Journal Watch June 2018

 CHRONIC PAIN

Early physical therapy benefits low-back pain patients: Patients with low-back pain are better off seeing a physical therapist first, according to a study of 150,000 insurance claims. Those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit -- but a 19 percent higher probability of hospitalization. Health Services Research

Galcanezumab Beats Placebo for Episodic Migraine: For patients with episodic migraine, galcanezumab is better than placebo for reducing migraine headache days, according to a study published online May 29 in JAMA Neurology.

Do arthritis treatments provide mental health benefits? Drugs used to treat rheumatoid arthritis may impact mental health by improving pain and stiffness and by targeting inflammatory processes common to arthritis and depression; however, a recent review demonstrates that relying on rheumatoid arthritis therapies alone may not meaningfully improve patients' mental health. Arthritis & Rheumatology

COMPLEMENTARY & ALTERNATIVE MEDICINE

Parkinson’s Disease and Complementary Health Approaches: Several complementary health approaches have been studied for Parkinson’s disease, and some have shown a positive benefit for the symptoms associated with the disease. There is some limited evidence that tai chi may improve some symptoms of Parkinson’s, but study results are mixed. Some systematic reviews and meta-analyses have found positive effects of acupuncture in people with Parkinson’s disease, but many of the studies have been of low quality so conclusive evidence is still lacking. No dietary supplements have been shown to be beneficial for symptoms of Parkinson’s disease. The American Academy of Neurology issued a practice parameter in April 2006 on neuroprotective strategies and alternative therapies for Parkinson’s disease and made evidence-based treatment recommendations that address the needs of specialists and caregivers for people with Parkinson’s disease. This issue of the digest provides a summary of evidence for several complementary health approaches that have been studied for Parkinson’s disease, including natural products and mind and body practices. NCCIH Clinical Digest May 2018

Yoga Can Reduce Urinary Incontinence in Older Women: A three-month yoga intervention can reduce urinary incontinence (UI) frequency in ambulatory women aged 50 years or older, according to a study presented at the annual meeting of the American Urological Association, held from May 18 to 23 in San Francisco. 

Mindfulness Program May Help Increase Physical Activity Levels: A meditation and stress reduction program may be as effective as structured exercise programs for increasing physical activity, according to a study published in Medicine & Science in Sports & Exercise. 

Herb List App: The National Center for Complementary and Integrative Health has a herb database app now available for free. It provides research based information about the safety and effectiveness of herbal products.

FDA ACTION

• Approved Palyniq for adults with phenylketonuria (PKU)

• Permitted marketing of Imagen OsteoDetect, a type of computer-aided detection and diagnosis software designed to detect wrist fractures in adult patients.

• Approved Doptelet (avatrombopag) tablets to treat low blood platelet count (thrombocytopenia) in adults with chronic liver disease who are scheduled to undergo a medical or dental procedure.

• Approved first artificial iris

• Approved Tofacitinib for moderate to severely active ulcerative colitis

• Warns Websites Marketing Unapproved Opioids

PREVENTION

Depression speeds up brain aging, find psychologists: Psychologists have found a link between depression and an acceleration of the rate at which the brain ages. Psychological Medicine

Review IDs Exercise 'Dose' That May Improve Cognition in Seniors: For older adults, exercise is associated with improved cognition, with exercising for at least 52 hours over a six month period for about an hour each session associated with improved cognitive skills, according to a review published online May 30 in Neurology: Clinical Practice.

ACS Updates Colorectal Cancer Screening to Start at Age 45: Colorectal cancer (CRC) screening should begin at age 45 for people at average risk, according to updated guidelines from the American Cancer Society published online May 30 in CA: A Cancer Journal for Clinicians. 

Social Isolation Tied to Worse Heart Failure Outcomes: Greater perceived social isolation is associated with an increased risk of death and health care use among patients with heart failure, according to a study published online May 23 in the Journal of the American Heart Association.

Loneliness is bad for the heart: Loneliness is bad for the heart and a strong predictor of premature death, according to a new study. The study found that feeling lonely was a stronger predictor of poor outcomes than living alone, in both men and women. European Society of Cardiology.

Suicide Prevention Should Be a Public Health Priority: Suicide prevention needs to be a public health priority, according to the American Psychological Association (APA). The APA calls for a multifaceted approach that includes increasing access to mental health screenings and ensuring that insurance covers both prevention services and treatment. 

Higher Blood Pressure at Mid-Life Increases Dementia Risk:The risk of dementia is increased in 50-year-olds with blood pressure ≥130 mm Hg, which is below the current threshold for hypertension, according to a study published online June 13 in the European Heart Journal 

Work Stress May Increase Risk of Developing Atrial Fibrillation: Job strain is associated with an increased risk of incident atrial fibrillation, according to a study published online May 30 in the European Journal of Preventive Cardiology. 

Job Strain May Raise Death Risk in Men with Cardiometabolic Disease: Job strain is associated with an increased risk of death among men with cardiometabolic disease, according to research published online June 5 in The Lancet Diabetes & Endocrinology.

Exercise May Lower Mortality in Adult Survivors of Childhood CA:For adult survivors of childhood cancer, vigorous exercise in early adulthood is associated with reduced risk of mortality, according to a study published online June 3 in JAMA Oncology. 

No to ECG Screening to Prevent CVD in Low-Risk Adults:The U.S. Preventive Services Task Force (USPSTF) recommends against screening with resting or exercise electrocardiography (ECG) to prevent cardiovascular disease (CVD) events in low-risk asymptomatic adults. This final recommendation statement has been published in the June 12 issue of the Journal of the American Medical Association. 

Long-Term Type 1 Diabetes Associated With Cognitive Decline:Both patients with type 1 and patients with type 2 diabetes show overall worse cognition than people without diabetes, according to a study published online June 5 in Diabetes Care.

Intellectual Activities in Later Life May Cut Dementia Risk: Active participation in intellectual activities among adults aged 65 years or older is associated with reduced risk of dementia, according to a study published online May 30 in JAMA Psychiatry.

Tonsil, Adenoid Removal Associated With Long-Term Risks of Respiratory, Allergic, Infectious Diseases: Both tonsillectomies and adenoidectomies are associated with higher levels of allergic, respiratory and infectious diseases later in life, according to a study published in JAMA Otolaryngology - Head & Neck Surgery.

Erectile Dysfunction Associated With Increased Risk for Heart Disease: Erectile dysfunction (ED) indicates greater cardiovascular risk, regardless of other risk factors, such as cholesterol, smoking, and hypertension, according to a study published in Circulation.

NUTRITION/SUPPLEMENTS/VITAMINS

Most popular vitamin and mineral supplements provide no health benefit, study finds: The systematic review of existing data and single randomized control trials published in English from January 2012 to October 2017 found that multivitamins, vitamin D, calcium and vitamin C -- the most common supplements -- showed no advantage or added risk in the prevention of cardiovascular disease, heart attack, stroke or premature death. Generally, vitamin and mineral supplements are taken to add to nutrients that are found in food. The study found folic acid alone and B-vitamins with folic acid may reduce cardiovascular disease and stroke. Meanwhile, niacin and antioxidants showed a very small effect that might signify an increased risk of death from any cause. Journal of the American College of Cardiology

Mediterranean Diet May Lessen Adverse Impact of Air Pollution: Adherence to a Mediterranean diet is associated with an attenuation in the effects of air pollution, according to a study presented at the American Thoracic Society's 2018 International Conference, held from May 18 to 23 in San Diego.

Higher Protein Intake Up Heart Failure Risk in Men: Higher dietary protein intake is associated with a trend toward increased heart failure risk among middle-aged men, according to a study published online May 29 in Circulation: Heart Failure.

Non-Nutritive Sweeteners Don't Up Blood Glucose Levels: Consumption of non-nutritive sweeteners (NNSs) does not increase blood glucose levels, according to a review published online May 15 in the European Journal of Clinical Nutrition.

Lentils significantly reduce blood glucose levels: Replacing potatoes or rice with pulses can lower your blood glucose levels by more than 20 per cent, according to a new study. Researchers found that swapping out half of a portion of these starchy side dishes for lentils can significantly improve your body's response to the carbohydrates. Replacing half a serving of rice with lentils caused blood glucose to drop by up to 20 per cent. Replacing potatoes with lentils led to a 35-per-cent drop. The Journal of Nutrition

Pregnant smokers may reduce harm done to baby's lungs by taking vitamin C: Women who are unable to quit smoking during their pregnancy may reduce the harm smoking does to their baby's lungs by taking vitamin C, according to a new randomized, controlled trial. American Thoracic Society 

High Quality Diet May Decrease Mortality in Cancer Survivors: High-quality diets are associated with decreased risks of overall and cancer-specific mortality among cancer survivors, according to a study published online June 5 in JNCI Cancer Spectrum.

 TREATMENT

Certolizumab Looks Promising for Moderate-to-Severe Psoriasis: Twice-weekly certolizumab biologic appears to be both safe and effective for the treatment of moderate-to-severe chronic plaque psoriasis, according to a study published online April 13 in the Journal of the American Academy of Dermatology.

CPAP Use May Improve Sexual QOL in Those With Sleep Apnea: Successful continuous positive airway pressure (CPAP) use for obstructive sleep apnea may be associated with improved sexual quality of life (QOL), according to a study published online May 24 in JAMA Otolaryngology-Head & Neck Surgery.

Antidepressant Prescribing Linked to Lasting Weight Gain: Antidepressant prescribing is associated with long-term increased risk of weight gain, according to a study published online May 23 in The BMJ.

New treatment for severe asthma: Two new studies of patients with difficult-to-control asthma show that the eczema drug dupilumab alleviates asthma symptoms and improves patients' ability to breathe better than standard therapies. Dupilumab, an injectable anti-inflammatory drug, was approved in 2017 by the Food and Drug Administration as a treatment for eczema, a chronic skin disease. NEJM

Nilvadipine Lowers BP, Without Increasing Risk of Orthostatic Hypotension in Patients With Alzheimer’s Disease: Nilvadipine lowers blood pressure (BP) without increasing the risk of orthostatic hypotension in patients with mild to moderate Alzheimer’s disease, according to a study presented here at 28th Scientific Meeting of the European Society of Hypertension (ESH).

 OTHER

To Lower Your Medicare Drug Costs, Ask Your Pharmacist for the Cash Price: A simple question at the pharmacy could unlock savings for millions of Medicare beneficiaries. Under a little-known Medicare rule, they can pay a lower cash price for prescriptions instead of using their insurance and doling out the amount the policy requires. But only if they ask. That's because pharmacists say their contracts with drug plans often contain "gag orders" forbidding them from volunteering this information. Researchers analyzing 9.5 million Part D prescription claims reported in a research letter to JAMA in March that a patient's copayment was higher than the cash price for nearly one in four drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent. VPR

One-third of US adults may unknowingly use medications that can cause depression: A new study suggests that more than one-third of U.S. adults may be using prescription medications that have the potential to cause depression or increase the risk of suicide. JAMA 

Federal Government Must Tackle Rising Insulin Prices: U.S. officials need to take action to control spiking insulin prices, the American Medical Association (AMA) says. The Federal Trade Commission and the Justice Department should monitor insulin pricing and market competition and take any necessary enforcement measures, AMA members agreed at the group's annual meeting. The nation's largest physicians group said the rising cost of insulin is causing big financial problems for patients, Medicare and Medicaid. 

Online Consumer Ratings of Physicians Tend to be Skewed: Online physician reviews tend to be skewed positively, according to a study published in the May issue of the Journal of Medical Internet Research.