Saturday, May 19, 2018

Journal Watch May 2018


To Treat Pain, You Need to Treat the Patient: People in chronic pain are some of the most difficult patients to treat. They have complex circumstances that medicine can't always remedy. Pain can be amplified, by depression and anxiety, genetics and quality of life. Genetics can also play a role in how people experience pain. Clinicians and researchers at UW Medicine's Center for Pain Relief found that an in-depth questionnaire can help immensely. Their work to create a pain assessment adaptable to any primary care clinic was recently published in the Journal of General Internal Medicine.

New approach for treating neuropathic pain: Neuropathic pain is the chronic, pathological pain that continues even when the cause of pain is removed. Causes include damage to nerve cells and medicines used to treat cancer. Scientists have discovered a novel therapeutic that appears to interrupt the signaling cascades in the body required for multiple forms of neuropathic pain.  Pain

MIV-711 Reduces Bone, Cartilage Disease Progression in Patients With Knee Osteoarthritis: MIV-711 significantly reduces bone and cartilage disease progression in patients with knee osteoarthritis, according to a study presented here on April 27 at the 2018 Osteoarthritis Research Society International (OARSI) World Congress. However, the primary endpoint for knee pain was not reached, most likely due to the short duration of the study.

Love hurts: Spats with spouse may worsen chronic pain, other symptoms: For patients with chronic conditions like arthritis or diabetes, arguments with a spouse may have physical repercussions, according to researchers. They found that in two groups of older individuals -- one group with arthritis and one with diabetes -- the patients who felt more tension with their spouse also reported worse symptoms on those days. Annals of Behavioral Medicine 

Fremanezumab Linked to Fewer Monthly Migraine Days: For episodic migraine patients, reduction in number of migraine days with monthly dosing, single dose. JAMA

Psychological Therapies May Help Older Adults With Chronic Pain: For older adults with chronic pain, psychological interventions have small benefits, including reducing pain and catastrophizing beliefs, according to a review published online May 7 in JAMA Internal Medicine.

Adding Chiropractic to Usual Care Beneficial for Low Back Pain: For active-duty military personnel, the addition of chiropractic care to usual medical care is associated with improvements in low back pain intensity and disability, according to a study published online May 18 in JAMA Network Open.


COMPLEMENTARY & ALTERNATIVE MEDICINE
Substance in Chinese medicine can cause cardiac arrhythmia: A medicinal plant frequently used in Traditional Chinese Medicine (TCM) -- Evodia rutaecarpa -- contains substances that can cause cardiac arrhythmia. Pharmacological Research

Acupuncture possible treatment for dental anxiety: Researchers have found evidence that acupuncture could help people who experience dental anxiety. European Journal of Integrative Medicine

Cannabidiol significantly reduces seizures inpatients with severe form of epilepsy: Cannabidiol (CBD), a compound derived from the cannabis plant that does not produce a 'high,' was shown in a new large-scale, randomized, controlled trial to significantly reduce the number of dangerous seizures in patients with a severe form of epilepsy called Lennox-Gastaut syndrome. This study also is the first to offer information on cannabidiol dosing for patients with treatment-resistant epilepsy. NEJM 

Many Oncologists Discuss, Recommend Medical Marijuana:Many oncologists recommend medical marijuana (MM) clinically despite not feeling sufficiently knowledgeable about its utility, according to a study published online May 10 in the Journal of Clinical Oncology.

Marijuana Use Not Linked to Risk of Arrhythmias After Acute MI: For patients with acute myocardial infarction (AMI), marijuana use is not associated with increased risk of ventricular tachycardia/ventricular fibrillation (VT/VF) or cardiac arrest, according to a study presented at the annual meeting of the Heart Rhythm Society.


FDA ACTION
Launched legal action to stop two stem cell clinics from providing unapproved treatments that have caused serious, long-term harm to some patients.
• Approved non opioid treatment, Lucemyra, for opioid withdrawl
• Approves novel preventive treatment for migraines, Aimovig, one a month injections
• Approves the first epoetin alfa bioseimilar, Retacrit, for the treatment of anemia
Permitted marketing of Hemospray, a new device used to help control certain types of bleeding in the gastrointestinal (GI) tract.
• Approved Tafinlar (dabrafenib) and Mekinist (trametinib), administered together, for the treatment of anaplastic thyroid cancer (ATC) that cannot be removed by surgery or has spread to other parts of the body

PREVENTION
Vigorous exercise reduces tiredness in testicular cancer survivors:High-intensity interval training reduces tiredness and improves self-esteem for testicular cancer survivors, according to a study published in the British Journal of Cancer 

Youth tackle football participation linked to earlier onset of cognitive and emotional symptoms: Starting to play tackle football before age 12 could lead to earlier onset of cognitive and emotional symptoms among athletes who were diagnosed with CTE and other brain diseases postmortem, according to a new study. Annals of Neurology h

Exercise beats genetics in determining amount of body fat: With obesity now a global epidemic, there is increased focus on risk factors that contribute to weight gain, especially in postmenopausal women. Although many women may blame genetics for their expanding waistlines, a new study shows that as women age they are more likely to overcome genetic predisposition to obesity through exercise. Menopause

Aerobic+ Strength Exercise Doesn't Slow Cognitive Decline: An aerobic and strength exercise program does not slow cognitive impairment among people with mild-to-moderate dementia, according to a study published online May 16 in The BMJ.

High Occupational Exercise Level Tied to Early Mortality in Men: High-level occupational physical activity linked to 18 percent increased risk of early death in men only. Among women, there was a trend toward an inverse association between occupational physical activity and early mortality. British Journal of Sports Medicine

Shower Cream, Body Lotion Combo Improves Atopic Dry Skin: A shower cream and a body lotion with physiological lipids are effective in improving skin hydration in patients with dry skin, according to a study published online May 10 in the Journal of Cosmetic Dermatology.

Resistance Exercise May Reduce Depressive Symptoms in Adults: Resistance exercise training (RET) is associated with reduced depressive symptoms among adults, according to a meta-analysis published online May 9 in JAMA Psychiatry.

USPSTF: Decision to Undergo PSA Screening Should Be Individual: The U.S. Preventive Services Task Force (USPSTF) concludes that the decision to undergo periodic prostate-specific antigen (PSA) screening for prostate cancer should be an individual one for men aged 55 to 69 years. These findings form the basis of a final recommendation statement, published in the May 8 issue of the Journal of the American Medical Association

Good Evidence That HPV Vaccines Protect Against Cervical Pre cancer: Human papillomavirus (HPV) vaccines protect against cervical precancer in adolescent girls and young women, according to a review published online May 9 in the Cochrane Library

Some water-filter pitchers much better attoxin removal: Scientists  compared three popular pitcher brands' ability to clear dangerous microcystins from tap water. They found that while one did an excellent job, other pitchers allowed the toxins -- which appear during harmful algal blooms (HABs) -- to escape the filter and drop into the drinking water. The purifier that filtered water fastest, and which was made entirely of coconut-based activated carbon, removed 50 percent or less of the microcystins from the water. But the purifier that filtered water slowest -- and which was made from a blend of active carbon -- rendered the microcystins undetectable in drinking water. The study appears in the journal Water Science Technology: Water Supply. "In general, the cheaper the pitcher, the worse job it did filtering out the toxins.”


 NUTRITION/SUPPLEMENTS/VITAMINS
Eggs not linked to cardiovascular risk, despite conflicting advice: Eating up to 12 eggs a week does not increase cardiovascular risk factors in people with pre-diabetes or type 2 diabetes, new research finds -- despite conflicting dietary advice continuing around the world. The American Journal of Clinical Nutrition

Symptoms of Osteoarthritis Lessened With Simple Changes to the Diet:One gram of fish oil a day could help reduce the pain of patients with osteoarthritis (OA), according to a study published in Rheumatology. In analysing 68 previous studies in the field, researchers found that a low-dose supplement of fish oil could result in pain reduction for patients with OA and help improve their cardiovascular health. Essential fatty acids in fish oil reduce inflammation in joints, helping to alleviate pain. The researchers also found that a reduction of weight for overweight and obese patients and the introduction of exercise tailored to mobility could also help ease the symptoms of OA.

Expert consensus finds that higher protein intake benefits adult bone health: In seniors with osteoporosis, dietary protein intake above currently recommended levels may help to reduce bone loss and fracture risk, especially at the hip, provided calcium intakes are adequate. Osteoporosis International

Healthy diet may lower risk of hearing loss in women: Patterns of healthy eating may lower risk of hearing loss by 30 percent. The Journal of Nutrition

Better Diet Quality Associated With Larger Brain Volume: Better diet quality, including high intake of vegetables, fruit, whole grains, dairy, nuts, and fish, and low intake of sugar containing beverages is associated with larger brain volume, gray matter volume, white matter and hippocampal volume according to a study published online May 16 in Neurology.

Exceptional Glycemic Control With Very Low-Carbohydrate Diet: For children and adults with type 1 diabetes mellitus (T1DM), consuming a very low-carbohydrate diet (VLCD) is associated with exceptional glycemic control, according to a study published online May 7 in Pediatrics.

Folic Acid May Cut Stroke Risk in High-Risk Hypertensive Patients: Hypertensive patients may lower their stroke risk with folic acid supplements, according to a study published in the May 15 issue of the Journal of the American College of Cardiology. 

Seafood Recommended 1 to 2 Times/Week for Cardiac Benefit: Benefits of seafood consumption include reduced risk of cardiac death, coronary heart disease, stroke. Circulation

TREATMENT
“Drug Holidays” May Lead to Bone Fractures for Patients With Osteoporosis: Patients with osteoporosis who take bisphosphonates for long periods typically are advised to temporarily discontinue the drugs to prevent rare but serious side effects. However, a recent study has found that 15.4% of patients who take “drug holidays” experience fractures. During a 6-year follow-up period, the yearly incidence of fractures ranged from 3.7% to 9.9%, with the most fractures occurring during the fourth and fifth years. Endocrine Practice 

Use of Pimavanserin in Combination With SSRIs Is Safe for Patients With Parkinson’s Disease: Treatment of Parkinson’s disease-related psychosis with pimavanserin (Nuplazid) is safe when used in combination with selective serotonin reuptake inhibitors (SSRIs), according to a study presented here at the 2018 Annual Meeting of the American Geriatrics Society (AGS).

Alternative treatment for mild asthma: People with mild asthma are often prescribed a daily treatment regimen, but up to 80 per cent do not follow the routine, using inhalers only when they have an asthma attack. Now the researchers have found an as-needed combined-drug inhaler is a viable treatment option- an inhaler with a combination of budesonide, a steroid that controls inflammation, and formoterol, a beta2-agonist. NEJM

Stroke prevention drug combo shows promise: If you've had a minor stroke or a transient ischemic stroke (TIA), taking the clot-preventing drug clopidogrel along with aspirin may lower your risk of having a major stroke within the next 90 days, according to new research. NEJM

Randomized trial finds ibuprofen not a safe alternative to antibiotics for UTIs: Ibuprofen, given instead of antibiotics to women with uncomplicated urinary tract infection (cystitis), leads to longer duration of symptoms and more serious adverse events related to the spread of the primary infection, according to a new study. PLOS

Commonly prescribed heartburn drug linked to pneumonia in older adults:Researchers have found a statistical link between pneumonia in older people and a group of medicines commonly used to neutralize stomach acid in people with heartburn or stomach ulcers. Although Proton-pump inhibitors (PPIs) are still a valuable group of medicines, research is indicating that PPIs are not as completely safe for older people as previously thought. Journal of the American Geriatrics Society

Low Dose Vaginal Estradiol Improves Menopause Linked quality of life: For menopausal women with moderate-severe vulvovaginal symptoms, treatment with low-dose vaginal estradiol is associated with improved menopause-related quality of life, according to a study published online May 7 in Menopause.

Chronic Aspirin Exposure Linked to Melanoma Risk in Males:Chronic acetylsalicylic acid (ASA; aspirin) exposure is associated with increased risk of malignant melanoma (MM) in men, but not women, according to a letter to the editor published online March 27 in the Journal of the American Academy of Dermatology

Clopidogrel+ Aspirin Cuts Ischemic Events in Stroke, TIA: However, combination is associated with increased risk of major hemorrhage within 90 days. NEJM 

Sustained Use of Oxymetazoline Cream Efficacious for Rosacea:Oxymetazoline is safe and effective for the treatment of moderate-to-severe persistent erythema of rosacea, according to a study published in the June issue of the Journal of the American Academy of Dermatology

OTHER
Asthma and hay fever linked to increased risk of psychiatric disorders: A new study is the first to find a significant link between asthma, hay fever and a broad spectrum of psychiatric disorders. Over 15 years, 10.8 percent of patients with allergic diseases developed a psychiatric disorder, compared to only 6.7 percent of those without allergies. Monitoring the mental health of patients with allergies could help doctors care for their patients more effectively. Frontiers in Psychiatry

Intimacy in later life does not slow memory loss: Research shows that sexual activity and emotional closeness are unrelated to the rate of cognitive decline Older people who enjoy a sexually active and emotionally close relationship with their partner tend to perform better at memory tests than sexually inactive older adults on a short-term basis, but this is not the case over a longer period of time. This is according to a study using data from more than 6000 adults aged 50 and over. Archives of Sexual Behavior








Wednesday, May 16, 2018

Take a Break: Be an armchair archeologist




GlobalXplorer° is an online platform that uses the power of the crowd to analyze the incredible wealth of satellite images currently available to archaeologists. Launched by 2016 TED Prize winner and National Geographic Fellow, Dr. Sarah Parcak, as her “wish for the world,” GlobalXplorer° aims to bring the wonder of archaeological discovery to all, and to help us better understand our connection to the past. 

So far, Dr. Parcak’s techniques have helped locate 17 potential pyramids, in addition to 3,100 potential forgotten settlements and 1,000 potential lost tombs in Egypt — and she's also made significant discoveries in the Viking world and Roman Empire. With the help of citizen scientists across the globe, she hopes to uncover much, much more.

Whether you take five minutes, 15 or a couple of hours, all you need is a computer, tablet, lap top or phone to check images for specific features to help in determining whether an area has potential archeological significance.

Not interested in today’s activities, try the Take a Break Pinterest Board.



Wednesday, May 9, 2018

Take a Break: Fill in the Blanks-Write Something


Pick a “fill-in-the-blank” inspiration  from Alex Franzen and write about it for at least 5 minutes. There are 88 fill in the blanks to jolt your brain in new and creative ways. Have fun!


Not interested in today’s activities, try the Take a Break Pinterest Board.

Saturday, May 5, 2018

Life With Chronic Conditions: Health Insurance When You Travel


With summer vacations rapidly approaching, many people are planning trips.  If you are traveling overseas or to other parts of the country, which your health insurance may not cover, it’s important to look into obtaining travelers insurance for:

• Trip Cancellation: If you have to cancel your trip at the last minute, this will cover the cost of the trip.

• Travel health: Your current health plan may not cover medical care in other parts of the country or the world.

• Medical evacuation: Covers the cost of transportation to high-quality health care facilities, in the event of an emergency. This type of insurance is important if you will be traveling in rural or remote areas.

Keep in mind that travel insurance plans have an automatic exclusion for pre existing conditions. However, some travel insurance companies offer an exclusion waiver. Check out Travel Insurance Review’s Pre-Existing Condition Coverage.  This article also provides a comparison of how much coverage various companies provide.

Note that you must be medically stable when you purchase your travel plan. With an existing medical condition, the safest course of action is to get your physician's certification that you're fine to travel before you book your trip. Allianz Global Assistance’s travel insurance requires you to be medically able to travel on the day you buy your policy. It doesn't matter if you expect to be able to travel in the future, or if your doctor says you should be able to travel by the time you're scheduled to leave. Allianz Travel Insurance

Nearly all plans require you to purchase your travel insurance soon after making the first trip payment and you must cover the full length of your trip not just a portion of it.

If you do need to receive medical attention, the travel insurance company will “look back” at your medical records. While this will vary by insurance carrier, the “look back” period is typically within 60-180 days prior to purchasing a comprehensive plan or within 90 days - 3 years prior to the departure date listed on a medical plan. In order to have an approved claim, the condition must have been stable within the look back period. "Stable" means that the condition has not changed or worsened in any way – no new diagnoses or treatments, no new medications, no treatments of any kind, and no pending or initiated treatments, scans, or test results. Insure My Trip 


Learn More


Wednesday, May 2, 2018

Take a Break: Try a Short Tai Chi Routine


Tai chi is an ancient Chinese tradition that, today, is practiced as a graceful form of exercise. It involves a series of movements performed in a slow, focused manner and accompanied by deep breathing. It’s a great way to reduce stress.

Tai chi is low impact and puts minimal stress on muscles and joints, making it generally safe for all ages and fitness levels.

If you’ve never tried Tai Chi, check out the videos below:



                                     Top Ten Tai Chi Moves for Beginners




                                                14 Minute Daily Taiji


Not interested in today’s activities, try the Take a Break Pinterest Board.

Saturday, April 28, 2018

Life With Chronic Conditions: Life Style Medicine Works


If you are tired of the “pill for every ill,” you may want to consider the growing movement of Lifestyle medicine.

Lifestyle Medicine is a scientific approach to decreasing disease risk and illness burden by utilizing lifestyle interventions such as nutrition, physical activity, stress reduction, rest, smoking cessation, and avoidance of alcohol abuse. Lifestyle medicine is the recommended foundational approach to preventing and treating many chronic diseases. American College of Preventive Medicine 

Data indicates that 80% of chronic diseases are a result of lifestyle with the big factors being:
• Lack of exercise (people are sitting an average of 9 hours a day)
• Poor nutrition (processed food is high in fact, sugar and salt)
• Lack of rest and restoration-sleep


Research is showing that there are more effective strategies than a pill
For Chronic Pain, A change in Habits can beat Opioids for Relief.  discusses how a low tech approach focused on lifestyle change can be more effective than opioids when treating chronic pain. In fact the gold standard of treatment is a combination of exercise, rehabilitation therapies, yoga, and cognitive behavioral therapies.

• Harvard Health recently updated their article Nutritional Psychiatry: Your Brain on Food which provides a variety of evidence that eating a diet of highly processed foods and meats significantly increases risk of depression. Many practitioners are embracing that the future of mental health treatment lies in nutrition as well as other lifestyle changes.

• The one study  that has shown a reversal in Alzheimer’s Disease, follows a 36 point program, where many of the steps include lifestyle changes-diet, exercise, sleep etc.

The Blue Zones Project has been championing lifestyle as a means to improve quality as well as length of life for years . Leveraging secrets discovered in Blue Zones around the world—rare longevity hotspots—Blue Zones Project® is helping transform communities across the U.S. into areas where the healthy choice is easy and people live longer with a higher quality of life.  The Blue Zones research found nine characteristics of communities where people lived to advanced old age- Move naturally (no gym required): a sense of purpose; a plant slant diet; ate until they felt 80% full; drink wine @ fine; Down shift; Family first; Right Tribe; Belong. Interestingly, access to health care wasn’t noted as a characteristic.

In order to make this meaningful for American companies and communities, where Blue Zones Project are offered, the Power Nine have been distilled down to making the healthy choice the easy choice. These including configuring environments so that people move naturally and exercise is built into their day; eating wisely;  connecting with others, “belong to live long;” and having the right outlook using tools such as mindfulness and purpose workshops.

                                              How to Live to be 100+ 

Learn more about Lifestyle Medicine


Saturday, April 21, 2018

Journal Watch April 2018



 CHRONIC PAIN
Noninvasive Brain Stimulation May Help Prevent Migraines: Single-pulse transcranial magnetic stimulation device is safe and easy to use. The efficacy and tolerability of single pulse transcranial magnetic stimulation (sTMS) for the preventive treatment of migraine among 263 individuals with migraine (December 2014 to March 2016) was studied. Participants completed a one-month baseline headache diary followed by three months of treatment, including preventive (four pulses twice daily) and acute (three pulses repeated up to three times for each attack) treatment. The researchers observed a mean reduction of 2.75 headache days from baseline versus the performance goal (0.63 fewer headache days; P < 0.0001). Similarly, the 50 percent responder rate of 46 percent also significantly exceeded (P < 0.0001) the performance goal (20 percent). Compared to the performance goal, there were also significant reductions in acute medication use (P < 0.0001) and total headache days of any intensity (P < 0.0001). There were no serious adverse events reported, but there were reports of lightheartedness (3.7 percent), tingling (3.2 percent), and tinnitus (3.2 percent). Cephalalgia. 

Erenumbab Shows Promise for Hard to Treat Migraine: For patients with episodic migraine who have failed prior preventive migraine treatments (PMTs), erenumab is associated with an increase in the proportion of patients achieving a ≥50 percent reduction in mean monthly migraine days (MMDs), according to a study presented at the annual meeting of the American Academy of Neurology

Study finds 31% Don’t use Opioids After Surgery: Almost 63 percent of patients did not use opioids after having an elective procedure, according to a study presented at the annual meeting of the American Surgical Association 

Opiate Use Linked to Early Mortality in IBD Patients: Heavy use in Crohn's, heavy or moderate use in ulcerative colitis tied to increased risk of death. Clinical Gastroenterology and Hepatology 

Ibuprofen, acetaminophen more effective thanopioids in treating dental pain: Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen are better at easing dental pain than opioids, according to new research that included 460 published studies. JOADA

 COMPLEMENTARY & ALTERNATIVE MEDICINE
Medical marijuana gets wary welcome from older adults, poll shows: Few older adults use medical marijuana, a new national poll finds, but the majority support its use if a doctor recommends it, and might talk to their own doctor about it if they developed a serious health condition. And two-thirds say the government should do more to study the drug's health effects. Science Daily 

Position statement: Avoid using medical marijuana to treat sleep apnea: Medical cannabis and synthetic marijuana extracts should not be used for the treatment of obstructive sleep apnea, according to a position statement from the American Academy of Sleep Medicine.

 School-based yoga can help children better manage stress and anxiety: Participating in yoga and mindfulness activities at school helps third-graders exhibiting anxiety improve their well-being and emotional health, according to a new study. Psychology Research and Behavior Management 

Practicing Tai Chi helps improve respiratory function in patients with COPD: Currently, pulmonary rehabilitation (PR) is used where available to improve exercise capacity and quality of life, but the treatment requires access to trained staff and specialized facilities. A new study looked at Tai Chi as a lower cost, more easily accessed treatment option. Investigators found that this slow, methodical form of exercise is equivalent to PR for improving respiratory function in patients with COPD. Chest  

Mind and Body Approaches for Substance Use Disorders from the National Center for Complementary and Integrative Health: Mindfulness-based approaches have shown some success when applied to the treatment of substance abuse and addiction. To date, there is not enough consistent data to support the use of acupuncture for substance use outcomes; however, there are some findings that suggest acupuncture may have positive effects as an adjunctive therapy for withdrawal/craving and anxiety symptoms. Only a few high-quality studies on acupuncture for smoking cessation have been conducted, so firm conclusions about its effectiveness cannot be drawn.

Small link for cannabis use, reduced cognitive functioning: For adolescents and young adults, frequent or heavy cannabis use has a small association with reduced cognitive functioning, according to research published online April 18 in JAMA Psychiatry.

FDA ACTION
• Approves the first medical device to use artificial intelligence to detect greater than a mild level of diabetic retinopathy in adults who have diabetes.
• Authorizes new use of test, first to identify the emerging pathogen Candida auris
• Approves first therapy for rare inherited form of rickets, x-linked hypophosphatemia
• Takes steps to protect consumers against dietary supplements containing dangerously high levels of extremely concentrated or pure caffeine
• Clears first contact lens with light adaptive technology
• Restricts sale and distribution of Essure
• Expands approval of Bilincyto for treatment of a type of leukemia in patients who have a certain risk factor for relapse
• Authorizes first fully interoperable continuous glucose monitoring system
• Expands approval of Adcetris for first line treatment of Stage III or IV classical Hodgkin lymphoma in combination with chemotherapy

PREVENTION
Music intensifies effects of anti-hypertensive medication: Research shows anti-hypertensive drugs improve heart rate more in patients who listen to music after taking medication. Among musical genres, classical music is the one with greatest efficiency at reducing arterial pressure; authors of the study speculate whether music acts on the patients' parasympathetic system, increasing their capability of absorbing medication. Scientific Reports 

Lingering negative responses to stress linked with health a decade later: People whose negative emotional responses to stress carry over to the following day are more likely to report health problems and physical limitations later in life compared with peers who are able to 'let it go.'  Psychological Science

Number of Cigarettes Smoked Daily Tied to Stroke Risk: Among men younger than 50, more cigarettes smoked linked to increased risk of ischemic stroke. Stroke 

Exercise Prevents Falls in Elderly: The U.S. Preventive Services Task Force (USPSTF) concludes that exercise interventions may be beneficial for preventing falls in older adults; however, the evidence is insufficient to weigh the benefits and harms of vitamin D, calcium, and combined supplementation. These findings form the basis of two recommendation statements published April 17 in the Journal of the American Medical Association.

Exercise Best Defense for those at Genetic Risk for CVD: Fitness and physical activity are tied to lower risk of incident cardiovascular disease in the general population and among individuals with elevated genetic risk for cardiovascular diseases, according to a study published online April 9 in Circulation.

TBI Associated with Increased Risk of Subsequent Dementia: Traumatic brain injury (TBI) is associated with increased risk of dementia, according to a study published online April 10 in The Lancet Psychiatry.

NUTRITION/SUPPLEMENTS/VITAMINS
Dietary supplement shows promise for reversing cardiovascular aging:A novel nutraceutical called nicotinomide riboside (NR_ has been found to kick-start the same biological pathways as calorie restriction does, and boost arterial health in people with mild hypertension. Supplementation also tends to improve blood pressure and arterial health, particularly in those with mild hypertension, the study found. The researchers found that 1,000 mg daily of NR boosted levels of another compound called nicotinamide adenine dinucleotide (NAD+) by 60 percent. NAD+ is required for activation of enzymes called sirtuins, which are largely credited with the beneficial effects of calorie restriction. It's involved in a host of metabolic actions throughout the body, but it tends to decline with age.Nature Communications

n-3 Fatty Acids Don't Seem to Be of Any Benefit in Dry Eye Disease: Supplementation with n-3 fatty acids is not associated with significant benefit in dry eye disease, according to a study published online April 13 in the New England Journal of Medicine

Consuming more than five drinks a week could shorten your life: Even moderate alcohol drinking linked to heart and circulatory diseases, study finds. drinking more alcohol is associated with a higher risk of stroke, fatal aneurysm, heart failure and death. The study compared the health and drinking habits of over 600,000 people in 19 countries worldwide and controlled for age, smoking, history of diabetes, level of education and occupation. Findings challenge the widely held belief that moderate drinking is beneficial to cardiovascular health, and support the UK's recently lowered guidelines. The Lancet

Links between eating red meat and distal colon cancer in women: A new study suggests that a diet free from red meat significantly reduces the risk of a type of colon cancer in women living in the United Kingdom. When comparing the effects of certain diets to cancer development in specific subsites of the colon, scientists found that those regularly eating red meat compared to a red meat-free diet had higher rates of distal colon cancer -- cancer found on the descending section of the colon, where feces is stored.  International Journal of Cancer 

People with Type 2 diabetes who eat breakfast later, more likely to have a higher BMI: Being an "evening person" is linked to higher body mass indices among people with Type 2 diabetes, and having breakfast later in the day seems to be what drives this association, according to a new article. Science Daily

High omega-6 levels can protect against premature death: Could omega-6 fatty acids protect you against premature death? The answer is yes, according to a new study. While protecting against death, omega-6 fatty acids also keep cardiovascular diseases at bay. “Linoleic acid is the most common polyunsaturated omega-6 fatty acid. We discovered that the higher the blood linoleic acid level, the smaller the risk of premature death,” says one of the researchers. The American Journal of Clinical Nutrition

Raw fruit and vegetables provide better mental health outcomes: Researchers have discovered raw fruit and vegetables may be better for your mental health than cooked, canned and processed fruit and vegetables. Frontiers in Psychology

Nut Consumption Associated with Reduced Risk of A-Fib: Nut consumption is associated with reduced risk of atrial fibrillation, according to a study published online April 16 in Heart.

Eating Pecans May Cut Risk of Cardiovascular Disease, Diabetes: Benefits seen in markers of cardiometabolic disease, including insulin sensitivity Nutrients 

Coffee Consumption Cuts Coronary Artery Calcification: Odds of coronary calcification significantly lower for never smokers drinking more than 3 cups/day. Journal of the American Heart Association


TREATMENT
Antiepileptic Drugs Increase Risk ofAlzheimer’s Disease, Dementia: The use of antiepileptic drugs is associated with an increased risk of Alzheimer’s disease and dementia, according to a study published in the Journal of the American Geriatrics Society. Continuous use of antiepileptic drugs for a period exceeding 1 year was associated with a 15% increased risk of Alzheimer’s disease and with a 30% increased risk of dementia.

Blue-Light Therapy May Reduce Anxiety, Sleep Difficulties After Mild Traumatic Brain Injury: Morning use of blue-light therapy may increase cortical volume and help reduce trait anxiety and sleep difficulties in people with mild traumatic brain injury, according to preliminary findings of a prospective study presented at the 38th Annual Meeting of the Anxiety and Depression Association of America (ADAA).

Pembrolizumab is associated with significantly longer recurrence-free survival than placebo as adjuvant therapy for high-risk stage III melanoma, according to a study published online April 15 in the New England Journal of Medicine.

Fecal microbiota transplantation produces sustained improvements in cognitive and clinical outcomes: A single treatment using an optimized, targeted form of fecal microbiota transplantation (FMT) produces sustained clinical and cognitive improvements, according to the results of a long-term follow-up of patients with liver cirrhosis and hepatic encephalopathy (HE) who had participated in a short-term study. The original, randomized, open label study, which enrolled 20 outpatient men with cirrhosis and recurrent HE receiving standard-of-care (SOC) treatment, had previously reported that a single FMT enema after antibiotic pretreatment improved cognitive function at Day 20 and reduced HE episodes and hospitalizations over the following 5 months compared with SOC.1 The long-term outcomes of this study, which were presented today at The International Liver Congress™ 2018 in Paris, France, demonstrated sustained and statistically significant reductions in the number of HE episodes and hospitalizations as well as improvements in cognitive function over 1 year in the men who received FMT compared with the control group.

Neuromodulation Therapy Gives Relief FromHand Tremor: Non-invasive neuromodulation therapy using a custom stimulation pattern provides symptomatic relief from hand tremor in essential tremor, according to a study presented at the annual meeting of the American Academy of Neurology

Triple Therapy Tied to Reduced Rate of COPD Exacerbations: Benefits seen for triple therapy with fluticasone furoate, umeclidinium, and vilanterol. NEJM 

Calcium Channel Blockers May up Cancer Risk in Women: Use of short-acting calcium channel blockers (CCBs) is associated with increased risk of pancreatic cancer in postmenopausal women, according to a study presented at the annual meeting of the American Association for Cancer Research.

OTHER
Physicians devise emergency and trauma care referral map for US: In response to repeated calls for an integrated emergency care system in the US, physicians rose to the challenge and divided the nation into hundreds of referral regions that describe how patients access advanced care, in a way that respects geopolitical borders. Annals of Emergency Medicine 

Three-Quarters of COPD Cases Are Linked to Childhood Risk Factors That Are Exacerbated in Adulthood: Three-quarters of chronic obstructive pulmonary disease (COPD) cases have their origins in poor lung function pathways beginning in childhood. These pathways are associated with exposures in childhood, and amplified by factors in adulthood, according to a study published in The Lancet Respiratory Medicine. While smoking remains the biggest risk factor for COPD, the study demonstrates that childhood illnesses (such as asthma, bronchitis, pneumonia, allergic rhinitis, eczema) and exposures to parental smoking are also linked to the disease. A second study in the journal also suggests that there could be a window of opportunity during childhood to reduce the risk of poor lung function in later life. Both studies identified pathways of how lung function changes over life, which are associated with different risk factors and disease risk in later life. The authors said that these insights are important for lung disease prediction, prevention, and treatment. 

Most Doctors' Offices Don't Offer Flexibility for Uninsured:Most uninsured patients can make primary care appointment but only if can pay full cash amount. Health Affairs 

Age affects how we predict and respond to stress at home: A recent study finds that older adults are better than younger adults at anticipating stressful events at home -- but older adults are not as good at using those predictions to reduce the adverse impacts of the stress. The Journals of Gerontology