01/26/17

Thursday, January 26, 2017

Kids' sugary drinks habits start early

Despite health messages to limit sugary drinks, many children consume sweetened beverages daily, report says

From: http://www.cbsnews.com/news/kids-sugary-drinks-habit-starts-early/

Washington state mumps outbreak nears 300 cases

Officials are urging people to get immunized and to take steps to prevent further spread

From: http://www.cbsnews.com/news/washington-state-mumps-outbreak-spokane-seattle/

Bob Hammes Mitral Clip Story

From: Mayo Clinic http://www.youtube.com/watch?v=G9eaVduzehk

Scientists take first steps to grow human organs in pigs

It's a very early step in research that could potentially help ease a shortage of human donors for transplants

From: http://www.cbsnews.com/news/scientists-take-first-steps-to-growing-human-organs-in-pigs/

Living without lungs for six days saves woman’s life

“They pulled me back from the dead,” says patient who was first in the world to receive the radical treatment

From: http://www.cbsnews.com/news/living-without-lungs-for-six-days-saves-canadian-womans-life/

Scientists Create Part-Human, Part-Pig Embryo

One goal of this stem cell research is to create organs for transplant

From: http://www.webmd.com/a-to-z-guides/news/20170126/scientists-create-part-human-part-pig-embryo?src=RSS_PUBLIC

Kids With ADHD Make 6.1M Doctor Visits a Year: CDC

Mental health specialist says study raises more questions than it answers

From: http://www.webmd.com/add-adhd/news/20170126/kids-with-adhd-make-61-million-doctor-visits-a-year-in-us-cdc?src=RSS_PUBLIC

Kids' Sugary Drink Habits Start Early

Two-thirds of U.S. children consume one or more sweetened beverages daily, report finds

From: http://www.webmd.com/parenting/news/20170126/kids-sugary-drink-habits-start-early?src=RSS_PUBLIC

Tax Identity Theft Awareness Week is Jan. 30-Feb. 3

Washington — The Federal Trade Commission will host this year’s Tax Identity Theft Awareness Week, Jan. 30 – Feb. 3, with webinars and other social media events designed to help people share information about tax identity theft.

From: http://www.ada.org/en/publications/ada-news/2017-archive/january/tax-identity-theft-awareness-week-is-jan-30-feb-3

Mental Disabilities and Organ Transplant Lists

30 members of U.S. Congress request clear guidance on this ethically fraught issue

From: http://www.webmd.com/mental-health/news/20170125/should-a-mental-disability-keep-patients-off-organ-transplant-lists?src=RSS_PUBLIC

Mary Tyler Moore’s legacy includes advocacy for diabetes

The actress and TV icon had an important role off-screen as a passionate, outspoken advocate for the disease

From: http://www.cbsnews.com/news/mary-tyler-moores-legacy-includes-passionate-advocacy-for-diabetes/

Amyloidosis

From: Mayo Clinic http://www.youtube.com/watch?v=yaWDPHlopiQ

A way to predict who'll become a drug addict

Armed with big data, Travelers Insurance developed a program that aims to spot those at risk for opioid dependency

From: http://www.cbsnews.com/news/a-way-to-predict-wholl-become-a-drug-addict/

Mayo Clinic Minute: Protecting babies from eczema risk

From: Mayo Clinic http://www.youtube.com/watch?v=0QVIvgsR6og

Mary Tyler Moore: Diabetes Patient and Advocate

Mary Tyler Moore, the 1970s television icon and Mary Tyler Moore Show star, is also fondly remembered for her efforts to advance diabetes research.

From: http://www.webmd.com/diabetes/news/20170126/mary-tyler-moore-diabetes-patient-and-advocate?src=RSS_PUBLIC

Mental Health May Affect Chances Against Cancer

Early research suggests anxiety, depression might raise risk of dying from certain malignancies

From: http://www.webmd.com/cancer/news/20170125/mental-health-may-affect-chances-against-cancer?src=RSS_PUBLIC

Pregnancy and Underactive Thyroid Treatment

New study finds the therapy may have potential risks, and specialists say more study is needed

From: http://www.webmd.com/baby/news/20170125/should-pregnant-women-always-be-treated-for-underactive-thyroid?src=RSS_PUBLIC

Early Death Rates Up for Whites, Down for Blacks

Drug overdoses, liver disease, suicides fuel jump in numbers for whites, U.S. study finds

From: http://www.webmd.com/healthy-aging/news/20170125/rates-of-early-deaths-rise-for-whites-drop-for-blacks?src=RSS_PUBLIC

1 in 4 U.S. Adults, 1 in 10 Teens Use Tobacco

About 40 percent of cigarette smokers also use e-cigarettes or other tobacco products, report finds

From: http://www.webmd.com/smoking-cessation/news/20170125/1-in-4-us-adults-1-in-10-teens-use-tobacco?src=RSS_PUBLIC

Drug May Be New Weapon Against a 'Superbug'

Zinplava cuts risk of recurrent C. difficile infections by 40 percent

From: http://www.webmd.com/digestive-disorders/news/20170125/drug-may-be-new-weapon-against-a-superbug?src=RSS_PUBLIC

Most Primary Care Docs Oppose ACA Repeal: Survey

Though many would support changes, only 15 percent want the controversial health care reform law dismantled

From: http://www.webmd.com/health-insurance/20170125/majority-of-primary-care-docs-oppose-repeal-of-obamacare-survey?src=RSS_PUBLIC

Does Celiac Disease Contribute to Other Autoimmune Diseases?

From: Mayo Clinic http://www.youtube.com/watch?v=079KrH8k01Q

Does your doctor’s gender matter?

Follow me on Twitter @RobShmerling

I’ve read medical research studies that surprised me. I’ve read medical news that inspired me to learn more. And, sure, there have been plenty of studies that went way over my head. But it’s rare that I’ve read a study that made me feel defensive. Until now.

Researchers publishing JAMA Internal Medicine reported that older adults admitted to the hospital fare better if under the care of a female physician rather than a male physician. More specifically, the patients in this study were less likely to end up back in the hospital, or die, in the 30 days after discharge if cared for by female physicians than similar patients cared for by male physicians.

How “good” was the study?

The study was large. Nearly 1.6 million hospital admissions among people covered by Medicare were analyzed for deaths within 30 days. Another 1.6 million admissions were analyzed for readmission within 30 days. When comparing care provided by male to female internists, the results clearly demonstrated small differences that consistently favored the female physicians:

Deaths within 30 days of admission occurred in 11.07% of patients cared for by female physicians while 11.49% of patients cared for by male physicians died in that timeframe.
Readmission to the hospital within 30 days of discharge occurred in 15.02% of patients with female physicians but in 15.57% of those cared for by male physicians.
Even after accounting for several relevant factors, such as severity or type of patients’ illness, or type of medical training, age or experience of the physicians, the findings remained largely the same.

Although these differences may seem small, they could have a large impact on unnecessary suffering, premature death, and costs of care when considered over the millions of hospital admissions that occur each year.

Your reaction, please

When I surveyed the members of my household about these results, the reactions ranged from “Of course, everyone knows women are better at everything,” (my wife’s perspective) to, “There must be some other reason for these findings; the researchers must have missed something.” OK, that last one was from me. Did I mention I was feeling defensive?

But after reading the research report’s results carefully, it’s hard to come up with an alternative explanation for the study’s findings. And there is other research that suggests that female physicians outperform their male counterparts in certain aspects of medical care, such as communication skills.

So, what’s their secret?

And that brings us to this question. If female physicians are getting better results, how do they do it? Just what are the differences in the ways male and female physicians practice that lead to better outcomes for patients of women doctors?

The answer is important. Identifying the differences in how male and female physicians provide care could lead to improved care across the board, regardless of physician gender.

The study’s authors are appropriately cautious in their conclusions because a study of this type cannot determine why the results turned out as they did. But they did offer a few possibilities:

Female physicians may follow clinical guidelines more often.
Female physicians may communicate better, with less medical jargon.
Male physicians may be less “deliberate” in addressing complicated patients’ problems (as suggested by past research).

I would add a couple of other possibilities:

Perhaps female physicians listen more carefully.
Female physicians may spend more time with their patients, and this could allow the doctor to get a better sense of the patient’s symptoms and help ensure that her recommendations are understood well by the patient.

There are more questions to answer

Beyond making us think about what female physicians are doing right, this study raises a number of other questions:

Would the results be the same if other areas of medicine were similarly studied? This study excluded patients of care for by other types of doctors such as surgeons, obstetricians, and psychiatrists.
Would physician gender matter if the patients were younger? The average age of patients in this Medicare-covered study population was nearly 81.
How would the results be affected if outpatients were included?

How can we use this information to improve care of patients?

Undoubtedly, future research will try to tease out how female and male doctors practice differently. Then it will be important to figure out why these differences exist and which ones matter most. It’s probable that each gender has something to teach the other. One thing is certain: accepting the possibility that female physicians may outperform male physicians in certain aspects of medical care, and then trying to understand why, is much more constructive than being defensive about it.

The post Does your doctor’s gender matter? appeared first on Harvard Health Blog.

From: Robert H. Shmerling, MD http://www.health.harvard.edu/blog/does-your-doctors-gender-matter-2017012611062

Infectious Diseases Subspecialties Update 2017: Surgical Site Infections

From: Mayo Clinic http://www.youtube.com/watch?v=fN-F0e2XZHg

Bone and joint problems associated with diabetes

From: http://www.mayoclinic.com/diseases-conditions/diabetes/in-depth/diabetes/art-20049314

Germs: Understand and protect against bacteria, viruses and infection

From: http://www.mayoclinic.com/diseases-conditions/infectious-diseases/in-depth/germs/art-20045289

Healthy breakfast: Quick, flexible options

From: http://www.mayoclinic.com/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/food-and-nutrition/art-20048294

Stretching: Focus on flexibility

Stretching may benefit your exercise routine. Here's how to do it safely.

From: http://www.mayoclinic.com/healthy-lifestyle/fitness/in-depth/stretching/art-20047931

Chronic pain can interfere with sexuality

From: http://www.mayoclinic.com/chronic-pain/art-20044369

Mylan CEO says EpiPen controversy was "a window into a broken system"

Heather Bresch, head of the pharma giant, is opening up about the firestorm created by the nearly-500 percent increase in the price of life-saving allergy medicine

From: http://www.cbsnews.com/news/mylan-ceo-heather-bresch-speaks-out-epipen-controversy-preview/

Bone and joint problems associated with diabetes

From: http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes/art-20049314

Germs: Understand and protect against bacteria, viruses and infection

From: http://www.mayoclinic.org/diseases-conditions/infectious-diseases/in-depth/germs/art-20045289

Healthy breakfast: Quick, flexible options

From: http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/food-and-nutrition/art-20048294

Chronic pain can interfere with sexuality

From: http://www.mayoclinic.org/chronic-pain/art-20044369

Stretching: Focus on flexibility

Stretching may benefit your exercise routine. Here's how to do it safely.

From: http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931

What is prediabetes and why does it matter?

When I’m seeing a new patient, I am especially alert to certain pieces of their history. Do they have a strong family history of diabetes? Are they of Latino, Asian, Native-American, or African-American ethnicity? Did they have diabetes in pregnancy? Are they overweight or obese? Do they have polycystic ovarian syndrome (PCOS)?

Why do I care about these things? Because they may be clues that the patient is at risk for developing adult-onset (type 2) diabetes, and that can lead to multiple major medical problems.

Many people have heard of type 2 diabetes, a disease where the body loses its ability to manage sugar levels. Adult-onset diabetes most often affects people with known risk factors and can take years to fully develop, unlike juvenile (type 1) diabetes, which can develop randomly and quickly.

Here is why high blood sugar is a problem

Untreated or undertreated diabetes means persistently high blood sugars, which can cause horrible arterial blockages, resulting in strokes and heart attacks. High blood sugars also cause nerve damage, with burning leg pain that eventually gives way to numbness. This, combined with the arterial blockages, can result in deformities and dead tissue, which is why many people with diabetes end up with amputations. The tiny blood vessels to the retina are also affected, which can cause blindness. And don’t forget the kidneys, which are especially susceptible to the damage caused by high blood sugar. Diabetes is a leading cause of kidney failure requiring dialysis and/or kidney transplant. But wait! There’s more. High blood sugar impairs the white blood cell function critical to a healthy immune system, and sugar is a great source of energy for invading bacteria and fungi. These factors put folks at risk of nasty infections of all kinds.

These facts scare me. Not just because I’m the doctor who gets to help manage these not-fun issues, but because I’m of Latina descent and diabetes runs in my own family. I’m at risk too.

So, what can we do? If we know who is at risk for diabetes, and it takes years to develop, we should be able to prevent it, right? Right!

Keeping prediabetes from becoming diabetes

A recent in-depth article by endocrine experts declares prediabetes a worldwide epidemic (which it is).¹ Prediabetes is defined by fasting blood sugars between 100 and 125, or an abnormal result on an oral glucose tolerance test. What can we do to treat prediabetes? The authors reviewed multiple large, well-conducted studies, and all showed that prediabetes can be targeted and diabetes delayed or prevented.

One of the largest studies was conducted here in the U.S.² Over 3,000 people from 27 centers who were overweight or obese and had prediabetes were randomly assigned to one of three groups:

standard lifestyle recommendations plus the medication metformin (Glucophage);
standard lifestyle recommendations plus a placebo pill;
an intensive program of lifestyle modification.

The intensive program included individualized dietary counseling, as well as instruction to walk briskly or do other exercise for 120 minutes per week, with the goal of some modest weight loss.

Investigators followed the subjects over three years, and the results were consistent with those from many other studies: the people in the intensive lifestyle modification group (nutrition counseling and exercise guidance) were far less likely to develop diabetes in that time span than those in either of the other groups.^3,4,5 Want numbers? The estimated cumulative incidence of diabetes at three years was 30% for placebo, 22% for metformin, and 14% for lifestyle modification. The incidence of diabetes was 39% lower in the lifestyle modification group than in the metformin group. As a matter of fact, they shut down the study early because it was deemed unethical to keep the subjects in the placebo and metformin-only groups from proper treatment.

The authors of the prediabetes review also looked at the multitude of other studies that more closely examined what kinds of diets are useful and concluded that “The consensus is that a diet rich in whole grains, vegetables, fruit, monounsaturated fat, and low in animal fat, trans fats, and simple sugars is beneficial, along with maintenance of ideal body weight and an active lifestyle.”

It’s really just common sense. And that’s why my husband and I greatly limit our intake of sugar and carbs, get four-plus servings of plant-based foods daily, and exercise.

A word about medication

For my patients who for whatever reason cannot change their diet and lifestyle, I do recommend a medication. For patients who are on the cusp of diabetes and who have multiple risk factors or other diseases, medication really is indicated. There are also people who want to add a medication to diet and exercise in order to boost weight loss and further decrease their risk, and that’s fair as well.

I know that using medications for prediabetes is controversial. Other doctors have warned that the label “pre-diabetes” is over-inclusive and that it’s all a vast big-pharma marketing scam.⁶ It’s true that we have to be informed about what we’re prescribing and why. But based on what I’ve seen in my career, I definitely do NOT want to develop diabetes myself, and if you’re at risk, believe me, you don’t either. So, consider the pros and cons of everything, talk to your doctor, and decide for yourself what action you want to take. And then, take action.

Sources

Edwards CM, Cusi K. Prediabetes: A Worldwide Epidemic. Endocrinology and Metabolism Clinics of North America, December 2016.
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, February 7, 2002.
Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care, April 1997.
Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine, May 3, 2001.
Lindstrom J, Peltonen M, Eriksson JG, et al. Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS). Diabetologia, February 2013.
Prediabetes: can prevention come too soon? Blog post by Richard Lehman, Cochrane UK Senior Fellow in General Practice, November 11, 2016.

The post What is prediabetes and why does it matter? appeared first on Harvard Health Blog.

From: Monique Tello, MD, MPH http://www.health.harvard.edu/blog/what-is-prediabetes-and-why-does-it-matter-2017012511025