Journal Watch May 2019

CHRONIC PAIN

Prevalence of Arthritis 22.8 Percent in U.S. Adults in 2017: The prevalence of arthritis was 22.8 percent in U.S. adults in 2017, with statewide variation in prevalence and in the prevalence of severe joint pain and physical inactivity among those with arthritis, according to research published in the May 3 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. Adults with arthritis in southeastern states have highest prevalence of severe joint pain, physical inactivity.

Does insulin resistance cause fibromyalgia? Researchers were able to dramatically reduce the pain of fibromyalgia patients with medication that targeted insulin resistance. This discovery could dramatically alter the way that chronic pain can be identified and managed. Plos One

Are Herbal Products Effective for Treating Neuropathic Pain? According to the results of a recent review, there is “insufficient” evidence to conclude that either nutmeg or St John’s wort are effective in helping treat pain in neuropathic conditions.

COMPLEMENTARY & ALTERNATIVE MEDICINE

Mindfulness smoking-cessation app can change the brain: Researchers have found that a mindfulness-based smartphone app designed to help people stop smoking was effective at reducing study participants' self-reported daily cigarette consumption. And those who reduced their cigarette consumption the most also showed decreased reactivity to smoking-related images in a brain region known to be activated when someone experiences a craving. Neuropsychopharmacology 

Clinicians could prescribe fitness apps to help cancer survivor's exercise: Fitness apps could be prescribed by clinicians to help patients recovering from cancer increase their physical activity levels, new research in the Journal of Cancer Survivorship reports.

Legal marijuana reduces chronic pain, but increases injuries and car accidents: The legalization of recreational marijuana is associated with an increase in its abuse, injury due to overdoses, and car accidents, but does not significantly change health care use overall, according to a study by researchers at UC San Francisco. In a review of more than 28 million hospital records from the two years before and after cannabis was legalized in Colorado, UCSF researchers found that Colorado hospital admissions for cannabis abuse increased after legalization, in comparison to other states. But taking the totality of all hospital admissions and time spent in hospitals into account, there was not an appreciable increase after recreational cannabis was legalized. BMJ Open

Health Professionals Supportive of Medicinal Cannabis: Health professionals are generally supportive of medicinal cannabis use but report a lack of knowledge about its use, according to a review published online May 6 in PLOS ONE. 

FDA ACTION

• Recalled six tattoo inks as they are contaminated with bacteria and could lead to infection that poses a serious health risk

• Approves Venetoclax for Chronic Lymphocytic Leukemia

• Warns against the use of unapproved or unauthorized devices for diabetes management, including continuous glucose monitoring systems, insulin pumps and automated insulin dosing systems

• Approved Fragmin (dalteparin sodium) injection, for subcutaneous use, to reduce the recurrence of symptomatic venous thromboembolism (VTE) in pediatric patients one month of age and older

• Sent warning letters to five companies who produce products labeled as homeopathic for significant violations of current good manufacturing practice (CGMP) regulations

• Approved Vyndaqel (tafamidis meglumine) and Vyndamax (tafamidis) capsules for the treatment of the heart disease (cardiomyopathy) caused by transthyretin mediated amyloidosis (ATTR-CM) in adults.

• Authorized the marketing of new tobacco products manufactured by Philip Morris Products S.A. for the IQOS “Tobacco Heating System” – an electronic device that heats tobacco-filled sticks wrapped in paper to generate a nicotine-containing aerosol. The FDA has placed stringent marketing restrictions on the products in an effort to prevent youth access and exposure.

• Approved Mavyret (glecaprevir and pibrentasvir) tablets to treat all six genotypes of hepatitis C virus (HCV) in children ages 12 to 17

• Requiring a new boxed warning – the agency’s most prominent warning – on certain prescription insomnia drugs to better ensure patients and their health care professionals have the information they need when considering use of these medicines. The new warnings will be required for eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, and Zolpimist).

• Approved a device, called Xvivo Perfusion System with Steen Solution Perfusate, that can temporarily ventilate, oxygenate, and pump (perfuse) preservation solution through lungs that were initially thought to be unacceptable for transplant

• Launched  a new education campaign to help Americans understand the important role they play in removing and properly disposing of unused prescription opioids from their homes

• Permitted marketing of the first medical device to treat attention deficit hyperactivity disorder (ADHD)

PREVENTION

Morning exercise can improve decision-making across the day in older adults: A study of older Australians has found a morning bout of moderate-intensity exercise improves cognitive performance like decision-making across the day compared to prolonged sitting without exercise. It also shows that a morning bout of exercise combined with brief walking breaks to frequently disrupt sitting throughout an eight-hour day can boost short-term memory compared to uninterrupted sitting, according to the study. British Journal of Sports Medicine

Stressed at work and trouble sleeping? It's more serious than you think: Work stress and impaired sleep are linked to a threefold higher risk of cardiovascular death in employees with hypertension. That's the finding of research published today in the European Journal of Preventive Cardiology

Chronic insomnia and memory problems: A direct link is established: Chronic insomnia disorder, which affects approximately 10 percent of adults, has a direct negative impact on cognitive function of people aged 45 and over, independent of the effect of other health issues. Canadian Longitudinal Study on Aging

Healthy Lifestyle Recommended for Reducing Dementia Risk: Guidelines emphasizing adoption of a healthy lifestyle for reducing the risk for cognitive decline and dementia have been developed by the World Health Organization. Adults who use tobacco should be offered interventions for tobacco cessation, and interventions should be offered to reduce or cease hazardous or harmful drinking. For adults with normal cognition and mild cognitive impairment, a Mediterranean-like diet may be recommended for reducing the risk for cognitive decline and/or dementia. A healthy balanced diet based on WHO recommendations should be recommended to all adults. Vitamins B and E, polyunsaturated fatty acids, and multicomplex supplementation should not be recommended for reducing cognitive decline and/or dementia risk. Interventions for overweight and/or obesity may be offered.

Regular crosswords and number puzzles linked to sharper brain in later life: Older adults who regularly take part in word and number puzzles have sharper brains, according to the largest online study to date.  The more regularly adults aged 50 and over played puzzles such as crosswords and Sudoku, the better their brain function, according to research in more than 19,000 participants. The findings emerge from two linked papers published today (May 16th) in the International Journal of Geriatric Psychiatry. 

Working Memory Affected by Sleep and Mood: Two linked medical studies on age-related working memory decline show surprisingly strong inverse and direct relationships with mood and sleep quality. For the mind to work at its best — especially among the elderly — it’s important to ensure one has good sleep quality and be in a good mood, which generally means freedom from depression. Journal of the International Neuropsychological Society

Moderate/Vigorous Exercise Attenuates Risks of Sitting: Moderate-to-vigorous physical activity (MVPA) equivalent to meeting current recommendations attenuates the association of sitting with all-cause and cardiovascular disease (CVD) mortality, according to a study published online April 22 in the Journal of the American College of Cardiology. 

Women Who Exercise Still More At Risk Of Depression Than Men: Researchers from the University of Michigan in Ann Arbor claimed exercise reduces the risk of depression but such manifestation differs for men and women. They tested whether exercise can alleviate depression caused by disturbed sleep, but they only found it effective in male participants. The findings were contradictory to previous research. According to the principal investigator Weiyun Chen, few women in the study participated in the high-intensity exercise and their conditions did not improve after the test. The previous study used in assessing the effects of exercise on depression showed that low-to-moderate intensity workouts may be an effective solution for depression. Vigorous physical activity done frequently also resulted in the growth of nerve cells. Journal of American College Health  

NUTRITION/SUPPLEMENTS/VITAMINS

A spoonful of peppermint helps the meal go down: When treated with peppermint oil, 63 percent of patients with disorders of the esophagus that cause difficulty swallowing and non-cardiac chest pain reported feeling much or slightly better, report researchers. Eighty-three percent of patients with spastic disorders of the esophagus reported feeling better. Peppermint is an attractive first-line treatment because it has few side effects and can be taken as needed by patients. Digestive Diseases and Sciences 

Walnuts may help lower blood pressure for those at risk of heart disease: When combined with a diet low in saturated fats, eating walnuts may help lower blood pressure in people at risk for cardiovascular disease. Journal of the American Heart Association

Habitual Glucosamine Use Linked to Reduced Risk for CVD Events: Habitual use of glucosamine supplements is associated with a reduced risk for cardiovascular disease (CVD) events-CVD death, coronary heart disease and stroke- , according to a study published online May 14 in The BMJ. 

Low Fat Dietary Pattern Cuts Breast Cancer Deaths: A low-fat dietary intervention is associated with reductions in deaths after breast cancer and deaths from breast cancer among postmenopausal women after long-term follow-up, according to a study scheduled to be presented at the annual meeting of the American Society for Clinical Oncology.

Does sunscreen compromise vitamin D levels? Maybe not Sunscreen can reduce the sun's adverse effects, but there are concerns that it might inhibit the body's production of vitamin D. In a new study, however, investigators recorded an increase of vitamin D in participants during a week of cloudless weather, with very high UV index, even when sunscreens were used properly and prevented sunburn. British Journal of Dermatology 

How Much Coffee is too Much for the Heart: People who frequently drank six or more cups of coffee per day — the scientists defined one cup as containing around 75 milligrams of caffeine — had a modest increase in cardiovascular disease risk. The American Journal of Clinical Nutrition 

Processed foods lead to weight gain, but it's about more than calories: In the first study of its kind, scientists have shown that eating ultra-processed foods leads to weight gain in human volunteers in as little as 2 weeks. Cell Metabolism

Is There Evidence to Support Kombucha Health Claims in Humans? According to the results of a systematic review, there is a lack of evidence supporting the potential health benefits of kombucha, a fermented tea beverage, in humans.

TREATMENT

rTMS Improves Memory in Younger and Older Adults: Magnetic stimulation of the brain improves working memory, offering a new potential avenue of therapy for individuals living with Alzheimer's disease and other forms of dementia, according to new research from the Duke University School of Medicine. Plos One

Combination therapy advisable for bowel disorder IBS: The more abnormalities in intestinal and brain function that IBS sufferers have, the more severe their symptoms of this functional bowel disorder, and the more adversely their everyday life is affected. This is shown by a Sahlgrenska Academy study indicating that patients with IBS should get treatments for different abnormalities simultaneously, to improve both bowel function and signaling from the brain to the gut. Gastroenterology 

Thyroid Hormones Not Endorsed for Subclinical Hypothyroidism: The researchers found that thyroid hormones consistently demonstrated no clinically relevant benefits for quality of life or thyroid-related symptoms, including depressive symptoms, fatigue, and body mass index, for adults with SCH (moderate- to high-quality evidence). Thyroid hormones seem to have little or no effect on cardiovascular events or mortality (low-quality evidence); only one trial measured harms, with few events at two-year follow-up. Based on these findings, the guideline panel issued a strong recommendation against thyroid hormones in adults with SCH. The recommendation does not apply to women trying to get pregnant or patients with thyroid stimulating hormone levels >20 mIU/L and may not apply to young adults or patients with severe symptoms. The BMJ

Risks, Benefits of Long-Term Drug Therapy for Osteoporosis Reviewed: Long-term osteoporosis drug therapy (ODT) reduces fracture risk in women but may increase risk for rare adverse events, and research gaps surround use of long-term drug therapies for osteoporotic fracture prevention, according to a review and position paper published online April 23 in the Annals of Internal Medicine. 

Sleeping Pill Use Tied to Greater Need for BP Meds in Older Adults: Consumption of sleeping pills is linked to a subsequent increase in the number of antihypertensive drugs taken among older adults, according to a study published online March 25 in Geriatrics & Gerontology International. "'Sleeping pill use' might be an indicator of future needs of antihypertensive treatment and a warning indicator to investigate underlying sleep disorders or unhealthy lifestyles," the authors write.

The Generic Drugs You're Taking May Not Be As Safe Or Effective As You Think: Often health insurance plans require patients to switch to generics as a way of controlling costs. But journalist Katherine Eban warns that some of these medications might not be as safe, or effective, as we think.  Eban has covered the pharmaceutical industry for more than 10 years. She notes that most of the generic medicines being sold in the U.S. are manufactured overseas, mostly in India and China. The U.S. Food and Drug Administration states that it holds foreign plants to the same standards as U.S. drugmakers, but Eban's new book, Bottle of Lies, challenges that notion. She writes that the FDA often announces its overseas inspections weeks in advance, which allows plants where generic drugs are made the chance to fabricate data and results. Eban advises consumers to research who manufactures their generics and look up any problems that regulators have found out about them. But some consumers may find they are not allowed by their health plan to switch to alternatives, because of cost. NPR 

Brain network activity can improve in epilepsy patients after surgery: Successful epilepsy surgery can improve brain connectivity similar to patterns seen in people without epilepsy.  Neurosurgery 

Blood pressure drug shows no benefit in Parkinson's disease: A study of a blood pressure drug does not show any benefit for people with Parkinson's disease. The drug isradipine had shown promise in small, early studies and hopes were high that this could be the first drug to slow the progression of the disease. American Academy of Neurology's 71st Annual Meeting

CAREGIVING

Teaching happiness to dementia caregivers reduces their depression, anxiety: Caring for family members with dementia -- which is on the rise in the US -- causes significant emotional and physical stress that increases caregivers' risk of depression, anxiety and death. A new method of coping with that stress by teaching people how to focus on positive emotions reduced their anxiety and depression after six weeks, reports a new national study. It also resulted in better self-reported physical health and positive attitudes toward caregiving.  Skills taught to participants in the study:

1. Recognizing a positive event each day

2. Savoring that positive event and logging it in a journal or telling someone about it

3. Starting a daily gratitude journal

4. Listing a personal strength each day and noting how you used this strength recently

5. Setting an attainable goal each day and noting your progress

6. Reporting a relatively minor stressor each day, then listing ways in which the event can be positively reappraised or reframed

7. Understanding small acts of kindness can have a big impact on positive emotion and practicing a small act of kindness each day

8. Practicing mindfulness through paying attention to daily experiences and with a daily 10-minute breathing exercise, concentrating on the breath

Health Psychology

Mindfulness may help decrease stress in caregivers of veterans: Caregivers of veterans who engaged in mindfulness-based cognitive therapy found it relieved stress, anxiety and worry, according to a new study. Mindfulness

OTHER

Two-Thirds of Sunscreens Fail Safety Tests: Nearly two-thirds of sunscreens that were analyzed failed safety tests proposed by the U.S. Food and Drug Administration, the Environmental Working Group said Wednesday. The findings are included in the nonprofit consumer advocacy group's latest edition of its annual Guide to Sunscreens, CNN reported. The group analyzed the ingredients and performance of more than 1,300 sunscreen products with sun protection factor (SPF). Of those, 750 are marketed as beach and sport sunscreens. The total sample size is just a small portion of the more than 12,000 sunscreen products the FDA says are available in the United States. Experts suggest that consumers look for products with zinc oxide and titanium dioxide, which studies show are not absorbed into the skin.CNN

Doctors Aware of Patient Difficulties Affording Medical Care: Physicians are aware of patients' difficulty with affording medical care and consider out-of-pocket costs in their decision making, according to an article published in a supplement to the May 7 issue of the Annals of Internal Medicine. 

Prices Will Soon Be Included in TV Drug Ads: Regulations will require companies to disclose prices of meds costing more than $35 for a month's supply . AP  

Appendix removal associated with development of Parkinson's disease: Patients who had their appendix removed were more likely to develop Parkinson's disease than those whose appendix remained in place, according to the largest study to address the relationship between the two conditions. The retrospective study involving more than 62 million patient records from 26 health systems. Digestive Disease Week 

Chronic kidney disease epidemic in agricultural workers: High heat, toxins: A mysterious epidemic of chronic kidney disease among agricultural workers and manual laborers may be caused by a combination of increasingly hot temperatures, toxins and infections, according to researchers.  NEJM