Cardiorespiratory fitness levels and atherogenic dyslipidemia | Neighborhood park use in the US | The high impact of penicillin allergy registration in hospitalized patients
October 13, 2016
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Cardiorespiratory fitness levels and atherogenic dyslipidemia
Low cardiorespiratory fitness has been established as a risk factor for cardiovascular-related morbidity. However, research about the impact of fitness on lipid abnormalities, including atherogenic dyslipidemia, has produced mixed results. The purpose of this investigation was to examine the influence of baseline fitness and changes in fitness on the development of atherogenic dyslipidemia.
The American Journal of Medicine (10/2016) 
New Complimentary Alzheimer's Disease CME
This CME Meeting Reporter activity will cover data presented by two experts summarizing the key learnings that were presented at the Alzheimer's Association International Conference® 2016 (AAIC®) in Toronto, Canada, July 22-28, 2016. Upon completion, you may receive up to 0.75 AMA PRA Category 1 Credit(s).
Click here to begin the activity
Clinical Updates
Neighborhood park use in the US
Neighborhood parks have never been assessed nationally to identify their role in physical activity. Park use, park-based physical activity, and park conditions were evaluated using systematic direct observation in 174 neighborhood parks across the US. Nationwide, the average neighborhood park averaged 20 users/hour. Walking loops and gymnasia each generated 221 hours/week of moderate to vigorous physical activity. Parks were used less in low-income than in high-income neighborhoods, possibly due to fewer supervised activities and marketing efforts. Offering more programming, using marketing tools, and installing facilities like walking loops may help currently underutilized parks increase population physical activity.
American Journal of Preventive Medicine (10/2016) 
The high impact of penicillin allergy registration in hospitalized patients
Suspected penicillin allergy (Pen-A) is often not verified or excluded by diagnostic testing. In a prospective matched cohort study, all admitted patients between July 2013 and July 2104 in a Dutch University Medical Center who underwent a pharmacotherapeutic interview were selected. Patients with a registered Pen-A were matched on age, sex, and department of admission with up to three patients without a registered penicillin allergy (non-Pen-A). Of 17,959 patients, the 1010 (5.6%) patients with a Pen-A registration had a higher risk of receiving reserve antibiotics (RR 1.38, 95% CI 1.22-1.56) and of being re-hospitalized within 12 weeks (RR 1.28, 95% CI 1.10-1.49). Verification of the penicillin allergy in hospitalized patients might restrict use of reserve antibiotics and improve patient outcomes.
The Journal of Allergy and Clinical Immunology: In Practice (10/2016) 
Spontaneous reversion of mild cognitive impairment to normal cognition
Return to normal cognition after being diagnosed with mild cognitive impairment (MCI) -- how common is it? Italian researchers performed a meta-analysis to examine this phenomenon, which traditionally has not received a lot of attention. After 25 studies met the criteria, 18% reversion from MCI to normal cognition was found overall. A diagnosis of MCI does not necessarily indicate an inevitable downward spiral, as there are cases (25% in population-based studies and 8% in clinic-based studies) where it has reversed.
Journal of the American Medical Directors Association (10/2016) 
Red reflex testing in newborns
Red reflex testing (RRT) as a routine part of the newborn physical examination may aid early identification of ocular problems, but the extent of its effectiveness and limitations are unknown. In this prospective study, sensitivity and specificity of an isolated RRT were validated by comparing results with comprehensive eye examinations. RRT identified 222 of 223 newborns with anterior or both anterior and posterior abnormalities, but it identified only 81 of 1,955 newborns with posterior abnormalities. RRT appears to be highly effective in the detection of anterior chamber abnormalities in newborns, but unreliable in detecting posterior abnormalities.
The Journal of Pediatrics (10/2016) 
In utero treatment of congenital cytomegalovirus infection
High-dosage oral valacyclovir given in pregnancy with cytomegalovirus infection is effective for improving the outcome of moderately symptomatic infected fetuses presenting with extracerebral ultrasound symptoms.
American Journal of Obstetrics & Gynecology (10/2016) 
A proposed algorithm for prostate cancer screening
Screening with prostate-specific antigen (PSA) has several limitations. Many men who do not have prostate cancer will screen positive and require a biopsy to rule out cancer. On the other hand, few men with aggressive disease have low PSA. Because many prostate cancers grow so slowly that they never threaten a patient's life, there is a danger of overtreatment if these cancers are detected. In this review, prostate cancer experts propose a management algorithm for shared decision-making between the primary care physician and the urologist. A PSA should be obtained with other routine laboratory tests in men between 40 and 70 years old. If PSA is less than 1.5 ng/mL, the patient should have a repeat PSA in 5 years. If PSA is greater than 1.5 ng/mL or if an abnormality on digital rectal examination is suspected, referral to urologist should be considered.
Urology (10/2016) 
Medical News
Study: 268 million children may be overweight by 2025
Study: 268 million children may be overweight by 2025
(China Photos/Getty Images)
UK researchers analyzed data prepared by the Global Burden of Disease collaborative for 2000 and 2013 and estimated that 4 million children will have type 2 diabetes in 2025, while up to 12 million will have impaired glucose tolerance, 38 million will have hepatic steatosis and 27 million will have hypertension. The findings in Pediatric Obesity also showed that up to 268 million children ages 5 to 17 may be overweight, including 91 million who may be obese, by 2025.
Business Standard (India)/Press Trust of India (10/9),  Medscape (free registration) (10/11) 
Study links orthostatic hypotension to increased dementia risk
A Dutch study in the journal PLOS Medicine found orthostatic hypotension -- the sudden drop in blood pressure when standing up -- was linked to a 15% higher long-term risk of dementia. Researchers, who reviewed 24-year data for over 6,000 patients, said brief episodes of decreased blood flow to the brain caused by orthostatic hypotension may result in hypoxia, which has damaging effects on brain tissue.
HealthDay News (10/11) 
Business Practice News
Culture shifts as providers transition to ACO from fee-for-service
Culture shifts as providers transition to ACO from fee-for-service.
(Joe Raedle/Getty Images)
Thirty-one percent of 392 Medicare accountable care organizations received bonuses last year, but most improved performance on quality metrics, such as lowering hospital admissions and improving management of hypertension and diabetes. Health care providers transitioning from a fee-for-service model must change how they think about care and engage patients, says Patrick Falvey, chief transformation officer at Aurora Health Care, a Milwaukee-area ACO that did receive a bonus.
Milwaukee Journal Sentinel (tiered subscription model) (10/8) 
Experts support including pharmacists on primary care teams
Including pharmacists on primary care teams to provide medication management services may reduce costs, help prevent hospital readmissions and improve care, panelists said at a congressional briefing. Medication management helps ensure patients can obtain prescribed medications and take them appropriately, panelists said.
MedPage Today (free registration) (10/7) 
Patient's Perspective
US data show consistent level of supplement use among adults
US data show consistent level of supplement use among adults
(Christopher Furlong/Getty Images)
US data showed 52% of adults said they used supplements in 1999-2000 and the same percentage reported using them in 2011-2012, according to a study in the Journal of the American Medical Association. Researchers said non-Hispanic white adults had the highest supplement use, and while more people took vitamin D and fish oil, fewer took multivitamins or multiminerals over the course of the study.
MedPage Today (free registration) (10/11) 
Exploding e-cigarettes are causing burns, other injuries
Twenty-two people have been treated at a Seattle burn center over the past 12 months for burns and other injuries caused by exploding electronic cigarettes, according to a research letter published in The New England Journal of Medicine. Lithium-ion batteries in e-cigarettes can overheat, causing fire or explosion, lead author Elisha Brownson said.
Physician's Briefing/HealthDay News (10/6) 
It is an incalculable added pleasure to any one's sum of happiness if he or she grows to know, even slightly and imperfectly, how to read and enjoy the wonder-book of nature.
Theodore Roosevelt,
26th US president
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