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Frequent #drinking is a more important risk factor for new-onset atrial #fibrillation than binge drinking: a nationwide population-based study

Compared with patients who drink twice per week (reference group), patients who drink once per week showed the lowest risk [hazard ratio (HR) 0.933, 95% confidence interval (CI) 0.916–0.950] and those who drink everyday had the highest risk for new-onset AF (HR 1.412, 95% CI 1.373–1.453), respectively.

However, the amount of alcohol intake per drinking session did not present any clear association with new-onset AF. Regardless of whether weekly alcohol intake exceeded 210 g, the frequency of drinking was significantly associated with the risk of new-onset AF. In contrast, when patients were stratified by weekly alcohol intake (210 g per week), those who drink large amounts of alcohol per drinking session showed a lower risk of new-onset AF.

Conclusion
Frequent drinking and amount of alcohol consumption per week were significant risk factors for new-onset AF, whereas the amount of alcohol consumed per each drinking session was not an independent risk factor. Avoiding the habit of consuming a low but frequent amount of alcohol might therefore be important to prevent AF.

https://academic.oup.com/europace/advance-article/doi/10.1093/europace/euz256/5587889

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Occurrence of #Salmonella, Campylobacter, Clostridium and Enterobacteriaceae in raw #meat-based diets for #dogs

The practice of feeding raw meat-based diets (RMBD) to dogs has increased in popularity in recent years. However, RMBD are based on offal that has not undergone any type of treatment to reduce the microbial content, so there is a risk of potential pathogenic microorganisms being present.

Enterobacteriaceae were detected in all 60 samples and in 31 samples exceeded a level of 5000 bacteria/g, which is the threshold for satisfactory microbial hygiene according to EU regulations. In two samples, the amount of C. perfringens exceeded 5000 bacteria/g, which is the maximum level of anaerobic bacteria permitted by Swedish national guidelines. Salmonella species were found in four (7 per cent) and Campylobacter species in three (5 per cent) samples. These results show that it is critical to maintain good hygiene when storing, handling and feeding RMBD, in order to limit the potential health risks to animals and humans, especially young and immunocompromised individuals.

https://veterinaryrecord.bmj.com/content/184/14/442

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Relationship Between Daily #Stress, #Depression Symptoms, and #Facebook Addiction Disorder in Germany and in the United States

This study investigated the link between experience of daily stress, depression symptoms, and the Facebook Addiction Disorder (FAD) in Germany and in the United States. In samples from both countries (German sample: N = 531; U.S. sample: N = 909), daily stress was positively associated with FAD. Depression symptoms significantly positively moderated this positive relationship.

Thus, current findings demonstrate that depressed individuals who often tend to intensively use Facebook to escape from daily stress and to find relief and social support are at enhanced risk to develop FAD, which reinforces their negative symptoms. Therefore, interventions for depressed individuals should include alternative strategies to cope with daily stressors.

https://www.liebertpub.com/doi/10.1089/cyber.2019.0165

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Association of Occupational Exposure to #Disinfectants With Incidence of Chronic Obstructive #Pulmonary Disease Among US Female Nurses

Exposure to disinfectants in health care workers has been associated with respiratory health outcomes, including asthma.

Weekly use of disinfectants to clean surfaces only (16 786 [22.9%] of participants exposed) and to clean medical instruments (13 899 [19.0%] exposed) was associated with COPD incidence, with adjusted hazard ratios of 1.38 (95% CI, 1.13-1.68) for cleaning surfaces only and 1.31 (95% CI, 1.07-1.61) for cleaning medical instruments after adjustment for age, smoking (pack-years), race, ethnicity, and body mass index. High-level exposure, evaluated by the JTEM, to several specific disinfectants (ie, glutaraldehyde, bleach, hydrogen peroxide, alcohol, and quaternary ammonium compounds) was significantly associated with COPD incidence, with adjusted hazard ratios ranging from 1.25 (95% CI, 1.04-1.51) to 1.36 (95% CI, 1.13-1.64). Associations were not modified by smoking or asthma status (P for interaction > .15).

Conclusions and Relevance These longitudinal results suggest that regular use of chemical disinfectants among nurses may be a risk factor for developing COPD. If future studies confirm these results, exposure-reduction strategies that are compatible with infection control in health care settings should be developed

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753247?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=101819

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Fatty #Airways: Implications for #Obstructive Disease

Epidemiological studies report that overweight or obese asthmatic subjects have more severe disease than those of a healthy weight. We postulated accumulation of adipose tissue within the airway wall may occur in overweight patients and contribute to airway pathology

..BMI ranged from 15 to 45 (kg·m−2) and was greater in NFA (p<0.05). Adipose tissue was identified in the outer wall of large airways (Pbm>6 mm), but was rarely seen in small airways (Pbm<6 mm). Adipose tissue area correlated positively with BMI and airway wall thickness in all groups. Densities of neutrophils correlated with adipose tissue area in control subjects (Pbm>6 mm, p=0.04) and both neutrophils and eosinophils in FA (Pbm>12 mm, p<0.01).

These data show that adipose tissue is present within the airway wall and is related to BMI, wall thickness and the number of inflammatory cells. The accumulation of airway adipose tissue in overweight individuals may therefore contribute to airway pathophysiology.

https://erj.ersjournals.com/content/early/2019/09/02/13993003.00857-2019

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#Metoprolol for the Prevention of Acute Exacerbations of #COPD

Observational studies suggest that beta-blockers may reduce the risk of exacerbations and death in patients with moderate or severe chronic obstructive pulmonary disease (COPD), but these findings have not been confirmed in randomized trials.

. There was no significant between-group difference in the median time until the first exacerbation, which was 202 days in the metoprolol group and 222 days in the placebo group (hazard ratio for metoprolol vs. placebo, 1.05; 95% confidence interval [CI], 0.84 to 1.32; P=0.66). Metoprolol was associated with a higher risk of exacerbation leading to hospitalization (hazard ratio, 1.91; 95% CI, 1.29 to 2.83). The frequency of side effects that were possibly related to metoprolol was similar in the two groups, as was the overall rate of nonrespiratory serious adverse events. During the treatment period, there were 11 deaths in the metoprolol group and 5 in the placebo group.

CONCLUSIONS
Among patients with moderate or severe COPD who did not have an established indication for beta-blocker use, the time until the first COPD exacerbation was similar in the metoprolol group and the placebo group. Hospitalization for exacerbation was more common among the patients treated with metoprolol.

https://www.nejm.org/doi/full/10.1056/NEJMoa1908142

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Regulation of #lifespan by #neural excitation and REST

..Here we show that extended longevity in humans is associated with a distinct transcriptome signature in the cerebral cortex that is characterized by downregulation of genes related to neural excitation and synaptic function.

In Caenorhabditis elegans, neural excitation increases with age and inhibition of excitation globally, or in glutamatergic or cholinergic neurons, increases longevity. Furthermore, longevity is dynamically regulated by the excitatory–inhibitory balance of neural circuits. The transcription factor REST is upregulated in humans with extended longevity and represses excitation-related genes.

Notably, REST-deficient mice exhibit increased cortical activity and neuronal excitability during ageing. Similarly, loss-of-function mutations in the C. elegans REST orthologue genes spr-3 and spr-4 elevate neural excitation and reduce the lifespan of long-lived daf-2 mutants. In wild-type worms, overexpression of spr-4 suppresses excitation and extends lifespan. REST, SPR-3, SPR-4 and reduced excitation activate the longevity-associated transcription factors FOXO1 and DAF-16 in mammals and worms, respectively.

These findings reveal a conserved mechanism of ageing that is mediated by neural circuit activity and regulated by REST.

https://www.nature.com/articles/s41586-019-1647-8

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Association Between High School #Personality Phenotype and #Dementia 54 Years Later in Results From a National US Sample

To examine whether personality during adolescence—a time when preclinical dementia pathology is unlikely to be present—confers risk of dementia in later life and to test whether associations could be accounted for by health factors in adolescence or differed across socioeconomic status (SES).

Lower risk of dementia was associated with higher levels of vigor (hazard ratio for 1 SD, 0.93; 95% CI, 0.90-0.97; P < .001). Calm and maturity showed protective associations with later dementia that increased with SES. At 1 SD of SES, calm showed a hazard ratio of 0.89 (95% CI, 0.84-0.95; P < .001 for the interaction) and maturity showed a hazard ratio of 0.90 (95% CI, 0.85-0.96; P = .001 for the interaction).

Conclusions and Relevance This study’s findings suggest that the adolescent personality traits associated with later-life dementia are similar to those observed in studies of older persons. Moreover, the reduction in dementia risk associated with a calm and mature adolescent phenotype may be greater at higher levels of SES. Personality phenotype may be a true independent risk factor for dementia by age 70 years, preceding it by almost 5 decades and interacting with adolescent socioeconomic conditions.

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2752387

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#Potato ingestion is as effective as carbohydrate gels to support prolonged #cycling performance

We investigated the effects of potato purée ingestion during prolonged cycling on subsequent performance versus commercial CHO gel or a water-only condition. Twelve cyclists (70.7 ± 7.7 kg, 173 ± 8 cm, 31± 9 years, 22 ± 5.1 % body fat; mean ± SD) with average peak oxygen consumption (VO2PEAK)of 60.7 ± 9.0 mL/kg/min performed a 2 h cycling challenge (60-85%VO2PEAK) followed by a time trial (TT, 6kJ/kg body mass) while consuming potato, gel, or water in a randomized-crossover design.

The race fuels were administered with U-[13C6]glucose for an indirect estimate of gastric emptying rate. Blood samples were collected throughout the trials. Blood glucose concentrations were higher (P<0.001) in potato and gel conditions when compared to water condition. Blood lactate concentrations were higher (P=0.001) after the TT completion in both CHO conditions when compared to water condition.

TT performance was improved (P=0.032) in both potato (33.0 ± 4.5 min) and gel (33.0 ± 4.2 min) conditions when compared to the water condition (39.5 ± 7.9 min). Moreover, no difference was observed in TT performance between CHO conditions (P=1.00). In conclusion, potato and gel ingestion equally sustained blood glucose concentrations and TT performance. Our results support the effective use of potatoes to support race performance for trained cyclists.

https://www.physiology.org/doi/abs/10.1152/japplphysiol.00567.2019

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Association Between Limited English #Proficiency and Revisits and Readmissions After #Hospitalization for Patients With Acute and Chronic Conditions in Toronto, Ontario, Canada

Patients with limited English proficiency (LEP) in predominantly Anglophone settings face barriers to safe and high-quality health care.1,2 We examined whether emergency department (ED) visits or readmissions differed between English-proficient (EP) and LEP patients discharged with acute and chronic conditionsEP

Patients with LEP and heart failure had an increased risk of a 30-day ED visit (21.6% vs 14.7%; RR, 1.32; 95% CI, 1.12-1.55) compared with EP patients. Patients with LEP and heart failure experienced greater risk of readmission at 30 days (18.1% vs 13.9%; RR, 1.29; 95% CI, 1.08-1.54) and at 90 days (30.2% vs 25.7%; RR, 1.24; 95% CI, 1.09-1.40). Patients with LEP and COPD also had greater risk of readmission at 30 days (15.6% vs 11.8%; RR, 1.51; 95% CI, 1.11-2.06) and at 90 days (26.1% vs 20.6%; RR, 1.32; 95% CI, 1.06-1.65) but did not have significantly increased risk of a 30-day ED visit (17.6% vs 14.5%; RR, 1.25; 95% CI, 0.95-1.66) than did EP patients. For patients discharged with pneumonia or hip fracture, there was no significant difference in ED visits or readmissions between patients with LEP or EP

https://jamanetwork.com/journals/jama/fullarticle/2753354

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#Stress related disorders and subsequent risk of life threatening #infections: population based sibling controlled cohort study

..144 919 individuals with stress related disorders (post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions) identified from 1987 to 2013

Stress related disorders were associated with all studied life threatening infections, with the highest relative risk observed for meningitis (sibling based analysis 1.63 (1.23 to 2.16)) and endocarditis (1.57 (1.08 to 2.30)). Younger age at diagnosis of a stress related disorder and the presence of psychiatric comorbidity, especially substance use disorders, were associated with higher hazard ratios, whereas use of selective serotonin reuptake inhibitors in the first year after diagnosis of a stress related disorder was associated with attenuated hazard ratios.

Conclusion In the Swedish population, stress related disorders were associated with a subsequent risk of life threatening infections, after controlling for familial background and physical or psychiatric comorbidities.

https://www.bmj.com/content/367/bmj.l5784

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Population-Attributable Risk for Cardiovascular Disease Associated With #Hypertension in #Black Adults

The multivariable-adjusted HR associated with hypertension was 1.91 (95% CI, 1.48-2.46) for CVD, 2.41 (95% CI,1.59-3.66) for coronary heart disease, 1.52 (95% CI, 1.01-2.30) for heart failure, and 2.20 (95% CI, 1.44-3.36) for stroke. The prevalence of hypertension was 53.2% among non-Hispanic black individuals. The PAR associated with hypertension was 32.5% (95% CI, 20.5%-43.6%) for CVD, 42.7% (95% CI, 24.0%-58.4%) for coronary heart disease, 21.6% (95% CI, 0.6%-40.8%) for heart failure, and 38.9% (95% CI, 19.4%-55.6%) for stroke. The PAR was higher among those younger than 60 years (54.6% [95% CI, 37.2%-68.7%]) compared with those 60 years or older (32.0% [95% CI, 11.9%-48.1%]). No differences were present in subgroup analyses.

Conclusions and Relevance These findings suggest that a substantial proportion of CVD cases among black individuals are associated with hypertension. Interventions to maintain normal blood pressure throughout the life course may reduce the incidence of CVD in this population.

https://jamanetwork.com/journals/jamacardiology/article-abstract/2753609

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C-Reactive Protein Testing to Guide Antibiotic Prescribing for #COPD Exacerbations

Point-of-care testing of C-reactive protein (#CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD).

A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of follow-up (59.1% vs. 79.7%, for a difference of 20.6 percentage points; adjusted odds ratio, 0.30; 95% CI, 0.20 to 0.46). Two patients in the usual-care group died within 4 weeks after randomization from causes considered by the investigators to be unrelated to trial participation.

CONCLUSIONS
CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm.

https://www.nejm.org/doi/10.1056/NEJMoa1803185

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#Bedtime hypertension treatment improves #cardiovascular risk reduction: the Hygia Chronotherapy Trial

In this multicentre, controlled, prospective endpoint trial, 19 084 hypertensive patients (10 614 men/8470 women, 60.5 ± 13.7 years of age) were assigned (1:1) to ingest the entire daily dose of ≥1 hypertension medications at bedtime (n = 9552) or all of them upon awakening (n = 9532)

..Patients of the bedtime, compared with the upon-waking, treatment-time regimen showed significantly lower hazard ratio—adjusted for significant influential characteristics of age, sex, type 2 diabetes, chronic kidney disease, smoking, HDL cholesterol, asleep systolic blood pressure (BP) mean, sleep-time relative systolic BP decline, and previous CVD event—of the primary CVD outcome [0.55 (95% CI 0.50–0.61), P < 0.001] and each of its single components (P < 0.001 in all cases), i.e. CVD death [0.44 (0.34–0.56)], myocardial infarction [0.66 (0.52–0.84)], coronary revascularization [0.60 (0.47–0.75)], heart failure [0.58 (0.49–0.70)], and stroke [0.51 (0.41–0.63)].

Conclusion
Routine ingestion by hypertensive patients of ≥1 prescribed BP-lowering medications at bedtime, as opposed to upon waking, results in improved ABP control (significantly enhanced decrease in asleep BP and increased sleep-time relative BP decline, i.e. BP dipping) and, most importantly, markedly diminished occurrence of major CVD events.

https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478

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Comprehensive comparative effectiveness and safety of first-line #antihypertensive drug classes: a systematic, multinational, large-scale analysis

..Most estimates revealed no effectiveness differences between classes; however, #thiazide or thiazide-like diuretics showed better primary effectiveness than angiotensin-converting enzyme inhibitors: acute myocardial infarction (HR 0·84, 95% CI 0·75–0·95), hospitalisation for heart failure (0·83, 0·74–0·95), and stroke (0·83, 0·74–0·95) risk while on initial treatment. Safety profiles also favoured thiazide or thiazide-like diuretics over angiotensin-converting enzyme inhibitors. The non-dihydropyridine calcium channel blockers were significantly inferior to the other four classes.

Interpretation
This comprehensive framework introduces a new way of doing observational health-care science at scale. The approach supports equivalence between drug classes for initiating monotherapy for hypertension—in keeping with current guidelines, with the exception of thiazide or thiazide-like diuretics superiority to angiotensin-converting enzyme inhibitors and the inferiority of non-dihydropyridine calcium channel blockers.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32317-7/fulltext

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Dietary #salt promotes cognitive impairment through tau phosphorylation

Dietary habits and vascular risk factors promote both #Alzheimer’s disease and cognitive impairment caused by vascular factors1,2,3. Furthermore, accumulation of hyperphosphorylated tau, a microtubule-associated protein and a hallmark of Alzheimer’s pathology4, is also linked to vascular cognitive impairment5,6. In mice, a salt-rich diet leads to cognitive dysfunction associated with a nitric oxide deficit in cerebral endothelial cells and cerebral hypoperfusion

Here we report that dietary salt induces hyperphosphorylation of tau followed by cognitive dysfunction in mice, and that these effects are prevented by restoring endothelial nitric oxide production..

..These findings identify a causal link between dietary salt, endothelial dysfunction and tau pathology, independent of haemodynamic insufficiency. Avoidance of excessive salt intake and maintenance of vascular health may help to stave off the vascular and neurodegenerative pathologies that underlie dementia in the elderly

https://www.nature.com/articles/s41586-019-1688-z

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Comparison of #fracture risk using different supplemental doses of #vitamin D, #calcium or their combination: a network meta-analysis of randomised controlled trials

Inconsistent findings in regard to association between different concentrations of vitamin D, calcium or their combination and the risk of fracture have been reported during the past decade in community-dwelling older people

A total of 25 randomised controlled trials involving 43 510 participants fulfilled the inclusion criteria. There was no evidence that the risk of total fracture was reduced using different concentrations of vitamin D, calcium or their combination compared with placebo or no treatment. No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of hip or vertebral fractures.

Conclusions The use of supplements that included calcium, vitamin D or both was not found to be better than placebo or no treatment in terms of risk of fractures among community-dwelling older adults. It means the routine use of these supplements in community-dwelling older people should be treated more carefully.

https://bmjopen.bmj.com/content/9/10/e024595

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#Statins After Myocardial Infarction in the Oldest: A Cohort Study in the Clinical Practice Research Datalink Database

Among the 3900 patients aged 80 years and older, 2 years of statin prescriptions resulted in a lower risk of the composite outcome (adjusted HR = 0.81; 95% confidence interval [CI] = 0.66‐0.99) and of all‐cause mortality (adjusted HR = 0.84; 95% CI = 0.73‐0.97). During 4.5 years of median follow‐up, the NNT for prevention of the primary outcome was 59; and for mortality, the NNT was 36. Correcting for 36.2% deaths during the first 2 years increased the NNT on the primary outcome to 93 and to 61 on all‐cause mortality.

CONCLUSION
Our data support statin initiation after a first #MI in patients aged 80 years and older if continued for at least 2 years. Especially in patients with a low risk of 2‐year mortality, statins should be considered.

https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.16227

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Lipid metabolism links nutrient-exercise timing to insulin sensitivity in men classified as overweight or #obese

Pre-exercise nutrient availability alters acute metabolic responses to exercise, which could modulate training responsiveness

..exercise before versus after breakfast consumption increased net intramuscular lipid utilization in type I (net change: -3.44±2.63% versus 1.44±4.18% area lipid staining, p < 0.01) and type II fibres (-1.89±2.48% versus 1.83±1.92% area lipid staining, p < 0.05). Training Study - postprandial glycemia was not differentially affected by 6-weeks of exercise training performed before versus after carbohydrate intake (p>0.05). However, postprandial insulinemia was reduced with exercise training performed before, but not after carbohydrate ingestion (p=0.03). This resulted in increased oral glucose insulin sensitivity (25±38 vs -21±32 mL.min-1.m-2; p=0.01), associated with increased lipid utilization during exercise (r=0.50, p=0.02). Regular exercise before nutrient provision also augmented remodelling of skeletal muscle phospholipids and protein content of the glucose transport protein GLUT4 (p<0.05).

Conclusions
Experiments investigating exercise training and metabolic health should consider nutrient-exercise timing, and exercise performed before versus after nutrient intake (i.e., in the fasted state) may exert beneficial effects on lipid utilisation and reduce postprandial insulinemia.

https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgz104/5599745

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Serum elaidic acid concentration and risk of #dementia The Hisayama study

The associations between #trans fatty acids and dementia have been unclear. We investigated the prospective association between serum elaidic acid (trans 18:1 n-9) levels, as an objective biomarker for industrial trans fat, and incident dementia and its subtypes.

Higher serum elaidic acid levels were significantly associated with greater risk of developing all-cause dementia (p for trend = 0.003) and AD (p for trend = 0.02) after adjustment for traditional risk factors. These associations remained significant after adjustment for dietary factors, including total energy intake and intakes of saturated and polyunsaturated fatty acids (both p for trend <0.05). No significant associations were found between serum elaidic acid levels and vascular dementia.

Conclusions The findings suggest that higher serum elaidic acid is a possible risk factor for the development of all-cause dementia and AD in later life. Public health policy to reduce industrially produced trans fatty acids may assist in the primary prevention of dementia.

https://n.neurology.org/content/early/2019/10/23/WNL.0000000000008464

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Efficacy and safety of #anti-inflammatory agents for the treatment of major #depressive disorder: a systematic review and meta-analysis of randomised controlled trials

..Four studies explored the antidepressant effects of NSAIDs in addition to traditional antidepressants. In all four studies, celecoxib was added at the same dose (400 mg/day). Traditional antidepressants used were sertraline, fluoxetine and reboxetine.

We combined these studies for a subgroup meta-analysis, finding that antidepressants combined with celecoxib were better than antidepressants alone, leading to a larger reduction in depressive score (four RCTs, SMD −0.76, 95% CI −1.14 to −0.39, p<0.0001). Heterogeneity among studies was insignificant

..Five trials focused on women with MDD. Of these, one assessed the effect of celecoxib added to sertraline, while the other four examined the antidepressive effect of omege-3 FA as monotherapy. Combining the five studies, no difference in score changes was found between groups (SMD −0.49, 95% CI −1.01 to 0.03, p=0.06), with moderate heterogeneity detected among studies

Conclusion
Our systematic review and meta-analysis suggests that anti-inflammatory agents exert an antidepressant effect in the treatment of MDD and were generally safe with rates of adverse effects similar to those of placebo. Adjunctive treatment shows a more remarkable effect with NSAIDs, omega-3 FAs, statins and minocyclines showing significant antidepressant effects for MDD.

Anti-inflammatory agents show promising effects for MDD. However, owing to the chronic course of MDD, quality of life and adverse effects should be further investigated in high-quality randomised clinical trials with long-term follow-up.

https://jnnp.bmj.com/content/early/2019/08/29/jnnp-2019-320912.full