Risk of major congenital #malformations in relation to maternal #overweight and obesity severity: cohort study of 1.2 million singletons
http://www.bmj.com/content/357/bmj.j2563

Objective To estimate the risks of major congenital malformations in the offspring of mothers who are underweight (body mass index (BMI) <18.5), overweight (BMI 25 to <30), or in obesity classes I (BMI 30 to <35), II (35 to <40), or III (≥40) compared with offspring of normal weight mothers (BMI 18.5 to <25) in early pregnancy. The risks of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased with BMI from overweight to obesity class III. The largest organ specific relative risks related to maternal overweight and increasing obesity were observed for malformations of the nervous system. Malformations of the genital and digestive systems were also increased in offspring of obese mothers.

Conclusions Risks of any major congenital malformation and several subgroups of organ specific malformations progressively increased with maternal overweight and increasing severity of obesity. For women who are planning pregnancy, efforts should be encouraged to reduce adiposity in those with a BMI above the normal range.

Association Between Proton Pump Inhibitor Use and Risk of Progression of Chronic Kidney Disease
http://www.gastrojournal.org/article/S0016-5085(17)35688-3/pdf?referrer=http%3A%2F%2Fwww.jwatch.org%2Fna44321%2F2017%2F06%2F15%2Fare-proton-pump-inhibitors-associated-with-chronic-kidney%3Fijkey%3DwAGY6O3ALF3yI%26keytype%3Dref%26siteid%3Djwatch%26variant%3Dfull-text

Proton pump inhibitors (PPI) have been associated with acute kidney injury (AKI) and recent studies suggest that they may be associated with the risk of chronic kidney disease (CKD).

Users of PPIs, compared to users of H2Bs, had an increased risk for doubled levels of creatinine (1985 events; adjusted hazard ratio HR, 1.26; 95% CI, 1.05–1.51) and decrease in estimated glomerular filtration rate of 30% or more (11045 events; 1.26; 95% CI, 1.16–1.36). PPI use also associated with development of end-stage renal disease (HR, 2.40; 0.76–7.58) and AKI (HR, 1.30; 95% CI, 1.00–1.69). There was a graded association between cumulative exposure to PPIs and risk of CKD progression. This was not the case for cumulative H2B use.

Conclusions

Initiation of PPI therapy and cumulative PPI exposure associate with increased risk of CKD progression in a large, North European healthcare system. Although consistent, the association was modest in magnitude, and cannot exclude residual confounding.

Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association
http://circ.ahajournals.org/content/early/2017/06/15/CIR.0000000000000510

In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality. In contrast, replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of CVD and did not reduce CVD in clinical trials. Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials. Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD. This recommended shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern such as DASH (Dietary Approaches to Stop Hypertension) or the Mediterranean diet as emphasized by the 2013 American Heart Association/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans.

#Gout and subsequent #erectile dysfunction: a population-based cohort study from England
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461678/

An association has been suggested between gout and erectile dysfunction (ED), however studies quantifying the risk of ED amongst gout patients are lacking. We aimed to precisely determine the population-level absolute and relative rate of ED reporting among men with gout over a decade in England.

Overall, the absolute rate of ED post-gout diagnosis was 193 (95% confidence interval (CI): 184–202) per 10,000 person-years. This corresponded to a 31% (hazard ratio (HR): 1.31 95%CI: 1.24–1.40) increased relative risk and 0.6% excess absolute risk compared to those without gout. We did not observe statistically significant differences in the risk of ED among those prescribed ULT within 1 and 3 years after gout diagnosis. Compared to those unexposed, the risk of ED was also high in the year before gout diagnosis (relative rate = 1.63 95%CI 1.27–2.08). Similar findings were also observed for severe ED warranting pharmacological intervention.

Conclusions
We have shown a statistically significant increased risk of ED among men with gout. Our findings will have important implications in planning a multidisciplinary approach to managing patients with gout.

Acute effects of #exercise on women with pre-existing body #image concerns: A test of potential mediators
http://www.sciencedirect.com/science/article/pii/S1469029217302170

The primary purpose of this study was to propose and test a mediation model of changes in physical self-efficacy, physical self-perceptions, and affect as mediators by which a single bout of exercise improves state body image. A secondary purpose was to identify how long improvements in state body image are sustained post-exercise. Sixty university-aged women (19.57 ± 1.37 y) with pre-existing body image concerns, and who exercised regularly, were randomized to perform 30 min of moderate-to-vigorous intensity exercise or quiet reading. State body image, physical self-efficacy, physical self-perceptions and affect were assessed. Mediational analyses revealed self-perceptions of body fatness (95% CI 0.03, 0.44, κ2 = 0.13, abps = 0.20) and strength (95% CI 0.15, 0.60, κ2 = 0.23, abps = 0.33) mediated improvements in state body image which were sustained at least 20 min post-exercise.

These results contribute to the development of a model explaining the effects of exercise on body image and practical recommendations for the use of exercise to improve body image

Timing of Aspirin and Other Nonsteroidal Anti-Inflammatory Drug Use Among Patients With Colorectal Cancer in Relation to Tumor Markers and Survival http://ascopubs.org/doi/abs/10.1200/JCO.2017.72.3569?journalCode=jco

Regular use of aspirin is associated with improved survival for patients with colorectal cancer (CRC). However, the timing of and the subtype of CRC that would benefit the most from using aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) in relation to survival is unclear. overall survival (OS)

The association between any NSAID use after diagnosis and OS differed significantly by KRAS-mutation status (Pinteraction = .01). Use of any NSAID after diagnosis was associated with improved OS only among participants with KRAS wild-type tumors (HR, 0.60; 95% CI, 0.46 to 0.80) but not among those with KRAS-mutant tumors (HR, 1.24; 95% CI, 0.78 to 1.96).

Conclusion
Among long-term CRC survivors, regular use of NSAIDs after CRC diagnosis was significantly associated with improved survival in individuals with KRAS wild-type tumors.

Effect of #antibiotic stewardship on the incidence of infection and colonisation with antibiotic-#resistant bacteria and #Clostridium difficile infection: a systematic review and meta-analysis
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30325-0/abstract

Antibiotic stewardship programmes significantly reduce the incidence of infections and colonisation with antibiotic-resistant bacteria and C difficile infections in hospital inpatients. These results provide stakeholders and policy makers with evidence for implementation of antibiotic stewardship interventions to reduce the burden of infections from antibiotic-resistant bacteria.

Comparing the success rates of standard and modified #Valsalva maneuvers to terminate #PSVT: A randomized controlled trial

http://www.ajemjournal.com/article/S0735-6757(17)30415-1/fulltext

Fifty-six patients were randomized to modified or standard VM with 28 patients in each treatment arm. Three of 28 patients (10.7%) in VM group and 12 of 28 patients (42.9%) in modified VM group were returned to sinus rhythm after intervention (p = 0.007). The number of patients who needed rescue treatment was lower in the modified VM group - 16 (57.1%) of 28 versus 25 (89.3%) of 28 in the standard VM group (p = 0.007).

Conclusion

This study suggests that modified VM therapy was more effective than standard VM for terminating PSVT. The modified VM therapy also indirectly reduced the need for anti-arrhythmic medication and indirectly caused fewer side effects

The Modified Valsalva Maneuver:
Procedure: In a semi-recumbent position patients produce 40mmHg pressure for 15 seconds and then repositioned in a supine position with a passive leg raise immediately after the valsalva strain

One popular method of generating a Valsalva Manoeuvre is to get the patient to blow into a syringe in an attempt to move the plunger. Different syringe sizes were tested. A 10ml (Terumo) syringe was best
The 10 mL syringe is useful in generating the recommended standard of 40 mmHg intrathoracic pressure for the Valsalva manoeuvre

#Religious Coping and #Glycemic Control in Couples with Type 2 Diabetes
http://onlinelibrary.wiley.com/doi/10.1111/jmft.12241/abstract

Findings show spousal engagement in shared activities is significantly associated with glycemic control. Furthermore, the use of negative religious coping by the diabetic spouse, and positive religious coping by the nondiabetic spouse, related to lower levels and higher levels of shared glycemic control activities, respectively. Religious coping and shared glycemic control activities appear integral to couples managing type 2 diabetes and, may serve as useful points of intervention.

Discharge Against Medical Advice of Elderly Inpatients in the United States
http://onlinelibrary.wiley.com/doi/10.1111/jgs.14985/abstract;jsessionid=C9B7C4E4313C012F309BFECF3C53F0E7.f03t03

Discharge against medical advice (DAMA) is associated with greater risk of hospital readmission and higher morbidity, mortality, and costs, but with a rapidly increasing elderly inpatient population, there is a lack of national data on DAMA in this subgroup.

Factors associated with higher adjusted odds of DAMA were generally similar between age groups, although risk of DAMA was higher in elderly adults than in those aged 18 to 64 for blacks (OR 1.65, 95% CI 1.49–1.82 vs OR 1.16, 95% CI 1.12–1.20), Hispanics (OR 1.58, 95% CI 1.41–1.77 vs OR 0.83, 95% CI 0.79–0.87), and those in the lowest income quartile (OR 1.57, 95% CI 1.43–1.72 vs OR 1.12, 95% CI 1.08–1.17), suggesting that race/ethnicity and poverty are more pronounced as risk factors for DAMA in elderly inpatients.