Group items tagged

Too many carbs, not fats, may be the culprit in raising risk of premature death, according to a study published online Aug. 29 in the The Lancet to coincide with the European Society of Cardiology Congress 2017, held from Aug. 26 to 30 in Barcelona, Spain. Mahshid Dehghan, Ph.D., an investigator with the Population Health Research Institute at McMaster University in Hamilton, Canada, and colleagues tracked the diet and health of 135,335 people, aged 35 to 70, from 18 countries around the world, to gain a global perspective on the health effects of diet. Participants provided detailed information on their social and economic status, lifestyle, medical history, and current health. They also completed a questionnaire on their regular diet, which researchers used to calculate their average daily calories from fats, carbohydrates, and proteins. The research team then tracked the participants' health for about seven years on average, with follow-up visits at least every three years. The investigators found that high-carbohydrate diets are common, with more than half of the people deriving 70 percent of their daily calories from carbs. People with a high fat intake -- about 35 percent of their daily diet -- had a 23 percent lower risk of early death and 18 percent lower risk of stroke compared to people who ate less fat. The researchers also noted that a very low intake of saturated fats (below 3 percent of daily diet) was associated with a higher risk of death in the study, compared to diets containing up to 13 percent daily. At the same time, high-carb diets -- containing an average 77 percent carbohydrates -- were associated with a 28 percent increased risk of death versus low-carb diets. "The study showed that contrary to popular belief, increased consumption of dietary fats is associated with a lower risk of death," Dehghan told HealthDay. "We found no evidence that below 10 percent of energy by saturated fat is beneficial, and going below 7 percent may even be har

It was not a big problem in order to improve and support my health during the winter. Due to the problems with health, I am trying to maintain my condition.

Unfortunately, there are diseases that are relevant at any time of the year and can affect people with any immunity and at any age. For example https://easystd.com/gonorrhea Of course a lot depends on us in this case, but I agree that to suffer from something like this is extremely unpleasant and treatment may also cost a lot of money.

Higher dietary total fiber and fruit fiber is protective against bone loss at the femoral neck in men, according to a study published online Oct. 12 in the Journal of Bone and Mineral Research. Zhaoli Dai, Ph.D., from the Boston University School of Medicine, and colleagues examined the correlation between dietary fiber, assessed using the Willett food frequency questionnaire, and bone loss at the femoral neck, trochanter, and lumbar spine in older men and women. Bone mineral density was measured using dual-energy X-ray absorptiometry at baseline (1996 to 2011) and in 2001 to 2005 and 2005 to 2008 among 792 men and 1,065 women. The researchers found that in men, but not women, higher dietary total fiber and fruit fiber was protective against bone loss at the femoral neck (P = 0.003 and 0.008, respectively). Compared with men in quartile 1 of fiber intake, those in quartiles 2 to 4 had significantly less bone loss at the femoral neck (all P < 0.04). There were no associations with hip bone loss in women; fiber from vegetables seemed protective against spine bone loss in women but not men. No correlations were seen for cereal fiber or nut and legume fiber with bone loss in men or women.

Management of type 2 diabetes should include shared decision making, and patients should be offered individualized diabetes self-management education and glycemic management plans, according to a summary of a clinical practice guideline published online Oct. 23 in the Annals of Internal Medicine. Paul R. Conlin, M.D., from the VA Boston Healthcare System in West Roxbury, Massachusetts, and colleagues convened a joint U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) Evidence-Based Practice Work Group to develop a guideline for management of type 2 diabetes mellitus. The authors provided updates on management within seven areas: patient-centered care and shared decision making, glycemic biomarkers, target ranges of hemoglobin A1c (HbA1c), individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patients in the hospital. Patients should be offered individualized diabetes self-management education, as well as individualized glycemic management plans and target ranges for HbA1c. "In summary, the VA/DoD CPG [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events. Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision making is thus foundational to setting and revising goals that are meaningful, safe, and achievable in everyday clinical practice," the authors write.

For young patients with type 1 diabetes, insulin pump therapy is associated with lower risks of severe hypoglycemia and diabetic ketoacidosis and better glycemic control than insulin injection therapy, according to a study published online Oct. 10 in the Journal of the American Medical Association. Beate Karges, M.D., from RWTH Aachen University in Germany, and colleagues conducted a population-based cohort study in 446 diabetes centers. They identified patients with type 1 diabetes who were younger than 20 years and had diabetes duration of more than one year. The researchers found that 14,119 patients used pump therapy and 16,460 used insulin injections. A total of 9,814 patients using pump therapy were matched with 9,814 using injection therapy. Compared with injection therapy, pump therapy was correlated with lower rates of severe hypoglycemia (9.55 versus 13.97 per 100 patient-years) and diabetic ketoacidosis (3.64 versus 4.26 per 100 patient-years). Lower levels of glycated hemoglobin were seen with pump versus injection therapy (8.04 versus 8.22 percent). Compared with injection therapy, pump therapy was associated with lower total daily insulin doses (0.84 versus 0.98 U/kg). No significant difference in body mass index was seen between the treatment regimens

For patients with stage 4 or 5 chronic kidney disease and hepatitis C virus (HCV) infection, 12 weeks of treatment with glecaprevir and pibrentasvir results in a high rate of sustained virologic response, according to a study published online Oct. 11 in the New England Journal of Medicine. Edward Gane, M.D., from Auckland City Hospital in New Zealand, and colleagues conducted a multicenter trial to examine the efficacy and safety of combination treatment with the NS3/4A protease inhibitor glecaprevir and the NS5A inhibitor pibrentasvir for 12 weeks in adults with HCV infection and compensated liver disease with severe renal impairment, dependence on dialysis, or both. Participants had stage 4 or 5 chronic kidney disease. One hundred four patients were enrolled in the trial. The researchers found that the sustained virologic response rate was 98 percent. During treatment, none of the patients had virologic failure, and none had a virologic relapse after the end of treatment. Pruritus, fatigue, and nausea were reported in at least 10 percent of the patients. Twenty-four percent of the patients reported serious adverse events. Because of adverse events, four patients discontinued the trial treatment prematurely; three of these had sustained virologic response

Most ophthalmologists write no more than 10 opioid prescriptions annually, with a mean supply per prescription of five days, according to a study published online Oct. 5 in JAMA Ophthalmology. Shriji Patel, M.D., and Paul Sternberg Jr., M.D., both from Vanderbilt Eye Institute in Nashville, Tennessee, analyzed physician and beneficiary measures using Medicare Part D Prescriber Data (2013 to 2015) to determine prescribing patterns for opioid drugs for participating ophthalmologists. The researchers found that, consistently, 88 to 89 percent of ophthalmologists wrote 10 opioid prescriptions or fewer annually. Only about 1 percent of ophthalmologists wrote more than 100 opioid prescriptions annually. On average, ophthalmologists wrote seven opioid prescriptions per year with a mean supply of five days. The six states with the highest volume of annual opioid prescriptions per ophthalmologist were in the South.

Ropinirole, bromocriptine, and piribedil are associated with the highest incidence rates of adverse effects in Parkinson's disease, according to a review published online Sept. 4 in CNS Neuroscience & Therapeutics. Bao-Dong Li, from the Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine in China, and colleagues conducted a systematic review to compare the adverse effects of 11 drugs used to treat Parkinson's disease. Data were included from 24 randomized controlled trials. The researchers found that, compared with placebo, the incidence of adverse reactions of ropinirole, rotigotine, entacapone, and sumanirole were higher in terms of nausea. The incidence rates of dyskinesia side effects were highest with ropinirole, while in terms of patients' hallucination, pramipexole was significantly higher. The surface under the cumulative ranking curve values of all drugs showed that the incidence of adverse reaction of pergolide was relatively high (nausea, 83.5 percent; hallucination, 79.8 percent); the incidence of dyskinesia and somnolence was higher with ropinirole (80.5 and 69.4 percent); in terms of dizziness, the incidence of adverse reaction of piribedil was higher (67.0 percent), and in terms of constipation, the incidence of bromocriptine was relatively high (62.3 percent). "In addition to current forms of treatment, we hope that our results can produce useful information for further development of new drugs to treat Parkinson's disease based on the natures of each drug," the authors write.

The American Academy of Family Physicians (AAFP) and the American Board of Family Medicine (ABFM) have launched a new performance improvement activity credit reporting process called the AAFP Credit System, according to an article published by the AAFP. To streamline the overall credit approval process, the AAFP and ABFM developed a system that allows continuing medical education (CME) providers to apply for AAFP Performance Improvement CME Credit and ABFM Certification Activity points for their performance improvement activities through the AAFP Credit System using a single application process. CME providers who apply for credit using the new process only pay one fee and do not have to complete two applications. In addition, for AAFP members reporting eligible CME credit for a performance improvement activity, the ABFM will automatically be notified that the performance improvement certification activity has been completed.

Immediate access to opioid agonist treatment (OAT) for patients presenting with opioid use disorder may provide greater health benefits at less cost than observed standard of care, according to a study published online Nov. 21 in the Annals of Internal Medicine. Emanuel Krebs, from St. Paul's Hospital in Vancouver, Canada, and colleagues sought to determine the cost-effectiveness of OAT versus observed standard of care for patients presenting with opioid use disorder. Population-level administrative databases capturing treatment and criminal justice records for California were linked (2006 to 2010). Immediate access to OAT for all treatment recipients was found by the researchers to cost less (by $78,257), with patients accumulating more quality-adjusted life-years (by 0.42) versus the observed standard of care. Imagining a hypothetical scenario where all Californians starting treatment of opioid use disorder in 2014 had immediate access to OAT, the team found that total lifetime savings for this cohort could be as high as $3.8 billion.

For patients with unruptured intracranial aneurysms (UIAs) that are 3 mm or smaller, no preventive treatment or imaging follow-up is the most effective management strategy, according to a study published online Nov. 20 in JAMA Neurology. Ajay Malhotra, M.D., from the Yale School of Medicine in New Haven, Conn., and colleagues used inputs from the medical literature to conduct a decision-analytic model-based comparative effectiveness analysis. Five management strategies were assessed: annual magnetic resonance angiography (MRA) screening, biennial MRA screening, MRA screening every five years, aneurysm coiling and follow-up, and no treatment or preventive follow-up. In an analysis of 10,000 iterations simulating adult patients, the researchers found that the highest health benefit was seen for the management strategy of no treatment or preventive follow-up (mean quality-adjusted life-years, 19.40). MRA every five years was the best of the management strategies that incorporate follow-up imaging, with the next highest effectiveness (mean quality-adjusted life-years, 18.05). When the annual growth rate and risk of rupture of growing aneurysms are varied, no routine follow-up remains the optimal strategy. No follow-up is the optimal strategy when the annual risk of rupture of nongrowing UIAs is less than 1.7 percent; coiling should be performed directly if the annual risk of rupture is >1.7 percent.

Most physicians on Twitter with a financial conflict of interest (FCOI) and frequent tweets mention specific drugs for which they have a conflict, according to a study published in the September issue of The Lancet Haematology. Victoria Kaestner, from the Oregon Health & Science University in Portland, and colleagues examined whether conflicted physicians tweet about specific products for which they have a FCOI. A total of 156 physicians who tweeted a median of 584 times were included, with a 2014 median general payment totaling $13,600.

More than 78 percent of health care personnel (HCP) and 53.6 percent of pregnant women received influenza vaccination during the 2016-2017 influenza season, according to two studies published in the Sept. 29 issue of Morbidity and Mortality Weekly Report. Carla L. Black, Ph.D., from the U.S. Centers for Disease Control and Prevention (CDC), and colleagues surveyed 2,438 HCP to estimate influenza vaccination coverage. The researchers found that during the 2016-2017 season, 78.6 percent of survey respondents reported receiving vaccination, similar to reported coverage in the previous three seasons. Coverage was highest for those working in hospitals compared with those working in ambulatory or long-term-care settings (92.3 versus 76.1 and 68 percent) and for those who were required by their employer to be vaccinated (96.7 percent), as in previous seasons. Helen Ding, M.D., from the CDC, and colleagues surveyed 1,893 women pregnant at any time during October 2016 to January 2017. The researchers found that 53.6 percent of respondents reported having received influenza vaccination before or during pregnancy (16.2 and 37.4 percent, respectively); this was similar to coverage during the previous four influenza seasons. Overall, 67.3, 11.9, and 20.7 percent of women reported receiving a provider offer for influenza vaccination, receiving a recommendation but no offer, and receiving no recommendation, respectively, similar to the previous influenza season; influenza vaccination coverage was 70.5, 43.7, and 14.8 percent, respectively, among these women.

The incidence of lower urinary tract injuries is 0.33 percent for patients undergoing gynecologic laparoscopy for benign indications, according to a review published online Dec. 4 in Obstetrics & Gynecology. Jacqueline M.K. Wong, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a systematic review of studies to examine the incidence, location, etiology, timing, management, and long-term sequelae of urinary tract injury in gynecologic laparoscopy for benign indication. Ninety studies met the inclusion criteria, representing 140,444 surgeries. The researchers identified 458 lower urinary tract injuries with an incidence of 0.33 percent. Bladder injury occurred three times more often than ureteral injury (0.24 versus 0.08 percent). The highest rates of injury were seen for laparoscopic hysterectomy not otherwise specified and laparoscopically assisted vaginal hysterectomy (1.8 and 1.0 percent, respectively). Most ureteral and bladder injuries resulted from electrosurgery (33.3 percent) and lysis of adhesions (23.3 percent), respectively. Ureteral injuries were most often recognized postoperatively (60 percent) and repaired by open ureteral anastomosis (47.4 percent), while most bladder injuries were recognized intraoperatively (85 percent) and repaired by laparoscopic suturing (34.9 percent).

Intensive blood pressure lowering may similarly decrease cardiovascular events in both patients with and patients without type 2 diabetes mellitus, according to a study published online Dec. 6 in Diabetes Care. Tom F. Brouwer, M.D., from the University of Amsterdam, and colleagues assessed the effect of both type 2 diabetes and baseline cardiovascular disease risk on the treatment effect of intensive blood pressure lowering based on data and pooled analysis from two randomized trials (ACCORD-BP [Action to Control Cardiovascular Risk in Diabetes Blood Pressure]and SPRINT [Systolic Blood Pressure Intervention Trial] studies; total of 14,094 patients). The researchers found that the mean baseline systolic blood pressure was 139.5 mm Hg for the cohort and just over one-third (33.6 percent) had type 2 diabetes. The hazard ratio for the primary composite end point of unstable angina, myocardial infarction, acute heart failure, stroke, and cardiovascular death was 0.82 (P = 0.0017). There was a nonsignificant interaction between intensive blood pressure lowering and type 2 diabetes (P = 0.13). While the 10-year cardiovascular risk was higher in patients with type 2 diabetes, there was no interaction between the risk and treatment effect (P = 0.84).

A novel bioinformatics approach can predict vaccine effectiveness for the influenza season, and indicates that the current vaccines are likely to be effective against H3N2 flu viruses in the U.S. 2017/2018 flu season, according to research published online Nov. 29 in F1000 Research. Slobodan Paessler, D.V.M., Ph.D., from the University of Texas Medical Branch, and Veljko Veljkovic, Ph.D., from Biomed Protection, both in Galveston, Texas, used a bioinformatics platform to predict vaccine effectiveness for the 2017/2018 influenza season in the United States. The hemagglutinin HA1 region of 251 and 113 human H3N2 viruses collected in Australia and the United States from July to September 2017 were analyzed. The informational spectrum method-based phylogenetic analysis of H3N2 viruses was performed to serve as a base for predicting vaccine effectiveness. The researchers found that analyses of Australian viruses generated two clusters; the vaccine virus was placed in the smaller group. As a result, the vaccine was predicted not to be efficient against most Australian H3N2 viruses in the 2017 flu season; low vaccine effectiveness was reported in Australia in the 2017 flu season in accordance with this prediction. The U.S. H3N2 viruses were also grouped into two clusters, but the vaccine virus was placed in the largest cluster encompassing 71 percent of analyzed viruses. Consequently, the vaccine effectiveness is expected not to be suboptimal in the United States.

During cardiopulmonary resuscitation (CPR) performed by males, self-adjusted and nearest kneeling postures are more effective for chest compression, with lower perceived exertion, according to a study published online Oct. 5 in the Journal of Clinical Nursing. S.H. Ho, from The Hong Kong Polytechnic University and Daniel H.K. Chow, Ph.D., from The Education University of Hong Kong, applied a self-controlled repeated-measures design to examine the impact of kneeling posture on chest compression during CPR in males. The authors recruited 18 participants with a qualified first-aid certificate. Each participant performed three sessions of CPR on a mannequin using one of three kneeling postures (farthest, self-adjusted, and nearest) in each. Each session comprised five CPR cycles (30 strokes of chest compression within 18 seconds) in each kneeling posture and lasted two minutes. The researchers found that the efficacy of chest compression was significantly better in the self-adjusted and nearest kneeling postures than in the farthest posture. Similar effect was seen for the self-adjusted and nearest postures, while because of the lower rate of perceived exertion, most participants preferred self-adjusted kneeling posture.

For patients with acute coronary syndromes (ACS), diabetes mellitus (DM), but not pre-DM, is associated with an increased risk of major adverse cardiac events (MACE), according to a study published online Oct. 18 in the Journal of the American College of Cardiology. Serdar Farhan, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues examined the impact of pre-DM on coronary plaque characteristics and ischemic outcome in patients with ACS. Participants underwent quantitative coronary angiography, grayscale intravascular ultrasound (IVUS), and radiofrequency IVUS after successful percutaneous coronary intervention. Patients were categorized based on their glucometabolic status as normal glucose metabolism (NGM; 162 patients), pre-DM (202 patients), and DM (183 patients). The researchers found that there were no significant between-group differences with respect to IVUS findings indicative of vulnerable plaques. Compared to patients with pre-DM or NGM, patients with DM had a higher crude rate of MACE (25.9 versus 16.3 and 16.1 percent; P = 0.03 and 0.02, respectively). Using NGM as the reference group, DM, but not pre-DM, was correlated with increased risk of MACE in an adjusted model (hazard ratios, 2.2 [95 percent confidence interval, 1.25 to 3.86; P = 0.006] and 1.29 [95 percent confidence interval, 0.71 to 2.33; P = 0.41]).

A new screening tool can adequately detect risk of diabetic retinopathy in adults with diabetes in low-income communities in Mexico, according to a study published in the October issue of Preventing Chronic Disease. Kenny Mendoza-Herrera, from the National Institute of Public Health in Mexico, and colleagues analyzed biochemical, clinical, anthropometric, and sociodemographic information from 1,000 adults with diabetes in low-income communities in Mexico in order to develop a screening tool based on a predictive model for early detection of diabetic retinopathy. Time since diabetes diagnosis, high blood glucose levels, systolic hypertension, and physical inactivity were risk factors included in the screening tool. The researchers found that the model had a mean area under the receiver operating characteristic curve (AUC ROC) of 0.78 in the validation data set. Using the optimized cut point that best represented the study population, the model had a sensitivity of 82.9 percent and a specificity of 61.9 percent. "We developed a low-cost and easy-to-apply screening tool to detect people at high risk of diabetic retinopathy in Mexico," the authors write. "Although classification performance of our tool was acceptable (AUC ROC > 0.75), error rates (precision) depend on false-negative and false-positive rates. Therefore, confirmatory assessment of all cases in mandatory."

Liraglutide treatment for weight management is not associated with increased risk of cardiovascular events, according to a study published online Sept. 26 in Diabetes, Obesity and Metabolism. Melanie J. Davies, M.D., from the University Hospitals of Leicester NHS Trust in the United Kingdom, and colleagues conducted post hoc analysis using data from 5,908 participants in five randomized, double-blind, placebo-controlled clinical trials of liraglutide, a glucagon-like peptide-1 receptor agonist approved for weight management, in order to assess cardiovascular risk. The researchers found that with liraglutide (3.0 mg), eight participants had positively adjudicated cardiovascular events (1.54 events/1,000 person-years), compared to 10 participants in the comparators group (3.65 events/1000 person-years). Compared to the non-liraglutide group, the hazard ratio for 3.0 mg liraglutide treatment was 0.42 (95 percent confidence interval, 0.17 to 1.08).

Internal medicine patients are frequently prescribed potentially inappropriate medications (PIMs), but screening tools can detect clinically relevant PIMs, according to a study published online Oct. 8 in the Journal of Clinical Pharmacy and Therapeutics. Anne-Laure Blanc, Pharm.D., Ph.D., from Geneva University Hospitals in Switzerland, and colleagues compared two PIM-screening tools -- STOPP/START and PIM-Check -- in a general internal medicine ward. They also analyzed a random sample of 50 patients hospitalized in 2013, whose readmission within 30 days of discharge had been potentially preventable, and 50 sex-and age-matched patients who were not readmitted. The researchers found that across the whole ward population, PIM-Check and STOPP/START detected 1,348 and 537 PIMs, respectively, which was the equivalent of 13.5 and 5.4 PIMs per patient. PIM-Check had a substantially shorter screening time versus STOPP/START (four versus 10 minutes). Of the PIMs detected using PIM-Check and STOPP/START, the clinical pharmacist found 45 percent and 42 percent, respectively, to be clinically relevant to individual patients' cases. There were no significant differences in the rates of detected and clinically relevant PIMs between readmitted and nonreadmitted patients.