Friday, July 26, 2019

Long-term dietary adherence and changes in dietary intake in coronary patients after intervention with a Mediterranean diet or a low-fat diet: the CORDIOPREV randomized trial.

Diet and exercise are important throughout life, starting at pre-conception. Parents who eat right and exercise regularly before conception tend to have healthier babies all other things considered. Children who exercise regularly and have a good diet are more likely to be healthier as adults. Adults throughout life with good exercise and dietary patterns are more likely to live longer, with a higher quality of life and less dementia. This principle also applies to those suffering from illness. This study shows that a dietary intervention in heart attack patients is effective. The long-term effect of this intervention is critically important. But what is the best way to do this in a cost-effective manner? - TFH





Long-term dietary adherence and changes in dietary intake in coronary patients after intervention with a Mediterranean diet or a low-fat diet: the CORDIOPREV randomized trial.:

Related Articles
Long-term dietary adherence and changes in dietary intake in coronary patients after intervention with a Mediterranean diet or a low-fat diet: the CORDIOPREV randomized trial.

Eur J Nutr. 2019 Jul 24;:

Authors: Quintana-Navarro GM, Alcala-Diaz JF, Lopez-Moreno J, Perez-Corral I, Leon-Acuña A, Torres-Peña JD, Rangel-Zuñiga OA, Arenas de Larriva AP, Corina A, Camargo A, Yubero-Serrano EM, Rodriguez-Cantalejo F, Garcia-Rios A, Luque RM, Ordovas JM, Perez-Martinez P, Lopez-Miranda J, Delgado-Lista J

Abstract

PURPOSE: Adherence to a healthy dietary pattern positively influences clinical outcomes in cardiovascular prevention, but long-term adherence is difficult to maintain. We evaluated 5-year changes in dietary habits, adherence achieved, and its maintenance in a cohort of coronary patients from the CORDIOPREV study.

METHODS: 1002 coronary patients were randomized to a Mediterranean diet (n = 502) or a low-fat diet (n = 500) and received individual-group-telephone visits and personalized dietary advice. A validated food-frequency questionnaire, a 14-point Mediterranean diet adherence screener, and a 9-point low-fat diet adherence score were used. Dietary adherence was categorized into Low, Medium, and High Adherence. Changes in nutrient intake, food consumption, and adherence were analyzed on a yearly basis. The maintenance of long-term dietary adherence was evaluated using data after the first year and fifth year.

RESULTS: From baseline to 5 years, significant increases were observed in overall dietary adherence (Mediterranean diet from 8.9 to 11.4; low-fat diet from 3.9 to 7.1) and in the percentage of patients considered High Adherence (Mediterranean diet from 41 to 89%; low-fat diet from 4 to 67%). When we evaluated the maintenance of adherence, patients considered Low and Medium Adherence at 1 year increased their adherence at the 5 years with both diets and patients considered High Adherence maintained their adherence with a Mediterranean diet, but decreased their adherence with a low-fat diet.

CONCLUSIONS: A comprehensive dietary intervention results in an overall long-term improvement and maintenance of adherence to the Mediterranean and low-fat diets. In our population, the Mediterranean diet group achieved a high level of adherence in the short term which was maintained in the long term.

PMID: 31342228 [PubMed - as supplied by publisher]

Long-term dietary adherence and changes in dietary intake in coronary patients after intervention with a Mediterranean diet or a low-fat diet: the CORDIOPREV randomized trial.

Diet and exercise are important throughout life, starting at pre-conception. Parents who eat right and exercise regularly before conception tend to have healthier babies all other things considered. Children who exercise regularly and have a good diet are more likely to be healthier as adults. Adults throughout life with good exercise and dietary patterns are more likely to live longer, with a higher quality of life and less dementia. This principle also applies to those suffering from illness. This study shows that a dietary intervention in heart attack patients is effective. The long-term effect of this intervention is critically important. But what is the best way to do this in a cost-effective manner? - TFH





Long-term dietary adherence and changes in dietary intake in coronary patients after intervention with a Mediterranean diet or a low-fat diet: the CORDIOPREV randomized trial.:

Related Articles
Long-term dietary adherence and changes in dietary intake in coronary patients after intervention with a Mediterranean diet or a low-fat diet: the CORDIOPREV randomized trial.

Eur J Nutr. 2019 Jul 24;:

Authors: Quintana-Navarro GM, Alcala-Diaz JF, Lopez-Moreno J, Perez-Corral I, Leon-Acuña A, Torres-Peña JD, Rangel-Zuñiga OA, Arenas de Larriva AP, Corina A, Camargo A, Yubero-Serrano EM, Rodriguez-Cantalejo F, Garcia-Rios A, Luque RM, Ordovas JM, Perez-Martinez P, Lopez-Miranda J, Delgado-Lista J

Abstract

PURPOSE: Adherence to a healthy dietary pattern positively influences clinical outcomes in cardiovascular prevention, but long-term adherence is difficult to maintain. We evaluated 5-year changes in dietary habits, adherence achieved, and its maintenance in a cohort of coronary patients from the CORDIOPREV study.

METHODS: 1002 coronary patients were randomized to a Mediterranean diet (n = 502) or a low-fat diet (n = 500) and received individual-group-telephone visits and personalized dietary advice. A validated food-frequency questionnaire, a 14-point Mediterranean diet adherence screener, and a 9-point low-fat diet adherence score were used. Dietary adherence was categorized into Low, Medium, and High Adherence. Changes in nutrient intake, food consumption, and adherence were analyzed on a yearly basis. The maintenance of long-term dietary adherence was evaluated using data after the first year and fifth year.

RESULTS: From baseline to 5 years, significant increases were observed in overall dietary adherence (Mediterranean diet from 8.9 to 11.4; low-fat diet from 3.9 to 7.1) and in the percentage of patients considered High Adherence (Mediterranean diet from 41 to 89%; low-fat diet from 4 to 67%). When we evaluated the maintenance of adherence, patients considered Low and Medium Adherence at 1 year increased their adherence at the 5 years with both diets and patients considered High Adherence maintained their adherence with a Mediterranean diet, but decreased their adherence with a low-fat diet.

CONCLUSIONS: A comprehensive dietary intervention results in an overall long-term improvement and maintenance of adherence to the Mediterranean and low-fat diets. In our population, the Mediterranean diet group achieved a high level of adherence in the short term which was maintained in the long term.

PMID: 31342228 [PubMed - as supplied by publisher]

Saturday, July 20, 2019

Risk of acute myocardial infarction and ischemic stroke in patients with asthma exacerbation: A population-based, self-controlled case series study.

This study found that the risk of an acute cardiovascular event was found to increase by about 5-fold after an asthma exacerbation in those over 40y old. Important to note and watch for. - TH



Risk of acute myocardial infarction and ischemic stroke in patients with asthma exacerbation: A population-based, self-controlled case series study.:

Related Articles
Risk of acute myocardial infarction and ischemic stroke in patients with asthma exacerbation: A population-based, self-controlled case series study.

J Allergy Clin Immunol Pract. 2019 Jul 16;:

Authors: Raita Y, Camargo CA, Faridi MK, Brown DFM, Shimada YJ, Hasegawa K

Abstract

BACKGROUND: Patients with asthma have a high incidence of acute myocardial infarction and ischemic stroke.

OBJECTIVE: We aim to investigate the acute effect of asthma exacerbation on these cardiovascular events.

METHODS: Using population-based inpatient data of three geographically-diverse U.S. states (Florida, Nebraska, and New York) during 2011-2014, we conducted a self-controlled case series study of adults (aged ≥40 years) hospitalized with asthma exacerbation. The primary outcome was a composite of acute myocardial infarction and ischemic stroke. We used conditional Poisson regression to compare each patient's incidence rate of the outcome during three sequential risk periods (1-7, 8-14, and 15-28 days after asthma exacerbation) with that of reference period (i.e., summed period before and after the three risk periods).

RESULTS: We identified 4,607 adults hospitalized for asthma exacerbation who had a first episode of acute myocardial infarction or ischemic stroke. During the reference period, the incidence rate of acute myocardial infarction or ischemic stroke was 25.0/100 person-years. Compared with the reference period, the incidence rate significantly increased during the first risk period (129.1/100 person-years), with a corresponding adjusted incidence rate ratio (aIRR) of 5.04 (95%CI, 4.29-5.88; P<0.001). In the two subsequent risk periods, the incidence rate declined but remained high-50.1/100 person-years (aIRR 1.96; 95%CI, 1.51-2.48; P<0.001) and 38.0/100 person-years (aIRR, 1.48; 95%CI, 1.20-1.81; P<0.001), respectively. The findings were similar when the two outcomes were examined separately.

CONCLUSIONS: In this population-based study of adults with asthma, the risk of acute myocardial infarction and ischemic stroke increased significantly after asthma exacerbation.

PMID: 31323338 [PubMed - as supplied by publisher]

Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review.

Moral injury appears to be a real mental health diagnosis. Developing strategies to prevent and treat the injuries are critical but still there's a long way to go to determine optimal therapies. - TH



Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review.:

Related Articles
Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review.

Front Psychiatry. 2019;10:443

Authors: Koenig HG, Youssef NA, Pearce M

Abstract

Background: Moral injury (MI) involves distress over having transgressed or violated core moral boundaries, accompanied by feelings of guilt, shame, self-condemnation, loss of trust, loss of meaning, and spiritual struggles. MI is often found in Veterans and Active Duty Military personnel with posttraumatic stress disorder (PTSD). MI is widespread among those with PTSD symptoms, adversely affects mental health, and may increase risk of suicide; however, MI is often ignored and neglected by mental health professionals who focus their attention on PTSD only. Methods: A review of the literature between 1980 and 2018 conducted in 2018 is presented here to identify scales used to assess MI. Databases used in this review were PsychInfo, PubMed (Medline), and Google Scholar. Search terms were "moral injury," "measuring," "screening," "Veterans," and "Active Duty Military." Inclusion criteria were quantitative measurement of MI and health outcomes, Veteran or Active Duty Military status, and peer-review publication. Excluded were literature reviews, dissertations, book chapters, case reports, and qualitative studies. Results: Of the 730 studies identified, most did not meet eligibility criteria, leaving 118 full text articles that were reviewed, of which 42 did not meet eligibility criteria. Of the remaining 76 studies, 34 were duplicates leaving 42 studies, most published in 2013 or later. Of 22 studies that assessed MI, five used scales assessing multiple dimensions, and 17 assessed only one or two aspects (e.g., guilt, shame, or forgiveness). The remaining 20 studies used one of the scales reported in the first 22. Of the five scales assessing multiple dimensions of MI, two assess both morally injurious events and symptoms and the remaining three assess symptoms only. All studies were cross-sectional, except three that tested interventions. Conclusions: MI in the military setting is widespread and associated with PTSD symptom severity, anxiety, depression, and risk of suicide in current or former military personnel. Numerous measures exist to assess various dimensions of MI, including five multidimensional scales, although future research is needed to identify cutoff scores and clinically significant change scores. Three multidimensional measures assess MI symptoms alone (not events) and may be useful for determining if treatments directed at MI may both reduce symptoms and impact other mental health outcomes including PTSD.

PMID: 31316405 [PubMed]

Junior doctors and moral exploitation.

This is a common occurence, possibly of educational benefit but proper balance is always necessary. This article thoughtfully explores the issue. -TH

Junior doctors and moral exploitation.:

Junior doctors and moral exploitation.

J Med Ethics. 2019 Jul 16;:

Authors: Parker J

Abstract

In this paper I argue that junior doctors are morally exploited. Moral exploitation occurs where an individual's vulnerability is used to compel them to take on additional moral burdens. These might include additional moral responsibility, making weighty moral decisions and shouldering the consequent emotions. Key to the concept of exploitation is vulnerability and here I build on Rosalind McDougall's work on the key roles of junior doctors to show how these leave them open to moral exploitation by restricting their reasonable options. I argue that there are a number of ways junior doctors are morally exploited. First, their seniors can leverage their position to force a junior to take on some discreet decision. More common is the second type of moral exploitation where rota gaps and staffing issues means junior doctors take on more than their fair share of the moral burdens of practice. Third, I discuss structural moral exploitation where the system offloads moral burdens onto healthcare professionals. Not every instance of exploitation is wrongful and so I conclude by exploring the ways that moral exploitation wrongs junior doctors.

PMID: 31311854 [PubMed - as supplied by publisher]

Dropping F-Bomb Increases Pain Tolerance By A Third, Study Finds

I can vouch for this. It is not the only study showing that profanity, used occasionally, has some internal emotional benefits. - TH





Dropping F-Bomb Increases Pain Tolerance By A Third, Study Finds:

Woman swearing, using curse words
LONDON — Can’t help but shout an expletive every time you stub your toe? Don’t feel too bad, you may actually be doing yourself a favor. A new study finds that swearing when injured has a measurable effect on pain tolerance. In fact, dropping the F-bomb specifically when in pain increases tolerance by up to…

The post Dropping F-Bomb Increases Pain Tolerance By A Third, Study Finds appeared first on Study Finds.

Wednesday, July 17, 2019

Study: Seniors Can Keep Memory, Brain Strong By Learning Multiple Skills Simultaneously

This makes a lot of sense. By developing talent stacks, we can be come more productive, brain healthy, and enthusiastic - TH



Study: Seniors Can Keep Memory, Brain Strong By Learning Multiple Skills Simultaneously:

Senior Couple Sitting At Outdoor Table Painting Landscape
RIVERSIDE, Calif. — As children grow up they absorb as much new information as possible and learn multiple new skills on an almost daily basis. This thirst for knowledge tends to fade away as we grow old, and many people avoid learning new skills past a certain age. Well, a new study finds that older…

The post Study: Seniors Can Keep Memory, Brain Strong By Learning Multiple Skills Simultaneously appeared first on Study Finds.

Monday, July 15, 2019

CRP Testing to Guide Antibiotic Therapy for COPD Exacerbations

=> This is a great idea. CRP tests can be done rapidly and are readily available. Benefit of stopping antibiotics as soon as possible, but not too soon, is high in terms of both the patient's health and the cost of hospitalization.



CRP Testing to Guide Antibiotic Therapy for COPD Exacerbations: In a randomized trial, point-of-care C-reactive protein measurements lowered antibiotic prescribing without compromising clinical outcomes for patients with chronic obstructive pulmonary disease.


Hate Speech On Twitter Predicts Actual Hate Crimes, Study Finds

=> This is not surprising. Will be interesting to follow this and see how law enforcement and governmental agencies start (or continue) using social media as a way to fight crime and/or exert more control over their populations.



Hate Speech On Twitter Predicts Actual Hate Crimes, Study Finds:

Twitter
NEW YORK — Can hate speech online lead to real-life violence? Censorship in social media is a hotly contested topic these days, but a new study out of New York University may be able to shed some light on the real-life consequences of online racism. Researchers say that online hate speech on the popular social media…

The post Hate Speech On Twitter Predicts Actual Hate Crimes, Study Finds appeared first on Study Finds.

Incorporating Information From Electronic and Social Media Into Psychiatric and Psychotherapeutic Patient Care: Survey Among Clinicians.





=> No clear guidelines exist regarding this practice, however, it appears to be common



Incorporating Information From Electronic and Social Media Into Psychiatric and Psychotherapeutic Patient Care: Survey Among Clinicians.:

Incorporating Information From Electronic and Social Media Into Psychiatric and Psychotherapeutic Patient Care: Survey Among Clinicians.

J Med Internet Res. 2019 Jul 12;21(7):e13218

Authors: Hobbs KW, Monette PJ, Owoyemi P, Beard C, Rauch SL, Ressler KJ, Vahia IV

Abstract

BACKGROUND: Obtaining collateral information from a patient is an essential component of providing effective psychiatric and psychotherapeutic care. Research indicates that patients' social and electronic media contains information relevant to their psychotherapy and clinical care. However, it remains unclear to what degree this content is being actively utilized by clinicians as a part of diagnosis or therapy. Moreover, clinicians' attitudes around this practice have not been well characterized.

OBJECTIVE: This survey aimed to establish the current attitudes and behaviors of outpatient clinicians regarding the incorporation of patients' social and electronic media into psychotherapy.

METHODS: A Web-based survey was sent to outpatient psychotherapists associated with McLean Hospital in Belmont, Massachusetts. The survey asked clinicians to indicate to what extent and with which patients they reviewed patients' social and electronic media content as part of their clinical practice, as well as their reasons for or against doing so.

RESULTS: Of the total 115 respondents, 71 (61.7%) indicated that they had viewed at least one patient's social or electronic media as part of psychotherapy, and 65 of those 71 (92%) endorsed being able to provide more effective treatment as a result of this information. The use of either short message service text messages or email was significantly greater than the use of other electronic media platforms (χ21=24.1, n=115, P<.001). Moreover, the analysis of survey responses found patterns of use associated with clinicians' years of experience and patient demographics, including age and primary diagnosis.

CONCLUSIONS: The incorporation of patients' social and electronic media into therapy is currently common practice among clinicians at a large psychiatric teaching hospital. The results of this survey have informed further questions about whether reviewing patient's media impacts the quality and efficacy of clinical care.

PMID: 31301127 [PubMed - in process]

Friday, July 5, 2019

An Advanced Practice Provider Clinical Fellowship as a Pipeline to Staffing a Hospitalist Program.

Excellent Idea



J Hosp Med. 2019 06 01;14(6):336-339

Authors: Lackner C, Eid S, Panek T, Kisuule F

Abstract

BACKGROUND: Approximately 83% of hospitalist groups around the country utilize advanced practice providers; however, the demand for hospitalists continues to exceed the supply, and this has led to increased utilization of advanced practice providers in hospital medicine. Advanced practice providers receive very limited inpatient training, and there is wide variation in their clinical abilities after graduation.

OBJECTIVE: To determine if an advanced practice provider fellowship is a cost-effective pipeline for filling vacancies within a hospitalist program.

METHODS: In 2014, a one-year advanced practice providers clinical fellowship in hospital medicine was established. Working one-on-one with an experienced hospitalist faculty member, the fellows evaluate and manage patients. The program consists of 80% clinical experience, in the inpatient setting, and 20% didactic instruction. Up to four fellows are accepted each year and are eligible for hire, after training, if there are vacancies.

RESULTS: The duration of onboarding and cost to the division were significantly reduced after implementation of the program (25.4 vs 11.0 weeks, P = .017 and $361,714 vs $66,000, P = .004).

CONCLUSION: The advanced practice provider fellowship has proven beneficial for the hospitalist division by (1) reducing costs associated with having unfilled vacancies, (2) improving capacity on the hospitalist service, and (3) providing a pipeline for filling nurse practitioners (NP) and physician assistant (PA) vacancies on the hospitalist service.

PMID: 30897050 [PubMed - in process]

Find the Joy

Lyrics I don’t know why it happened. Where it’s going, a mystery. Somewhere there’s an answer, But the hurt is still inside. And time just k...