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.