Saturday, November 16, 2024

Journal Watch November 2024



 

 

 


PAIN

Can Stem Cells Relieve Chronic Low Back Pain?: Allogeneic bone marrow–derived mesenchymal stromal cells (BM-MSCs) are safe but do not show efficacy in treating intervertebral disc degeneration (IDD) in patients with chronic low back pain.  published onlineon October 11, 2024, in Annals of the Rheumatic Diseases.

 

Hourglass-shaped stent could ease severe chest pain from microvascular disease:  A study at Mayo Clinic suggests that an hourglass-shaped stent could improve blood flow and ease severe and reoccurring chest pain in people with microvascular disease. Of 30 participants in a phase 2 clinical trial, 76% saw improvement in their day-to-day life. For example, some participants who reported not being able to walk around the block or up a flight of stairs without chest pain were able to do these ordinary physical activities at the end of a 120-day period. Clinical measures of blood flow related to the microvasculature of the heart significantly improved during follow-up, according to findings published in the Journal of the American College of Cardiology: Cardiovascular Interventions.

 

Research shows Cleveland Clinic’s therapeutic virtual yoga program can be effective for chronic low back pain: Cleveland Clinic researchers found that a 12-week therapeutic virtual yoga program for chronic low back pain can be a feasible, safe and effective treatment option. The findings are published in JAMA Network Open.  

 

Communication with doctor during first visit affects pain patients’ outcomes: A recent study of 200 adults with chronic neck or back pain, found that effective physician-patient communication during the initial consultation helps patients manage their uncertainties, including their fears, anxieties and confidence in their ability to cope with their condition. “We found that providers and patients who perceive themselves and each other as competent medical communicators during consultations can alleviate patients’ negative feelings of uncertainty such as distress and increase their positive feelings about uncertainties such as their sense of hope and beliefs in their pain-management self-efficacy,” Thompson said. “Providers and patients successfully manage patients’ uncertainty through two fundamental medical communication processes — informational and socioemotional, each of which can have important clinical implications.” Health Communication 

 

Ozempic and Wegovy May Provide Strong Relief from Osteoarthritis Knee Pain: A study published in The New England Journal of Medicine found that using the type 2 diabetes and weight loss drug semaglutide was linked with improved pain scores in those with osteoarthritis, a painful and degenerative condition affecting the joints. The weight loss engendered by this medication reduces the strain on joints.  Additionally, semaglutide helps to balance blood sugar and reduce inflammation. The sum of these effects is likely what reduces osteoarthritis pain in the knee. Experts say we are likely to see continued beneficial effects from drugs like semaglutide due to the ways GLP-1 drugs impact signaling pathways.

 


COMPLEMENTARY AND ALTERNATIVE MEDICINE

DIY Brain Stim Is Growing in Popularity, but Is It Safe, Effective? As at-home, do-it-yourself (DIY) brain stimulation devices like transcranial direct current stimulation (tDCS) gain popularity for common psychiatric conditions like depression, anxiety, and posttraumatic stress disorder (PTSD), questions arise about their safety and efficacy. However, the US Food and Drug Administration (FDA) has yet to "fully" clear any of these devices and has only granted breakthrough device designation to a few. In addition, most of the portable products don't market themselves as medical interventions, putting them into a regulatory "grey area" that has little oversight. Data from studies examining unsupervised at-home and use under medical supervision are mixed. Results from a recent randomized trial of more than 200 participants showed no significant difference in safety or efficacy between adjunctive at-home tDCS and at-home sham tDCS for depressive symptoms. Medscape


Bright Light Therapy Effective for Nonseasonal Depression: Bright light therapy (BLT) is associated with a 41% remission rate in patients with nonseasonal depressive disorders, significantly higher than the remission rates reported with other treatments, a new meta-analysis shows. BLT was administered using a fluorescent light box producing white light at 10,000 lux for at least 30 minutes daily.

  published online on October 2 in JAMA Psychiatry


More Evidence Avatar Therapy Quiets Auditory Hallucinations in Psychosis: A novel digital treatment designed to reduce the frequency of auditory hallucinations and associated distress in patients with psychosis has been shown to be safe and effective, results from the largest study of avatar therapy to date show.  The therapy allows patients to interact with a “digital embodiment” of the voice they hear, which is represented by a computer-generated face, also known as an avatar. In the randomized, multisite, phase 2/3 AVATAR2 trial, patients who received AVATAR-Extended therapy, which included a personalized series of voiced dialogues based on their life history, plus treatment as usual (TAU) showed significantly greater improvement in distress and voice severity levels at 16-weeks vs those who received TAU only. They also had significant reductions in voice frequency at 16 and 28 weeks. Patients in a third arm who were assigned to TAU plus AVATAR-Brief therapy, which included six sessions of a standardized version of the therapy, also showed improvements at 16 weeks compared with TAU alone — but the clinical impact was stronger with the extended version. The findings were published online on October 28 in Nature Medicine. 

 

 


FDA ACTION

• Announced a voluntary manufacturer-initiated recall of more than 7000 bottles of duloxetine delayed-release capsules due to unacceptable levels of a potential carcinogen.

• Approved Orlynvah, a new oral treatment for uncomplicated urinary tract infections (UTIs) in women who have limited options for effective antibiotic therapy.

• Approved obecabtagene autoleucel, or obe-cel (AUTO1, Autolus Therapeutics) for the treatment of relapsed or refractory adult B-cell acute lymphoblastic leukemia (ALL).

• Approved Kebilidi (eladocagene exuparvovec-tneq), an adeno-associated virus vector-based gene therapy indicated for the treatment of adult and pediatric patients with aromatic L-amino acid decarboxylase (AADC) deficiency. Kebilidi is the first FDA-approved gene therapy for treatment of AADC deficiency.

 

PREVENTION


Exercise

High-Intensity Exercise Works Like An Appetite Suppressant: Exercise has a complex relationship with appetite that may make you feel hungry or satiated. New research indicates that high-intensity exercise could mitigate feelings of hunger, particularly in women, by decreasing ghrelin levels. Ghrelin, popularly referred to as the “hunger hormone” stimulates appetite and signals when the stomach is empty. Journal of the Endocrine Society

 

Standing More May Not Offset Effects of Sitting, Could Cause Circulatory Issues: Standing desks and other innovations have made standing a popular antidote to extended periods of sitting. Unfortunately, standing may not be enough to offset those risks, according to new research. A new study published in International Journal of Epidemiology suggests that prolonged standing may not offer much in the way of health benefits and raise the risk of orthostatic circulatory disease.

 

Sitting too long can harm heart health, even for active people: More time spent sitting, reclining or lying down during the day may increase the risk of cardiovascular disease (CVD) and death, according to a study in JACC, the flagship journal of the American College of Cardiology, and presented at the American Heart Association’s Scientific Sessions 2024. More than roughly 10-and-a-half hours of sedentary behavior per day was significantly linked with future heart failure (HF) and cardiovascular (CV) death, even among people meeting recommended levels of exercise.

 

A Single Jog Can Improve Glucose Metabolism in Young Adults: In healthy young adults, a single 30-minute bout of outdoor aerobic exercise significantly reduces fasting and 1-hour glucose levels during an oral glucose tolerance test (OGTT) the next day and improves insulin sensitivity.  published online in the Journal of Endocrinological Investigation.

 

Being a Weekend Warrior Linked to Lower Dementia Risk: Weekend exercise, involving one or two sessions per week, is associated with a similar reduction in risk for mild dementia as that reported with more frequent exercise, a new study shows. Investigators say the findings suggest even limited physical activity may offer protective cognitive benefits. published online on October 29 in the British Journal of Sports Medicine.

 

An Extra 5 Minutes of Vigorous Exercise Per Day Could Help Lower Blood Pressure: A new study published November 6 in the journal Circulation suggests that adding a few minutes of vigorous physical activity to your daily exercise routine can help lower blood pressure.

 

Just 1 Hour of Weekly Exercise May Lower AFib Risk, but More Is Still Better: New research indicates that one hour of moderate exercise per week can help prevent atrial fibrillation (AFib). The study utilized robust data from thousands of individuals using FitBit fitness trackers to report exercise behavior. While a minimum amount of exercise lowered AFib risk in study participants, those who exercised more reaped even greater benefits.  American Heart Association Scientific SessionsTrusted Source

 

 

Sleep

Poor Sleep In Your 40s Linked to Faster Brain Aging Later In Life: A new study reports that people in their 40s who have difficulty sleeping have a brain age 1.6 to 2.6 years older by the time they’re in their 50s compared to people who consistently get quality sleep. Experts say quality sleep can improve brain health and lower dementia risk and also decrease inflammation in the body and boost the immune system.

You can promote a good night’s sleep by exercising during the day, putting away electronic devices before bedtime, going to sleep around the same time every night, and sleeping in a cool, darkened room. Neurology,

 


Diet/Nutrition

 Can Restricting Carbohydrates Cut the Need for Medication in T2D? Eating a low-carbohydrate diet can help preserve beta-cell function in people with mild type 2 diabetes (T2D), potentially allowing some to achieve target glucose levels without medication, new research suggests. The results were published onlineon October 22, 2024, in The Journal of Clinical Endocrinology & Metabolism.

 

Vegetarian diets can protect against diabetes, cardiovascular diseases: Two review studies published in October 2024 highlight that vegetarian and vegan diets can be beneficial for individuals with type 2 diabetes and may lower heart disease risk across the general adult population. The study on type 2 diabetes appears in Advances in Nutrition, while the heart disease findings are published in the American Journal of Preventive Cardiology.

 

Early-Life Sugar Restriction Reduces T2D, Hypertension Risk: Exposure to sugar rationing in the womb and in early childhood may lower the risk for type 2 diabetes (T2D) and hypertension later in life, with the protective effects most pronounced when sugar restriction lasts more than 6 months after birth.  published online in Science,

 

New study links liver-brain communication to daily eating patterns: People who work the nightshift or odd hours and eat at irregular times are more prone to weight gain and diabetes, likely due to eating patterns not timed with natural daylight and when people typically eat. But is it possible to stave off the ill effects of eating at these “unusual” times despite it not being biologically preferable? A new study from the Perelman School of Medicine at the University of Pennsylvania says ‘yes’, and sheds light on how the body knows when to eat. The study, published today in Science, explains how researchers discovered a connection between the liver's internal clock and feeding centers in the brain. 

 

New study reveals blood sugar control is a key factor in slowing brain aging, highlighting the benefits of the Mediterranean diet: Age-related brain atrophy, the gradual loss of neurons and shrinkage of brain tissue, is a natural part of aging, which can lead to cognitive decline and other neurological issues. While so far aging cannot be prevented, recent research from an 18-month dietary intervention offers hope that lifestyle and dietary changes can slow brain aging. The study, which was published recently in The American Journal of Clinical Nutrition 2024

 


Vitamins/Supplements

High levels of omega-3, omega-6 may protect against cancer: In addition to lowering your cholesterol, keeping your brain healthy and improving mental health, new research from the University of Georgia suggests omega-3 and omega-6 fatty acids may help ward off a variety of cancers. The study relied on data from more than 250,000 people and found that higher levels of omega-3 and omega-6 fatty acids were associated with a lower risk of developing cancer. Participants with higher levels of omega-3s had lower rates of colon, stomach and lung cancer, in addition to lower rates of other digestive tract cancers.High omega-6 levels led to lower rates of 14 different cancers, including brain, malignant melanoma, bladder and more. The study relied on data from a United Kingdom-based study of over 250,000 people who were followed for more than a decade. Of those participants, almost 30,000 developed some form of cancer during the study period.

 

Two topical treatments show similar improvement in age spots on hands:  Topically applied products containing human platelet extract or vitamin C provide similar improvements in age spots (photoaging) of the hands, as reported in a clinical trial within the November issue of Plastic and Reconstructive Surgery®,


Vitamin D Supplements Lower Blood Pressure in Older Adults with Obesity, According to new research  in the Journal of the Endocrine Society, supplementation with vitamin D plus calcium may help lower blood pressure in older adults with obesity (body mass index (BMI) greater than 30). These supplements appeared to decrease both systolic blood pressure (the top number in a blood pressure reading) and diastolic blood pressure (the bottom number). However, they noted that more is not necessarily better when it comes to lowering blood pressure. The effect was independent of the dose administered. The people who took part in the study had high blood pressure.

 

Vitamin K Supplementation Reduces Nocturnal Leg Cramps in Older Adults: Vitamin K supplementation significantly reduced the frequency, intensity, and duration of nocturnal leg cramps in older adults. No adverse events related to vitamin K were identified.  published online on October 28 in JAMA Internal Medicine.

 


Other

80% of Strokes Are Preventable: The American Stroke Association has updated its guidelines on stroke risk reduction for the first time since 2014. In their recommendations, the ASA urges healthcare professionals to carefully screen patients for risk factors such as high blood pressure, elevated cholesterol levels, obesity, and high blood sugar. The new stroke guidelines highlight unique risk factors for females and transgender women and how social determinants of health impact stroke risk. The guidelines also emphasize the benefits of GLP-1 drugs for cardiovascular health, and encourage a balanced diet, regular physical activity, maintaining a healthy weight, and getting adequate sleep.  2024 Guideline for the Primary Prevention of StrokeTrusted Source

 

ACIP Recommends Pneumococcal Vaccine for Adults Aged 50 Years or Older: The US Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) now recommends a pneumococcal conjugate vaccine (PCV) for all PCV-naive adults aged 50 years or older. The new recommendation, which passed with an ACIP member vote of 14 for and 1 against, expands the current age-based recommendations, which include children younger than 5 years and adults older than 65 years, as well as adults aged 19-64 years with underlying conditions or risk factors who have not received a PCV and certain adults who have received PCV13 but not PCV20. 

 

AHA Scientific Statement Links Three Common Cardiovascular Diseases to Cognitive Decline, Dementia: The American Heart Association (AHA) has issued a new scientific statement on the link between heart failure (HF), atrial fibrillation (AF), and coronary heart disease (CHD) and the increased risk for cognitive impairment and dementia. The statement includes an extensive research review and offers compelling evidence of the inextricable link between heart health and brain health, which investigators said underscores the benefit of early intervention. The statement was published online on October 10 in Stroke.

 

ACOG Updates Breast Cancer Screening Guidelines: The American College of Obstetricians and Gynecologists (ACOG) has updated its breast cancer screening guidelines, recommending that individuals at an average risk for breast cancer initiate mammography screening at age 40. This change reflects evolving evidence that starting earlier screening yields greater net benefits in reducing breast cancer mortality, particularly for certain racial groups with higher risk factors.

 

 


TREATMENT

Ozempic Linked to Lower Alzheimer’s Risk in People with Type 2 Diabetes: According to a studyTrusted Source published on October 24, 2024, in the journal Alzheimer’s & Dementia, the type 2 diabetes and weight loss drug semaglutide (sold under the brand names OzempicWegovy, and Rybelsus) may reduce people’s risk of Alzheimer’s disease. Those people who were using semaglutide had a lower risk of being diagnosed with Alzheimer’s disease than those using other diabetes drugs.

 

New Cervical Cancer Treatment Improves Survival Rates, Clinical Trial Shows: A phase 3 clinical trial recently published in The LancetTrusted Source proposes a new standard of care for people with cervical cancer who aren’t candidates for surgery. The recommendation includes a combination of induction chemotherapy followed by chemoradiotherapy instead of chemoradiotherapy alone. Compared to participants who received only chemoradiotherapy, those who received both induction chemotherapy and chemoradiotherapy saw an increase from 64% to 72% in their 5-year progression-free survival rates.

 

For Bloodstream Infection, 7 Days of Antibiotics as Effective as 14: A 7-day antibiotic course for treating hospitalized patients’ bloodstream infection (BSI) was just as effective as a 14-day course, according to new data from a seven-country noninferiority trial.  Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) 

 

Metformin May Reduce Long COVID in Non-Diabetic Population: Metformin prescribed within a week of SARS-CoV-2 infection was associated with a 53% reduction in long COVID or death over 6 months in people without diabetes or prediabetes, according to data presented at the Infectious Disease Week (IDWeek) 2024 Annual Meeting.

 

Home-Based Phototherapy for Psoriasis as Effective as Office-Based Treatment: "These data support the use of home phototherapy as a first-line treatment option for psoriasis," and "efforts are needed to make home and office phototherapy more available to patients," said the study's lead author. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis meeting during the European Academy of Dermatology and Venereology (EADV) 2024 Congress

 

Cognitive Decline and Antihypertensive Use: New Data: Deprescribing antihypertensive medications is associated with a 12% lower likelihood of cognitive decline in older nursing home residents, a new study suggests. The association was strongest among those with dementia. published online on September 23 in JAMA Internal Medicine.

 

Novel Intervention Slows Cognitive Decline in At-Risk Adults: Combining cognitive remediation (CR) with transcranial direct current stimulation (tDCS) was associated with slower cognitive decline for up to 6 years in older adults with major depressive disorder that is in remission (rMDD), mild cognitive impairment (MCI), or both, new research suggests. The CR intervention included a series of progressively difficult computer-based and facilitator-monitored mental exercises designed to sharpen cognitive function. Researchers found that using CR with tDCS slowed decline in executive function and verbal memory more than other cognitive functions. The effect was stronger among people with rMDD vs those with MCI and in those at low genetic risk for Alzheimer’s disease. JAMA Psychiatry

 

Updates on Risk, Diagnosis, and Treatment of Thyroid Cancer: Patients who are new users of glucagon-like peptide-1 (GLP-1) receptor agonists have a low absolute risk of thyroid cancer, according to a new study presented at the American Thyroid Association (ATA) Annual Meeting

 

Prostate Cancer Treatment Associated With More Complications: Patients treated for prostate cancer had higher rates of complications, including urinary and sexual issues, than a control group of men. Radiotherapy increases the risk for bladder cancer and radiation-specific complications, according to the new cohort study.  published online on November 7, in JAMA Oncology.

 

Leukemia Drug Shows Promise in Lewy Body Dementia: Nilotinib, a drug approved by the US Food and Drug Administration (FDA) to treat chronic myeloid leukemia, improved biomarkers and cognitive outcomes in patients with dementia with Lewy bodies (DLB) in a phase 2 randomized, double-blind, placebo-controlled trial.  The findings align with an earlier study that showed possible disease-modifying effects of nilotinib in patients with mild cognitive impairment or Alzheimer’s disease, as previously reported by Medscape Medical News.The data were presented at the 17th Clinical Trials on Alzheimer’s Disease (CTAD)conference.

Intranasal Insulin Drug Combo Promising for Alzheimer’s: The combination of intranasal insulin (INI) and the sodium-glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin had positive effects on cognition and immune and inflammatory biomarkers in patients with mild cognitive impairment (MCI) or early Alzheimer’s disease (AD), in a phase 2 trial. The findings were presented at the 17th Clinical Trials on Alzheimer's Disease (CTAD)conference.

 

More Evidence Ties Semaglutide to Reduced Alzheimer’s Risk: A new study provides real-world evidence to support the potential repurposing of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), used to treat type 2 diabetes and obesity, for prevention of Alzheimer’s disease (AD).  Adults with type 2 diabetes who were prescribed the GLP-1 RA semaglutide had a significantly lower risk for AD compared with their peers who were prescribed any of seven other antidiabetic medications, including other types of GLP-1 receptor–targeting medications.  The study was published online on October 24 in Alzheimer’s & Dementia.

 

Semaglutide 2.4 mg Reduces All-Cause Hospital Admissions: Treatment with once-weekly semaglutide 2.4 mg (Wegovy) significantly reduced hospital admissions for all causes — not just cardiac — and overall hospitalization time in people with overweight/obesity and established cardiovascular disease (CVD). The new findings come from prespecified analyses of Novo Nordisk’s multicenter, randomized SELECT trial, which showed that compared with placebo, weekly semaglutide 2.4 mg significantly reduced the risk for cardiovascular events (death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke) over a mean of 39.8 months’ follow-up in 17,604 patients aged ≥ 45 years who had overweight/obesity and established CVD but not diabetes. The main SELECT results were presented at the American Heart Association meeting in November 2023 and simultaneously published in The New England Journal of Medicine.

 

Tirzepatide Slashes Progression From Prediabetes to T2D: Once-weekly tirzepatide (Zepbound) reduced the risk for progression from prediabetes to type 2 diabetes (T2D) by more than 90% at 3 years and continued to maintain dramatic levels of weight loss achieved earlier, but these benefits began reversing when the drug was stopped.  The findings, from the subset of 1032 individuals with prediabetes in Eli Lilly’s randomized, placebo-controlled SURMOUNT-1 trial, were presented November 4, 2024, at The Obesity Society’s ObesityWeek meeting and are due to be published November 13 in The New England Journal of Medicine. 

 

Mayo Clinic researchers recommend alternatives to hysterectomy for uterine fibroids, according to study: Uterine fibroids are a common condition that affects up to 80% of women in their lifetime. Nearly half of those women will experience symptoms that affect their quality of life and fertility, including severe pain and anemia. Uterine fibroids are the major reason for the removal of the uterus by hysterectomy. However, Mayo Clinic researchers recommend minimally invasive treatment alternatives to hysterectomy, in an invited clinical practice paper published in the New England Journal of Medicine. "Less invasive treatments can help women recover faster and resume their normal activities more quickly. Additionally, many studies have now shown that there are health benefits to keeping the uterus and the ovaries.”

 

Oral Semaglutide 25-mg Dose May Provide Most Benefit: Oral semaglutide 25 mg appears to be just as effective in promoting weight loss and other beneficial outcomes as are the investigational 50-mg oral dose and the injectable 2.4-mg dose (Wegovy), in new research. Obesity Week 2024 

 

Grief-specific cognitive behavioral therapy vs present-centered therapy: This randomized clinical trial demonstrates that cognitive behavioral therapy for prolonged grief was superior to present-centered therapy after treatment and at follow-up with regard to comorbid symptoms. Both treatments were shown to be effective and acceptable, showing the potential for dissemination and increasing patient choice. JAMA Psychiatry 

 

Endoscopic Sleeve Gastroplasty Yields Durable Weight Loss at 10 Years: New data showed durable weight loss of about 10% at 10 years after endoscopic sleeve gastroplasty (ESG) in adults with obesity. “The procedure is dependable and safe and should be considered among individuals who have not attained their desired results through lifestyle medications and those who are not eligible for or choose not to undergo bariatric procedures.” The American College of Gastroenterology (ACG) 2024 Annual Scientific Meeting.

 

OTHER

COVID on the Floor Linked to Outbreaks on Two Hospital Wards: The viral burden of SARS-CoV-2 on floors, even in healthcare worker–only areas, was strongly associated with COVID-19 outbreaks in two acute-care hospitals, according to a new study from Ontario, Canada. The study was published online on September 20 in Infection Control & Hospital 

Hospital Diagnostic Errors May Affect 7% of Patients: Diagnostic errors are common in hospitals and are largely preventable, according to a new observational study from the Division of General Internal Medicine at Brigham and Women’s Hospital and Harvard Medical School in Boston, published in BMJ Quality & Safety. Researchers found that 1 in 14 general medicine patients (7%) suffer harm due to diagnostic errors, and up to 85% of these cases could be prevented.

Abortion Rights Expanded in 7 States, But Change Will Take Time: Abortion was a key focal point of the 2024 presidential election, with abortion rights ballot measures passing in 7 of 10 states-Arizona, Colorado, Maryland, Missouri, Montana, Nevada, and New York. Donald Trump’s victory over Kamala Harris marks a turning point for American politics and an uncertain future for reproductive rights. While Trump has said he won’t sign a nationwide abortion ban, experts remain skeptical of the impending administration. In Florida, an amendment to limit government interference with abortion fell short of the needed 60% support at just over 57%.  In Nebraska, where both abortion protective and anti-abortion measures were on the ballot. The anti-abortion measure passed.  In South Dakota, an amendment to prohibit the state from restricting abortion during the first trimester failed to pass. The state currently has an abortion ban that only allows abortions to save the life of a pregnant person. Healthline 

 

5 Changes to Medicare in 2025 Will Affect Part D Coverage, Drug Costs: In 2025, an annual $2,000 out-of-pocket cap will keep costs low for Medicare enrollees on drugs covered by Part D plans. A payment plan will allow Medicare enrollees to pay for their drugs in capped monthly installments rather than paying the full cost upfront at the pharmacy. A drop in the number of stand-alone Part D drug plans will mean fewer choices for enrollees, which may simplify the process of choosing a Medicare plan. Healthline 

 

Bystander CPR up to 10 minutes after cardiac arrest may protect brain function: The sooner a lay rescuer (bystander) starts cardiopulmonary resuscitation (CPR) on a person having a cardiac arrest at home or in public, up to 10 minutes after the arrest, the better the chances of survival and brain protection, according to an analysis of nearly 200,000 out-of-hospital cardiac arrest cases in the U.S. from 2013 to 2022. American Heart Association's Resuscitation Science Symposium 2024.

 

Patients may become unnecessarily depressed by common heart medicine: All patients who have had a heart attack are typically treated using beta blockers. According to a recent study, this drug is unlikely to be needed for those heart patients who have a normal pumping ability. Now a sub-study shows that there is also a slight risk that these patients will become depressed by the treatment. European Heart Journal: Acute Cardiovascular Care 

 

Saturday, November 9, 2024

Living With Chronic Conditions: What to Do Now that Trump is Elected 2024 Edition


Today’s post is to help those who are affected by chronic and life threatening conditions get the care they need regardless of what the next four years brings. 

 In 2016, I knew that Trump’s election was going to create some unique challenges in healthcare, particularly for women, so I wrote the post What to Do Now that Trump is Elected. In the last eight years later, I’ve seen my fears come to fruition. Trump’s appointees to the Supreme Court overturned Row V Wade, which has resulted in increased death rates for women [Study finds higher maternal mortality in states with most abortion restrictions ] and infants [AJMC ] in states that enacted strict abortion bans. 

 

Trump’s funding cuts to Planned Parenthood (PP), which hasn’t used federal funds for decades to pay for abortions, resulted in the closure of PP offices in rural towns and cities across the country-including five in Vermont. Many do not realize that these offices are often the only source of primary care in this areas. My state, as well as many other parts of the country, lost basic primary care for women, particularly those who are living in poorer communities. 

 

Based on Trump’s track record, plus the publication of Project 2025,from the Heritage Foundation, which was written by many of Trump’s former advisers, we will see more impacts on healthcare. Note that while Trump has disassociated himself from Project 2025 to a certain extent, some of the proposals are ones that were set forth in his first administration and many are also consistent with his campaign speeches. 

 

The 900-page Project 2025 contains hundreds of policy proposals, some of which could impact the care you are receiving, as well as your well-being.  Such measures include: increased out of pocket expenses;  increasing premiums based on your gender or even eliminating them all together due to a pre-existing condition. This latter is very concerning to me as I have a child with a serious pre-existing condition. Whether Trump’s administration will do away with the Affordable Care Act and other programs remains to be seen. However keep in mind that subsidies to buy insurance from the Affordable Care Act marketplace are set to expire at the end of 2025. 

 

If you live in an area prone to floods and other national disasters, Project 2025 calls for Privatizing … the Federal Emergency Management Agency (FEMA) National Flood Insurance Program, reforming FEMA emergency spending to shift the majority of preparedness and response costs to states and localities instead of the federal government, eliminating most of DHS’s grant programs.”  How this will play out remains to be seen but the potential is there for significant impact on how disasters and recoveries are handled, which can have significant bearing on health and well-being. 


I follow the website “Your Local Epidemiologist,”  because that is my educational background. I found Jetelina’s comments in her post Now What for Public Health: We need to be ready for a new world to reflect my own thinking. 

 

For many in public health, like me, the prospect of national leadership by individuals with an established track record of ignoring the evidence is deeply disconcerting. This has led to anxiety (and even feelings of loss and sadness). So much is unknown about the future of this field—from policies like routine vaccinations, to the impact of falsehoods moving mainstream, to the resources available to hold up an “invisible shield” for the public’s health.

 

What is becoming increasingly clear is that we are entering a new world. As we put one foot in front of another, we must remember there’s a difference between what we can and can’t change, and sometimes, there’s a difference between what is easy and what is needed.

 

With that in mind, these are constructive things you can do:

1. Join the local chapter of the condition specific organization you are affected by (e.g. American Lung Association) and become actively involved.

 

2, Be an activist. Lobby congress, state and local governments for health care that is affordable for all. Keep on top of legislation in areas other than health care that could adversely impact you, e.g. removing pollution standards. Many health related organizations and health departments monitor state and national pending legislation so subscribe to their newsletters and check their blogs. Get involved in whatever level you can-your healthcare could depend on it. 

 

3. Boost your social capital: Resources that you now count on from local organizations-be it rides, homemaker services etc.-may no longer be available. Your social networks have value and importance, By being an active participant in your community, family, work and other networks, you have an opportunity to give to those in need and in turn, have community you can reach out to for help. One way to organize the people who make up your networks, so that they can help you or someone else, is a Lotsa Helping Hands website

 

4. Support Organizations (locally whenever possible) that are working with vulnerable communities and are seeking equality for all. Not everyone can make a financial contribution, but can help by volunteering and engaging in other forms of community activism.  Click here for health equity organizations and associations. Additional organizations to consider include:

• Free Clinics and Dental Services: If you are not familiar with the clinic in your area, try a Google search, State Listing  of Free clinics or call 2.1.1

• Area hospitals and community health centers

• Community Based Organizations: These are local organizations that work to meet the needs of a given community and can include churches, schools, civic groups (Rotary, Elks), day care etc. 

 

5.Try to Live Below Your Means or at the very least within your means: For many this is a challenge, but the money you can save now can help if you should find yourself needing to pay more out of pocket for care and/or increased premiums.

• Recession Proof Your Life 

• How to deal with rapidly rising costs 

• Financial Planning 

• Eight ways to cut your health care costs

• The Big Three (Diet, Exercise & Sleep): Making lifestyle changes can improve your health but also save money by reducing pharmacy bills, fewer office visits etc. 

•  I can’t afford my Meds 

•  Shop Around for the Best Pharmaceutical Prices

 

6. Be an informed health consumer:separate fact from fiction: There is a lot of misinformation on-line, particularly sites like Tic Tock. Keep in mind that scammers target those dealing with conditions without effective treatments and/or are life threatening. If it sounds too good to be true, it probably is.  Note that the third Saturday of every month is Journal Watch on this blog. The following short video can help you be a better e-health consumer.


 

7. Minimize Stress: Consider the following to reduce stress you might be experiencing: below is a list of activities that can improve how you feel. 

 Exercise (do something) including yoga, Tai chi or Qigong, a walk around the bock etc. 

• Eat a healthy diet & avoid bad habits (e.g. too much caffeine, drinking, cigarettes): 

• Meditate 

Breathe

• Laugh more

• Socialize: In person if possible. 

• Sleep

• Keeping a journal 

• Take a break with art, music and other creative endeavors: There are over 600 ways to do this at Take a Break Pinterest Board.