Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
1. Modeling study suggests that schools can safely reopen with proper mitigation strategies
With adherence to masking and distancing, cases introduced into a school unlikely to lead to community transmission
Abstract: https://www.acpjournals.org/doi/10.7326/M21-0600
Editorial: https://www.acpjournals.org/doi/10.7326/M21-2291
URL goes live when the embargo lifts
A modeling study found that with controlled community transmission and moderate mitigation strategies in place, schools can reopen safely. Asymptomatic screening is one mitigation strategy identified that could facilitate reopening at higher local incidence while minimizing transmission risk. The findings are published in Annals of Internal Medicine.
Researchers from the University of Maryland School of Medicine, Harvard University, Stanford University, and Massachusetts General Hospital used a simulation model to assess the risk for SARS-CoV-2 transmission in schools. The model considered average U.S. classroom sizes for both elementary and high schools. Interactions within schools and homes, as well as those between households outside school, were incorporated. Mitigation strategies included were isolation of symptomatic individuals, quarantine of an infected individual's contacts, reduced class sizes, alternative schedules, staff vaccination, and weekly asymptomatic screening. Transmission was projected among students, staff, and families after a single infection in school and over an 8-week quarter, contingent on local incidence.
The data showed that school transmission varied according to student age and local incidence and was substantially reduced with mitigation measures, such as teacher vaccination, masking, social distancing, and asymptomatic screening. Testing was impactful because when transmission occurs, it may be difficult to detect as most school-aged children experience asymptomatic or mild infections. While the data suggest that reopening with careful mitigation strategies in place is safe, the authors noted that the risk for transmission was substantially higher in high schools than elementary schools.
An accompanying editorial from New York City Health + Hospitals suggests that during the pandemic, emergency department visits for children aged 5 to 11 and 12 to 17 years that were mental health-related increased approximately 24% and 31%, respectively. Isolation associated with remote learning may be partially to blame. As such, in-person learning is one of the most powerful tools available to support children's and adolescents' mental health. Based on the science, local, state, and federal agencies should prioritize effective interventions that permit the benefits of in-person education while protecting the safety of both students and educators.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Dr. Meagan Fitzpatrick, please contact January Payne at January.payne@som.umaryland.edu.
2. Simultaneous screening for lung cancer and aortic valve calcification could identify people at risk for aortic stenosis
Abstract: https://www.acpjournals.org/doi/10.7326/M20-5507
URL goes live when the embargo lifts
A brief research report finds that aortic valve calcification (AVC) can be found using low-dose computed tomography (LDCT) during lung cancer screening, identifying those at high risk for aortic stenosis (AS). Cardiovascular events are known to have the same modifiable risk factors as lung cancer, suggesting that screening for the two at the same time could be useful. The findings are published in Annals of Internal Medicine.
Researchers from Medical University of Gdansk, Gdansk, Poland studied more than 6,600 older smokers/ever-smokers who were enrolled in the MOLTEST BIS lung cancer screening program between 2016 and 2018 to assess the usefulness of LDCT performed during lung cancer screening in determining the degree of AVC as an additional finding. The researchers arbitrarily determined a calcium cutoff point indicating a positive test result. Positive patients were sent for an echocardiogram for confirmation of diagnosis.
Any degree of AVC was identified in 869 (13.1%) of the patients using the author's measure. Fifty-four participants provided informed consent and were enrolled in the study. Of those, 0.5% were diagnosed with at least moderate AS upon echocardiogram. Most of the participants with AS (55.1%) were unaware of their valvular heart disease, including the 23% with severe AS. Based on these findings, the authors propose that AVC assessment become a routine procedure in the LDCT protocol for lung cancer screening.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Marcin Fijalkowski, MD, PhD, please contact mfijalkowski@gumed.edu.pl.
Also new in this issue:
How Would You Manage This Patient With Nonvariceal Upper Gastrointestinal Bleeding?
Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Zahir Kanjee, MD, MPH; Akwi W. Asombang, MD, MPH; Tyler M. Berzin, MD, MS; and Risa Burns, MD, MPH
Beyond the Guidelines
Abstract: https://www.acpjournals.org/doi/10.7326/M21-1206
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with a discussant, please contact Kendra McKinnon at kmckinn1@bidmc.harvard.edu.
In the Clinic: Multiple Sclerosis Update
Michael J. Olek, DO
In the Clinic
Abstract: https://www.acpjournals.org/doi/10.7326/AITC202106080
A Historic Opportunity to Update Asylum Law's Outdated Assumptions about Trauma
Erin Shortell, JD, MPH; Aldis H. Petriceks, BA; Francis X. Shen, JD, PhD; and Judith G. Edersheim, JD, MD
Ideas and Opinions
Abstract: https://www.acpjournals.org/doi/10.7326/M21-0489
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Journal
Annals of Internal Medicine