Primary Care

On the Horizon: Promising New Drugs for Unresponsive Asthma

How to determine which patients will benefit from new therapies.

Help or Hurt: Steroids, Human Growth Hormone for Elderly Hip and Knee Patients

  • Anabolic steroids and human growth hormone help people build muscle.
  • Could these drugs benefit some of your older hip and knee arthroplasty patients?
  • The drugs carry some risks of heart and bone disease.
  • Do these risks outweigh the risk of weakness and immobility?

More than 15 Million Americans at Risk of Significant Kidney Damage

  • Proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide.
  • H2 blockers are equally effective for acid control and pose significantly less risk.
  • Long-term PPI exposure is linked to significantly increased risk of chronic kidney disease (CKD), CKD progression, and end-stage renal disease.
  • The risk of developing these diseases correlated directly with the duration of therapy.
  • PPI use was associated with CKD in all analyses, including a time-varying new-user design.
  • Twice-daily PPI dosing was associated with a higher risk than once-daily dosing.

Falls Increasingly Lead to Death in Older Americans

  • In 2012, there were 24,190 fatal and 3.2 million medically treated non-fatal fall related injuries.
  • Direct medical costs totaled $616.5 million for fatal and $30.3 billion for non-fatal injuries in 2012 and rose to $637.5 million and $31.3 billion, respectively, in 2015
  • During 2014, approximately 27,000 older adults died because of falls; 2.8 million were treated in emergency departments for fall-related injuries, and approximately 800,000 of these patients were subsequently hospitalized
  • The projected 2030 population would result in an estimated 48.8 million falls and 11.9 million fall injuries.

Acetaminophen Increasingly Seen as Risky in Pregnancy

  • A mother’s use of acetaminophen during pregnancy increased the risk of hyperactivity by 31% by the child’s age 7 years.
  • Children exposed to acetaminophen prenatally are at increased risk of multiple behavioral difficulties.
  • A mother’s use of acetaminophen during pregnancy raised the risk of her child developing asthma by 13%.

Psychological Nutrition: A New Prescription for Non-Pharmacologic Interventions for Chronic Pain

  • High fat (or negative) emotions are draining; they can heighten the perception of pain.
  • Low fat (or positive) emotions are energizing; they can decrease the perception of pain.
  • High stress-low reward experiences lead to a diet heavy in high fat (negative emotions) and lead to psychological undernourishment. Alternatively, low-stress, high-reward diets are rich in positive emotions and can lead to a psychologically nourishing state.

Jenny Craig, Weight Watchers Are Most Effective Weight-Loss Programs

  • Weight Watchers and Jenny Craig are the most effective commercial weight-loss programs for overweight or obese patients.
  • Authors reviewed 39 were randomized, controlled studies.
  • At 12 months, Weight Watchers participants achieved at least 2.6% greater weight loss compared to participants who were assigned to control/education.
  • Jenny Craig resulted in at least 4.9% greater weight loss at 12 months versus control/education and counseling.

Prescribe Dog Walking for Aging Patients

  • Dog walking linked to better physical health in older patients.
  • Dog walking was associated with lower body mass index, fewer limitations in activities of daily living, fewer doctor visits, and more frequent moderate and vigorous exercise.
  • Study provides evidence for the association between dog walking and physical health using a large, nationally representative sample.
  • Results based on an analysis of data from the 2012 University of Michigan Health and Retirement Study.

Your Patients Aren’t Sleeping Enough; Risking Obesity, Stroke, Heart Disease, Death

  • Sleeping <7 hours per night is associated with increased risk for obesity, diabetes, high blood pressure, coronary heart disease, stroke, frequent mental distress, and all-cause mortality, according to the CDC.
  • Insufficient sleep impairs cognitive performance, which can increase the likelihood of motor vehicle and other transportation accidents, industrial accidents, medical errors.
  • The elderly and single parents at greatest risk of disordered sleep.
  • Good sleep hygiene can significantly improve sleep quality and duration.

Runners Experience Injuries at High Rates Overall, But Some are at Much Greater Risk. Why?

  • Runners who strike with greater force, increased vertical impact peaks, and increased vertical load rates have a higher risk for injuries requiring medical attention.
  • Higher impact forces at landing increased the risk of bony and soft tissue injuries.
  • Runners who have never been injured had the lowest impact loading of all studied groups.
  • Vertical average loading rate was the strongest predictor of injury risk.

Use Available Tx to Decrease Food Allergy Costs, Improve Pts’ Quality of Life

  • Food allergies (FA) impair quality of life in both sufferers and family.
  • Allergies are associated with increased healthcare costs for sufferers, family, healthcare systems.
  • Effective treatments are available to clinicians but are found to be underused.
  • Food manufacturers increasingly offer alternatives to highly allergenic foods.
  • Promising newer approaches are available to clinicians, such as specific oral or epicutaneous immunotherapy and the use of monoclonal antibodies.
  • A good deal of research shows that early exposure to minute amounts of potential allergens can entirely prevent the development of many types of allergies.
  • Evaluation of FA severity and strategies for mitigation must be part of routine primary care.

Depression, Now The Sixth Vital Sign

  • U.S. Preventive Services Task Force has recommended that clinicians routinely screen all adults for depression.
  • Depression is among the leading causes of disability in the U.S. among people aged 15 years and older, affecting individuals, families, businesses, and society as a whole.
  • It is among common among patients in the primary care setting.
  • The Task Force has specifically recommended screening women who are pregnant and those who have recently given birth.
  • Screening should be implemented in a routine manner; adequate systems should be in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up, the Task Force recommended.

Behavior Modification Significantly More Cost Effective vs. Pharmacotherapy for ADHD

  • Beginning treatment of attention deficit hyperactivity disorder (ADHD) with a low-dose/intensity regimen of behavior modification was found to be less costly for a school year of treatment than beginning treatment with a low dose of stimulant medication.
  • Behavior modification therapy (large-group parent training) cost $961 per school year in 2013 U.S. dollars compared with $1,669 for pharmacologic therapy.
  • Outcome data found equivalent or superior outcomes for treatments beginning with low-intensity behavior modification compared to intervention beginning with medication.

Data Show HPV Vaccine Highly Cost Effective, Beneficial, When Adhered

  • Human papillomavirus (HPV) causes approximately 1.6% of the more than 1.6 million cases of cancer diagnosed in the U.S. each year.
  • HPV the most common sexually transmitted infection.
  • A highly effective vaccine is available to protect against HPV infection.
  • Only about 38% of eligible females and 14% of eligible males receive the vaccine.
  • Higher rates of adherence to CDC vaccination guidelines could significantly reduce the rate of HPV-related cancers.

Highly Cost-Effective Pre-Op Smoking Cessation Programs Lead to Long-Term Quits

  • Smoking cessation programs are highly cost-effective; The economic cost and healthcare expenditure associated with tobacco use are estimated at $97 billion and $96 billion, respectively.
  • Results support the long-term (≥12 months) efficacy of preoperative smoking cessation programs.
  • Five million deaths are attributed to tobacco annually in the U.S, annual mortality will increase to 8 million by 2030.
  • Projections suggest that tobacco will kill more people than any single disease pathology by 2020.