Resistant hypertension and aldosterone | Asthma, obesity, and physical fitness in adolescent girls and boys | Effects of analgesic regulatory changes
July 14, 2016
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Resistant hypertension and aldosterone
True resistant hypertension must be distinguished from apparent resistant hypertension, of which important causes include medication nonadherence, illicit drug use, and alcoholism. Ambulatory blood pressure monitoring should be considered to rule out white coat hypertension. The pathogenesis is multifactorial, but the two pivotal factors are volume excess and the myriad effects of aldosterone. Aldosterone increases vascular tone because of endothelial dysfunction and enhances the pressor response to catecholamines. It also plays a crucial role in vascular remodeling of small and large arteries. In addition, aldosterone promotes collagen synthesis, which leads to increased arterial stiffness and elevation of blood pressure. Because aldosterone has been demonstrated to modulate baroreflex resetting, in cases of severe hypertension, there would be fewer compensatory mechanisms available to offset the blood pressure elevation.
The American Journal of Medicine (7/2016) 
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Clinical Updates
Asthma, obesity, and physical fitness in adolescent girls and boys
Significant reductions in physical activity leading to decreased aerobic fitness have occurred during the past few decades, during which time rates of obesity and asthma have dramatically increased. In this study, the authors evaluated the associations between obesity, fitness, and asthma risk in adolescents. Overweight/obesity was associated with increased asthma prevalence and morbidity in girls but not in boys, independent of fitness. High fitness was associated with decreased rates of asthma morbidity in boys but not in girls, independent of weight status.
The Journal of Pediatrics (7/2016) 
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Effects of analgesic regulatory changes
Headaches are a common health problem, with the most common types being migraine and tension headaches. The aims of this study were to evaluate the effects of the law amendment of 2003 in Norway on consumption of prescription-free analgesics and whether the change has affected the prevalence of headaches with or without somatic pain and their interrelations in the population. A hypothesis was that the regulatory change may have led to higher consumption of prescription-free analgesics. The authors conclude that making over-the-counter analgesics available outside of pharmacies did not increase the self-reported intake.
The Journal of Pain (7/2016) 
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Examining asthma-related school absenteeism
Asthma is a leading cause of chronic disease–related school absenteeism. This study investigated how asthma-related absenteeism was associated with asthma control, exacerbations, and associated modifiable risk factors. Compared with children without asthma-related absenteeism, children who missed any school because of asthma were more likely to have not well-controlled or very poorly controlled asthma and to visit an emergency department or urgent care center for asthma. Mold in the home and cost as a barrier to asthma-related health care were also significantly associated with asthma-related absenteeism.
American Journal of Preventive Medicine (7/2016) 
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The effect of antidepressants on fertility
Antidepressants, but not depression, may negatively affect natural fertility.
American Journal of Obstetrics & Gynecology (7/2016) 
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Nocturia and diabetes
Diabetes and nighttime urination, or nocturia, can be a sign of uncontrolled blood sugar levels. Nocturia is defined as needing to urinate more than once during the night. There are a number of causes of nocturia, including prostate enlargement, diabetes insipidus, excess fluid intake, and neurological disorders such as multiple sclerosis or Parkinson's disease. This Japanese study demonstrated that diabetic retinopathy was associated with nocturia. Diabetic cystopathy is a well-recognized complication of diabetes mellitus, which usually develops in patients with long-standing and poorly controlled disease. Diabetic cystopathy may be asymptomatic or may result in a wide variety of voiding complaints, from overactive bladder, nocturia, and urge incontinence to decreased bladder sensation, incomplete bladder emptying, and overflow incontinence. The treatment of overactive vs underactive bladder is different and needs to be recognized early so proactive steps can be taken to prevent "end-stage" bladder dysfunction. 
Urology (7/2016) 
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Risk of traumatic brain injury in the elderly
Traumatic Brain Injury (TBI) among older persons is on the increase, causing more hospital admissions. German researchers found that older persons who live in nursing homes are at increased risk compared with those with functional limitations. Those who suffer traumatic intracranial hemorrhage (TIH) as a result of a TBI are especially at risk of poor outcomes. This points to a need for better fall prevention programs that not only prevent fragility fractures but also target prevention of TBIs.
Journal of the American Medical Directors Association (7/2016) 
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Medical News
CDC, WHO initiative seeks to end violence against children
The CDC, the World Health Organization and other partner organizations have introduced a global approach aimed at ending child violence through a seven-point strategy. The strategy includes implementing and enforcing laws restricting access to firearms among youths, creating safe environments through housing, bolstering parent and caregiver support, reinforcing support services, modifying beliefs and values around gender roles, boosting economies, and including life and social skills in children's education.
The Washington Post (tiered subscription model) (7/12) 
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Type 2 diabetes may be tied to cancer, study suggests
A Canadian study in the journal Cancer showed that type 2 diabetes patients had a 23% increased risk of having been diagnosed with cancer in the 10 years before being diagnosed with diabetes, compared with those without diabetes. The findings, based on an analysis of data from more than 1 million adults with cancer, only revealed a correlation between type 2 diabetes and cancer, not a causal relationship.
HealthDay News (7/11) 
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Study links obesity to inadequate hydration
Study links obesity to inadequate hydration
(Anne-Christine Poujoulat/AFP/Getty Images)
A study in the Annals of Family Medicine showed that adults with inadequate hydration had a 1.32 kg/m2 higher body mass index, on average, and increased odds of being obese than those who were adequately hydrated. Researchers evaluated 2009-2012 data from the National Health and Nutrition Examination Survey involving 9,528 adults ages 18 to 64.
Medscape (free registration) (7/12) 
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Business Practice News
Physician practices can boost revenue by billing for CCM, TCM
The CMS pays physicians to provide transitional care management and chronic care management, but some doctors question whether the financial benefits are worth the administrative hassles linked to reporting requirements. Data suggest physicians could add thousands of dollars in revenue to their practices, and Barbie Hays, a coding expert with the AAFP, said she advises doctors to file for the reimbursement since they are providing the services.
Medical Economics (7/10) 
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ACOs may help improve clinical health outcomes
Accountable care organizations have access to a large amount of data that providers can use with intuitive analytical tools to help improve clinical outcomes, patient experience and cost efficiency, writes Tim Moore, chief medical officer and executive vice president of health affairs for AxisPoint Health. The effective use of big data presents challenges to ACOs because of its sources, such as EHRs, and ACOs must change this data into actionable information in order to succeed, Moore writes.
Health Data Management (7/11) 
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Patient's Perspective
Some patients take antibiotics without seeing a doctor, study shows
Some patients take antibiotics without seeing a doctor, study shows.
(Justin Sullivan/Getty Images)
Researchers found that 5% of 400 primary care patients surveyed in Houston took antibiotics without seeing a physician beforehand, and 25% expressed willingness to do so. The study in the journal Antimicrobial Agents and Chemotherapy notes that 14% of patients said they had stored antibiotics at home, and that group was more than four times as likely to indicate willingness to use antibiotics without seeing a doctor.
Kaiser Health News (7/11) 
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A failure is a man who has blundered but is not able to cash in on the experience.
Elbert Hubbard,
writer and artist
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