Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Repost] Most practice guideline recommendations based on less-than-ideal quality of evidence

Most practice guideline recommendations based on less-than-ideal quality of evidence.

From the 15 January 2014 Mayo Clinic NewsNetwork article by Shelly Plutowski (@rwp01)

ROCHESTER, Minn. — Jan. 15, 2014 — A study published in the January issue of Mayo Clinic Proceedings shows that most clinical practice guidelines for interventional procedures (e.g., bronchoscopy, angioplasty) are based on lower-quality medical evidence and fail to disclose authors’ conflicts of interest.

“Guidelines are meant to create a succinct roadmap for the diagnosis and treatment of medical conditions by analyzing and summarizing the increasingly abundant medical research,” write Joseph Feuerstein, M.D., and colleagues from Beth Israel Deaconess Medical Center. “Guidelines are used as a means to establish a standard of care … However, a guideline’s validity is rooted in its development process.”

Journalists: Sound bites with Dr. Talwalkar are available in the downloads.

In an accompanying editorial, Jayant Talwalkar, M.D., associate medical director of theValue Analysis Program in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, says that the study further illustrates that existing guidelines are highly variable with respect to evidence quality and transparency.

“Most of the current practice guidelines in circulation do not meet criteria that represent trustworthiness as defined by the Institute of Medicine,” Dr. Talwalkar says.

Dr. Talwalkar also points out that more attention needs to be paid to potential conflicts of interest among guideline authors and guideline development panels.

“There is a growing body of literature documenting the existence of one or more potential conflicts of interest reported for authors or members of guideline development panels,” he says. “As a result, the influence of external activities such as consulting or speaking fees, research grant funding and stock ownership has the potential to create significant bias and uncertainty for issued recommendations.”

Dr. Talwalkar notes that up to 80 percent of recommendations from most guidelines are supported by evidence from non-randomized studies or expert consensus opinion, making conflict of interest disclosure crucial.

Dr. Talwalkar says that, in the future, the guideline-writing process must evolve to include more concise and up-to-date recommendations as well as more transparency about the management of potential conflicts of interest.

Read the entire article here

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January 21, 2014 Posted by | health care, Medical and Health Research News | , | Leave a comment

[Repost] Racism may accelerate aging in African-American men

Racism may accelerate aging in African-American men.

From the 15 January posting at the University of Maryland Web site

MD-led study is first to link racism-related factors and cellular age

Screen Shot 2014-01-21 at 5.28.01 AMCOLLEGE PARK, Md. – A new University of Maryland-led study reveals that racism may impact aging at the cellular level. Researchers found signs of accelerated aging in African American men who reported high levels of racial discrimination and who had internalized anti-Black attitudes. Findings from the study, which is the first to link racism-related factors and biological aging, are published in the American Journal of Preventive Medicine.

Racial disparities in health are well-documented, with African Americans having shorter life expectancy, and a greater likelihood of suffering from aging-related illnesses at younger ages compared to whites. Accelerated aging at the biological level may be one mechanism linking racism and disease risk.

“We examined a biomarker of systemic aging, known as leukocyte telomere length,” explained Dr. David H. Chae, assistant professor of epidemiology at UMD’s School of Public Health and the study’s lead investigator. Shorter telomere length is associated with increased risk of premature death and chronic disease such as diabetes, dementia, stroke and heart disease.  “We found that the African American men who experienced greater racial discrimination and who displayed a stronger bias against their own racial group had the shortest telomeres of those studied,” Chae explained.

Even after adjusting for participants’ chronological age, socioeconomic factors, and health-related characteristics, investigators found that the combination of high racial discrimination and anti-black bias was associated with shorter telomeres. On the other hand, the data revealed that racial discrimination had little relationship with telomere length among those holding pro-black attitudes. “African American men who have more positive views of their racial group may be buffered from the negative impact of racial discrimination,” explained Chae. “In contrast, those who have internalized an anti-black bias may be less able to cope with racist experiences, which may result in greater stress and shorter telomeres.”

Screen Shot 2014-01-21 at 5.30.04 AMThe findings from this study are timely in light of regular mediareports of racism facing African American men. “Stop-and-friskpolicies, and other forms of criminal profiling such as ‘driving orshopping while black’ are inherently stressful and have a real impact on the health of African Americans,” said Chae. Researchers found that racial discrimination by police was most commonly reported by participants in the study, followed by discrimination in employment. In addition, African American men are more routinely treated with less courtesy or respect, and experience other daily hassles related to racism.

Chae indicated the need for additional research to replicate findings, including larger studies that follow participants over time. “Despite the limitations of our study, we contribute to a growing body of research showing that social toxins disproportionately impacting African American men are harmful to health,” Chae explained. “Our findings suggest that racism literally makes people old.”

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January 21, 2014 Posted by | Medical and Health Research News, Public Health | , , , | Leave a comment

[Repost] Altering the community of gut bacteria promotes health and increases lifespan

Altering the community of gut bacteria promotes health and increases lifespan.

Screen Shot 2014-01-21 at 5.12.38 AMScientists at the Buck Institute for Research on Aging have promoted health and increased lifespan in Drosophila by altering the symbiotic, or commensal, relationship between bacteria and the absorptive cells lining the intestine. The research, appearing in the January 16, 2014 edition of Cell, provides a model for studying many of the dysfunctions that are characteristic of the aging gut and gives credence to the growing supposition that having the right balance of gut bacteria may be key to enjoying a long healthy life.

Even though recent research in humans has linked the composition of gut flora with diet and health in the elderly and the list of age-related diseases associated with changes in gut bacteria include cancer, diabetes, and inflammatory bowel disease, lead author and Buck faculty Heinrich Jasper, PhD, says there is no systematic understanding of how we go from having a young, healthy gut to one that is old and decrepit. “Our study explores age-related changes in the gut that include increased oxidative stress, inflammation, impaired efficiency of the immune response, and the over-proliferation of stem cells,” said Jasper. “It puts these changes into a hierarchical, causal relationship and highlights the points where we can intervene to rescue the negative results of microbial imbalance.”

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January 21, 2014 Posted by | Medical and Health Research News | , , , , | Leave a comment

Study reveals role of sex in spread of deadly disease

English: Life cycle of the parasites from the ...

English: Life cycle of the parasites from the genus Leishmania, the cause of the disease Leishmaniasis. Français : Cycle de vie (en anglais) des parasites du genre Leishmania, responsables de la Leishmaniose. (Photo credit: Wikipedia)

 

Study reveals role of sex in spread of deadly disease.

 

 Research involving scientists at the University of York has provided important new information about transmission of human leishmaniasis, a group of infectious diseases which kills more than 100,000 people a year.

rofessor Deborah Smith of the Centre for Immunology and Infection at York, working with colleagues at the Wellcome Trust Sanger Institute and Charles University in Prague, has shown that “Leishmania” parasites reproduce sexually in the wild.

The research, published in PLOS Genetics, is a significant step forward in understanding how leishmaniasis is spread in endemic regions. Caused by “Leishmania”parasites, human leishmaniasis is a serious public health problem in more than 90 countries worldwide. There are high fatality rates among children and young people and those with suppressed immune systems. Pharmaceutical treatments are limited and there is no vaccine.

These microscopic organisms infect humans through the bite of a female blood-feeding sand fly carrying infective parasites in its gut. People only become infected, therefore, in geographical regions that are well-suited to support sand fly populations — those with suitable habitats, humidity and temperature. But the biology of the parasite in the sandfly is also critically important in determining the outcome of infection in man.

The new research uses DNA sequencing to investigate genetic variation at the highest level of resolution in “Leishmania “parasites isolated from sand flies caught in a defined focus of human leishmaniasis in south-east Turkey. This analysis provides evidence that “Leishmania “parasites can reproduce sexually in wild-caught sand flies, an event only detected previously under specialised laboratory conditions.. It also establishes, for the first time, quantitative estimates of the relative rates of sexual and asexual reproduction during the parasite life cycle.

 

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January 21, 2014 Posted by | Medical and Health Research News | , , , | Leave a comment

[Repost] Here comes the sun to lower your blood pressure

Here comes the sun to lower your blood pressure.

From the 14 January 2014 ScienceDaily article

Exposing skin to sunlight may help to reduce blood pressure and thus cut the risk of heart attack and stroke, a study published in theJournal of Investigative Dermatology suggests.

Research carried out at the Universities of Southampton and Edinburgh shows that sunlight alters levels of the small messenger molecule, nitric oxide (NO) in the skin and blood, reducing blood pressure.

Martin Feelisch, Professor of Experimental Medicine and Integrative Biology at the University of Southampton, comments: “NO along with its breakdown products, known to be abundant in skin, is involved in the regulation of blood pressure. When exposed to sunlight, small amounts of NO are transferred from the skin to the circulation, lowering blood vessel tone; as blood pressure drops, so does the risk of heart attack and stroke.”

English: blood pressure measurement Deutsch: :...

English: blood pressure measurement Deutsch: :deBlutdruckmessung (Photo credit: Wikipedia)

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January 21, 2014 Posted by | Medical and Health Research News | , , | Leave a comment

Patients with learning disabilities become ‘invisible’ in hospitals, says study

Patients with learning disabilities become ‘invisible’ in hospitals, says study.

From the 17th January 2014 ScienceDaily article

Hospital patients with learning disabilities face longer waits and mismanaged treatment due to a failure to understand them by nursing staff, says a new report.

In one case, a patient who had problems making herself understood was accused of being drunk by hard pressed hospital staff.

It is estimated that one in 50 people in England have some form of learning disabilities such as Down’s syndrome.

Dr Irene Tuffrey-Wijne, senior research fellow in nursing at St George’s, University of London and Kingston University, said: “People with learning disabilities are largely invisible within the hospitals, which meant that their additional needs are not recognised or understood by staff.

“Our study found many examples of good practice, but also many examples where the safety of people with learning disabilities in hospitals was at risk.”

Dr Tuffrey-Wijne, a co-author of the study who works at the Faculty of Health, Social Care and Education, a partnership between the two universities, added: “The most common safety issues were delays and omissions of care and treatment.

“Some examples come down to basic nursing care like providing enough nutrition but other serious consequences were also seen in our study.

It found that the main barrier to better and safer care was a lack of effective flagging systems, leading to a failure to identify patients with learning disabilities in the first place.

 

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January 21, 2014 Posted by | health care | , , , , , | Leave a comment

Living Sick and Dying Young in Rich America – Leah Sottile – The Atlantic

Living Sick and Dying Young in Rich America – Leah Sottile – The Atlantic.

From the 19 December 2014 article at The Atlantic

We were standing at Target in an aisle we’d never walked down before, looking at things we didn’t understand. Pill splitters, multivitamins, supplements, and the thing we were here to buy: a long blue pill box—the kind with seven little doors labeled “S M T W T F S “ for each day of the week, the kind that old people cram their pills into when they have too many to remember what they’ve already taken.

My husband, Joe Preston, shook his head. “Do I really need this?”

I grabbed it off the shelf and threw it in our basket. And when we got home, Joe—then a fit and fairly spry 30-year-old man with a boss-level beard—stood at the kitchen counter, dropping each of his prescriptions with a plink into the container.

I guess it’s true that life is full of surprises, but for the three years since Joe’s crippling pain was diagnosed as the result of an autoimmune disease called Ankylosing Spondylitis, our life has been full of surprises like this one. Pill boxes, trips to the emergency room, early returns from vacation. Terms like “flare-up” have dropped into our vocabulary. We’ve sat in waiting rooms where Joe was the only person without a walker or a cane. Most of our tears have been over the fact that these aren’t the kind of surprises either of us thought we’d be encountering at such a young age.

But here’s the thing: We recently realized we weren’t alone. Almost all of our friends are sick, too. When we met our friend Missy Narrance, Joe found solace in talking to her about his health. She’s 29 and has been battling lupus and fibromyalgia for the past 10 years. She’s been through chemotherapy twice, and her daily symptoms are so extreme that she was granted federal disability status when she was just 23 years old. In our close group of friends—who range from 25 to 35 years old—we know people with everything from tumors to chronic pain. Sometimes our conversations over beers on a Friday night turn to discussions of long-term care and miscommunication between doctors.

Despite the fact that America shells out more money on healthcare than any other country in the world, according to a report by the Centers for Disease Control and Prevention—and a hefty 75 percent of those dollars are going toward aiding people with chronic conditions—almost half of American adults had at least one chronic condition in 2005.

Read the entire article here

The rest of the article includes analysis on how personal choices must be backed up by facts. It points out that research has been done on how infrastructural changes (which need tax dollars) can improve public health. But there has to be political will.
Research on these aspects of public health have not been widely disseminated by the press.

 

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January 21, 2014 Posted by | Consumer Health | , , , | Leave a comment

[Reblog] Physicians discuss willingness to write prescriptions for health apps

From the 18th January 2014 at Scope (published by Stanford Medicine)

By   

health_appsThe mobile health market is rapidly growing, and it’s estimated that within five years 50 percent of mobile device users will have downloaded mobile health apps. While past surveys haveshown that patients are eager for doctors to recommend such apps, it remains unclear if physicians feel comfortable prescribing them.

Over on MedPage Today, writer Kristina Fiore explores the potential of physicians prescribing health apps, such as BlueStar, which is approved by the U.S. Food and Drug Administration and helps patients monitor diabetes. Several of the clinicians contacted for the story said they are open to the idea, assuming that patients are comfortable using the app and that data shows the app to be effective. From the article:

Sue Kirkman, MD, of the University of North Carolina at Chapel Hill, said a prescription app could be helpful, but its usefulness may be limited in that the patients “who want the app and are willing to enter data and respond to prompts may already be the more proactive ones.”

Kirkman added that she hopes potential insurer reimbursement for apps opens the door wider to support of reimbursement for self-management tools such as contact with diabetes educators.

“Right now, pretty much only face-to-face visits are covered, not the ongoing contacts by phone, fax, email, etc., that are really needed to help someone sustain behavior changes and self-manage their diabetes optimally,” she said.

Previously: Text message reminders shown effective in boosting flu shot rates among pregnant womenTexts may help people with diabetes manage care, Why physicians should consider patients’ privacy before recommending health, fitness apps and Designing a mobile app to help patients and doctors identify personalized food triggers
Photo by Intel Free Press

Will Docs Write Rx for Apps?[Medpage Today]

Doctors can now write scripts for the first prescription-only app — but the question remains whether they’ll pick up a prescription pad to write for mobile technology.

The app, BlueStar, is a tracker for patients with diabetes. It analyzes logged blood glucose data and offers advice based on trends it detects — such as telling patients to adjust their diets based on sugar levels after meals. Clinicians also receive a report on their patients’ progress.

Parent company WellDoc just won $20 million in venture financing for the app, and the company has a track record of success with online disease management tools and applications. WellDoc’s argument is that better blood sugar control will lead to better patients outcomes, and, thus, less spending on healthcare in the long run.
   Read entire article here

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January 21, 2014 Posted by | Consumer Health, health care | , , , , , , , | Leave a comment

   

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