Niacin, a potent high-density lipoprotein cholesterol-raising drug, seems an attractive approach to reduce cardiac events in patients with or at risk of atherosclerotic cardiovascular disease. However, previous evidence for niacin has been challenged recently by negative outcomes in two large, randomized, controlled trials comparing niacin to placebo with background statin therapy. The authors studied the available evidence for the role of niacin treatment to reduce the risk of cardiovascular events in current practice.

Overall perinatal mortality is higher in twin pregnancies than in singleton pregnancies, but during the preterm period, mortality is considerably lower in twins.

Declines in national adolescent birth rates from 1990 to 2012 were profoundly and independently shaped by national income, income inequalities, and expenditures on education. National strategies to reduce adolescent fertility should include investments in economic development, job creation, and improvement and expansion of schooling -- in addition to improving access to contraception.

Dietary protein comes from foods with greatly different compositions that may not relate equally with mortality risk. The associations between dietary protein sources and all-cause, cardiovascular disease, and cancer mortality were evaluated in the Golestan Cohort Study in Iran. The findings supported associations between higher fish and legume consumption with lower cancer mortality, as well as higher egg consumption and lower all-cause mortality. Significant associations between total red meat and poultry intake and all-cause, cardiovascular disease, or cancer mortality rate were not observed among all participants.

Poor intake at lunch could predict six-month mortality in nursing homes. A study from Europe reported findings from a one-day evaluation of lunchtime food intake (nutritionDay) repeated in yearly intervals for 7 years in 15 countries. While poor intake at lunch seemed to lead to poor outcome (mortality), the use of nutritional interventions was not associated with mortality. The results point to the importance of monitoring nutritional intake in residents and finding strategies to improve intake in the vulnerable.

Although women with vulvodynia typically have increased vulvar sensitivity, data on characteristics associated with the degree of vulvar sensitivity are lacking. This research measured vulvar sensitivity by cotton swab test and vulvodolorimeter among a subset of 335 women. Findings demonstrate that women with vulvodynia have more vulvar sensitivity than controls, but the spectrum of sensitivity is broad. Furthermore, those with and without vulvar sensitivity did not differ in most vulvar pain characteristics or in prognosis, suggesting a positive swab test is not required to substantiate the diagnosis.

This study aimed to assess the determinants of incomplete asthma control in 260 patients with allergic rhinitis (AR) and asthma. Multiple factors, including AR severity and use of nasal corticosteroids (NCS), were evaluated in relation to asthma control as assessed by the Asthma Control Questionnaire (ACQ). In a multivariate model adjusted by age, asthma treatment, airflow limitation, and exhaled nitric oxide fraction, persistence and severity of rhinitis (OR 2.57, 95% CI 1.41 to 4.70, and OR 2.00, 95% CI 1.10 to 3.65), and non-use of NCS (OR 3.83, 95% CI 1.50 to 9.81) were independently associated with incomplete asthma control (ACQ ≥ 0.75). Further studies are required to determine whether appropriate treatment of rhinitis would improve asthma control.

This CME/CNE activity will review how follow-on insulin products are developed, manufactured, and receive regulatory approval; evaluate clinical trial data for new and emerging follow-on basal insulin agents; and provide practical information and guidance on how they may be incorporated into clinical practice. Upon completion of this activity, you may receive up to 1.25 AMA PRA Category 1 Credits™ or 1.25 Contact Hours. Begin this activity!

A study in JAMA Internal Medicine showed the use of opioid painkillers, tranquilizers, antidepressants and antipsychotic drugs increased more than twofold among individuals older than 60 years from 2004 to 2013, with a more than threefold increase seen for those in rural areas. The findings, based on CDC data, showed an estimated 3.7 million provider visits annually by seniors who used three or more of these brain-affecting drugs.

A Mediterranean diet that included nuts or virgin olive oil improved the function of high-density lipoprotein cholesterol, compared with a control diet that restricted red meat, processed food, high-fat dairy and sugar, researchers reported in the journal Circulation. The study found the Mediterranean diet enriched with virgin olive oil was associated with the biggest increase in HDL function, and while the control diet reduced total and low-density-lipoprotein cholesterol levels, none of the diets increased HDL levels.

Ninety-three percent of youths with irritable bowel syndrome had insufficient vitamin D based on the deficiency's clinical definition, compared with 75% of those without IBS, according to a study in PLOS ONE. The findings, based on data involving 171 children, also showed that more than 50% of those with IBS had vitamin D deficiency based on a tighter definition by the NIH, compared with 27% of healthy controls.

Medical practices that adopt a membership-based model can significantly reduce their patient panel size and create a sustainable revenue stream, while spending more time with patients and less on paperwork, physicians say. Physicians who have embraced this model also avoid dealing with new payment models and regulations associated with the Medicare Access and CHIP Reauthorization Act.

Using systems engineering principles can help hospitals and ICUs integrate technologies to streamline patient care and improve safety, ICU safety expert Dr. Peter Pronovost and two engineers wrote in the Harvard Business Review. "We need to integrate technology, people, and processes so that they are seamlessly joined in pursuit of a shared goal," the authors wrote.

Forty-four percent of more than 3,000 US adults surveyed worry that their personal health information might be stolen, while 76% believe that a secure electronic approach to sharing documents between providers is safer than faxing paper documents, according to the 2017 Xerox eHealth Survey. Researchers also found that 87% of respondents believe that better coordination and information sharing among health care providers will improve the quality of health care services.