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A recent study of over 3.4 million people conducted in Sweden has found a link between dog ownership and a significant reduction in risk of heart attack, stroke, cardiovascular death, and all cause death. The study, published in the journal Scientific Reports, found that when adjusted for age and sex, dog owners had a 23% reduced risk of cardiovascular related death and 20% reduced risk of all cause death. Interestingly, compared to people who live alone, single dog owners had a 33% reduced risk of death and 11% reduced risk of heart attack. People who own dogs are more likely to be physically active, have social contact, and be exposed to different beneficial bacteria that a non-owner might not be. The dog breed with the largest risk reduction were hunting dogs such as pointers (40%) and scent hounds (37%).
For more information please visit the BBC, and the original study via Scientific Reports.
Do you think that the reduced risk of death in this study was more related to the effect of owning a dog, or the type of person who owns a dog? Should we consider recommending that people who live on their own get a dog given the huge death risk reduction for that population?
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Preliminary results from a safety clinical trial showed an increased risk of heart-related death with Febuxostat (Uloric) compared to another medication used for gout called Allopurinol. Clinical trials conducted prior to the drug approval showed a higher rate of heart-related problems including heart attack, stroke, and heart-related deaths in patients treated with Febuxostat compared to Allopurinol. As a result, the FDA required the drug manufacturer, Takeda Pharmaceuticals, to conduct an additional safety clinical trial in 2009 after the drug was approved. This trial was recently finished, showing an increased risk of heart-related deaths and death from all causes. Once the final results from the manufacturer are received, the FDA will conduct a review and update the public with any new information.
For more information visit FDA.gov.
Do you know anyone taking Febuxostat (Uloric)? Why do you think the drug was approved even though it showed a higher rate of heart related problems? As a healthcare professional, do you know how and where to report adverse effects related to medications your patients are taking?
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The Massachusetts State Senate, by a vote of 27-0, has approved a bill that will ensure access to no-copay birth control once signed by Governor Baker. The bill will cover pills, devices, emergency contraception, and female sterilization procedures without co-pay. The new bill expands upon the current Affordable Care Act by forcing insurance companies to allow women to fill a 12 month supply of birth control once they have completed a 3 month trial period. The bill was created in response to an executive order in October that would allow employers to claim religious or moral objections and deny birth control coverage, and is expected to cost the healthcare system nearly $2-6 million annually. The no-cost birth control measures provided in this bill will not apply to the self-insured market.
For more information please visit the Boston Globe, and Bill H4009.
Do you agree that all forms of FDA approved female birth control should be available cost-free to patients? Do you think that filling a 12-month supply of birth control at one time will be beneficial for patients?
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The FDA issued a public health advisory this week regarding the herbal supplement Kratom, warning of the potential for misuse, addiction, and death when used improperly. Kratom is a plant grown in Southeast Asia that is believed to work by activating the same receptors as opioid pain killers with less respiratory depression. Some use Kratom safely to self-manage pain and depression, while others abuse Kratom recreationally in combination with other drugs for its euphoric effects. The FDA is concerned as there is currently no reliable scientific data for either the risks or benefits, and Kratom related calls to poison control centers increased ten-fold from 2010-2015 with 36 related deaths in 2016. Some drug companies are beginning to research Mitragyna (the plant Kratom powder is derived from) as an opioid replacement in pain management.
For more information please visit The Washington Post and the FDA.
Have you ever discussed Kratom with patients who used the substance? What was their experience? Do you think that large opioid companies may be lobbying the FDA against Kratom?
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The American Heart Association (AHA) and the American College of Cardiology released new guidelines redefining high blood pressure as a reading of 130/80mmHg. The new guidelines eliminated the category pre-hypertension (120-139/80-89mmHg). Now categorizing those patients with either elevated blood pressure (120-129/<80mmHg) or Stage 1 hypertension (130-139/80-89mmHg). The guidelines incorporate data from the SPRINT trial, which demonstrated a 25% lower relative risk of a major cardiovascular event (myocardial infarction, stroke, heart failure, or death attributable to cardiovascular disease), 43% lower risk of death from cardiovascular causes, and 27% lower risk of death from any cause with a lower blood pressure goal of <120/80mmHg. The new blood pressure goal for all adults, including those older than 65, is <130/80mmHg.
For more information visit The American Heart Association
According to the new guidelines do you have high blood pressure? Do you think this new blood pressure goal is too aggressive?
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A recent study published in the Journal of the American Medical Association examined the link between obesity during pregnancy and increased birth weight. Researchers found that at 32 weeks gestation in pregnant women with a pre-pregnancy BMI greater than 30, the fetus on average has greater arm length, leg length, head circumference, and overall body weight than in pregnant women with a pre-pregnancy BMI of 30 or less. Increased complications of obesity during pregnancy include fetal overgrowth, gestational diabetes, hypertension, increased risk of bone fracture during delivery, and increased incidence of C-section birth. The lead author of the study stressed the importance of attaining a healthy weight prior to pregnancy and careful monitoring of all pregnancies in obese women.
For more information please visit National Institutes of Health, and JAMA Pediatrics
How will the results of this research change your counseling practices of expecting mothers? Were you aware that your physical health as a pregnant mother could have such a profound effect on the growth of the fetus? What steps have you taken to improve your health before attempting to have a child?
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Cardiac arrest occurs when the heart’s electrical system malfunctions, causing an abrupt loss of heart function, breathing and consciousness. It may occur without warning and is often fatal if not treated with in minutes. Researchers from Cedars-Sinai Medical Center Heart Institute in Los Angeles looked at data on 4,557 adults who died from sudden cardiac arrest and found only 34 cases linked to sexual activity, which is less than 1%. Survival odds tended to be a little better when sex preceded cardiac arrest, about 20% of people survived in sex related cases vs. only 13% for other cases. Survival often depends on how quickly patients receive CPR, the odds of the patient receiving CPR was a lot higher in the sex related cases. Usually sex-related cases of cardiac arrest occur because the patient had undiagnosed or untreated coronary artery disease.
For more information go to Reuters.com.
Do you know someone who may be at risk of Coronary artery disease? How do you feel about this research findings?
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Researchers at the National Autonomous University of Mexico believe that they have found a connection between late night eating and an increased risk of heart disease and diabetes. Studies performed on rats showed that subjects fed before rest periods had higher levels of fat in the blood than subjects that were fed before activity periods. We have an area of the brain that controls the circadian rhythm, our natural body clock, which times release of hormones. When the part of the brain that controls the circadian rhythm was removed, the rats did not show any difference in blood fat levels whether they were fed before rest or before activity. The key finding, therefore, is that the circadian rhythm influences how the fat is processed in the body and that not only what we eat but when we eat it is important to consider. Increased levels of blood fats are associated with heart disease, diabetes, and weight gain.
For more information please visit ScienceDaily, and Experimental Psychology
Questions: Do you find yourself often eating dinner or snacking right before bed? Do you know why your internal clock is thrown off from what would be considered “normal”?
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Emergency department physicians provide a comparatively small portion of opioid prescriptions dispensed in the US, but this is where most patients receive their first opioid therapy. Many acute pain patients, that are not expected to have recurrent chronic pain wind up continuing opioid therapy longer than expected. A clinical trial of 416 patients with acute extremity pain compared acetaminophen plus an opioid (5mg oxycodone, 5mg hydrocodone or 30mg codeine) versus acetaminophen plus ibuprofen 400mg. The one-time administration of acetaminophen with ibuprofen produced a similar acute pain reduction to an opioid combination when measured 2 hours after administration. The combination of ibuprofen and acetaminophen with different mechanisms of action provides additive analgesic effects while reducing the short-term risk for adverse effects (sedation, constipation, dry mouth). More studies are needed, but this is a step in the right direction toward reducing the number of opioids prescribed.
For more information visit JAMA.
What percent of your patients pick up opioid prescriptions for acute pain daily? How long does it take to become addicted to an opioid? Do you know where to find more information on opioid addiction?
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The World Health Organization just published new guidelines on the use of medically important antibiotics in food-producing animals. These recommendations include overall reduction in use of medically important antibiotics, complete restriction of all medically important antibiotics for growth promotion and undiagnosed infectious disease, and restriction of the use of critically important to human antibiotics in food-producing animals. Overuse of antibiotics in animals over the past few decades has led to increased antibiotic resistance. These new guidelines aim to reduce the risk of increased antibiotic resistance that could lead to untreatable bacterial infections in the future.
For more information, please visit WHO
Questions: Were you aware that many animals we eat have been receiving antibiotics improperly? How often do you pay attention to the packaging at the grocery store and buy antibiotic free meats?