role on July 1, 2020.

The Society of Hospital Medicine has announced that Eric Howell, MD, MHM, will become its next CEO effective July 1, 2020. Dr. Howell will replace Laurence Wellikson, MD, MHM, who helped to found the society, and has been its first and only CEO since 2000.

“On behalf of the SHM board of directors, we welcome Dr. Howell as the incoming CEO for our organization who, with the mission-driven commitment and dedication of SHM staff, will take SHM into the future,” said Danielle Scheurer, MD, MSRC, SFHM, president-elect of SHM and chair of the CEO search committee. “With his broad knowledge of hospital medicine and extensive volunteer leadership at SHM, Dr. Howell’s experience is a natural complement to SHM’s core mission.”

Dr. Howell has a long history with SHM and has a wealth of expertise in hospital medicine. Since July 2018, he has served as chief operating officer of SHM, leading senior management’s planning and defining organizational goals to drive extensive, sustainable growth. Dr. Howell has also served as the senior physician advisor to SHM’s Center for Quality Improvement, the society’s arm that conducts quality improvement programs for hospitalist teams, since 2015. He is a past president of SHM’s board of directors and currently serves as the course director for the SHM Leadership Academies.

“Having been involved with SHM in many capacities since first joining, I am truly honored to become SHM’s CEO,” Dr. Howell said. “I always tell everyone that my goal is to make the world a better place, and I know that SHM’s staff will be able to do just that through the development and deployment of a variety of products, tools, and services to help hospitalists improve patient care.”

In addition to serving in various capacities at SHM, Dr. Howell has been a professor of medicine in the department of medicine at Johns Hopkins University, Baltimore. He has held multiple titles within the Johns Hopkins medical institutions, including chief of the division of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, section chief of hospital medicine for Johns Hopkins Community Physicians, deputy director of hospital operations for the department of medicine at Johns Hopkins Bayview, and chief medical officer of operations at Johns Hopkins Bayview. Dr. Howell joined the Johns Hopkins Bayview hospitalist program in 2000, began the Howard County (Md.) General Hospital hospitalist program in 2010, and oversaw nearly 200 physicians and clinical staff providing patient care in three hospitals.

Dr. Howell received his electrical engineering degree from the University of Maryland, which has proven instrumental in his mastery of managing and implementing change in the hospital. His research has focused on the relationship between the emergency department and medicine floors, improving communication, throughput, and patient outcomes.

The search process was led by a CEO search committee, comprised of members of the SHM board of directors and assisted by the executive search firm Spencer Stuart. Launching a nationwide search, the firm identified candidates with the values and leadership qualities necessary to ensure the future growth of the organization.

“After a thorough search process, Dr. Eric Howell emerged as the right person to lead SHM,” said SHM board president Christopher Frost, MD, SFHM, “His experience in hospital medicine and his servant leadership style make him an ideal fit to lead SHM to even greater future success.”

In the coming weeks, the SHM board of directors will work with Dr. Howell and Dr. Wellikson on a smooth transition plan to have Dr. Howell assume the role on July 1, 2020.

Personalized treatment for depression may soon become a reality, thanks to an artificial intelligence (AI) algorithm that accurately predicts antidepressant efficacy in specific patients.

A landmark study of more than 300 patients with major depressive disorder (MDD) showed that a latent-space machine-learning algorithm tailored for resting-state EEG robustly predicted patient response to sertraline. The findings were generalizable across different study sites and EEG equipment.

“We found that the use of the artificial intelligence algorithm can identify the EEG signature for patients who do well on sertraline,” study investigator Madhukar H. Trivedi, MD, professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas, said in an interview.

“Interestingly, when we looked further, it became clear that patients with that same EEG signature do not do well on placebo,” he added.

The study was published online Feb. 10 in Nature Biotechnology (doi: 10.1038/s41587-019-0397-3).

Pivotal study

Currently, major depression is defined using a range of clinical criteria. As such, it encompasses a heterogeneous mix of neurobiological phenotypes. Such heterogeneity may account for the modest superiority of antidepressant medication relative to placebo.

While recent research suggests that resting-state EEG may help identify treatment-predictive heterogeneity in depression, these studies have also been hindered by a lack of cross-validation and small sample sizes.

What’s more, these studies have either identified nonspecific predictors or failed to yield generalizable neural signatures that are predictive at the individual patient level (Am J Psychiatry. 2019 Jan 1;176[1]:44-56).

For these reasons, there is currently no robust neurobiological signature for an antidepressant-responsive phenotype that may help identify which patients would benefit from antidepressant medication. Nevertheless, said Dr. Trivedi, detailing such a signature would promote a neurobiological understanding of treatment response, with the potential for notable clinical implications.

“The idea behind this [National Institutes of Health]–funded study was to develop biomarkers that can distinguish treatment outcomes between drug and placebo,” he said. “To do so, we needed a randomized, placebo-controlled trial that has significant breadth in terms of biomarker evaluation and validation, and this study was designed specifically with this end in mind.

“There has not been a drug-placebo study that has looked at this in patients with depression,” Dr. Trivedi said. “So in that sense, this was really a pivotal study.”

To help address these challenges, the investigators developed a machine-learning algorithm they called SELSER (Sparse EEG Latent Space Regression).

Using data from four separate studies, they first established the resting-state EEG predictive signature by training SELSER on data from 309 patients from the EMBARC (Establishing Moderators and Biosignatures of Antidepressant Response in Clinic Care) study, a neuroimaging-coupled, placebo-controlled, randomized clinical study of antidepressant efficacy.

The generalizability of the antidepressant-predictive signature was then tested in a second independent sample of 72 depressed patients.

In a third independent sample of 24 depressed patients, the researchers assessed the convergent validity and neurobiological significance of the treatment-predictive, resting-state EEG signature.

Finally, a fourth sample of 152 depressed patients was used to test the generalizability of the results.

‘Fantastic’ result but validation needed

These combined efforts were aimed at revealing a treatment responsive phenotype in depression, dissociate between medication and placebo response, establish its mechanistic significance, and provide initial evidence regarding the potential for treatment selection on the basis of a resting-state EEG signature.

The study showed that improvement in patients’ symptoms was robustly predicted by the algorithm. These predictions were specific for sertraline relative to placebo.

When generalized to two depression samples, the researchers also found that the algorithm reflected general antidepressant medication responsivity and related differentially to a repetitive transcranial magnetic stimulation (TMS) treatment outcome.

“Although we only looked at sertraline,” Dr. Trivedi said, “we also applied the signature to a sample of patients who had been treated with transcranial magnetic stimulation. And we found that the signature for TMS [response] is different than the signature for sertraline.”

Interestingly, the antidepressant-predictive signature identified by SELSER was also superior to that of conventional machine-learning models or latent modeling methods, such as independent-component analysis or principal-component analysis. This SELSER signature was also superior to a model trained on clinical data alone and was able to predict outcome using resting-state EEG data acquired at a study site not included in the model training set.

The study also revealed evidence of multimodal convergent validity for the antidepressant-response signature by virtue of its correlation with expression of a task-based functional MRI signature in one of the four datasets.

The strength of the resting-state signature was also found to correlate with prefrontal neural responsivity, as indexed by direct stimulation with single-pulse TMS and EEG.

Given the ability of the algorithm to both predict outcome with sertraline and distinguish response between sertraline and placebo at the individual patient level, the investigators believe SELSER may one day support machine learning–driven personalized approaches to depression treatment.

“Our findings advance the neurobiological understanding of antidepressant treatment through an EEG-tailored computational model and provide a clinical avenue for personalized treatment of depression,” the authors wrote.

Yet, their work is far from over. Among the investigators’ next steps is the development of an AI interface that can be widely integrated with EEGs across the country.

“Identifying this signature was fantastic, but you’ve got to be able to validate it as well,” Dr. Trivedi noted. “And luckily, we were able to validate it in the three additional studies.

“The next question is whether it can be broadened to other illnesses.”

Promising research

Commenting on the findings in an interview, Michele Ferrante, PhD, said he believes there may soon be a time during which algorithms such as this are used to personalize depression treatment.

“It’s well known that there are no good biological tests in psychiatry, but promising computational tools, biomarkers, and behavioral signatures for segregating patients according to treatment response are starting to emerge for depression,” said Dr. Ferrante, program chief of the Theoretical and Computational Neuroscience Program at the National Institute of Mental Health (NIMH).

“Precision in the ability to predict what patient will respond to each treatment will improve over time, I have no doubt,” added Dr. Ferrante, who was not involved with the current study.

However, he noted, such approaches are not without their potential drawbacks.

“The greatest challenge is to continuously validate these computational tools as they keep on learning from more heterogeneous groups. Another challenge will be to make sure that these computational tools become well-established, widely adopted, safe, and regulated by the [Food and Drug Administration] as Software as a Medical Device,” he said.

The current algorithm will also need to undergo further testing, said Dr. Ferrante.

“It has been validated on an external dataset,” he said, “but now we need to do rigorous prospective clinical trials where patients are selectively assigned by the AI to a treatment according to their biosignature, to see if these results hold true.

“Down the road, it would be important to implement computational models [that are] able to assign patients across the multiple treatments available for depression, including pharmaceuticals, psychosocial interventions, and neural devices.”

The study was funded directly and indirectly by the NIMH of the National Institutes of Health, the Stanford Neurosciences Institute, the Hersh Foundation, the National Key Research and Development Plan of China, and the National Natural Science Foundation of China.

Dr. Trivedi disclosed numerous financial relationships with pharmaceutical companies and device manufacturers. He has received grants/research support from the Agency for Healthcare Research and Quality, Cyberonic, the National Alliance for Research in Schizophrenia and Depression, the NIMH, and the National Institute on Drug Abuse.
 

A version of this article first appeared on Medscape.com.

Personalized treatment for depression may soon become a reality, thanks to an artificial intelligence (AI) algorithm that accurately predicts antidepressant efficacy in specific patients.

A landmark study of more than 300 patients with major depressive disorder (MDD) showed that a latent-space machine-learning algorithm tailored for resting-state EEG robustly predicted patient response to sertraline. The findings were generalizable across different study sites and EEG equipment.

“We found that the use of the artificial intelligence algorithm can identify the EEG signature for patients who do well on sertraline,” study investigator Madhukar H. Trivedi, MD, professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas, said in an interview.

“Interestingly, when we looked further, it became clear that patients with that same EEG signature do not do well on placebo,” he added.

The study was published online Feb. 10 in Nature Biotechnology (doi: 10.1038/s41587-019-0397-3).

Pivotal study

Currently, major depression is defined using a range of clinical criteria. As such, it encompasses a heterogeneous mix of neurobiological phenotypes. Such heterogeneity may account for the modest superiority of antidepressant medication relative to placebo.

While recent research suggests that resting-state EEG may help identify treatment-predictive heterogeneity in depression, these studies have also been hindered by a lack of cross-validation and small sample sizes.

What’s more, these studies have either identified nonspecific predictors or failed to yield generalizable neural signatures that are predictive at the individual patient level (Am J Psychiatry. 2019 Jan 1;176[1]:44-56).

For these reasons, there is currently no robust neurobiological signature for an antidepressant-responsive phenotype that may help identify which patients would benefit from antidepressant medication. Nevertheless, said Dr. Trivedi, detailing such a signature would promote a neurobiological understanding of treatment response, with the potential for notable clinical implications.

“The idea behind this [National Institutes of Health]–funded study was to develop biomarkers that can distinguish treatment outcomes between drug and placebo,” he said. “To do so, we needed a randomized, placebo-controlled trial that has significant breadth in terms of biomarker evaluation and validation, and this study was designed specifically with this end in mind.

“There has not been a drug-placebo study that has looked at this in patients with depression,” Dr. Trivedi said. “So in that sense, this was really a pivotal study.”

To help address these challenges, the investigators developed a machine-learning algorithm they called SELSER (Sparse EEG Latent Space Regression).

Using data from four separate studies, they first established the resting-state EEG predictive signature by training SELSER on data from 309 patients from the EMBARC (Establishing Moderators and Biosignatures of Antidepressant Response in Clinic Care) study, a neuroimaging-coupled, placebo-controlled, randomized clinical study of antidepressant efficacy.

The generalizability of the antidepressant-predictive signature was then tested in a second independent sample of 72 depressed patients.

In a third independent sample of 24 depressed patients, the researchers assessed the convergent validity and neurobiological significance of the treatment-predictive, resting-state EEG signature.

Finally, a fourth sample of 152 depressed patients was used to test the generalizability of the results.

‘Fantastic’ result but validation needed

These combined efforts were aimed at revealing a treatment responsive phenotype in depression, dissociate between medication and placebo response, establish its mechanistic significance, and provide initial evidence regarding the potential for treatment selection on the basis of a resting-state EEG signature.

The study showed that improvement in patients’ symptoms was robustly predicted by the algorithm. These predictions were specific for sertraline relative to placebo.

When generalized to two depression samples, the researchers also found that the algorithm reflected general antidepressant medication responsivity and related differentially to a repetitive transcranial magnetic stimulation (TMS) treatment outcome.

“Although we only looked at sertraline,” Dr. Trivedi said, “we also applied the signature to a sample of patients who had been treated with transcranial magnetic stimulation. And we found that the signature for TMS [response] is different than the signature for sertraline.”

Interestingly, the antidepressant-predictive signature identified by SELSER was also superior to that of conventional machine-learning models or latent modeling methods, such as independent-component analysis or principal-component analysis. This SELSER signature was also superior to a model trained on clinical data alone and was able to predict outcome using resting-state EEG data acquired at a study site not included in the model training set.

The study also revealed evidence of multimodal convergent validity for the antidepressant-response signature by virtue of its correlation with expression of a task-based functional MRI signature in one of the four datasets.

The strength of the resting-state signature was also found to correlate with prefrontal neural responsivity, as indexed by direct stimulation with single-pulse TMS and EEG.

Given the ability of the algorithm to both predict outcome with sertraline and distinguish response between sertraline and placebo at the individual patient level, the investigators believe SELSER may one day support machine learning–driven personalized approaches to depression treatment.

“Our findings advance the neurobiological understanding of antidepressant treatment through an EEG-tailored computational model and provide a clinical avenue for personalized treatment of depression,” the authors wrote.

Yet, their work is far from over. Among the investigators’ next steps is the development of an AI interface that can be widely integrated with EEGs across the country.

“Identifying this signature was fantastic, but you’ve got to be able to validate it as well,” Dr. Trivedi noted. “And luckily, we were able to validate it in the three additional studies.

“The next question is whether it can be broadened to other illnesses.”

Promising research

Commenting on the findings in an interview, Michele Ferrante, PhD, said he believes there may soon be a time during which algorithms such as this are used to personalize depression treatment.

“It’s well known that there are no good biological tests in psychiatry, but promising computational tools, biomarkers, and behavioral signatures for segregating patients according to treatment response are starting to emerge for depression,” said Dr. Ferrante, program chief of the Theoretical and Computational Neuroscience Program at the National Institute of Mental Health (NIMH).

“Precision in the ability to predict what patient will respond to each treatment will improve over time, I have no doubt,” added Dr. Ferrante, who was not involved with the current study.

However, he noted, such approaches are not without their potential drawbacks.

“The greatest challenge is to continuously validate these computational tools as they keep on learning from more heterogeneous groups. Another challenge will be to make sure that these computational tools become well-established, widely adopted, safe, and regulated by the [Food and Drug Administration] as Software as a Medical Device,” he said.

The current algorithm will also need to undergo further testing, said Dr. Ferrante.

“It has been validated on an external dataset,” he said, “but now we need to do rigorous prospective clinical trials where patients are selectively assigned by the AI to a treatment according to their biosignature, to see if these results hold true.

“Down the road, it would be important to implement computational models [that are] able to assign patients across the multiple treatments available for depression, including pharmaceuticals, psychosocial interventions, and neural devices.”

The study was funded directly and indirectly by the NIMH of the National Institutes of Health, the Stanford Neurosciences Institute, the Hersh Foundation, the National Key Research and Development Plan of China, and the National Natural Science Foundation of China.

Dr. Trivedi disclosed numerous financial relationships with pharmaceutical companies and device manufacturers. He has received grants/research support from the Agency for Healthcare Research and Quality, Cyberonic, the National Alliance for Research in Schizophrenia and Depression, the NIMH, and the National Institute on Drug Abuse.
 

A version of this article first appeared on Medscape.com.

Personalized treatment for depression may soon become a reality, thanks to an artificial intelligence (AI) algorithm that accurately predicts antidepressant efficacy in specific patients.

A landmark study of more than 300 patients with major depressive disorder (MDD) showed that a latent-space machine-learning algorithm tailored for resting-state EEG robustly predicted patient response to sertraline. The findings were generalizable across different study sites and EEG equipment.

“We found that the use of the artificial intelligence algorithm can identify the EEG signature for patients who do well on sertraline,” study investigator Madhukar H. Trivedi, MD, professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas, said in an interview.

“Interestingly, when we looked further, it became clear that patients with that same EEG signature do not do well on placebo,” he added.

The study was published online Feb. 10 in Nature Biotechnology (doi: 10.1038/s41587-019-0397-3).

Pivotal study

Currently, major depression is defined using a range of clinical criteria. As such, it encompasses a heterogeneous mix of neurobiological phenotypes. Such heterogeneity may account for the modest superiority of antidepressant medication relative to placebo.

While recent research suggests that resting-state EEG may help identify treatment-predictive heterogeneity in depression, these studies have also been hindered by a lack of cross-validation and small sample sizes.

What’s more, these studies have either identified nonspecific predictors or failed to yield generalizable neural signatures that are predictive at the individual patient level (Am J Psychiatry. 2019 Jan 1;176[1]:44-56).

For these reasons, there is currently no robust neurobiological signature for an antidepressant-responsive phenotype that may help identify which patients would benefit from antidepressant medication. Nevertheless, said Dr. Trivedi, detailing such a signature would promote a neurobiological understanding of treatment response, with the potential for notable clinical implications.

“The idea behind this [National Institutes of Health]–funded study was to develop biomarkers that can distinguish treatment outcomes between drug and placebo,” he said. “To do so, we needed a randomized, placebo-controlled trial that has significant breadth in terms of biomarker evaluation and validation, and this study was designed specifically with this end in mind.

“There has not been a drug-placebo study that has looked at this in patients with depression,” Dr. Trivedi said. “So in that sense, this was really a pivotal study.”

To help address these challenges, the investigators developed a machine-learning algorithm they called SELSER (Sparse EEG Latent Space Regression).

Using data from four separate studies, they first established the resting-state EEG predictive signature by training SELSER on data from 309 patients from the EMBARC (Establishing Moderators and Biosignatures of Antidepressant Response in Clinic Care) study, a neuroimaging-coupled, placebo-controlled, randomized clinical study of antidepressant efficacy.

The generalizability of the antidepressant-predictive signature was then tested in a second independent sample of 72 depressed patients.

In a third independent sample of 24 depressed patients, the researchers assessed the convergent validity and neurobiological significance of the treatment-predictive, resting-state EEG signature.

Finally, a fourth sample of 152 depressed patients was used to test the generalizability of the results.

‘Fantastic’ result but validation needed

These combined efforts were aimed at revealing a treatment responsive phenotype in depression, dissociate between medication and placebo response, establish its mechanistic significance, and provide initial evidence regarding the potential for treatment selection on the basis of a resting-state EEG signature.

The study showed that improvement in patients’ symptoms was robustly predicted by the algorithm. These predictions were specific for sertraline relative to placebo.

When generalized to two depression samples, the researchers also found that the algorithm reflected general antidepressant medication responsivity and related differentially to a repetitive transcranial magnetic stimulation (TMS) treatment outcome.

“Although we only looked at sertraline,” Dr. Trivedi said, “we also applied the signature to a sample of patients who had been treated with transcranial magnetic stimulation. And we found that the signature for TMS [response] is different than the signature for sertraline.”

Interestingly, the antidepressant-predictive signature identified by SELSER was also superior to that of conventional machine-learning models or latent modeling methods, such as independent-component analysis or principal-component analysis. This SELSER signature was also superior to a model trained on clinical data alone and was able to predict outcome using resting-state EEG data acquired at a study site not included in the model training set.

The study also revealed evidence of multimodal convergent validity for the antidepressant-response signature by virtue of its correlation with expression of a task-based functional MRI signature in one of the four datasets.

The strength of the resting-state signature was also found to correlate with prefrontal neural responsivity, as indexed by direct stimulation with single-pulse TMS and EEG.

Given the ability of the algorithm to both predict outcome with sertraline and distinguish response between sertraline and placebo at the individual patient level, the investigators believe SELSER may one day support machine learning–driven personalized approaches to depression treatment.

“Our findings advance the neurobiological understanding of antidepressant treatment through an EEG-tailored computational model and provide a clinical avenue for personalized treatment of depression,” the authors wrote.

Yet, their work is far from over. Among the investigators’ next steps is the development of an AI interface that can be widely integrated with EEGs across the country.

“Identifying this signature was fantastic, but you’ve got to be able to validate it as well,” Dr. Trivedi noted. “And luckily, we were able to validate it in the three additional studies.

“The next question is whether it can be broadened to other illnesses.”

Promising research

Commenting on the findings in an interview, Michele Ferrante, PhD, said he believes there may soon be a time during which algorithms such as this are used to personalize depression treatment.

“It’s well known that there are no good biological tests in psychiatry, but promising computational tools, biomarkers, and behavioral signatures for segregating patients according to treatment response are starting to emerge for depression,” said Dr. Ferrante, program chief of the Theoretical and Computational Neuroscience Program at the National Institute of Mental Health (NIMH).

“Precision in the ability to predict what patient will respond to each treatment will improve over time, I have no doubt,” added Dr. Ferrante, who was not involved with the current study.

However, he noted, such approaches are not without their potential drawbacks.

“The greatest challenge is to continuously validate these computational tools as they keep on learning from more heterogeneous groups. Another challenge will be to make sure that these computational tools become well-established, widely adopted, safe, and regulated by the [Food and Drug Administration] as Software as a Medical Device,” he said.

The current algorithm will also need to undergo further testing, said Dr. Ferrante.

“It has been validated on an external dataset,” he said, “but now we need to do rigorous prospective clinical trials where patients are selectively assigned by the AI to a treatment according to their biosignature, to see if these results hold true.

“Down the road, it would be important to implement computational models [that are] able to assign patients across the multiple treatments available for depression, including pharmaceuticals, psychosocial interventions, and neural devices.”

The study was funded directly and indirectly by the NIMH of the National Institutes of Health, the Stanford Neurosciences Institute, the Hersh Foundation, the National Key Research and Development Plan of China, and the National Natural Science Foundation of China.

Dr. Trivedi disclosed numerous financial relationships with pharmaceutical companies and device manufacturers. He has received grants/research support from the Agency for Healthcare Research and Quality, Cyberonic, the National Alliance for Research in Schizophrenia and Depression, the NIMH, and the National Institute on Drug Abuse.
 

A version of this article first appeared on Medscape.com.

As of 6 a.m. Geneva time, Feb. 21, China reported 75,567 cases of COVID-19 and 2,239 deaths, including a total of 892 new confirmed cases that were reported in China in the past 24 hours, with 118 deaths, stated Tedros Adhanom Ghebreyesus, MD, World Health Organization Director-General, in a Feb. 21 news conference on the COVID-19 outbreak.

What he described as “the significant decline in newly reported cases” is partly because of a change in reporting in which China switched from including “clinically diagnosed” cases to reporting only “suspected” and “laboratory confirmed cases.” The reporting procedure changed because the medical facilities in Wuhan regained the capability of checking all suspected cases with laboratory tests. As a result, some cases that were clinically confirmed were subtracted from the total because they tested negative, said Dr. Ghebreyesus.

Although the number of cases in Hubuei province continues to decline, the WHO is concerned about an increase seen in Shandong province and they are seeking more information. Outside China, there are now 1,152 cases in 26 countries and eight deaths. “Although the number of cases outside of China remains small, we are concerned about the cases with no clear epidemiological link, such as travel history to China, or contact with a confirmed case,” said Dr. Ghebreyesus. “Apart from the Diamond Princess cruise ship, the Republic of Korea now has the most cases outside China, and we are working closely with that government to understand the transmission dynamics that led to this increase.”

“We are also concerned about the increase of cases in the Islamic Republic of Iran, where there are now 18 cases and four deaths in just the past 2 days.”

“Our particular concern is for COVID-19 to spread in countries with weaker health systems,” he said, adding that tomorrow, he will address an emergency meeting of African health ministers held jointly by the African Union and the African Centres for Disease Control and Prevention on dealing with COVID-19.

Dr. Ghebreyesus also announced that today the WHO has designated six special envoys on COVID-19 to provide strategic advice and high-level political advocacy and engagement in different parts of the world.

In his remarks, Dr. Ghebreyesus particularly stressed that: “The measures that China and other countries have taken have given us a fighting chance of containing the spread of the virus. We call on all countries to continue their commitment for containment measures, while preparing for community transmission if it occurs. We must not look back and regret that we failed to take advantage of the window of opportunity that we have now.”

In the question and answer period, Dr. Ghebreyesus specifically addressed the issue of misinformation and conspiracy theories being promulgated by certain individuals and on social media about the source of the virus, especially those people who believe that it was designed in a Chinese virus laboratory. Scientists play an important role in refuting such particular misinformation, he said, and research must continue to track down the actual source in nature.

To that regard, a paper published online in the Lancet on Feb. 19, provided a consensus statement by more than 25 health scientists outside of China stating: “We stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin. Scientists from multiple countries have published and analyzed genomes of the causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and they overwhelmingly conclude that this coronavirus originated in wildlife, as have so many other emerging pathogens.”

The WHO issues daily coronavirus disease (COVID-2019) situation reports on its website and provides these telebriefing updates daily.

mlesney@mdedge.com

As of 6 a.m. Geneva time, Feb. 21, China reported 75,567 cases of COVID-19 and 2,239 deaths, including a total of 892 new confirmed cases that were reported in China in the past 24 hours, with 118 deaths, stated Tedros Adhanom Ghebreyesus, MD, World Health Organization Director-General, in a Feb. 21 news conference on the COVID-19 outbreak.

What he described as “the significant decline in newly reported cases” is partly because of a change in reporting in which China switched from including “clinically diagnosed” cases to reporting only “suspected” and “laboratory confirmed cases.” The reporting procedure changed because the medical facilities in Wuhan regained the capability of checking all suspected cases with laboratory tests. As a result, some cases that were clinically confirmed were subtracted from the total because they tested negative, said Dr. Ghebreyesus.

Although the number of cases in Hubuei province continues to decline, the WHO is concerned about an increase seen in Shandong province and they are seeking more information. Outside China, there are now 1,152 cases in 26 countries and eight deaths. “Although the number of cases outside of China remains small, we are concerned about the cases with no clear epidemiological link, such as travel history to China, or contact with a confirmed case,” said Dr. Ghebreyesus. “Apart from the Diamond Princess cruise ship, the Republic of Korea now has the most cases outside China, and we are working closely with that government to understand the transmission dynamics that led to this increase.”

“We are also concerned about the increase of cases in the Islamic Republic of Iran, where there are now 18 cases and four deaths in just the past 2 days.”

“Our particular concern is for COVID-19 to spread in countries with weaker health systems,” he said, adding that tomorrow, he will address an emergency meeting of African health ministers held jointly by the African Union and the African Centres for Disease Control and Prevention on dealing with COVID-19.

Dr. Ghebreyesus also announced that today the WHO has designated six special envoys on COVID-19 to provide strategic advice and high-level political advocacy and engagement in different parts of the world.

In his remarks, Dr. Ghebreyesus particularly stressed that: “The measures that China and other countries have taken have given us a fighting chance of containing the spread of the virus. We call on all countries to continue their commitment for containment measures, while preparing for community transmission if it occurs. We must not look back and regret that we failed to take advantage of the window of opportunity that we have now.”

In the question and answer period, Dr. Ghebreyesus specifically addressed the issue of misinformation and conspiracy theories being promulgated by certain individuals and on social media about the source of the virus, especially those people who believe that it was designed in a Chinese virus laboratory. Scientists play an important role in refuting such particular misinformation, he said, and research must continue to track down the actual source in nature.

To that regard, a paper published online in the Lancet on Feb. 19, provided a consensus statement by more than 25 health scientists outside of China stating: “We stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin. Scientists from multiple countries have published and analyzed genomes of the causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and they overwhelmingly conclude that this coronavirus originated in wildlife, as have so many other emerging pathogens.”

The WHO issues daily coronavirus disease (COVID-2019) situation reports on its website and provides these telebriefing updates daily.

mlesney@mdedge.com

As of 6 a.m. Geneva time, Feb. 21, China reported 75,567 cases of COVID-19 and 2,239 deaths, including a total of 892 new confirmed cases that were reported in China in the past 24 hours, with 118 deaths, stated Tedros Adhanom Ghebreyesus, MD, World Health Organization Director-General, in a Feb. 21 news conference on the COVID-19 outbreak.

What he described as “the significant decline in newly reported cases” is partly because of a change in reporting in which China switched from including “clinically diagnosed” cases to reporting only “suspected” and “laboratory confirmed cases.” The reporting procedure changed because the medical facilities in Wuhan regained the capability of checking all suspected cases with laboratory tests. As a result, some cases that were clinically confirmed were subtracted from the total because they tested negative, said Dr. Ghebreyesus.

Although the number of cases in Hubuei province continues to decline, the WHO is concerned about an increase seen in Shandong province and they are seeking more information. Outside China, there are now 1,152 cases in 26 countries and eight deaths. “Although the number of cases outside of China remains small, we are concerned about the cases with no clear epidemiological link, such as travel history to China, or contact with a confirmed case,” said Dr. Ghebreyesus. “Apart from the Diamond Princess cruise ship, the Republic of Korea now has the most cases outside China, and we are working closely with that government to understand the transmission dynamics that led to this increase.”

“We are also concerned about the increase of cases in the Islamic Republic of Iran, where there are now 18 cases and four deaths in just the past 2 days.”

“Our particular concern is for COVID-19 to spread in countries with weaker health systems,” he said, adding that tomorrow, he will address an emergency meeting of African health ministers held jointly by the African Union and the African Centres for Disease Control and Prevention on dealing with COVID-19.

Dr. Ghebreyesus also announced that today the WHO has designated six special envoys on COVID-19 to provide strategic advice and high-level political advocacy and engagement in different parts of the world.

In his remarks, Dr. Ghebreyesus particularly stressed that: “The measures that China and other countries have taken have given us a fighting chance of containing the spread of the virus. We call on all countries to continue their commitment for containment measures, while preparing for community transmission if it occurs. We must not look back and regret that we failed to take advantage of the window of opportunity that we have now.”

In the question and answer period, Dr. Ghebreyesus specifically addressed the issue of misinformation and conspiracy theories being promulgated by certain individuals and on social media about the source of the virus, especially those people who believe that it was designed in a Chinese virus laboratory. Scientists play an important role in refuting such particular misinformation, he said, and research must continue to track down the actual source in nature.

To that regard, a paper published online in the Lancet on Feb. 19, provided a consensus statement by more than 25 health scientists outside of China stating: “We stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin. Scientists from multiple countries have published and analyzed genomes of the causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and they overwhelmingly conclude that this coronavirus originated in wildlife, as have so many other emerging pathogens.”

The WHO issues daily coronavirus disease (COVID-2019) situation reports on its website and provides these telebriefing updates daily.

mlesney@mdedge.com

LOS ANGELES – Higher case volumes matter for getting better outcomes in acute ischemic stroke patients treated with endovascular thrombectomy, according to data from more than 13,000 Medicare patients treated during 2016 and 2017.

Mitchel L. Zoler/MDedge News

That’s hardly surprising, given that it’s consistent with what’s already been reported for several other types of endovascular and transcatheter procedures: The more cases a center or individual proceduralist performs, the better their patients do. Routine use of endovascular thrombectomy to treat selected acute ischemic stroke patients is a new-enough paradigm that until now few reports have come out that looked at this issue (Stroke. 2019 May;50[5]:1178-83).

The new analysis of Medicare data “is one of the first contemporary studies of the volume-outcome relationship in endovascular thrombectomy,” Laura K. Stein, MD, said at the International Stroke Conference sponsored by the American Heart Association. The analysis showed that, when the researchers adjusted the Medicare data to better reflect overall case volumes (Medicare patients represent just 59% of all endovascular thrombectomies performed on U.S. acute ischemic stroke patients), the minimum case number for a stroke center to have statistically better in-hospital survival than lower volume centers was 24 cases/year, and 29 cases/year to have a statistically significant higher rate of “good” outcomes than lower-volume centers, reported Dr. Stein, a stroke neurologist with the Mount Sinai Health System in New York. For individual proceduralists, the minimum, adjusted case number to have statistically better acute patient survival was 4 cases/year, and 19 cases/year to have a statistically better rate of good outcomes.

For this analysis, good outcomes were defined as cases when patients left the hospital following their acute care and returned home with either self care or a home health care service, and also patients discharged to rehabilitation. “Bad” outcomes for this analysis were discharges to a skilled nursing facility or hospice, as well as patients who died during their acute hospitalization.

The analyses also showed no plateau to the volume effect for any of the four parameters examined: in-hospital mortality by center and by proceduralist, and the rates of good outcomes by center and by proceduralist. For each of these measures, as case volume increased above the minimum number needed to produce statistically better outcomes, the rate of good outcomes continued to steadily rise and acute mortality continued to steadily fall.

The study run by Dr. Stein and associates used data collected by the Center for Medicare & Medicaid Services on 13,311 Medicare patients who underwent endovascular thrombectomy for acute ischemic stroke at any of 641 U.S. hospitals and received treatment from any of 2,754 thrombectomy proceduralists. Outcomes rated as good occurred in 56% of the patients. The statistical adjustments that the researchers applied to calculate the incremental effect of increasing case volume took into account the variables of patient age, sex, and comorbidities measured by the Charlson Comorbidity Index.

The analysis also showed that, during this 2-year period, the average number of endovascular thrombectomy cases among Medicare patients was just under 21 cases per center, with a range of 1-160 cases; for individual proceduralists, the average was just under 5 cases, with a range of 1-82 cases.

The 19 case/year volume minimum that the analysis identified for an individual proceduralist to have a statistically significant higher rate of good outcomes, compared with lower-volume proceduralists, came close to the 15 cases/year minimum set by the Joint Commission in 2019 for individual operators at centers seeking accreditation from the Joint Commission as either a Thrombectomy-Capable Stroke Center or a Comprehensive Stroke Center. The CMS has not yet set thrombectomy case-load requirements for centers or operators to qualify for Medicare reimbursements, although CMS has set such standards for other endovascular procedures, such as transcatheter aortic valve replacement. When setting such standards, CMS has cited its need to balance the better outcomes produced by higher-volume centers against a societal interest in facilitating access to vital medical services, a balance that Dr. Stein also highlighted in her talk.

“We want to optimize access as well as outcomes for every patient,” she said. “These data support certification volume standards,” but they are “in no way an argument for limiting access based on volume.”

Dr. Stein had no disclosures.

mzoler@mdedge.com

SOURCE: Stein LK et al. ISC 2020, Abstract LB11.

LOS ANGELES – Higher case volumes matter for getting better outcomes in acute ischemic stroke patients treated with endovascular thrombectomy, according to data from more than 13,000 Medicare patients treated during 2016 and 2017.

Mitchel L. Zoler/MDedge News

That’s hardly surprising, given that it’s consistent with what’s already been reported for several other types of endovascular and transcatheter procedures: The more cases a center or individual proceduralist performs, the better their patients do. Routine use of endovascular thrombectomy to treat selected acute ischemic stroke patients is a new-enough paradigm that until now few reports have come out that looked at this issue (Stroke. 2019 May;50[5]:1178-83).

The new analysis of Medicare data “is one of the first contemporary studies of the volume-outcome relationship in endovascular thrombectomy,” Laura K. Stein, MD, said at the International Stroke Conference sponsored by the American Heart Association. The analysis showed that, when the researchers adjusted the Medicare data to better reflect overall case volumes (Medicare patients represent just 59% of all endovascular thrombectomies performed on U.S. acute ischemic stroke patients), the minimum case number for a stroke center to have statistically better in-hospital survival than lower volume centers was 24 cases/year, and 29 cases/year to have a statistically significant higher rate of “good” outcomes than lower-volume centers, reported Dr. Stein, a stroke neurologist with the Mount Sinai Health System in New York. For individual proceduralists, the minimum, adjusted case number to have statistically better acute patient survival was 4 cases/year, and 19 cases/year to have a statistically better rate of good outcomes.

For this analysis, good outcomes were defined as cases when patients left the hospital following their acute care and returned home with either self care or a home health care service, and also patients discharged to rehabilitation. “Bad” outcomes for this analysis were discharges to a skilled nursing facility or hospice, as well as patients who died during their acute hospitalization.

The analyses also showed no plateau to the volume effect for any of the four parameters examined: in-hospital mortality by center and by proceduralist, and the rates of good outcomes by center and by proceduralist. For each of these measures, as case volume increased above the minimum number needed to produce statistically better outcomes, the rate of good outcomes continued to steadily rise and acute mortality continued to steadily fall.

The study run by Dr. Stein and associates used data collected by the Center for Medicare & Medicaid Services on 13,311 Medicare patients who underwent endovascular thrombectomy for acute ischemic stroke at any of 641 U.S. hospitals and received treatment from any of 2,754 thrombectomy proceduralists. Outcomes rated as good occurred in 56% of the patients. The statistical adjustments that the researchers applied to calculate the incremental effect of increasing case volume took into account the variables of patient age, sex, and comorbidities measured by the Charlson Comorbidity Index.

The analysis also showed that, during this 2-year period, the average number of endovascular thrombectomy cases among Medicare patients was just under 21 cases per center, with a range of 1-160 cases; for individual proceduralists, the average was just under 5 cases, with a range of 1-82 cases.

The 19 case/year volume minimum that the analysis identified for an individual proceduralist to have a statistically significant higher rate of good outcomes, compared with lower-volume proceduralists, came close to the 15 cases/year minimum set by the Joint Commission in 2019 for individual operators at centers seeking accreditation from the Joint Commission as either a Thrombectomy-Capable Stroke Center or a Comprehensive Stroke Center. The CMS has not yet set thrombectomy case-load requirements for centers or operators to qualify for Medicare reimbursements, although CMS has set such standards for other endovascular procedures, such as transcatheter aortic valve replacement. When setting such standards, CMS has cited its need to balance the better outcomes produced by higher-volume centers against a societal interest in facilitating access to vital medical services, a balance that Dr. Stein also highlighted in her talk.

“We want to optimize access as well as outcomes for every patient,” she said. “These data support certification volume standards,” but they are “in no way an argument for limiting access based on volume.”

Dr. Stein had no disclosures.

mzoler@mdedge.com

SOURCE: Stein LK et al. ISC 2020, Abstract LB11.

LOS ANGELES – Higher case volumes matter for getting better outcomes in acute ischemic stroke patients treated with endovascular thrombectomy, according to data from more than 13,000 Medicare patients treated during 2016 and 2017.

Mitchel L. Zoler/MDedge News

That’s hardly surprising, given that it’s consistent with what’s already been reported for several other types of endovascular and transcatheter procedures: The more cases a center or individual proceduralist performs, the better their patients do. Routine use of endovascular thrombectomy to treat selected acute ischemic stroke patients is a new-enough paradigm that until now few reports have come out that looked at this issue (Stroke. 2019 May;50[5]:1178-83).

The new analysis of Medicare data “is one of the first contemporary studies of the volume-outcome relationship in endovascular thrombectomy,” Laura K. Stein, MD, said at the International Stroke Conference sponsored by the American Heart Association. The analysis showed that, when the researchers adjusted the Medicare data to better reflect overall case volumes (Medicare patients represent just 59% of all endovascular thrombectomies performed on U.S. acute ischemic stroke patients), the minimum case number for a stroke center to have statistically better in-hospital survival than lower volume centers was 24 cases/year, and 29 cases/year to have a statistically significant higher rate of “good” outcomes than lower-volume centers, reported Dr. Stein, a stroke neurologist with the Mount Sinai Health System in New York. For individual proceduralists, the minimum, adjusted case number to have statistically better acute patient survival was 4 cases/year, and 19 cases/year to have a statistically better rate of good outcomes.

For this analysis, good outcomes were defined as cases when patients left the hospital following their acute care and returned home with either self care or a home health care service, and also patients discharged to rehabilitation. “Bad” outcomes for this analysis were discharges to a skilled nursing facility or hospice, as well as patients who died during their acute hospitalization.

The analyses also showed no plateau to the volume effect for any of the four parameters examined: in-hospital mortality by center and by proceduralist, and the rates of good outcomes by center and by proceduralist. For each of these measures, as case volume increased above the minimum number needed to produce statistically better outcomes, the rate of good outcomes continued to steadily rise and acute mortality continued to steadily fall.

The study run by Dr. Stein and associates used data collected by the Center for Medicare & Medicaid Services on 13,311 Medicare patients who underwent endovascular thrombectomy for acute ischemic stroke at any of 641 U.S. hospitals and received treatment from any of 2,754 thrombectomy proceduralists. Outcomes rated as good occurred in 56% of the patients. The statistical adjustments that the researchers applied to calculate the incremental effect of increasing case volume took into account the variables of patient age, sex, and comorbidities measured by the Charlson Comorbidity Index.

The analysis also showed that, during this 2-year period, the average number of endovascular thrombectomy cases among Medicare patients was just under 21 cases per center, with a range of 1-160 cases; for individual proceduralists, the average was just under 5 cases, with a range of 1-82 cases.

The 19 case/year volume minimum that the analysis identified for an individual proceduralist to have a statistically significant higher rate of good outcomes, compared with lower-volume proceduralists, came close to the 15 cases/year minimum set by the Joint Commission in 2019 for individual operators at centers seeking accreditation from the Joint Commission as either a Thrombectomy-Capable Stroke Center or a Comprehensive Stroke Center. The CMS has not yet set thrombectomy case-load requirements for centers or operators to qualify for Medicare reimbursements, although CMS has set such standards for other endovascular procedures, such as transcatheter aortic valve replacement. When setting such standards, CMS has cited its need to balance the better outcomes produced by higher-volume centers against a societal interest in facilitating access to vital medical services, a balance that Dr. Stein also highlighted in her talk.

“We want to optimize access as well as outcomes for every patient,” she said. “These data support certification volume standards,” but they are “in no way an argument for limiting access based on volume.”

Dr. Stein had no disclosures.

mzoler@mdedge.com

SOURCE: Stein LK et al. ISC 2020, Abstract LB11.

Excessive masculinity is linked to a significantly increased risk for death by suicide in men, new research suggests.

In the first study to show this association, investigators found that men with high traditional masculinity (HTM) – a set of norms that includes competitiveness, emotional restriction, and aggression – were about two and half times more likely to die by suicide than their counterparts without HTM. The finding underscores the “central role” of gender in suicide death.

“We found that high-traditional-masculinity men were 2.4 times more likely to die by suicide than those who were not [of] high traditional masculinity. We feel this is a significant finding, and one that’s very rare to have evidence for,” study investigator Daniel Coleman, PhD, said in an interview.

“Our other findings are also important and interesting,” added Dr. Coleman, associate professor of social service at Fordham University, New York. “One was that high traditional masculinity was associated with a host of other significant risk factors for suicide death. So not only does high traditional masculinity add to the risk of suicide death, it also may have indirect effects through other variables, such as acting-out behavior.”

The study was published online Feb. 12 in JAMA Psychiatry (doi: 10.1001/jamapsychiatry.2019.4702).
 

First look

In the United States, death by suicide is 3.5 times more common in men than in women. Several potential drivers may explain this phenomenon; one plausible factor may be high levels of what the investigators describe as “traditional masculinity.”

Interestingly, previous studies suggest that HTM men experience suicidal thoughts to a greater degree than do other persons (Soc Psychiatry Psychiatr Epidemiol. 2017 Mar;52[3]:319-27). Nevertheless, the potential influence of HTM and suicide mortality has not been examined before now.

The study is a secondary analysis of the longitudinal Add Health (the National Longitudinal Study of Adolescent to Adult Health) study, which began in 1995 and followed 20,745 adolescents through young adulthood. Not only did that study show a direct association between measures of HTM and death by suicide, but it also corroborated the connection between HTM and other risk factors for suicide revealed in earlier research (Suicide Life Threat Behav. 2016 Apr;46[2]:191-205).

To tease out this relationship, Dr. Coleman and colleagues used data from the nationally representative Add Health study. That earlier research concluded that nine Add Health variables were associated with suicide; these included suicide by a family member, being expelled from school, running away from home, using a weapon, being of white race, a past history of smoking, being in a serious fight in the past year, delinquency, and fighting.

In the current study, the researchers hypothesized that HTM would be associated with these nine variables, in addition to suicide, depression, and gun access.

In the Add Health study, the adolescents were followed over time. In the current analysis, the researchers matched data from that study with death records from the National Death Index from 2014. Death by suicide was defined using National Death Index procedures.

The investigators then used an established procedure for scoring gender-typed attitudes and behaviors. As part of this, a single latent probability variable for identifying oneself as male was generated from 16 gender-discriminating variables.

Participants who were found to score at least a 73% probability of identifying as male (greater than 1 standard deviation above the mean) were classified as HTM.

“There’s been a lot of speculating about masculinity as a risk factor for male suicides,” Dr. Coleman said. “But it’s very difficult to study suicide death and something psychosocial like masculinity. So this was an attempt to fill that gap and test the hypothesis that’s being discussed quite a bit.”
 

A relevant risk factor

Twenty-two deaths occurred among the Add Health participants. Of those participants, 21 were men (odds ratio, 21.7; 95% confidence interval, 2.9-161; P less than .001).

The analysis showed that all nine risks for suicide that were highlighted in previous research were positively associated with HTM, with small to medium effect sizes. Of these, the most pronounced was family member suicide, with an OR of 1.89 (95% CI, 1.3-2.7).

Most tellingly, HTM men were 2.4 times more likely to end their lives by suicide than were men not defined as such (95% CI, 0.99-6.0; P less than .046). Nevertheless, HTM men were also 1.45 times less likely to report suicidal ideation (OR, 0.69; 95% CI, 0.60-0.81; P less than .001). There was no association between HTM and nonfatal suicide attempts.

Interestingly, HTM men were slightly more likely to report easy access to guns (OR, 1.1; 95% CI, 1.01-1.20; P less than .04), but they had lower levels of depression (Cohen’s d, 0.17; P less than .001).

HTM not only has a direct association with suicide but also with a web of indirect effects as well, thanks to its association with all the other risks identified in the previous study by another group of investigators.

HTM may be an underlying influence in male suicide that increases the probability of externalizing such behavioral risk factors as anger, violence, gun access, and school problems.

The finding that almost all of the people who died by suicide were men underscores the central role that gender plays in these tragedies. As such, the investigators hope that the study prompts more research, as well as intervention efforts aimed at the role of masculinity in suicide.

“There are already things going on around the world to try to address the risk factors of masculinity for suicide death,” Dr. Coleman said. “So even though we haven’t had the evidence that it’s a risk factor, people have been operating under that assumption anyway.

“Hopefully our research contributes to raising the profile that high traditional masculinity is a relevant risk factor that we can organize prevention and treatment around.”
 

An important contribution

Mark S. Kaplan, DrPH, commenting on the findings in an interview, said the study makes an important contribution to suicide research.

“Any study that tries to link a living sample with death data, as they did here, is important,” said Dr. Kaplan, professor of social welfare at the Luskin School of Public Affairs of the University of California, Los Angeles.

“It’s also important because it begins to scratch the surface of more proximal or distal factors that are associated with suicide, and masculinity is one of those factors,” Dr. Kaplan added.

“In an incremental way, it begins to add to the puzzle of why men have a higher mortality rate than their female counterparts. Because when it comes to suicide, men and women really are apples and oranges.”

Dr. Kaplan believes HTM is one of several traits that may lead men to take their own lives.

“There are all sorts of other issues. For example, masculinity might be interacting with some of the harsh socioeconomic conditions that many men face. I think all of this points to the real need to understand why men die from suicide,” he said.

The Add Health study is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. No direct support was received from the grant for the current study. Dr. Coleman and Dr. Kaplan have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Excessive masculinity is linked to a significantly increased risk for death by suicide in men, new research suggests.

In the first study to show this association, investigators found that men with high traditional masculinity (HTM) – a set of norms that includes competitiveness, emotional restriction, and aggression – were about two and half times more likely to die by suicide than their counterparts without HTM. The finding underscores the “central role” of gender in suicide death.

“We found that high-traditional-masculinity men were 2.4 times more likely to die by suicide than those who were not [of] high traditional masculinity. We feel this is a significant finding, and one that’s very rare to have evidence for,” study investigator Daniel Coleman, PhD, said in an interview.

“Our other findings are also important and interesting,” added Dr. Coleman, associate professor of social service at Fordham University, New York. “One was that high traditional masculinity was associated with a host of other significant risk factors for suicide death. So not only does high traditional masculinity add to the risk of suicide death, it also may have indirect effects through other variables, such as acting-out behavior.”

The study was published online Feb. 12 in JAMA Psychiatry (doi: 10.1001/jamapsychiatry.2019.4702).
 

First look

In the United States, death by suicide is 3.5 times more common in men than in women. Several potential drivers may explain this phenomenon; one plausible factor may be high levels of what the investigators describe as “traditional masculinity.”

Interestingly, previous studies suggest that HTM men experience suicidal thoughts to a greater degree than do other persons (Soc Psychiatry Psychiatr Epidemiol. 2017 Mar;52[3]:319-27). Nevertheless, the potential influence of HTM and suicide mortality has not been examined before now.

The study is a secondary analysis of the longitudinal Add Health (the National Longitudinal Study of Adolescent to Adult Health) study, which began in 1995 and followed 20,745 adolescents through young adulthood. Not only did that study show a direct association between measures of HTM and death by suicide, but it also corroborated the connection between HTM and other risk factors for suicide revealed in earlier research (Suicide Life Threat Behav. 2016 Apr;46[2]:191-205).

To tease out this relationship, Dr. Coleman and colleagues used data from the nationally representative Add Health study. That earlier research concluded that nine Add Health variables were associated with suicide; these included suicide by a family member, being expelled from school, running away from home, using a weapon, being of white race, a past history of smoking, being in a serious fight in the past year, delinquency, and fighting.

In the current study, the researchers hypothesized that HTM would be associated with these nine variables, in addition to suicide, depression, and gun access.

In the Add Health study, the adolescents were followed over time. In the current analysis, the researchers matched data from that study with death records from the National Death Index from 2014. Death by suicide was defined using National Death Index procedures.

The investigators then used an established procedure for scoring gender-typed attitudes and behaviors. As part of this, a single latent probability variable for identifying oneself as male was generated from 16 gender-discriminating variables.

Participants who were found to score at least a 73% probability of identifying as male (greater than 1 standard deviation above the mean) were classified as HTM.

“There’s been a lot of speculating about masculinity as a risk factor for male suicides,” Dr. Coleman said. “But it’s very difficult to study suicide death and something psychosocial like masculinity. So this was an attempt to fill that gap and test the hypothesis that’s being discussed quite a bit.”
 

A relevant risk factor

Twenty-two deaths occurred among the Add Health participants. Of those participants, 21 were men (odds ratio, 21.7; 95% confidence interval, 2.9-161; P less than .001).

The analysis showed that all nine risks for suicide that were highlighted in previous research were positively associated with HTM, with small to medium effect sizes. Of these, the most pronounced was family member suicide, with an OR of 1.89 (95% CI, 1.3-2.7).

Most tellingly, HTM men were 2.4 times more likely to end their lives by suicide than were men not defined as such (95% CI, 0.99-6.0; P less than .046). Nevertheless, HTM men were also 1.45 times less likely to report suicidal ideation (OR, 0.69; 95% CI, 0.60-0.81; P less than .001). There was no association between HTM and nonfatal suicide attempts.

Interestingly, HTM men were slightly more likely to report easy access to guns (OR, 1.1; 95% CI, 1.01-1.20; P less than .04), but they had lower levels of depression (Cohen’s d, 0.17; P less than .001).

HTM not only has a direct association with suicide but also with a web of indirect effects as well, thanks to its association with all the other risks identified in the previous study by another group of investigators.

HTM may be an underlying influence in male suicide that increases the probability of externalizing such behavioral risk factors as anger, violence, gun access, and school problems.

The finding that almost all of the people who died by suicide were men underscores the central role that gender plays in these tragedies. As such, the investigators hope that the study prompts more research, as well as intervention efforts aimed at the role of masculinity in suicide.

“There are already things going on around the world to try to address the risk factors of masculinity for suicide death,” Dr. Coleman said. “So even though we haven’t had the evidence that it’s a risk factor, people have been operating under that assumption anyway.

“Hopefully our research contributes to raising the profile that high traditional masculinity is a relevant risk factor that we can organize prevention and treatment around.”
 

An important contribution

Mark S. Kaplan, DrPH, commenting on the findings in an interview, said the study makes an important contribution to suicide research.

“Any study that tries to link a living sample with death data, as they did here, is important,” said Dr. Kaplan, professor of social welfare at the Luskin School of Public Affairs of the University of California, Los Angeles.

“It’s also important because it begins to scratch the surface of more proximal or distal factors that are associated with suicide, and masculinity is one of those factors,” Dr. Kaplan added.

“In an incremental way, it begins to add to the puzzle of why men have a higher mortality rate than their female counterparts. Because when it comes to suicide, men and women really are apples and oranges.”

Dr. Kaplan believes HTM is one of several traits that may lead men to take their own lives.

“There are all sorts of other issues. For example, masculinity might be interacting with some of the harsh socioeconomic conditions that many men face. I think all of this points to the real need to understand why men die from suicide,” he said.

The Add Health study is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. No direct support was received from the grant for the current study. Dr. Coleman and Dr. Kaplan have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Excessive masculinity is linked to a significantly increased risk for death by suicide in men, new research suggests.

In the first study to show this association, investigators found that men with high traditional masculinity (HTM) – a set of norms that includes competitiveness, emotional restriction, and aggression – were about two and half times more likely to die by suicide than their counterparts without HTM. The finding underscores the “central role” of gender in suicide death.

“We found that high-traditional-masculinity men were 2.4 times more likely to die by suicide than those who were not [of] high traditional masculinity. We feel this is a significant finding, and one that’s very rare to have evidence for,” study investigator Daniel Coleman, PhD, said in an interview.

“Our other findings are also important and interesting,” added Dr. Coleman, associate professor of social service at Fordham University, New York. “One was that high traditional masculinity was associated with a host of other significant risk factors for suicide death. So not only does high traditional masculinity add to the risk of suicide death, it also may have indirect effects through other variables, such as acting-out behavior.”

The study was published online Feb. 12 in JAMA Psychiatry (doi: 10.1001/jamapsychiatry.2019.4702).
 

First look

In the United States, death by suicide is 3.5 times more common in men than in women. Several potential drivers may explain this phenomenon; one plausible factor may be high levels of what the investigators describe as “traditional masculinity.”

Interestingly, previous studies suggest that HTM men experience suicidal thoughts to a greater degree than do other persons (Soc Psychiatry Psychiatr Epidemiol. 2017 Mar;52[3]:319-27). Nevertheless, the potential influence of HTM and suicide mortality has not been examined before now.

The study is a secondary analysis of the longitudinal Add Health (the National Longitudinal Study of Adolescent to Adult Health) study, which began in 1995 and followed 20,745 adolescents through young adulthood. Not only did that study show a direct association between measures of HTM and death by suicide, but it also corroborated the connection between HTM and other risk factors for suicide revealed in earlier research (Suicide Life Threat Behav. 2016 Apr;46[2]:191-205).

To tease out this relationship, Dr. Coleman and colleagues used data from the nationally representative Add Health study. That earlier research concluded that nine Add Health variables were associated with suicide; these included suicide by a family member, being expelled from school, running away from home, using a weapon, being of white race, a past history of smoking, being in a serious fight in the past year, delinquency, and fighting.

In the current study, the researchers hypothesized that HTM would be associated with these nine variables, in addition to suicide, depression, and gun access.

In the Add Health study, the adolescents were followed over time. In the current analysis, the researchers matched data from that study with death records from the National Death Index from 2014. Death by suicide was defined using National Death Index procedures.

The investigators then used an established procedure for scoring gender-typed attitudes and behaviors. As part of this, a single latent probability variable for identifying oneself as male was generated from 16 gender-discriminating variables.

Participants who were found to score at least a 73% probability of identifying as male (greater than 1 standard deviation above the mean) were classified as HTM.

“There’s been a lot of speculating about masculinity as a risk factor for male suicides,” Dr. Coleman said. “But it’s very difficult to study suicide death and something psychosocial like masculinity. So this was an attempt to fill that gap and test the hypothesis that’s being discussed quite a bit.”
 

A relevant risk factor

Twenty-two deaths occurred among the Add Health participants. Of those participants, 21 were men (odds ratio, 21.7; 95% confidence interval, 2.9-161; P less than .001).

The analysis showed that all nine risks for suicide that were highlighted in previous research were positively associated with HTM, with small to medium effect sizes. Of these, the most pronounced was family member suicide, with an OR of 1.89 (95% CI, 1.3-2.7).

Most tellingly, HTM men were 2.4 times more likely to end their lives by suicide than were men not defined as such (95% CI, 0.99-6.0; P less than .046). Nevertheless, HTM men were also 1.45 times less likely to report suicidal ideation (OR, 0.69; 95% CI, 0.60-0.81; P less than .001). There was no association between HTM and nonfatal suicide attempts.

Interestingly, HTM men were slightly more likely to report easy access to guns (OR, 1.1; 95% CI, 1.01-1.20; P less than .04), but they had lower levels of depression (Cohen’s d, 0.17; P less than .001).

HTM not only has a direct association with suicide but also with a web of indirect effects as well, thanks to its association with all the other risks identified in the previous study by another group of investigators.

HTM may be an underlying influence in male suicide that increases the probability of externalizing such behavioral risk factors as anger, violence, gun access, and school problems.

The finding that almost all of the people who died by suicide were men underscores the central role that gender plays in these tragedies. As such, the investigators hope that the study prompts more research, as well as intervention efforts aimed at the role of masculinity in suicide.

“There are already things going on around the world to try to address the risk factors of masculinity for suicide death,” Dr. Coleman said. “So even though we haven’t had the evidence that it’s a risk factor, people have been operating under that assumption anyway.

“Hopefully our research contributes to raising the profile that high traditional masculinity is a relevant risk factor that we can organize prevention and treatment around.”
 

An important contribution

Mark S. Kaplan, DrPH, commenting on the findings in an interview, said the study makes an important contribution to suicide research.

“Any study that tries to link a living sample with death data, as they did here, is important,” said Dr. Kaplan, professor of social welfare at the Luskin School of Public Affairs of the University of California, Los Angeles.

“It’s also important because it begins to scratch the surface of more proximal or distal factors that are associated with suicide, and masculinity is one of those factors,” Dr. Kaplan added.

“In an incremental way, it begins to add to the puzzle of why men have a higher mortality rate than their female counterparts. Because when it comes to suicide, men and women really are apples and oranges.”

Dr. Kaplan believes HTM is one of several traits that may lead men to take their own lives.

“There are all sorts of other issues. For example, masculinity might be interacting with some of the harsh socioeconomic conditions that many men face. I think all of this points to the real need to understand why men die from suicide,” he said.

The Add Health study is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. No direct support was received from the grant for the current study. Dr. Coleman and Dr. Kaplan have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.