!!
Common #mental disorders within chronic #inflammatory disorders: a primary care database prospective investigation

https://ard.bmj.com/content/early/2019/03/07/annrheumdis-2018-214676

Among 538 707 participants, the incidence of depression ranged from 14 per 1000 person-years (severe psoriasis) to 9 per 1000 person-years (systemic vasculitis), substantively higher compared with their comparison group (5–7 per 1000 person-years). HRs of multiple depression and anxiety events were 16% higher within inflammatory disorders (HR, 1.16, 95% CI 1.12 to 1.21, p<0.001) compared with the matched comparison group. The incidence of depression and anxiety was strongly associated with the age at inflammatory disorder onset. The overall HR estimate for depression was 1.90 (95% CI 1.66 to 2.17, p<0.001) within early-onset disorder (<40 years of age) and 0.93 (95% CI 0.90 to 1.09, p=0.80) within late-onset disorder (≥60 years of age).

Conclusions
Primary care patients with inflammatory disorders have elevated rates of depression and anxiety incidence, particularly those patients with early-onset inflammatory disorders. This finding may reflect the impact of the underlying disease on patients’ quality of life, although the precise mechanisms require further investigation.

!!
Epidemiology and implications of concurrent diagnosis of #eosinophilic oesophagitis and #IBD based on a prospective population-based analysis

https://gut.bmj.com/content/early/2019/03/28/gutjnl-2018-318074

Eosinophilic oesophagitis (EoO) and IBD are immune-mediated diseases of the gastrointestinal tract with possible overlapping pathogenic mechanisms. Our aim was to define the epidemiology and clinical implications of concurrent EoO and IBD diagnoses.

Among 134 013 536 individuals, the incidence of EoO, CD and UC were 23.1, 51.2 and 55.2 per 100 000 person-years, respectively. The risk of EoO was higher among patients with CD (incidence rate ratio IRR 5.4, p<0.01; prevalence ratio (PR) 7.8, p<0.01) or UC (IRR 3.5, p<0.01; PR 5.0, p<0.01), while the risk of IBD was higher among patients with EoO (CD: IRR 5.7, p<0.01; PR 7.6, p<0.01; UC: IRR 3.4, p<0.01; PR 4.9, p<0.01) versus individuals without either diagnosis. Concurrent diagnosis of EoO and IBD was associated with greater composite risk of IBD-related complications (CD: adjusted HR (aHR) 1.09, p=0.01; UC: aHR 1.10, p=0.04) but lower composite risk of EoO-related complications (aHR 0.59; p<0.01).

Conclusion Based on a population-based prospective cohort analysis, the risk of EoO is significantly higher among patients with IBD and vice versa. Concurrent diagnoses might modify the risk of IBD-related and EoO-related complications. Studies defining the mechanisms underlying these observations are needed.

!!
#Caring for Others Cares for the Self: An Experimental Test of Brief Downward Social Comparison, Loving-Kindness, and Interconnectedness Contemplations

https://link.springer.com/article/10.1007/s10902-019-00100-2

Those who wished others well (loving-kindness) had lower #anxiety, greater happiness, greater empathy, and higher feelings of caring and connectedness than those in a control condition. The Interconnectedness condition resulted only in beneficial effects on social connection. Although social comparison theory suggests that downward social comparison should improve mood, this study found that it had no beneficial effects relative to the control condition and was significantly worse than the loving-kindness condition.

This brief loving-kindness contemplation worked equally well across several measured individual differences, and is a simple intervention that can be used to reduce anxiety, increase happiness, empathy, and feelings of social connection.

!!
American Diabetes Association® Issues Critical Updates to the 2019 Standards of Medical Care in #Diabetes

http://www.diabetes.org/newsroom/press-releases/2019/ada-issues-critical-updates-to-2019-standards-of-care.html

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality for individuals with diabetes, and heart disease is the cause of one in four deaths in the U.S. Diabetes is the leading cause of chronic kidney disease, and approximately one out of four adults with diabetes has kidney disease

Standards of Care updates are:

Section 10 was updated based on the outcome of Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT), which determined the addition of icosapent ethyl to statin therapy for patients with high triglyceride levels reduced cardiovascular events. The Standards of Care now include a recommendation that icosapent ethyl be considered for patients with diabetes and atherosclerotic cardiovascular disease (ASCVD) or other cardiac risk factors on a statin with controlled LDL-C, but with elevated triglycerides (135-499) to reduce cardiovascular risk.

Sections 9, 10, and 11 have been revised based on findings from The Dapagliflozin Effect on Cardiovascular Events-Thrombosis in Myocardial Infarction 58 (DECLARE-TIMI 58) Trial, in which dapagliflozin treatment showed a reduction of hospitalization for heart failure and a reduction in progression of chronic kidney disease (CKD).

Based on a revision to the prescribing information for dapagliflozin, for patients with diabetes and CKD, the approved use per estimated glomerular filtration rate (eGFR) has been revised from ≥60 mL/min/1.73 m2 to ≥45 mL/min/1.73 m2 in Section 11 of the Standards of Care

!!
Lifetime Risks for #Hypertension by Contemporary Guidelines in African American and White Men and Women

https://jamanetwork.com/journals/jamacardiology/article-abstract/2728380

Patterns of hypertension risk development over the adult lifespan and lifetime risks for hypertension under the American Heart Association and American College of Cardiology (AHA/ACC) 2017 thresholds for hypertension (≥130/80 mm Hg) are unknown.

Baseline prevalence of hypertension under the AHA/ACC 2017 threshold in participants entering the data set between 20 and 30 years of age was 30.7% in white men (n = 549 of 1790), 23.1% in African American men (n = 245 of 1063), 10.2% in white women (n = 210 of 2070), and 12.3% in African American women (n = 171 of 1390).

White men had lifetime risk of hypertension of 83.8% (95% CI, 82.5%-85.0%); African American men, 86.1% (95% CI, 84.1%-88.1%); white women, 69.3% (95% CI, 67.8%-70.7%); and African American women, 85.7% (95% CI, 84.0%-87.5%). These were greater than corresponding lifetime risks under the JNC7 threshold for hypertension (white men, 60.5% 95% CI, 58.9%-62.1%; African American men, 74.7% 95% CI, 71.9%-77.5%; white women, 53.9% 95% CI, 52.5%-55.4%; and African American women, 77.3% 95% CI, 75.0%-79.5%).

Conclusions and Relevance Under the AHA/ACC 2017 blood pressure threshold for hypertension, lifetime risks for hypertension exceeded 75% for African American men and women and white men. Furthermore, prevalence of blood pressure of 130/80 mm Hg or more is very high in young adulthood, suggesting that efforts to prevent development of hypertension should be focused early in the life course.

!!
Use of Contrast-Enhanced #MRI in Management of Discordant Core #Biopsy Results

https://www.ajronline.org/doi/abs/10.2214/AJR.18.20157

Evaluating concordance between core biopsy results and imaging findings is an integral component of #breast intervention. Pathologic results deemed benign discordant reflect concern that a malignancy may have been incorrectly sampled. Standard of care currently is surgical excision, although a large percentage of these lesions will be benign at final pathologic analysis. The purpose of this study was to determine whether inclusion of contrast-enhanced MRI would optimize patient care.

Fourteen patients had suspicious MRI findings; 31 patients did not. Negative or benign MRI findings were validated by stability at imaging follow-up of at least 1 year in 27 patients (28 lesions) and at least 6 months in four patients. Eight of the total of 46 discordant lesions were ultimately malignant, a rate of 17.3%, an expected result for BI-RADS 4 lesions. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI calculated in the group of 41 patients (42 lesions) with documented stability for at least 1 year were 100%, 93.3%, 85.7%, and 100%. The false-negative rate of MRI was 0%; the false-positive rate was 2 of 30 (6.7%).

CONCLUSION. In the management of discordant benign core biopsy results, contrast-enhanced MRI facilitated successful triage of patients to surgery; 31 of the original 45 patients (68.9%) avoided su

!!
Antimicrobial resistance patterns in #urinary E. #coli isolates after a change in a single center’s guidelines for uncomplicated cystitis in ambulatory settings

https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/antimicrobial-resistance-patterns-in-urinary-e-coli-isolates-after-a-change-in-a-single-centers-guidelines-for-uncomplicated-cystitis-in-ambulatory-settings/23C0C0A814FEBF9C7D24E8045437F5D6

Recommending #nitrofurantoin to treat uncomplicated cystitis was associated with increased nitrofurantoin use from 3.53 to 4.01 prescriptions per 1,000 outpatient visits, but nitrofurantoin resistance in E. coli isolates remained stable at 2%. Concomitant levofloxacin resistance was a significant risk for nitrofurantoin resistance in E. coli isolates (odds ratio [OR], 2.72; 95% confidence interval [CI], 1.04–7.17).

!!
Association of #Amyloid Positron Emission Tomography With Subsequent Change in Clinical Management Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia

https://jamanetwork.com/journals/jama/article-abstract/2729371

Amyloid #PET results were positive in 3817 patients with MCI (55.3%) and 3154 patients with dementia (70.1%). The composite end point changed in 4159 of 6905 patients with MCI (60.2% 95% CI, 59.1%-61.4%) and 2859 of 4504 patients with dementia (63.5% 95% CI, 62.1%-64.9%), significantly exceeding the 30% threshold in each group (P < .001, 1-sided). The etiologic diagnosis changed from Alzheimer disease to non–Alzheimer disease in 2860 of 11 409 patients (25.1% 95% CI, 24.3%-25.9%) and from non–Alzheimer disease to Alzheimer disease in 1201 of 11 409 (10.5% 95% CI, 10.0%-11.1%).

Conclusions and Relevance Among Medicare beneficiaries with MCI or dementia of uncertain etiology evaluated by dementia specialists, the use of amyloid PET was associated with changes in clinical management within 90 days. Further research is needed to determine whether amyloid PET is associated with improved clinical outcomes

!!
Some #Ecigarette Users Are Having #Seizures, Most Reports Involving Youth and Young Adults

https://www.fda.gov/TobaccoProducts/NewsEvents/ucm635133.htm

The FDA has become aware that some people who use e-cigarettes have experienced seizures, with most reports involving youth or young adult users. Seizures or convulsions are known potential side effects of nicotine toxicity and have been reported in the scientific literature in relation to intentional or accidental swallowing of e-liquid. However, a recent uptick in voluntary reports of adverse experiences with tobacco products that mentioned seizures occurring with e-cigarette use (e.g., vaping) signal a potential emerging safety issue. The FDA continues to monitor all adverse experiences reported to the agency about the use of e-cigarettes and encourages the public to report cases of individuals who use e-cigarettes and have had a seizure via the online Safety Reporting Portal, as further described below.

!!
Chronic Obstructive Pulmonary Disease Prevalence Among Adults Who Have Never Smoked, by #Industry and Occupation — United States, 2013–2017

https://www.cdc.gov/mmwr/volumes/68/wr/mm6813a2.htm

Highest prevalences were among workers aged ≥65 years (4.6%), women (3.0%), and those reporting fair/poor health (6.7%). Among industries and occupations, the highest #COPD prevalences were among workers in the information industry (3.3%) and office and administrative support occupations (3.3%).

Among women, the highest prevalences were among those employed in the information industry (5.1%) and in the transportation and material moving occupation (4.5%), and among men, among those employed in the agriculture, forestry, fishing, and hunting industry (2.3%) and the administrative and support, waste management, and remediation services industry (2.3%). High COPD prevalences in certain industries and occupations among persons who have never smoked underscore the importance of continued surveillance, early identification of COPD, and reduction or elimination of COPD-associated risk factors, such as the reduction of workplace exposures to dust, vapors, fumes, chemicals, and exposure to indoor and outdoor air pollutants.

!!
Genome-Wide Expression Profiling Unveils Autoimmune Response Signatures in the #Perivascular Adipose Tissue of Abdominal Aortic #Aneurysm

https://www.ahajournals.org/doi/10.1161/ATVBAHA.118.311803

Perivascular adipose tissue (PVAT) is thought to play a role in vascular homeostasis and in the pathogenesis of large vessel diseases, including abdominal aortic aneurysm (AAA). Herein, we tested the hypothesis that locally restricted transcriptional profiles characterize PVAT surrounding AAA, indicating specific dysfunctions associated with the disease.

..both innate and adaptive immune-response genes along with genes related to cell-death pathways, metabolic processes of collagen, sphingolipids, aminoglycans, and extracellular matrix degradation were strongly overrepresented in PVAT of AAA compared with PVAT of the not-dilated aorta.

Conclusions—
Our results support a possible function of PVAT in AAA pathogenesis and suggest that AAA is an immunologic disease with an underlying autoimmune component. Interfering with these disease-specific pathways would clarify their precise role in AAA pathogenesis.

!!
Gut #microbiota dependent anti-tumor immunity restricts #melanoma growth in Rnf5−/− mice

https://www.nature.com/articles/s41467-019-09525-y

Accumulating evidence points to an important role for the gut microbiome in anti-tumor immunity. Here, we show that altered intestinal microbiota contributes to anti-tumor immunity, limiting tumor expansion.

Mice lacking the ubiquitin ligase RNF5 exhibit attenuated activation of the unfolded protein response (UPR) components, which coincides with increased expression of inflammasome components, recruitment and activation of dendritic cells and reduced expression of antimicrobial peptides in intestinal epithelial cells.

..transfer of 11 bacterial strains, including B. rodentium, enriched in Rnf5−/− mice, establishes anti-tumor immunity and restricts melanoma growth in germ-free WT mice. Altered UPR signaling, exemplified in Rnf5−/− mice, coincides with altered gut microbiota composition and anti-tumor immunity to control melanoma growth.

12458024-textneck.jpg (700×525)

!!
Association Between Pre-Diabetes/ #Diabetes and Asthma Exacerbations in a Claims-Based Obese #Asthma Cohort

https://www.jaci-inpractice.org/article/S2213-2198(19)30244-2/abstract

Metabolic dysfunction may contribute to worsened asthma in obesity. The relationship between pre-diabetes and diabetes, metabolic conditions more common in obesity, and asthma outcomes is not well-characterized.

Individuals with a hemoglobin A1c (HbA1c) measurement were identified, categorized as within normal (<5.6%), pre-diabetes (5.7-6.4%), and diabetes (≥6.5%) ranges. Exacerbations, defined as asthma-related hospitalization, emergency department visit, or corticosteroid prescription ±14 days of an asthma-related outpatient visit, were ascertained

5,722 individuals were identified. Higher HgbA1c was associated with higher asthma exacerbation rates. In the fully-adjusted model, compared to individuals with normal HbA1c, those in the pre-diabetes range had a 27% higher rate (95% CI, 5%-52%), and those in the diabetes range had a 33% higher rate (95% CI, 2%-73%).

Conclusion
Pre-diabetes and diabetes were associated with higher rates of asthma exacerbation among obese adults with asthma. Results support evidence that insulin resistance and metabolic syndrome, metabolic features common in pre-diabetes/diabetes, can influence asthma morbidity.

!!
#Mind and #gut: Associations between mood and gastrointestinal distress in children exposed to adversity

https://www.cambridge.org/core/journals/development-and-psychopathology/article/mind-and-gut-associations-between-mood-and-gastrointestinal-distress-in-children-exposed-to-adversity/D29E390A71A1E74CAD6955177CDFAE44

Interactions between the brain and bacteria that live within the gastrointestinal system (the microbiome) underlie adversity–gastrointestinal–anxiety interactions, but these links have not been investigated during human development.

.. In Study 1, we demonstrated that previous adverse care experiences were associated with increased incidence of gastrointestinal symptoms in youth. Gastrointestinal symptoms were also associated with concurrent and future anxiety (measured across 5 years), and those gastrointestinal symptoms mediated the adversity–anxiety association at Time 1.

In a subsample of children who provided both stool samples and functional magnetic resonance imaging of the brain (Study 2, which was a “proof-of-principle”), adversity was associated with changes in diversity (both alpha and beta) of microbial communities, and bacteria levels (adversity-associated and adversity-independent) were correlated with prefrontal cortex activation to emotional faces. Implications of these data for supporting youth mental health are discussed.

!!
#Coffee cues elevate #arousal and reduce level of construal

https://www.sciencedirect.com/science/article/pii/S1053810018303350?via%3Dihub

Coffee and tea are two beverages commonly-consumed around the world. Therefore, there is much research regarding their physiological effects. However, less is known about their psychological meanings.

Derived from a predicted lay association between coffee and arousal, we posit that exposure to coffee-related cues should increase arousal, even in the absence of actual ingestion, relative to exposure to tea-related cues. We further suggest that higher arousal levels should facilitate a concrete level of mental construal as conceptualized by Construal Level Theory.

In four experiments, we find that coffee cues prompted participants to see temporal distances as shorter and to think in more concrete, precise terms. Both subjective and physiological arousal explain the effects. We situate our work in the literature that connects food and beverage to cognition or decision-making. We also discuss the applied relevance of our results as coffee and tea are among the most prevalent beverages globally.

!!
Use of vitamin D drops leading to kidney failure in a 54-year-old man

http://www.cmaj.ca/content/191/14/E390

The aim of this case study is to inform a wider audience that vitamin #D at large doses [10,000 IU daily] in patients with normal serum vitamin D levels can lead to #toxicity

KEY POINTS

.Vitamin D toxicity is rare, but clinicians must be aware of the risks of vitamin D use to limit complications related to hypercalcemia.

.Calcium levels may get worse before getting better in patients even after cessation of supplements, as vitamin D is fat soluble.

.Observational data and expert opinion suggest that glucocorticoids, ketoconazole and hydroxychloroquine are reasonable options to treat hypercalcemia related to vitamin D toxicity by decreasing the “active” 1, 25 dihydroxyvitamin D3 levels.

!!
Association Among Dietary #Supplement Use, Nutrient Intake, and #Mortality Among U.S. Adults: A Cohort Study

https://annals.org/aim/article-abstract/2730525/association-among-dietary-supplement-use-nutrient-intake-mortality-among-u

Ever-use of dietary supplements was not associated with mortality outcomes. Adequate intake (at or above the Estimated Average Requirement or the Adequate Intake level) of vitamin A, vitamin K, magnesium, zinc, and copper was associated with reduced all-cause or CVD mortality, but the associations were restricted to nutrient intake from foods.

Excess intake of calcium was associated with increased risk for cancer death (above vs. at or below the Tolerable Upper Intake Level: multivariable-adjusted rate ratio, 1.62 [95% CI, 1.07 to 2.45]; multivariable-adjusted rate difference, 1.7 [CI, −0.1 to 3.5] deaths per 1000 person-years), and the association seemed to be related to calcium intake from supplements (≥1000 mg/d vs. no use: multivariable-adjusted rate ratio, 1.53 [CI, 1.04 to 2.25]; multivariable-adjusted rate difference, 1.5 [CI, −0.1 to 3.1] deaths per 1000 person-years) rather than foods.

Use of dietary supplements is not associated with mortality benefits among U.S. adults.

!!
#Screening for #Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians

https://annals.org/aim/fullarticle/2730520/screening-breast-cancer-average-risk-women-guidance-statement-from-american

Guidance Statement 1:
In average-risk women aged 40 to 49 years, clinicians should discuss whether to screen for breast cancer with mammography before age 50 years. Discussion should include the potential benefits and harms and a woman's preferences. The potential harms outweigh the benefits in most women aged 40 to 49 years.

Guidance Statement 2:
In average-risk women aged 50 to 74 years, clinicians should offer screening for breast cancer with biennial mammography.

Guidance Statement 3:
In average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less, clinicians should discontinue screening for breast cancer.

Guidance Statement 4:
In average-risk women of all ages, clinicians should not use clinical breast examination to screen for breast cancer

!!
#Breakfast Skipping Is Associated with Increased Risk of Type 2 #Diabetes among Adults: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

https://academic.oup.com/jn/article-abstract/149/1/106/5167902?redirectedFrom=fulltext

In total 6 studies, based on 96,175 participants and 4935 cases, were included. The summary RR for type 2 diabetes comparing ever with never skipping breakfast was 1.33 (95% CI: 1.22, 1.46, n = 6 studies) without adjustment for BMI, and 1.22 (95% CI: 1.12, 1.34, n = 4 studies) after adjustment for BMI.

Nonlinear dose-response meta-analysis indicated that risk of type 2 diabetes increased with every additional day of breakfast skipping, but the curve reached a plateau at 4–5 d/wk, showing an increased risk of 55% (summary RR: 1.55; 95% CI: 1.41, 1.71). No further increase in risk of type 2 diabetes was observed after 5 d of breakfast skipping/wk (P for nonlinearity = 0.08).

Conclusions
This meta-analysis provides evidence that breakfast skipping is associated with an increased risk of type 2 diabetes, and the association is partly mediated by BMI.