Journal Watch February 2019

CHRONIC PAIN

Positive self belief key to recovery from shoulder pain: Positive self belief is the key to recovery from pain, say Uresearchers. The research team studied over 1,000 people undergoing physiotherapy for shoulder pain. They found that people are more likely to recover if they have the confidence to carry on doing most things, despite their pain. Those who expected physiotherapy would help them were likely to recover more than those who expected minimal or no benefit. British Journal of Sports Medicine,

Higher Optimism Tied to Lower Odds of Pain After Deployment: For U.S. soldiers, higher levels of optimism are associated with lower odds of reporting new pain after deployment, according to a study published online Feb. 8 in JAMA Network Open.

Certain Opioids Less Effective With SSRI Antidepressants: Certain opioids are less effective for postoperative pain in patients taking selective serotonin reuptake inhibitor (SSRI) antidepressants, according to a study published online Feb. 6 in PLOS ONE.

Discord Found in Clinician-, Criteria-Based Fibromyalgia Diagnosis: There is disagreement between clinical diagnosis and criteria-based diagnosis of fibromyalgia, according to a study published online Feb. 6 in Arthritis Care & Research. Physicians fail to ID half of criteria-positive patients, incorrectly ID 11 percent of criteria-negative patients. "It is likely that misdiagnosis is a public health problem and one that can lead to over diagnosis and over treatment, as well as to inappropriate treatment of individuals not recognized to have fibromyalgia symptoms.” 

Compounded Topical Pain Creams No Better Than Placebo: Compounded topical pain creams are no better than placebo creams for neuropathic pain, nociceptive pain, or mixed pain, according to a study published online Feb. 5 in the Annals of Internal Medicine.

Evidence Lacking for Benefit of Surgery for Vertebral Fractures: Surgical procedures do not appear to provide significant benefit for patients with vertebral fractures (VF), according to a second American Society for Bone and Mineral Research Task Force report published in the January issue of the Journal of Bone and Mineral Research.

COMPLEMENTARY & ALTERNATIVE MEDICINE

Evidence of Therapeutic Efficacy Substantial for Cannabis Use: Most qualifying conditions for which patients are licensed to use cannabis medically have substantial or conclusive evidence of therapeutic efficacy, according to a report published in the February issue of Health Affairs.

Mindfulness-Based Stress Reduction Also Benefits Chronic Pain: For patients with chronic pain (CP), both mindfulness-based stress reduction (MBSR) and cognitive behavioral therapy (CBT) improve physical functioning, pain intensity, and depression, according to a review published online Jan. 31 in Evidence-Based Mental Health.

Medical Cannabis Decisions Being Made by Users, Not Doctors: Many patients use medical cannabis without their mainstream health care provider's knowledge, and further, they self-adjust their pharmaceutical use in response to cannabis use, according to a study published online Jan. 8 in the Journal of Psychoactive Drugs. 

Yoga regimen reduces severity of rheumatoid arthritis symptoms: According to a new study, eight weeks of intensive yoga practice significantly decreases the severity of physical and psychological symptoms in patients with active rheumatoid arthritis (RA), a debilitating chronic auto-immune inflammatory disease. Marked improvements were seen in the levels of certain inflammatory biomarkers and assessments of functional status and disease activity in patients studied, demonstrating yoga's promotive, preventive, curative, and rehabilitative potential for achieving optimal health. Restorative Neurology and Neuroscience

FDA ACTION

• Issued Statement from FDA Commissioner Scott Gottlieb, M.D., on new policy to improve access and foster price competition for drugs that face inadequate generic competition

• Authorizes first interoperable insulin pump intended to allow patients to customize treatment through their individual diabetes management devices

• Issued statement from FDA Commissioner Scott Gottlieb, M.D., on the agency’s new efforts to strengthen regulation of dietary supplements by modernizing and reforming FDA’s oversight

• Takes action against 17 companies for illegally selling products claiming to treat Alzheimer’s disease

• Approved Cablivi (caplacizumab-yhdp) injection, the first therapy specifically indicated, in combination with plasma exchange and immunosuppressive therapy, for the treatment of adult patients with acquired thrombotic thrombocytopenic purpura (aTTP), a rare and life-threatening disorder that causes blood clotting.

• Warned patients and doctors, who use at-home or in-the-office medical devices to monitor levels of the blood thinner warfarin, that certain test strips used with the devices may provide inaccurate results and should not be relied upon to adjust the drug dosage. Medical product distributor Terrific Care/Medex Supply LLC issued a voluntary Recall of certain Roche Diagnostic test lots used with CoaguCheck test meter devices.

• Approved the first generic of Advair Diskus (fluticasone propionate and salmeterol inhalation powder) for the twice-daily treatment of asthma in patients aged four years and older

• Permitted marketing of a new test to aid in the diagnosis of a sexually-transmitted infection (STI) called Mycoplasma genitalium (M. gen.).

• Approved the first generic version of Sabril (vigabatrin) 500 mg tablets for treating complex partial seizures, also called focal seizures, as an adjunctive therapy (given with another primary treatment) in patients 10 years and older who have responded inadequately to several alternative (refractory) treatments.

PREVENTION

How exercise may protect against Alzheimer's: A hormone called irisin -- produced during exercise -- may protect neurons against Alzheimer's disease. Nature Medicine

Aerobic Exercise Tied to Better Cognition at All Ages: Aerobic exercise contributes to brain health in individuals as young as 20 years, according to a study published online Jan. 30 in Neurology. The researchers found that aerobic capacity increased significantly and body mass index decreased significantly in the aerobic exercise group but not in the stretching/toning group. In the aerobic exercise group, executive function improved significantly, with the effect moderated by age. The aerobic exercise group had significant increases in cortical thickness in a left frontal region, with no interaction with age.

How sleep can fight infection: Researchers have discovered why sleep can sometimes be the best medicine. Sleep improves the potential ability of some of the body's immune cells to attach to their targets, according to a new study. The study helps explain how sleep can fight off an infection, whereas other conditions, such as chronic stress, can make the body more susceptible to illness. Journal of Experimental Medicine

Accelerated risk of mobility loss for people aged 60+ tied to excess weight/inactivity:New study shows older women with obesity at higher risk of mobility loss compared to older men. The combination of excess weight/obesity and an inactive lifestyle represents a powerful joint risk factor for developing mobility loss after age 60, according to a new study. International Journal of Obesity. 

Fewer Older Men Assessed, Treated for Osteoporosis: Fewer older men than women undergo evaluation for or management of osteoporosis, according to a study published online Feb. 12 in the Journal of Investigative Medicine. 

Most A-Fib Patients Have at Least One Identifiable Trigger: Most patients with atrial fibrillation (AF) report at least one identifiable trigger, with the most common triggers being alcohol, caffeine, exercise, and lack of sleep, according to research published online Feb. 14 in HeartRhythm.

CDC Examines Safety of Recombinant Zoster Vaccine: During the first eight months of recombinant zoster vaccine (RZV) use, there were reports of 4,381 adverse events, 3 percent of which were serious, according to research published in the Feb. 1 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.

E-Cigarettes More Effective for Smoking Cessation: Electronic cigarettes are more effective for smoking cessation than nicotine replacement therapy, according to a study published online Jan. 30 in the New England Journal of Medicine.  

New Type of E Cigarette as Bad as Regular: “Heat-not-burn” tobacco products are already incredibly popular in some overseas markets, but they haven’t made inroads into the United States yet. Promoted in a similar fashion to e-cigarettes as a safer alternative to traditional smoking, public health experts worry that “heat-not-burn” products could be the next big phase for the tobacco industry. New research looked at the in vitro effects of vapor produced by IQOS devices (IQOS is the brand name of a “heat-not-burn” tobacco product by Philip Morris International, an American tobacco company) on human cells found in the lungs and airways. IQOS device’s vapor was found to have a comparable toxicity to traditional smoking. ERJ Open Research

Trained Alert Dogs Can Detect Impending T1DM-Related Events: Trained alert dogs can help patients with type 1 diabetes regulate their blood glucose levels, according to a study published online Jan. 15 in PLOS ONE.

NUTRITION/SUPPLEMENTS/VITAMINS

Higher sodium intake associated with increased light headedness in the context of the DASH-sodium trial: Study turns common knowledge on its head by challenging experts' traditional recommendations Researchers found that higher sodium intake, when studied in the context of the DASH-Sodium trial (Dietary Approaches to Stop Hypertension), increases lightheadedness. These findings challenge traditional recommendations to increase sodium intake to prevent lightheadedness. The Journal of Clinical Hypertension 

Fried Chicken, Fish Linked to All-Cause,Cardiovascular Death: Among postmenopausal women, fried food consumption, especially fried chicken and fish/shellfish, is associated with an increased risk for all-cause and cardiovascular mortality, according to a study published online Jan. 23 in The BMJ.

Body building supplement could be bad for the brain: L-norvaline is an ingredient widely used in body building supplements and is promoted as a compound that can boost workouts and aid recovery. Similar compounds have been linked to neurodegenerative diseases, and a study on human cells suggests L-norvaline may also cause damage to brain cells. People taking the protein supplement L-norvaline should be aware of its potential for harm, scientists say. Toxicology in Vitro 

Bone Health in Older Adults Not Improved by High-Dose Vitamin D: There is little benefit for older adults taking high-dose vitamin D supplements to improve their bone strength and reduce the risk for falls, according to a study published online Jan. 8 in The American Journal of Clinical Nutrition.

 Study examines aspirin use to prevent colorectal cancer: The US Preventive Services Task Force (USPSTF) concluded that aspirin reduces the risk of colorectal cancer by 40 percent as well as recurrence of advanced polyps, which are a major risk factor. To explore whether high risk patients are adhering to USPSTF guidelines, researchers analyzed data from structured interviews with 84 patients and found that less than half (42.9 percent) reported taking aspirin. These findings pose major challenges that require multifactorial approaches by physicians and patients.  The American Journal of Medicine  

Meta-Analysis: Aspirin Linked to Lower Risk for CV Events in Primary Prevention: For individuals without cardiovascular disease, use of aspirin is associated with a reduced risk for cardiovascular events and an increased risk for major bleeding, according to a meta-analysis published in the Jan. 22 issue of the Journal of the American Medical Association.

 Artificially Sweetened Drinks Linked to Stroke After Menopause: Among postmenopausal women, consumption of artificially sweetened beverages (ASB) is associated with an increased risk for stroke, coronary heart disease, and all-cause mortality, according to a study published online Feb. 14 in Stroke. 

 TREATMENT

Direct-acting antivirals reduce risk of premature mortality and liver cancer for people with chronic hepatitis C, study finds: The first prospective, longitudinal study investigating treatment of chronic hepatitis C with direct-acting antivirals finds that the treatment is associated with reduced risk of mortality and liver cancer.  The Lancet 

Shorter course of radiation therapy effective in treating men with prostate cancer: A long-term study finds that those with low- or intermediate-risk disease can safely cut treatment to four to five days.  This type of radiation, known as stereotactic body radiotherapy, is a form of external beam radiation therapy and reduces the duration of treatment from 45 days to four to five days. The approach has been in use since 2000, but has not yet been widely adopted because of concerns over how safe and effective this approach would be in the long term. JAMA 

Study links psoriasis treatment and improvement in heart artery disease: Researchers have found that treating psoriasis, a chronic inflammatory skin disease, with biologic drugs that target immune system activity can reduce the early plaque buildup that clogs arteries, restricts blood flow, and leads to heart attacks and stroke. The findings highlight how immunotherapies that treat inflammatory conditions might play a role in the reduction of cardiovascular disease risks. Cardiovascular Research

Subsymptom Threshold Exercise Speeds Concussion Recovery: For adolescent athletes, subsymptom threshold aerobic exercise prescribed during the first week after sport-related concussion (SRC) speeds recovery, according to a study published online Feb. 4 in JAMA Pediatrics.

Trazodone Not Associated With Reduced Risk for Dementia: Trazodone is not associated with a reduced risk for dementia compared with other antidepressants at the prodromal stage of disease, according to a study published online Feb. 5 in PLOS Medicine. 

Intensive BP Treatment Does Not Reduce Dementia Risk: Treating systolic blood pressure (BP) to a goal of less than 120 mm Hg rather than 140 mm Hg does not result in a significant reduction in the risk for probable dementia, according to a study published online Jan. 28 in the Journal of the American Medical Association.

NOACs Recommended as First-Line Prevention of Stroke in A-Fib: For patients with atrial fibrillation, novel oral anticoagulants (NOACs) are recommended over warfarin to prevent stroke and weight loss is recommended for overweight and obese individuals, according to updated guidelines published online Jan. 28 in Circulation.

OTHER

New scan technique reveals brain inflammation associated with post-treatment Lyme disease syndrome: More than 1 in 10 people successfully treated with antibiotics for Lyme disease go on to develop chronic, sometimes debilitating, and poorly understood symptoms of fatigue and brain fog that may last for years after their initial infection has cleared up. Now, in a small study, Johns Hopkins Medicine researchers report they have used an advanced form of brain scan to show that 12 people with documented post-treatment Lyme disease syndrome (PTLDS) all show elevation of a chemical marker of widespread brain inflammation, compared with 19 healthy controls. Journal of Neuroinflammation 

Health Care Spending Per Person Increased to $5,641 in 2017: In 2017, health care spending per person reached $5,641, according to the Health Care Cost Institute (HCCI) annual Health Care Cost and Utilization Report.

USPSTF Still Recommends Against Pancreatic Cancer Screening: The U.S. Preventive Services Task Force (USPSTF) recommends against screening for pancreatic cancer in asymptomatic adults. These findings form the basis of a draft recommendation statement published online Feb. 5 by the USPSTF.

AHA: Nearly Half of U.S. Adults Have Cardiovascular Disease: The prevalence of cardiovascular disease (CVD) is 48.0 percent in adults in the United States based on 2013 to 2016 data, according to a report published online Jan. 31 in Circulation. Forty-six percent of U.S. adults have hypertension

Large Insulin Price Hike to Be Investigated by U.S. Congress: "I have heard stories about people reducing their lifesaving medicines, like insulin, to save money," said Senate Finance Committee Chairman Charles Grassley, R-Iowa, the Associated Press reported. "This is unacceptable and I intend to specifically get to the bottom of the insulin price increase."