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#Fruit and #Vegetable Intake and Mortality in Adults undergoing Maintenance #Hemodialysis
https://cjasn.asnjournals.org/content/early/2019/01/30/CJN.08580718
Compared with the lowest tertile of servings per week (0–5.5, median 2), the adjusted hazard ratios for the middle (5.6–10, median 8) and highest (>10, median 17) tertiles were 0.90 (95% CI, 0.81 to 1.00) and 0.80 (95% CI, 0.71 to 0.91) for all-cause mortality, 0.88 (95% CI, 0.76 to 1.02) and 0.77 (95% CI, 0.66 to 0.91) for noncardiovascular mortality and 0.95 (95% CI, 0.81 to 1.11) and 0.84 (95% CI, 0.70 to 1.00) for cardiovascular mortality, respectively.
Conclusions Fruit and vegetable intake in the hemodialysis population is low and a higher consumption is associated with lower all-cause and noncardiovascular death.
#Fruit and #Vegetable Intake and Mortality in Adults undergoing Maintenance #Hemodialysis
https://cjasn.asnjournals.org/content/early/2019/01/30/CJN.08580718
Compared with the lowest tertile of servings per week (0–5.5, median 2), the adjusted hazard ratios for the middle (5.6–10, median 8) and highest (>10, median 17) tertiles were 0.90 (95% CI, 0.81 to 1.00) and 0.80 (95% CI, 0.71 to 0.91) for all-cause mortality, 0.88 (95% CI, 0.76 to 1.02) and 0.77 (95% CI, 0.66 to 0.91) for noncardiovascular mortality and 0.95 (95% CI, 0.81 to 1.11) and 0.84 (95% CI, 0.70 to 1.00) for cardiovascular mortality, respectively.
Conclusions Fruit and vegetable intake in the hemodialysis population is low and a higher consumption is associated with lower all-cause and noncardiovascular death.
American Society of Nephrology
Fruit and Vegetable Intake and Mortality in Adults undergoing Maintenance Hemodialysis
![Figure][1]
Background and objectives Higher fruit and vegetable intake is associated with lower cardiovascular and all-cause mortality in the general population. It is unclear whether this association occurs in patients on hemodialysis, in whom high…
Background and objectives Higher fruit and vegetable intake is associated with lower cardiovascular and all-cause mortality in the general population. It is unclear whether this association occurs in patients on hemodialysis, in whom high…
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Association between suicidal #ideation and #suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value
https://www.cambridge.org/core/journals/bjpsych-open/article/association-between-suicidal-ideation-and-suicide-metaanalyses-of-odds-ratios-sensitivity-specificity-and-positive-predictive-value/D8A8A76A4AC052EEAF34E7EF44E20013
The expression of suicidal ideation is considered to be an important warning sign for suicide. However, the predictive properties of suicidal ideation as a test of later suicide are unclear.
The pooled sensitivity of suicidal ideation for later suicide was 41% (95% CI 35–48) and the pooled specificity was 86% (95% CI 76–92), with high between-study heterogeneity. Studies of suicidal ideation expressed by current and former psychiatric patients had a significantly higher pooled sensitivity (46% v. 22%) and lower pooled specificity (81% v. 96%) than studies conducted in non-psychiatric settings. The PPV among non-psychiatric cohorts (0.3%, 95% CI 0.1%–0.5%) was significantly lower (Q-value = 35.6, P < 0.001) than among psychiatric samples (3.9%, 95% CI 2.2–6.6).
Conclusions
Estimates of the extent of the association between suicidal ideation and later suicide are limited by unexplained between-study heterogeneity. The utility of suicidal ideation as a test for later suicide is limited by a modest sensitivity and low PPV.
Association between suicidal #ideation and #suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value
https://www.cambridge.org/core/journals/bjpsych-open/article/association-between-suicidal-ideation-and-suicide-metaanalyses-of-odds-ratios-sensitivity-specificity-and-positive-predictive-value/D8A8A76A4AC052EEAF34E7EF44E20013
The expression of suicidal ideation is considered to be an important warning sign for suicide. However, the predictive properties of suicidal ideation as a test of later suicide are unclear.
The pooled sensitivity of suicidal ideation for later suicide was 41% (95% CI 35–48) and the pooled specificity was 86% (95% CI 76–92), with high between-study heterogeneity. Studies of suicidal ideation expressed by current and former psychiatric patients had a significantly higher pooled sensitivity (46% v. 22%) and lower pooled specificity (81% v. 96%) than studies conducted in non-psychiatric settings. The PPV among non-psychiatric cohorts (0.3%, 95% CI 0.1%–0.5%) was significantly lower (Q-value = 35.6, P < 0.001) than among psychiatric samples (3.9%, 95% CI 2.2–6.6).
Conclusions
Estimates of the extent of the association between suicidal ideation and later suicide are limited by unexplained between-study heterogeneity. The utility of suicidal ideation as a test for later suicide is limited by a modest sensitivity and low PPV.
Cambridge Core
Association between suicidal ideation and suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive…
Association between suicidal ideation and suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value - Volume 5 Issue 2
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Computer simulations suggest that #prostate enlargement due to benign prostatic #hyperplasia mechanically impedes prostate cancer growth
https://www.pnas.org/content/116/4/1152
Prostate cancer and benign prostatic hyperplasia are common genitourinary diseases in aging men. Both pathologies may coexist and share numerous similarities, which have suggested several connections or some interplay between them.
The mechanical stress fields that originate as tumors enlarge have been shown to slow down their dynamics. Benign prostatic hyperplasia contributes to these mechanical stress fields, hence further restraining prostate cancer growth. We derived a tissue-scale, patient-specific mechanically coupled mathematical model to qualitatively investigate the mechanical interaction of prostate cancer and benign prostatic hyperplasia.
Our simulations show that a history of benign prostatic hyperplasia creates mechanical stress fields in the prostate that impede prostatic tumor growth and limit its invasiveness. The technology presented herein may assist physicians in the clinical management of benign prostate hyperplasia and prostate cancer by predicting pathological outcomes on a tissue-scale, patient-specific basis
Computer simulations suggest that #prostate enlargement due to benign prostatic #hyperplasia mechanically impedes prostate cancer growth
https://www.pnas.org/content/116/4/1152
Prostate cancer and benign prostatic hyperplasia are common genitourinary diseases in aging men. Both pathologies may coexist and share numerous similarities, which have suggested several connections or some interplay between them.
The mechanical stress fields that originate as tumors enlarge have been shown to slow down their dynamics. Benign prostatic hyperplasia contributes to these mechanical stress fields, hence further restraining prostate cancer growth. We derived a tissue-scale, patient-specific mechanically coupled mathematical model to qualitatively investigate the mechanical interaction of prostate cancer and benign prostatic hyperplasia.
Our simulations show that a history of benign prostatic hyperplasia creates mechanical stress fields in the prostate that impede prostatic tumor growth and limit its invasiveness. The technology presented herein may assist physicians in the clinical management of benign prostate hyperplasia and prostate cancer by predicting pathological outcomes on a tissue-scale, patient-specific basis
PNAS
Computer simulations suggest that prostate enlargement due to benign prostatic hyperplasia mechanically impedes prostate cancer…
Benign prostatic hyperplasia (BPH) is a common disease in aging men that causes the prostate to enlarge progressively. Men with larger prostates tend to harbor prostatic tumors with more favorable features. The underlying mechanisms that explain this interaction…
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The neuroactive potential of the human #gut #microbiota in quality of life and depression
https://www.nature.com/articles/s41564-018-0337-x
The relationship between gut microbial metabolism and mental health is one of the most intriguing and controversial topics in microbiome research. Bidirectional microbiota–gut–brain communication has mostly been explored in animal models, with human research lagging behind.
Butyrate-producing Faecalibacterium and Coprococcus bacteria were consistently associated with higher quality of life indicators. Together with Dialister, Coprococcus spp. were also depleted in depression, even after correcting for the confounding effects of antidepressants.
Using a module-based analytical framework, we assembled a catalogue of neuroactive potential of sequenced gut prokaryotes. Gut–brain module analysis of faecal metagenomes identified the microbial synthesis potential of the dopamine metabolite 3,4-dihydroxyphenylacetic acid as correlating positively with mental quality of life and indicated a potential role of microbial γ-aminobutyric acid production in depression.
Our results provide population-scale evidence for microbiome links to mental health, while emphasizing confounder importance.
The neuroactive potential of the human #gut #microbiota in quality of life and depression
https://www.nature.com/articles/s41564-018-0337-x
The relationship between gut microbial metabolism and mental health is one of the most intriguing and controversial topics in microbiome research. Bidirectional microbiota–gut–brain communication has mostly been explored in animal models, with human research lagging behind.
Butyrate-producing Faecalibacterium and Coprococcus bacteria were consistently associated with higher quality of life indicators. Together with Dialister, Coprococcus spp. were also depleted in depression, even after correcting for the confounding effects of antidepressants.
Using a module-based analytical framework, we assembled a catalogue of neuroactive potential of sequenced gut prokaryotes. Gut–brain module analysis of faecal metagenomes identified the microbial synthesis potential of the dopamine metabolite 3,4-dihydroxyphenylacetic acid as correlating positively with mental quality of life and indicated a potential role of microbial γ-aminobutyric acid production in depression.
Our results provide population-scale evidence for microbiome links to mental health, while emphasizing confounder importance.
Nature
The neuroactive potential of the human gut microbiota in quality of life and depression
Nature Microbiology - Correlation of microbiome features with host quality of life and depression identified specific taxa and microbial pathways in two independent, large population cohorts,...
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Compounded Topical Pain #Creams to Treat Localized Chronic #Pain: A Randomized Controlled Trial
https://annals.org/aim/article-abstract/2724041/compounded-topical-pain-creams-treat-localized-chronic-pain-randomized-controlled
Pain creams compounded for neuropathic pain (ketamine, gabapentin, clonidine, and lidocaine), nociceptive pain (ketoprofen, baclofen, cyclobenzaprine, and lidocaine), or mixed pain (ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, and lidocaine), or placebo.
For the primary outcome, no differences were found in the mean reduction in average pain scores between the treatment and control groups for patients with neuropathic pain (−0.1 points [95% CI, −0.8 to 0.5 points]), nociceptive pain (−0.3 points [CI, −0.9 to 0.2 points]), or mixed pain (−0.3 points [CI, −0.9 to 0.2 points]), or for all patients (−0.3 points [CI, −0.6 to 0.1 points]). At 1 month, 72 participants (36%) in the treatment groups and 54 (28%) in the control group had a positive outcome (risk difference, 8% [CI, −1% to 17%]).
Compounded pain creams were not better than placebo creams, and their higher costs compared with approved compounds should curtail routine use.
Compounded Topical Pain #Creams to Treat Localized Chronic #Pain: A Randomized Controlled Trial
https://annals.org/aim/article-abstract/2724041/compounded-topical-pain-creams-treat-localized-chronic-pain-randomized-controlled
Pain creams compounded for neuropathic pain (ketamine, gabapentin, clonidine, and lidocaine), nociceptive pain (ketoprofen, baclofen, cyclobenzaprine, and lidocaine), or mixed pain (ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, and lidocaine), or placebo.
For the primary outcome, no differences were found in the mean reduction in average pain scores between the treatment and control groups for patients with neuropathic pain (−0.1 points [95% CI, −0.8 to 0.5 points]), nociceptive pain (−0.3 points [CI, −0.9 to 0.2 points]), or mixed pain (−0.3 points [CI, −0.9 to 0.2 points]), or for all patients (−0.3 points [CI, −0.6 to 0.1 points]). At 1 month, 72 participants (36%) in the treatment groups and 54 (28%) in the control group had a positive outcome (risk difference, 8% [CI, −1% to 17%]).
Compounded pain creams were not better than placebo creams, and their higher costs compared with approved compounds should curtail routine use.
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Comparing #Automated Office Blood #Pressure Readings With Other Methods of Blood Pressure Measurement for Identifying Patients With Possible Hypertension
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2723074
Automated office blood pressure (AOBP) measurement involves recording several blood pressure (BP) readings using a fully automated oscillometric sphygmomanometer with the patient resting alone in a quiet place
Data were compiled from 31 articles comprising 9279 participants (4736 men and 4543 women). In samples with systolic AOBP of 130 mm Hg or more, routine office and research systolic BP readings were substantially higher than AOBP readings, with a pooled mean difference of 14.5 mm Hg (95% CI, 11.8-17.2 mm Hg; n = 9; I2 = 94.3%; P < .001) for routine office systolic BP readings and 7.0 mm Hg (95% CI, 4.9-9.1 mm Hg; n = 9; I2 = 85.7%; P < .001) for research systolic BP readings. Systolic awake ambulatory BP and AOBP readings were similar, with a pooled mean difference of 0.3 mm Hg (95% CI, −1.1 to 1.7 mm Hg; n = 19; I2 = 90%; P < .001).
Conclusions and Relevance Automated office blood pressure readings, only when recorded properly with the patient sitting alone in a quiet place, are more accurate than office BP readings in routine clinical practice and are similar to awake ambulatory BP readings, with mean AOBP being devoid of any white coat effect. There has been some reluctance among physicians to adopt this technique because of uncertainty about its advantages compared with more traditional methods of recording BP during an office visit. Based on the evidence, AOBP should now be the preferred method for recording BP in routine clinical practice.
Comparing #Automated Office Blood #Pressure Readings With Other Methods of Blood Pressure Measurement for Identifying Patients With Possible Hypertension
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2723074
Automated office blood pressure (AOBP) measurement involves recording several blood pressure (BP) readings using a fully automated oscillometric sphygmomanometer with the patient resting alone in a quiet place
Data were compiled from 31 articles comprising 9279 participants (4736 men and 4543 women). In samples with systolic AOBP of 130 mm Hg or more, routine office and research systolic BP readings were substantially higher than AOBP readings, with a pooled mean difference of 14.5 mm Hg (95% CI, 11.8-17.2 mm Hg; n = 9; I2 = 94.3%; P < .001) for routine office systolic BP readings and 7.0 mm Hg (95% CI, 4.9-9.1 mm Hg; n = 9; I2 = 85.7%; P < .001) for research systolic BP readings. Systolic awake ambulatory BP and AOBP readings were similar, with a pooled mean difference of 0.3 mm Hg (95% CI, −1.1 to 1.7 mm Hg; n = 19; I2 = 90%; P < .001).
Conclusions and Relevance Automated office blood pressure readings, only when recorded properly with the patient sitting alone in a quiet place, are more accurate than office BP readings in routine clinical practice and are similar to awake ambulatory BP readings, with mean AOBP being devoid of any white coat effect. There has been some reluctance among physicians to adopt this technique because of uncertainty about its advantages compared with more traditional methods of recording BP during an office visit. Based on the evidence, AOBP should now be the preferred method for recording BP in routine clinical practice.
Jamanetwork
Automated Office BP Readings vs Other Methods of BP Measurement to Identify Hypertension
This systematic review and meta-analysis examines the association between automated office blood pressure and office blood pressure readings measured in routine clinical practice and in research studies, and ambulatory blood pressure recorded during awake…
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Clinical Practice Guideline: #Tonsillectomy in Children (Update)
https://journals.sagepub.com/doi/full/10.1177/0194599818801757
The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should recommend watchful waiting for recurrent throat infection if there have been <7 episodes in the past year, <5 episodes per year in the past 2 years, or <3 episodes per year in the past 3 years. (2) Clinicians should administer a single intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy. (3) Clinicians should recommend ibuprofen, acetaminophen, or both for pain control after tonsillectomy.
Clinical Practice Guideline: #Tonsillectomy in Children (Update)
https://journals.sagepub.com/doi/full/10.1177/0194599818801757
The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should recommend watchful waiting for recurrent throat infection if there have been <7 episodes in the past year, <5 episodes per year in the past 2 years, or <3 episodes per year in the past 3 years. (2) Clinicians should administer a single intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy. (3) Clinicians should recommend ibuprofen, acetaminophen, or both for pain control after tonsillectomy.
SAGE Journals
Clinical Practice Guideline: Tonsillectomy in Children (Update)
Objective This update of a 2011 guideline developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation provides evidence-based recommend...
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A Randomized Trial of #E-Cigarettes versus #Nicotine-Replacement Therapy
https://www.nejm.org/doi/full/10.1056/NEJMoa1808779?query=featured_home
A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3%, vs. 51.2% in the nicotine-replacement group) and nausea more frequently in the nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette group). The e-cigarette group reported greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than did the nicotine-replacement group (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group differences in the incidence of wheezing or shortness of breath.
CONCLUSIONS
E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support.
A Randomized Trial of #E-Cigarettes versus #Nicotine-Replacement Therapy
https://www.nejm.org/doi/full/10.1056/NEJMoa1808779?query=featured_home
A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3%, vs. 51.2% in the nicotine-replacement group) and nausea more frequently in the nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette group). The e-cigarette group reported greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than did the nicotine-replacement group (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group differences in the incidence of wheezing or shortness of breath.
CONCLUSIONS
E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support.
New England Journal of Medicine
A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy | NEJM
Original Article from The New England Journal of Medicine — A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy
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Prevalence of #Malnutrition Risk and the Impact of Nutrition Risk on #Hospital Outcomes: Results From nutritionDay in the U.S.
https://onlinelibrary.wiley.com/doi/abs/10.1002/jpen.1499
The overall prevalence of malnutrition risk (MST score ≥2) was 32.7%. On nutritionDay, 32.1% of patients ate a quarter of their meal or less. Hospital mortality hazard ratio was 3.24 (95% CI: 1.73, 6.07; P‐value < 0.001) for patients eating a quarter compared with those who ate all their meal and increased to 5.99 (95% CI: 3.03, 11.84; P‐value < 0.0001) for patients eating nothing despite being allowed to eat.
Conclusion
This study provides the most robust estimate of malnutrition risk in U.S. hospitalized patients to date, finding that approximately 1 in 3 are at risk. Additionally, patients who have diminished meal intake experience increased mortality risk. These results highlight the ongoing issue of malnutrition in the hospital setting.
Prevalence of #Malnutrition Risk and the Impact of Nutrition Risk on #Hospital Outcomes: Results From nutritionDay in the U.S.
https://onlinelibrary.wiley.com/doi/abs/10.1002/jpen.1499
The overall prevalence of malnutrition risk (MST score ≥2) was 32.7%. On nutritionDay, 32.1% of patients ate a quarter of their meal or less. Hospital mortality hazard ratio was 3.24 (95% CI: 1.73, 6.07; P‐value < 0.001) for patients eating a quarter compared with those who ate all their meal and increased to 5.99 (95% CI: 3.03, 11.84; P‐value < 0.0001) for patients eating nothing despite being allowed to eat.
Conclusion
This study provides the most robust estimate of malnutrition risk in U.S. hospitalized patients to date, finding that approximately 1 in 3 are at risk. Additionally, patients who have diminished meal intake experience increased mortality risk. These results highlight the ongoing issue of malnutrition in the hospital setting.
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Full Study Report of #Andexanet Alfa for #Bleeding Associated with Factor Xa Inhibitors
https://www.nejm.org/doi/full/10.1056/NEJMoa1814051
In patients who had received apixaban, the median anti–factor Xa activity decreased from 149.7 ng per milliliter at baseline to 11.1 ng per milliliter after the andexanet bolus (92% reduction; 95% confidence interval [CI], 91 to 93); in patients who had received rivaroxaban, the median value decreased from 211.8 ng per milliliter to 14.2 ng per milliliter (92% reduction; 95% CI, 88 to 94). Excellent or good hemostasis occurred in 204 of 249 patients (82%) who could be evaluated. Within 30 days, death occurred in 49 patients (14%) and a thrombotic event in 34 (10%). Reduction in anti–factor Xa activity was not predictive of hemostatic efficacy overall but was modestly predictive in patients with intracranial hemorrhage.
CONCLUSIONS
In patients with acute major bleeding associated with the use of a factor Xa inhibitor, treatment with andexanet markedly reduced anti–factor Xa activity, and 82% of patients had excellent or good hemostatic efficacy at 12 hours, as adjudicated according to prespecified criteria.
Full Study Report of #Andexanet Alfa for #Bleeding Associated with Factor Xa Inhibitors
https://www.nejm.org/doi/full/10.1056/NEJMoa1814051
In patients who had received apixaban, the median anti–factor Xa activity decreased from 149.7 ng per milliliter at baseline to 11.1 ng per milliliter after the andexanet bolus (92% reduction; 95% confidence interval [CI], 91 to 93); in patients who had received rivaroxaban, the median value decreased from 211.8 ng per milliliter to 14.2 ng per milliliter (92% reduction; 95% CI, 88 to 94). Excellent or good hemostasis occurred in 204 of 249 patients (82%) who could be evaluated. Within 30 days, death occurred in 49 patients (14%) and a thrombotic event in 34 (10%). Reduction in anti–factor Xa activity was not predictive of hemostatic efficacy overall but was modestly predictive in patients with intracranial hemorrhage.
CONCLUSIONS
In patients with acute major bleeding associated with the use of a factor Xa inhibitor, treatment with andexanet markedly reduced anti–factor Xa activity, and 82% of patients had excellent or good hemostatic efficacy at 12 hours, as adjudicated according to prespecified criteria.
The New England Journal of Medicine
Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors | NEJM
Andexanet alfa is a modified recombinant inactive form of human factor Xa developed
for reversal of factor Xa inhibitors. We evaluated 352 patients who had acute major
bleeding within 18 hours afte...
for reversal of factor Xa inhibitors. We evaluated 352 patients who had acute major
bleeding within 18 hours afte...
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Factors Associated With Outcomes of Patients With Primary Sclerosing #Cholangitis and Development and Validation of a #Risk Scoring System
https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.30479
Serum alkaline phosphatase ≥2.4×ULN at 1 year post diagnosis, was predictive of 10‐year outcome (HR=3.05, C=0.63, median transplant‐free survival 63 versus 108 months, p<0.0001), as was the presence of extra‐hepatic biliary disease (HR=1.45, p=0.01). We developed two risk scoring systems based upon age, values of bilirubin, alkaline phosphatase, albumin, platelets, presence of extra‐hepatic biliary disease and variceal haemorrhage, which predicted 2‐ and 10‐year outcome with good discrimination (C=0.81 and 0.80 respectively). Both UK‐PSC risk scores were well‐validated in our external cohort, and out‐performed the Mayo and APRI scores (C=0.75 and 0.63 respectively). Whilst heterozygosity for the previously validated HLA‐DR*03:01 risk allele predicted increased risk of adverse outcome (HR=1.33, p=.001), its addition did not improve the predictive accuracy the UK‐PSC risk scores.
Conclusions
Our analyses, based upon a detailed clinical evaluation of a large representative cohort of participants with PSC, furthers our understanding of clinical risk markers and reports the development and validation of a real‐world scoring system to identify those patients most likely to die or require liver transplantation.
Factors Associated With Outcomes of Patients With Primary Sclerosing #Cholangitis and Development and Validation of a #Risk Scoring System
https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.30479
Serum alkaline phosphatase ≥2.4×ULN at 1 year post diagnosis, was predictive of 10‐year outcome (HR=3.05, C=0.63, median transplant‐free survival 63 versus 108 months, p<0.0001), as was the presence of extra‐hepatic biliary disease (HR=1.45, p=0.01). We developed two risk scoring systems based upon age, values of bilirubin, alkaline phosphatase, albumin, platelets, presence of extra‐hepatic biliary disease and variceal haemorrhage, which predicted 2‐ and 10‐year outcome with good discrimination (C=0.81 and 0.80 respectively). Both UK‐PSC risk scores were well‐validated in our external cohort, and out‐performed the Mayo and APRI scores (C=0.75 and 0.63 respectively). Whilst heterozygosity for the previously validated HLA‐DR*03:01 risk allele predicted increased risk of adverse outcome (HR=1.33, p=.001), its addition did not improve the predictive accuracy the UK‐PSC risk scores.
Conclusions
Our analyses, based upon a detailed clinical evaluation of a large representative cohort of participants with PSC, furthers our understanding of clinical risk markers and reports the development and validation of a real‐world scoring system to identify those patients most likely to die or require liver transplantation.
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Prevalence and Likelihood of Meeting #Sleep, Physical Activity, and #Screen-Time Guidelines Among US Youth
https://jamanetwork.com/journals/jamapediatrics/article-abstract/2723518
Sleep, physical activity, and screen-time behaviors among adolescents are risk factors for physical health (eg, obesity), mental and emotional health, behavioral outcomes (eg, tobacco use), and performance-based outcomes (eg, academic achievement).1-3 Accordingly, it is recommended that children (age 6-12 years) sleep 9 to 12 hours and adolescents (age 14-18 years) sleep 8 to 10 hours a night and that both groups accumulate at least 1 hour of moderate-intensity or vigorous-intensity aerobic physical activity and limit screen time (ie, exposure to all screen-based digital media) to less than 2 hours within a 24-hour period.3,4 Meeting recommendations for all 3 behaviors may have a greater association with health outcomes than meeting any 1 recommendation in isolation
Prevalence and Likelihood of Meeting #Sleep, Physical Activity, and #Screen-Time Guidelines Among US Youth
https://jamanetwork.com/journals/jamapediatrics/article-abstract/2723518
Sleep, physical activity, and screen-time behaviors among adolescents are risk factors for physical health (eg, obesity), mental and emotional health, behavioral outcomes (eg, tobacco use), and performance-based outcomes (eg, academic achievement).1-3 Accordingly, it is recommended that children (age 6-12 years) sleep 9 to 12 hours and adolescents (age 14-18 years) sleep 8 to 10 hours a night and that both groups accumulate at least 1 hour of moderate-intensity or vigorous-intensity aerobic physical activity and limit screen time (ie, exposure to all screen-based digital media) to less than 2 hours within a 24-hour period.3,4 Meeting recommendations for all 3 behaviors may have a greater association with health outcomes than meeting any 1 recommendation in isolation
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Predictors of Symptomatic #Kidney #Stone Recurrence After the First and Subsequent Episodes
https://www.mayoclinicproceedings.org/article/S0025-6196(18)30757-2/abstract
A parsimonious model identified the following independent risk factors for recurrence: younger age; male sex; higher body mass index; family history of stones; pregnancy; incident asymptomatic stone on imaging before the first episode; suspected stone episode before the first episode; history of a brushite, struvite, or uric acid stone; no history of calcium oxalate monohydrate stone; kidney pelvic or lower pole stone on imaging; no ureterovesical junction stone on imaging; number of kidney stones on imaging; and diameter of the largest kidney stone on imaging. The model had a C-index corrected for optimism of 0.681 and was used to develop a prediction tool. The risk of recurrence in 5 years ranged from 0.9% to 94%, depending on risk factors, number of past episodes, and years since the last episode.
Conclusion
The revised Recurrence Of Kidney Stone tool predicts the risk of symptomatic recurrence by using readily available clinical characteristics of stone formers
Predictors of Symptomatic #Kidney #Stone Recurrence After the First and Subsequent Episodes
https://www.mayoclinicproceedings.org/article/S0025-6196(18)30757-2/abstract
A parsimonious model identified the following independent risk factors for recurrence: younger age; male sex; higher body mass index; family history of stones; pregnancy; incident asymptomatic stone on imaging before the first episode; suspected stone episode before the first episode; history of a brushite, struvite, or uric acid stone; no history of calcium oxalate monohydrate stone; kidney pelvic or lower pole stone on imaging; no ureterovesical junction stone on imaging; number of kidney stones on imaging; and diameter of the largest kidney stone on imaging. The model had a C-index corrected for optimism of 0.681 and was used to develop a prediction tool. The risk of recurrence in 5 years ranged from 0.9% to 94%, depending on risk factors, number of past episodes, and years since the last episode.
Conclusion
The revised Recurrence Of Kidney Stone tool predicts the risk of symptomatic recurrence by using readily available clinical characteristics of stone formers
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Association Between #Ultraprocessed Food Consumption and Risk of #Mortality Among Middle-aged Adults in France
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2723626
Ultraprocessed foods accounted for a mean (SD) proportion of 14.4% (7.6%) of the weight of total food consumed, corresponding to a mean (SD) proportion of 29.1% (10.9%) of total energy intake. Ultraprocessed foods consumption was associated with younger age (45-64 years, mean [SE] proportion of food in weight, 14.50% [0.04%]; P < .001), lower income (<€1200/mo, 15.58% [0.11%]; P < .001), lower educational level (no diploma or primary school, 15.50% [0.16%]; P < .001), living alone (15.02% [0.07%]; P < .001), higher body mass index (calculated as weight in kilograms divided by height in meters squared; ≥30, 15.98% [0.11%]; P < .001), and lower physical activity level (15.56% [0.08%]; P < .001). A total of 602 deaths (1.4%) occurred during follow-up. After adjustment for a range of confounding factors, an increase in the proportion of ultraprocessed foods consumed was associated with a higher risk of all-cause mortality (HR per 10% increment, 1.14; 95% CI, 1.04-1.27; P = .008).
Conclusions and Relevance An increase in ultraprocessed foods consumption appears to be associated with an overall higher mortality risk among this adult population; further prospective studies are needed to confirm these findings and to disentangle the various mechanisms by which ultraprocessed foods may affect health.
Association Between #Ultraprocessed Food Consumption and Risk of #Mortality Among Middle-aged Adults in France
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2723626
Ultraprocessed foods accounted for a mean (SD) proportion of 14.4% (7.6%) of the weight of total food consumed, corresponding to a mean (SD) proportion of 29.1% (10.9%) of total energy intake. Ultraprocessed foods consumption was associated with younger age (45-64 years, mean [SE] proportion of food in weight, 14.50% [0.04%]; P < .001), lower income (<€1200/mo, 15.58% [0.11%]; P < .001), lower educational level (no diploma or primary school, 15.50% [0.16%]; P < .001), living alone (15.02% [0.07%]; P < .001), higher body mass index (calculated as weight in kilograms divided by height in meters squared; ≥30, 15.98% [0.11%]; P < .001), and lower physical activity level (15.56% [0.08%]; P < .001). A total of 602 deaths (1.4%) occurred during follow-up. After adjustment for a range of confounding factors, an increase in the proportion of ultraprocessed foods consumed was associated with a higher risk of all-cause mortality (HR per 10% increment, 1.14; 95% CI, 1.04-1.27; P = .008).
Conclusions and Relevance An increase in ultraprocessed foods consumption appears to be associated with an overall higher mortality risk among this adult population; further prospective studies are needed to confirm these findings and to disentangle the various mechanisms by which ultraprocessed foods may affect health.
Jamanetwork
Association of Ultraprocessed Foods With Mortality Risk Among French Adults
This cohort study uses the self-reported food intake and other nutrition-related data of a large cohort of adults enrolled in the French NutriNet-Santé Study to assess the association between ultraprocessed food consumption and risk of death from any cause.
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Effect of Combination of Paracetamol (Acetaminophen) and #Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After Total Hip #Arthroplasty
https://jamanetwork.com/journals/jama/article-abstract/2724188
Median 24-hour morphine consumption was 20 mg (99.6% CI, 0-148) in the PCM + IBU group, 36 mg (99.6% CI, 0-166) for PCM alone, 26 mg (99.6% CI, 2-139) for IBU alone, and 28 mg (99.6% CI, 2-145) for HS–PCM + IBU. The median difference in morphine consumption between the PCM + IBU group vs PCM alone was 16 mg (99.6% CI, 6.5 to 24; P < .001); for the PCM-alone group vs HS–PCM + IBU, 8 mg (99.6% CI, −1 to 14; P = .001); and for the PCM + IBU group vs IBU alone, 6 mg (99.6% CI, −2 to 16; P = .002).
Conclusions and Relevance Among patients undergoing THA, paracetamol plus ibuprofen significantly reduced morphine consumption compared with paracetamol alone in the first 24 hours after surgery; there was no statistically significant increase in SAEs in the pooled groups receiving ibuprofen alone vs with paracetamol alone. However, the combination did not result in a clinically important improvement over ibuprofen alone, suggesting that ibuprofen alone may be a reasonable option for early postoperative oral analgesia.
Effect of Combination of Paracetamol (Acetaminophen) and #Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After Total Hip #Arthroplasty
https://jamanetwork.com/journals/jama/article-abstract/2724188
Median 24-hour morphine consumption was 20 mg (99.6% CI, 0-148) in the PCM + IBU group, 36 mg (99.6% CI, 0-166) for PCM alone, 26 mg (99.6% CI, 2-139) for IBU alone, and 28 mg (99.6% CI, 2-145) for HS–PCM + IBU. The median difference in morphine consumption between the PCM + IBU group vs PCM alone was 16 mg (99.6% CI, 6.5 to 24; P < .001); for the PCM-alone group vs HS–PCM + IBU, 8 mg (99.6% CI, −1 to 14; P = .001); and for the PCM + IBU group vs IBU alone, 6 mg (99.6% CI, −2 to 16; P = .002).
Conclusions and Relevance Among patients undergoing THA, paracetamol plus ibuprofen significantly reduced morphine consumption compared with paracetamol alone in the first 24 hours after surgery; there was no statistically significant increase in SAEs in the pooled groups receiving ibuprofen alone vs with paracetamol alone. However, the combination did not result in a clinically important improvement over ibuprofen alone, suggesting that ibuprofen alone may be a reasonable option for early postoperative oral analgesia.
Jamanetwork
Paracetamol and Ibuprofen and Morphine Consumption After Total Hip Arthroplasty
This randomized clinical trial compares the effects of combination paracetamol (acetaminophen) and ibuprofen at full vs half strength vs either drug alone on 24-hour patient-controlled morphine consumption and 90-day serious adverse events after total hip…
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A User-Friendly Prediction Tool to Identify #Colectomy Risk in Patients With #Ulcerative Colitis
https://academic.oup.com/ibdjournal/advance-article-abstract/doi/10.1093/ibd/izz014/5310380?redirectedFrom=fulltext
We identified 115 cases and 325 controls. TPC predictors included albumin, 9-point Mayo score >5, Mayo endoscopic subscore >1, and corticosteroid use within 6 months. The areas under the receiver operating characteristic curve for the multivariable model were 0.94 (95% confidence interval [CI], 0.92–0.95) and 0.92 (95% CI, 0.89–0.95) for the test and validation cohorts, respectively. The validation cohort demonstrated a significant difference in calculated probability distributions between patients who did and did not have TPC (P < 0.01). We incorporated our model into a web-based application to allow convenient calculation of a patient’s TPC risk.
Conclusions
We created a user-friendly tool to assess TPC risk in UC. Prospective assessment will determine its utility for shared therapeutic decision-making.
A User-Friendly Prediction Tool to Identify #Colectomy Risk in Patients With #Ulcerative Colitis
https://academic.oup.com/ibdjournal/advance-article-abstract/doi/10.1093/ibd/izz014/5310380?redirectedFrom=fulltext
We identified 115 cases and 325 controls. TPC predictors included albumin, 9-point Mayo score >5, Mayo endoscopic subscore >1, and corticosteroid use within 6 months. The areas under the receiver operating characteristic curve for the multivariable model were 0.94 (95% confidence interval [CI], 0.92–0.95) and 0.92 (95% CI, 0.89–0.95) for the test and validation cohorts, respectively. The validation cohort demonstrated a significant difference in calculated probability distributions between patients who did and did not have TPC (P < 0.01). We incorporated our model into a web-based application to allow convenient calculation of a patient’s TPC risk.
Conclusions
We created a user-friendly tool to assess TPC risk in UC. Prospective assessment will determine its utility for shared therapeutic decision-making.
OUP Academic
User-Friendly Prediction Tool to Identify Colectomy Risk in Patients With Ulcerative Colitis
AbstractBackground. Many patients with ulcerative colitis (UC) fear the potential side effects of immunosuppressive therapies. However, those with medically re
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Artificially #Sweetened Beverages and #Stroke, Coronary #Heart Disease, and All-Cause Mortality in the Women’s Health Initiative
https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023100
Adjusted models indicated that hazard ratios and 95% confidence intervals were 1.23 (1.02–1.47) for all stroke; 1.31 (1.06–1.63) for ischemic stroke; 1.29 (1.11–1.51) for coronary heart disease; and 1.16 (1.07–1.26) for all-cause mortality. In women with no prior history of cardiovascular disease or diabetes mellitus, high consumption of ASB was associated with more than a 2-fold increased risk of small artery occlusion ischemic stroke hazard ratio =2.44 (95% confidence interval, 1.47–4.04.) High consumption of ASBs was associated with significantly increased risk of ischemic stroke in women with body mass index ≥30; hazard ratio =2.03 (95% confidence interval, 1.38–2.98).
Conclusions—
Higher intake of ASB was associated with increased risk of stroke, particularly small artery occlusion subtype, coronary heart disease, and all-cause mortality. Although requiring replication, these new findings add to the potentially harmful association of consuming high quantities of ASB with these health outcomes.
Artificially #Sweetened Beverages and #Stroke, Coronary #Heart Disease, and All-Cause Mortality in the Women’s Health Initiative
https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023100
Adjusted models indicated that hazard ratios and 95% confidence intervals were 1.23 (1.02–1.47) for all stroke; 1.31 (1.06–1.63) for ischemic stroke; 1.29 (1.11–1.51) for coronary heart disease; and 1.16 (1.07–1.26) for all-cause mortality. In women with no prior history of cardiovascular disease or diabetes mellitus, high consumption of ASB was associated with more than a 2-fold increased risk of small artery occlusion ischemic stroke hazard ratio =2.44 (95% confidence interval, 1.47–4.04.) High consumption of ASBs was associated with significantly increased risk of ischemic stroke in women with body mass index ≥30; hazard ratio =2.03 (95% confidence interval, 1.38–2.98).
Conclusions—
Higher intake of ASB was associated with increased risk of stroke, particularly small artery occlusion subtype, coronary heart disease, and all-cause mortality. Although requiring replication, these new findings add to the potentially harmful association of consuming high quantities of ASB with these health outcomes.
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Association of #Cannabis Use in Adolescence and Risk of #Depression, Anxiety, and Suicidality in Young Adulthood
A Systematic Review and Meta-analysis
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2723657
The OR of developing depression for cannabis users in young adulthood compared with nonusers was 1.37 (95% CI, 1.16-1.62; I2 = 0%). The pooled OR for anxiety was not statistically significant: 1.18 (95% CI, 0.84-1.67; I2 = 42%). The pooled OR for suicidal ideation was 1.50 (95% CI, 1.11-2.03; I2 = 0%), and for suicidal attempt was 3.46 (95% CI, 1.53-7.84, I2 = 61.3%).
Conclusions and Relevance Although individual-level risk remains moderate to low and results from this study should be confirmed in future adequately powered prospective studies, the high prevalence of adolescents consuming cannabis generates a large number of young people who could develop depression and suicidality attributable to cannabis. This is an important public health problem and concern, which should be properly addressed by health care policy.
Association of #Cannabis Use in Adolescence and Risk of #Depression, Anxiety, and Suicidality in Young Adulthood
A Systematic Review and Meta-analysis
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2723657
The OR of developing depression for cannabis users in young adulthood compared with nonusers was 1.37 (95% CI, 1.16-1.62; I2 = 0%). The pooled OR for anxiety was not statistically significant: 1.18 (95% CI, 0.84-1.67; I2 = 42%). The pooled OR for suicidal ideation was 1.50 (95% CI, 1.11-2.03; I2 = 0%), and for suicidal attempt was 3.46 (95% CI, 1.53-7.84, I2 = 61.3%).
Conclusions and Relevance Although individual-level risk remains moderate to low and results from this study should be confirmed in future adequately powered prospective studies, the high prevalence of adolescents consuming cannabis generates a large number of young people who could develop depression and suicidality attributable to cannabis. This is an important public health problem and concern, which should be properly addressed by health care policy.
Jamanetwork
Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood
This systematic review and meta-analysis examines the association of cannabis use during adolescence with risk of developing subsequent major depression, anxiety, and suicidal behavior in young adulthood.
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Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis #A Vaccine for Persons Experiencing #Homelessness
https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a6.htm?s_cid=mm6806a6_w
Hepatitis A (HepA) vaccine is highly safe and effective, and a complete HepA vaccine series provides long-term protection against hepatitis A virus (HAV) infection. Person-to-person HAV outbreaks among persons using drugs or experiencing homelessness are widespread and ongoing.
What is added by this report?
All persons aged ≥1 year experiencing homelessness should be routinely immunized against HAV. Vaccination of homeless persons facilitates integration of HepA vaccine into routine preventive services.
What are the implications for public health practice?
HepA vaccination of homeless persons would improve protection of persons at increased risk of exposure to HAV and complications of hepatitis A disease and reduce the risk for large-scale outbreaks by increasing immunity to HAV among homeless persons living in congregate settings where HAV can spread readily.
Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis #A Vaccine for Persons Experiencing #Homelessness
https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a6.htm?s_cid=mm6806a6_w
Hepatitis A (HepA) vaccine is highly safe and effective, and a complete HepA vaccine series provides long-term protection against hepatitis A virus (HAV) infection. Person-to-person HAV outbreaks among persons using drugs or experiencing homelessness are widespread and ongoing.
What is added by this report?
All persons aged ≥1 year experiencing homelessness should be routinely immunized against HAV. Vaccination of homeless persons facilitates integration of HepA vaccine into routine preventive services.
What are the implications for public health practice?
HepA vaccination of homeless persons would improve protection of persons at increased risk of exposure to HAV and complications of hepatitis A disease and reduce the risk for large-scale outbreaks by increasing immunity to HAV among homeless persons living in congregate settings where HAV can spread readily.
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Overall and Site-Specific #Cancer Mortality in Patients on #Dialysis and after Kidney #Transplant
https://jasn.asnjournals.org/content/early/2019/02/13/ASN.2018090906
Overall, cancer SMRs were 2.6 for patients on dialysis and 2.7 for transplant recipients. For patients on dialysis, SMRs were highest for multiple myeloma (30.5), testicular cancer (17.0), and kidney cancer (12.5); for transplant recipients, SMRs were highest for non-Hodgkin lymphoma (10.7), kidney cancer (7.8), and melanoma (5.8). Some 61.0% of patients on dialysis and 9.6% of transplant recipients who experienced cancer death had preexisting cancer. The SMRs for de novo cancer was 1.2 for patients on dialysis and 2.6 for transplant recipients.
Conclusions Patients on dialysis and transplant recipients experienced >2.5-fold increased risk of cancer death compared with the general population. This increased risk was largely driven by preexisting cancers in patients on dialysis and de novo cancers in patients with transplants.
Overall and Site-Specific #Cancer Mortality in Patients on #Dialysis and after Kidney #Transplant
https://jasn.asnjournals.org/content/early/2019/02/13/ASN.2018090906
Overall, cancer SMRs were 2.6 for patients on dialysis and 2.7 for transplant recipients. For patients on dialysis, SMRs were highest for multiple myeloma (30.5), testicular cancer (17.0), and kidney cancer (12.5); for transplant recipients, SMRs were highest for non-Hodgkin lymphoma (10.7), kidney cancer (7.8), and melanoma (5.8). Some 61.0% of patients on dialysis and 9.6% of transplant recipients who experienced cancer death had preexisting cancer. The SMRs for de novo cancer was 1.2 for patients on dialysis and 2.6 for transplant recipients.
Conclusions Patients on dialysis and transplant recipients experienced >2.5-fold increased risk of cancer death compared with the general population. This increased risk was largely driven by preexisting cancers in patients on dialysis and de novo cancers in patients with transplants.