Most Deaths During Triathlons Occur During The Swim

MedicalResearch.com Interview with:

Kevin M. Harris, MD Director, Fellowship Training; Director, Echocardiography Allina Health, Minnesota

Dr. Harris

Kevin M. Harris, MD
Director, Fellowship Training; Director, Echocardiography
Allina Health, Minnesota

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Triathlon is a popular endurance sport which combines swimming, bicycling and running. We investigated the death rate in the triathlon since its inception in the United States in 1985 through 2016. Specifically we were able to look at the rate of death in USAT races from 2006 to 2016.

We identified 135 deaths/cardiac arrests over the time period. 85% of victims were male and victims averaged 47 years. Most deaths and cardiac arrests occurred in the swim. 15 of the deaths were traumatic occurring during the bike portion. The rate of death was 1.74 per 100,000 participants. The death rate was significantly higher for males than females and increased significantly for men > 40 years. On autopsy, nearly half of those victims were found to have significant cardiovascular disease.

Continue reading

New Rapid Flu Tests Are Simple, Fast and Accurate

MedicalResearch.com Interview with:

Jesse Papenburg, MD MSc FRCPC FRQS Clinical Research Scholar Assistant Professor of Pediatrics, McGill University Div. of Pediatric Infectious Diseases, Dept. of Microbiology Montreal Children’s Hospital Montreal, QC

Dr. Papenburg

Jesse Papenburg, MD MSc FRCPC
FRQS Clinical Research Scholar
Assistant Professor of Pediatrics, McGill University
Div. of Pediatric Infectious Diseases, Dept. of Microbiology
Montreal Children’s Hospital
Montreal, QC 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Influenza viruses cause yearly epidemics of acute respiratory illness affecting 5 to 30 percent of the population. Diagnosing influenza on the basis of only clinical symptoms is difficult because its manifestations vary and are nonspecific. Reverse transcriptase polymerase chain reaction (RT-PCR) is the gold standard for flu diagnosis, but these tests must be sent to a laboratory and have turnaround times that extend beyond the clinical encounter. Rapid and accurate diagnosis of influenza has the potential to improve patient outcomes and decrease health care costs.

Since 2011, two novel classes of rapid influenza diagnostic assays i.e., with results available in <30 minutes, have been commercialized with claims of improved sensitivities based on technological improvements: 1) automated immunochromatographic antigen detection tests (digital immunoassays, DIAs) and 2) rapid nucleic acid amplification tests (NAATs).

Our systematic review and meta-analysis synthesized the available evidence and compared the diagnostic accuracy of commercially available rapid tests for the detection of influenza A and B infection:

  • Overall, the rapid tests displayed very high specificities (≥98%). Physicians can therefore diagnose influenza with confidence on the basis of a positive RIDT, DIA, or rapid NAAT result.
  • The pooled sensitivities for DIAs (80.0% for influenza A and 76.8% for influenza B) and rapid NAATs (91.6% for influenza A and 95.4% for influenza B) are markedly higher than those for RIDTs (54.4% for influenza A and 53.2% for influenza B).

Continue reading

Cardiovascular Prediction Tool Underestimated Risk In Poor Socioeconomic Groups

MedicalResearch.com Interview with:

Jarrod Dalton PhD Department of Quantitative Health Sciences Cleveland Clinic , Cleveland 

Dr. Dalton

Jarrod Dalton PhD
Department of Quantitative Health Sciences
Cleveland Clinic , Cleveland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Accurate risk assessment is critical for identifying patients who are at high risk of cardiovascular events such as heart attacks and strokes.

We evaluated the performance of a widely-used risk assessment tool against the socioeconomic position of patients’ neighborhoods of residence. This tool, called the Pooled Cohort Equations Risk Model, or PCERM, was developed in 2013 jointly by the American College of Cardiology and the American Heart Association (ACC/AHA).

We found that the PCERM model accurately characterized risk among patients from affluent communities, but performed more poorly among patients from disadvantaged communities. In particular, for these patients, major cardiovascular events occurred at rates that were as much as 2-3 times than predicted from the PCERM model.

Continue reading

Almost 40% US Adults Used Prescription Opioids In Course of One Year

MedicalResearch.com Interview with:
Beth Han, MD, PhD, MPH

From Substance Abuse and Mental Health Services Administration, Rockville, Maryland
National Institute on Drug Abuse, Bethesda, Maryland and
Office of the Assistant Secretary for Planning and Evaluation
U.S. Department of Health and Human Services
Washington, DC. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Using the 2015 National Survey on Drug Use and Health (NSDUH), this is the first study examining the prevalence of overall prescription opioid use in addition to misuse, use disorders, and motivations for misuse in the U.S. adult population. The 2015 NSDUH collected nationally representative data on prescription opioid use, misuse, use disorder, and motivations for misuse among the U.S. civilian, noninstitutionalized population aged 12 or older. In 2015, NSDUH started to collect data on overall prescription opioid use as well as data on motivations for prescription opioid misuse.

This study found that in 2015, 91.8 million (37.8%) U.S. civilian, non-institutionalized adults used prescription opioids, 11.5 million (4.7%) misused them, and 1.9 million (0.8%) had a prescription opioid use disorder. Among adults who used prescription opioids, 12.5% reported misuse and, of those reporting misuse, 16.7% reported a prescription opioid use disorder.

The most common reported misuse motivation was to relieve physical pain (63.4%). Misuse and use disorders were most commonly reported in adults who were uninsured, were unemployed, had low income, or had behavioral health problems. Among adults with misuse, 59.9% reported using opioids without a prescription, and 40.8% obtained prescription opioids free from friends or relatives for their most recent misuse.

Continue reading

Hepatitis C Can Be Safely Treated By Primary Care Providers

MedicalResearch.com Interview with:

Sarah Kattakuzhy, MD Clinical and Administrative Director, DC PFAP Hepatitis Clinical Research Program Assistant Professor, Institute of Human Virology Division of Infectious Diseases University of Maryland 

Sarah Kattakuzhy, MD
Clinical and Administrative Director, DC PFAP Hepatitis Clinical Research Program
Assistant Professor, Institute of Human Virology
Division of Infectious Diseases
University of Maryland  

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The recent introduction of highly effective, well-tolerated direct-acting antiviral (DAA) therapy for hepatitis C virus infection has raised the possibility of rapid treatment expansion and widespread cure. However, the current specialist workforce is insufficient to meet the treatment demands of the 2.7 million Americans living with HCV infection. Several studies of partial task shifting—shared treatment between specialists and primary care providers—have demonstrated success in improving access to HCV care. Yet, information on the success of nonspecialists practicing independent of specialist supervision is limited.

The primary objective of ASCEND was to evaluate the efficacy of Hepatitis C treatment managed independently by 3 community-based provider types—nurse practitioners (NPs), PCPs, and specialists—after a succinct, guideline-driven educational intervention, set within a real-world, urban population.

In this investigation, 516 out of 600 patients achieved SVR, a response rate of 86% (95% CI, 83.0% to 88.7%), with no major safety signals. Rates of SVR were consistent across the 3 provider types—NPs: 89.3% (CI, 83.3% to 93.8%); PCPs: 86.9% (CI, 80.6% to 91.7%); and specialists: 83.8% (CI, 79.0% to 87.8%). Patient loss to follow-up was the major cause of non-SVR.

Continue reading

Single Measurement May Underestimate HIV Viral Suppression

MedicalResearch.com Interview with:
Dr. Nicole Crepaz PhD
Behavioral Scientist
Division of HIV/AIDS Prevention
CDC

MedicalResearch.com: What is the background for this study?

Response: The most common measure of viral suppression in clinical and surveillance studies is the most recent viral load in past 12 months. This single-value measure does not capture the viral load dynamics over time. We examined durable viral suppression, never virally suppressed, and cumulative HIV burden (measured in the viremia copy-year) to help us better understand viral suppression and transmission risk potential.

Continue reading

Cross-Sex Hormone Therapy Associated With Medical Risks and Psychosocial Benefits in Transgender Patients

MedicalResearch.com Interview with:

Carl G Streed Jr. M.D. Pronouns: he, him, his, himself Fellow, Division General Internal Medicine & Primary Care Brigham & Women’s Hospital

Dr. Streed

Carl G Streed Jr. M.D.
Pronouns: he, him, his, himself
Fellow, Division General Internal Medicine & Primary Care
Brigham & Women’s Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Recent reports estimate that 0.6% of adults in the United States, or approximately 1.4 million persons, identify as transgender. Despite gains in rights and media attention, the reality is that transgender persons experience health disparities, and a dearth of research and evidence-based guidelines remains regarding their specific health needs. The lack of research to characterize cardiovascular disease (CVD) and CVD risk factors in transgender populations receiving cross-sex hormone therapy (CSHT) limits appropriate primary and specialty care. As with hormone therapy in cisgender persons (that is, those whose sex assigned at birth aligns with their gender identity), existing research in transgender populations suggests that CVD risk factors are altered by CSHT.

Continue reading

Trying Statins Again After Adverse Effect Linked To Lower Risk of Heart Attack

MedicalResearch.com Interview with:

Alexander Turchin, MD,MS Director of Quality in Diabetes Associate Professor, Harvard Medical School Brigham and Women's Hospital Boston, MA

Dr. Turchin

Alexander TurchinMD,MS
Director of Quality in Diabetes
Associate Professor, Harvard Medical School
Brigham and Women’s Hospital
Boston, MA

MedicalResearch.com: What is the background for this study?

Response: Cardiovascular disease is the # 1 cause of death in the U.S. and worldwide. Statins are some of the most effective medications available for prevention of cardiovascular events.

However, many patients stop statins, frequently because of adverse reactions. In our study we aimed to assess the risk-benefit balance of trying a statin again after experiencing an adverse reaction.

Continue reading

Moderate Coffee Drinking Linked To Lower Risk of Death

MedicalResearch.com Interview with:
Marc J. Gunter, PhD 

From International Agency for Research on Cancer
Lyon, France

MedicalResearch.com: What is the background for this study?

Response: U.S. and Japanese studies have previously found that drinking more coffee was related with a lower risk of death. However, in European populations, where coffee consumption and preparation methods are more varied, the relationship was less certain as relatively small studies had previously been conducted. Our analysis was undertaken in ~500,000 men and women from 10 European countries, the largest study to date investigating the coffee and mortality relationship.

Continue reading

Yoga As Effective As Physical Therapy For Chronic Low Back Pain

MedicalResearch.com Interview with:

Robert B. Saper, MD, MPH Department of Family Medicine Boston Medical Center Boston, MA

Dr. Saper

Robert B. Saper, MD, MPH
Department of Family Medicine
Boston Medical Center
Boston, MA

MedicalResearch.com: What is the background for this study?

Response: There are a number of studies that show that yoga is effective for chronic low back pain (cLBP), but those studies included mostly white and middle-class individuals as research participants. cLBP disproportionately impacts those who are economically disadvantaged and minorities; they receive less referrals to specialists, less referrals to rehabilitation, and also less patient-education. Therefore, it was important to test whether yoga would be well- received by an underserved population, as well as be an effective form of treating chronic low back pain.

This study consisted of patients from diverse racial and economic backgrounds with multiple medical problems who were able to successfully participate and benefit from both yoga and physical therapy. This study used yoga classes that were specifically designed for people suffering from  chronic low back pain and compared the results of that treatment to those who did physical therapy.

MedicalResearch.com: What are the main findings?

Response: The results show that the yoga was as effective as physical therapy for reducing pain intensity and improving people’s physical function. Patients in the study who did yoga reported that their overall pain intensity went down, that they were able to be more physically active, and a number of patients were also able to reduce or even stop all of their pain medication. The study shows that when yoga is made available and affordable to a diverse population, people of both sexes, people who are disabled, and people of different races and economic backgrounds are both receptive to yoga and, more importantly, can benefit from it.

MedicalResearch.com: What should readers take away from your report?

Response: Doctors should know that a structured yoga program for cLBP is a reasonable, effective, and safe approach for patients with chronic  chronic low back pain. Patients with cLBP should talk with their doctors about different options for treatment of back pain, starting with non-drug approaches like yoga and physical therapy. Policy makers need to examine the potential benefits for patients and cost savings for covering non-pharmacological approaches to pain.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The cost effectiveness of yoga and physical therapy for chronic low back pain still needs to be looked at carefully, as well as how the medical community can implement yoga classes for back pain widely.

While medication, imaging and invasive procedures absolutely have their place, research and clinical guidelines show that non-pharmacological procedures as first treatment options may be best.

MedicalResearch.com: Is there anything else you would like to add?

Response: Yoga is increasingly popular in the United States, and many yoga teachers are available in urban areas. However, yoga teachers and yoga classes are still relatively rare in communities of color and disadvantaged areas. Therefore, it’s important that we begin to train, build, and make yoga more available to diverse communities. Changing the common view of yoga from a fitness exercise for the healthy and wealthy, to a therapeutic approach for people with chronic pain and other conditions, is also an ongoing challenge.

Finding that yoga is non-inferior to physical therapy makes a strong case that yoga programs like the one in this study should be covered by insurance and offered by health care facilities. When a therapy like yoga is shown to be as effective as standard therapies, it should be made available to everyone regardless of ability to pay. For patients who attended more classes or physical therapy sessions, their cLBP improvement was even greater.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Saper RB, Lemaster C, Delitto A, Sherman KJ, Herman PM, Sadikova E, et al. Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial. Ann Intern Med. [Epub ahead of print 20 June 2017] doi: 10.7326/M16-2579

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.