finds

medicine

After 41 years of practice, Mendota Heights doctor finds renewed purpose in virtual medicine

Dr. Carolyn Borow has delivered more than 3,500 babies in her 41 years as a family doctor. But she hasn’t delivered one since the coronavirus pandemic began.

Instead Borow, like many medical professionals, has gone virtual, doing all those appointments about pregnancy complications, sore throats and COVID fears via computer and FaceTime. In fact, the only time she’s been in a hospital recently was when she herself had surgery.

“I am definitely going through baby withdrawal,” said Borow, who works out of Allina Health in West St. Paul and Eagan. “I’d never planned that at some point I’m not going to be doing this. Only a pandemic would keep me from it.”

At a time when a growing number of veteran doctors are suddenly considering retirement, Borow is finding renewed purpose in her work.

A 2020 survey of 2,300 U.S. physicians by the nonprofit Physicians Foundation reported that 37% of doctors said they would like to retire within a year. Many expressed fear for their personal health, including 28% who had “serious concerns” about catching COVID-19.

Borow, though, sees value in her shifting work experience.

“I thank everybody who is making these appointments,” Borow said. “Because it has allowed me to still feel meaningful. Because I had no intention ever of not continuing to serve people.”

Initially, to cut down on coronavirus exposure, Allina limited the number of its doctors going in and out of United Hospital in St. Paul, where Borow has worked. So, Allina hired doctors to serve full time in the hospital.

Secondly, because of her age and medical risks during the COVID crisis, Borow decided to curtail her in-person contact with patients. She went virtual on the fly.

“It was all new to me,” she said of distance doctoring. “But in my motivation to serve people, I just learned it quickly.”

Borow is as busy as ever. An empty nester with a retired husband, she dons her scrubs every morning — in the clinic, she used to wear streets clothes and a lab coat — and sits at an Allina-issued computer in her son’s old bedroom in their Mendota Heights home. Her two cats sometimes scratch at the door. But Borow is diligent and determined, officially working 9 a.m. to 5 p.m. Monday through Friday (actually, two nights until 6) and on-call every other weekend. Of course, that doesn’t include the two or three hours every night of paperwork and the pre-shift prep for her appointments.

She also spends a half-day per week in the clinic signing forms, wearing a mask and shield over her glasses.

With a different virtual patient scheduled every 20 minutes, the doctor is much more punctual than in her days at the clinic, where an assistant could warn an impatient patient that the physician is running late.

“I have openings every day, people can get right in, which was never the case before,” Borow said. “Although before, we could work someone in with double booking.”

She’s now able to see patients

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fitness

Large study finds clear association between fitness and mental health

New research from a large study demonstrates that low cardiorespiratory fitness and muscle strength have a significant association with worse mental health.

Researchers have reported a clear link between low physical fitness and the risk of experiencing symptoms of depression, anxiety, or both.

The study, which included more than 150,000 participants, found that cardiorespiratory fitness and muscle strength independently contribute to a greater risk of worse mental health.

However, the researchers saw the most significant association when they looked at cardiorespiratory fitness and muscle strength in combination.

The research, which appears in the journal BMC Medicine, may help inform clinical guidance on mental health and physical fitness.

Problems with mental health, just like physical health issues, can have a significant negative effect on a person’s life. Two of the more common mental health conditions are anxiety and depression.

According to the Anxiety and Depression Association of America, 18.1% of adults in the United States have experienced an anxiety disorder in the past year. In addition, the National Institute of Mental Health note that 7.1% of U.S. adults have had a major depressive episode.

There is growing evidence that being physically active may help prevent or treat mental health conditions. However, many questions still need answering.

For example, what measures should researchers use to quantify physical activity? In what ways can it prevent mental health issues or improve a person’s mental health? And is it possible to demonstrate a causal link between physical activity and better mental health?

It is important to have detailed evidence of the relationship between physical activity and mental health, as well as the mechanisms that might underlie it. With this information, clinicians can offer more targeted guidance to people with mental health conditions.

To begin to answer some of these questions, a team of researchers analyzed an existing large dataset that allowed them to build on their understanding of the association between physical fitness and mental health.

In the present study, the researchers drew on data from the U.K. Biobank — a data repository comprising information from more than 500,000 volunteers aged 40–69 years from England, Wales, and Scotland.

Between August 2009 and December 2010, a subset of the U.K. Biobank participants — amounting to 152,978 participants — underwent tests to measure their fitness.

Investigators assessed the participants’ cardiorespiratory fitness by monitoring their heart rate before, during, and after a 6-minute submaximal exercise test on a stationary bicycle.

They also measured the volunteers’ grip strength, which the researchers of the present study used as a proxy for muscle strength.

Alongside these physical fitness tests, the participants completed two standard clinical questionnaires relating to anxiety and depression to give the researchers an overview of their mental health.

After 7 years, the researchers assessed each person’s anxiety and depression again using the same two clinical questionnaires.

In their analysis, the researchers accounted for potential confounding factors, such as age, natal sex, previous mental health issues, smoking status, income level, physical activity, educational experience, parental depression, and diet.

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medicine

The Lancet Respiratory Medicine: Clinical trial finds inhaled immune response protein increases odds of recovery for hospitalised COVID-19 patients

Peer-reviewed / Randomised Controlled Trial / People

  • Inhaled delivery of a formulation of a key protein involved in the immune response – interferon beta-1a – to hospitalised COVID-19 patients in the UK reduced the odds that they would develop severe disease or die from SARS CoV-2 infection.
  • Those patients who received inhaled interferon beta-1a were more than twice as likely to recover from COVID-19 infection to a point where everyday activities were not limited compared with those who received a placebo.
  • The trial included 101 patients, with the data providing strong rationale for larger studies to further investigate the impact of this treatment on clinical outcomes.

Hospitalised COVID-19 patients in the UK who received an inhaled form of interferon beta-1a (SNG001) were more likely to recover and less likely to develop severe symptoms than patients who received a placebo, according to a new clinical trial published in The Lancet Respiratory Medicine journal. This is the first evidence published in a peer-reviewed medical journal that inhaled interferon beta-1a could lessen the clinical consequences of COVID-19 and serves as proof-of-concept that this treatment could help hospitalised patients recover, but further research is required.

As the number of COVID-19 infections continues to rise around the world, there is a pressing need to develop new treatments for the more severe and life-threatening symptoms such as pneumonia and respiratory failure.

Interferon beta is a naturally occurring protein that coordinates the body’s immune response to viral infections. Laboratory studies have found that the SARS CoV-2 virus directly suppresses the release of interferon beta, while clinical trials demonstrate decreased activity of this important protein in COVID-19 patients. The formulation of interferon beta used in this new study – SNG001 – is directly delivered to the lungs via inhalation and has been trialled in the treatment of asthma and chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the safety and efficacy of SNG001 to treat hospitalised COVID-19 patients.

The trial was conducted at nine UK hospitals with patients who had a confirmed SARS-CoV-2 infection. It compared the effects of SNG001 and placebo given to patients once daily for up to 14 days, and followed up patients for a maximum of 28 days after starting the treatment. Patients were recruited from March 30 to May 30, 2020, and were randomly assigned to receive the treatment or a placebo. All members of the research team were blinded to which group the patients were allocated. During the study, changes in the clinical condition of patients were monitored.

Of the 101 patients enrolled in the study, 98 patients were given the treatment in the trial (three patients withdrew from the trial) – 48 received SNG001 and 50 received a placebo. At the outset of the trial 66 (67%) patients required oxygen supplementation at baseline (29 people in the placebo group and 37 in the SNG001 group). Patients who received SNG001 were twice as likely to show an improvement in their clinical condition at day 15 or 16, compared with

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health

There’s no extra Covid risk from living with kids, study finds

  • Living with children does not carry with it a greater risk of contracting Covid-19, according to a study in the U.K.
  • Living with children appears to lower the risk of dying from Covid-19.
  • The study looked at 9 million adults in the U.K. under the age of 65.



a group of people standing on top of a grass covered field: Students play during their break on their first day of school after the summer break at St Luke's Church of England Primary School in East London on September 3, 2020.


© Provided by CNBC
Students play during their break on their first day of school after the summer break at St Luke’s Church of England Primary School in East London on September 3, 2020.

If you live with children, you’re not at a greater risk of contracting Covid-19, according to a large study carried out in the U.K.

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In fact, living with children was associated with a lower risk of dying from the coronavirus compared to those that didn’t live with children, researchers from the University of Oxford and London’s School of Hygiene and Tropical Medicine found.

They investigated 9 million adults in the U.K. under the age of 65 between February and August to see whether the risk of infection with Covid-19, and the risk of severe outcomes from having the virus, was different for those living with and without children.

The researchers found that living with children under the age of 11 “was not associated with increased risks of recorded Covid-19 infection, Covid-19 related hospital or ICU (intensive care unit) admission but was associated with reduced risk of Covid-19 death.”

However, living with children aged 12-18 years was associated with a small increased risk of recorded coronavirus infection, the study noted, but not associated with other Covid-19 outcomes.

Living with children of any age was associated with a lower risk of dying from non-Covid-19 causes, the researchers found.

The study also looked at an additional 2.5 million adults above the age of 65 and also found that “there was no association between living with children and outcomes related to Covid-19.”

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Researchers highlighted that parents are known to have lower all-cause mortality than individuals without children, noting that the “protective mechanisms of having children are likely to be multifactorial, including healthier behaviours among parents, e.g. in relation to smoking and alcohol, and self-selection of healthier individuals becoming parents.”

They also said “beneficial changes in immune function from exposure to young children have been proposed to cause reduced mortality among parents.”

Wrangling over schools

The study comes amid ongoing uncertainty over the role of children and adolescents in the transmission of the coronavirus. But the researchers in this study noted that there was “accruing evidence” that suggests that, when it comes to Covid-19, “lower susceptibility and possibly lower infectiousness among children means that they may not transmit infection more than adults.”

There has been heated debate over whether schools and colleges should remain open during national lockdowns, with millions of kids having to stay at home when governments first locked down their economies

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health

Active surveillance may be safe for Black men with prostate cancer, study finds

Nov. 3 (UPI) — African-American men on active surveillance for low-risk prostate cancer are more likely than their White counterparts to experience disease progression and ultimately require treatment, a study published Tuesday by JAMA found.

However, men of both races included in the study were at the same risk for metastatic cancer — cancer that has spread to other organs — and death from the disease.

The findings, researchers said, suggest that active surveillance is just as safe for African-American men as it is for White men.

In active surveillance, a person’s cancer is monitored closely, with prostate-specific antigen, or PSA, blood tests taken every six months as well as annual digital rectal exam and prostate biopsies, according to the American Cancer Society.

Based on the results of these more frequent assessments, more aggressive treatment may be recommended, the society said.

“Our research provides evidence that active surveillance is safe for African-American men,” study co-author Dr. Brent Rose said in a press release.

“This means more African-American men can avoid definitive treatment and the associated side effects of urinary incontinence, erectile dysfunction and bowel problems,” said Rose, assistant professor of radiation medicine and applied sciences at University of California San Diego School of Medicine.

Prostate cancer is the second-most common cancer among men, after skin cancer, according to the U.S. Centers for Disease Control and Prevention.

One in nine men will receive a prostate cancer diagnosis in their lifetime, but African-American men are nearly twice as likely to be diagnosed with the disease and more than twice as likely to die from it than men in other ethnic groups, the agency estimates.

The cancer is typically slow growing, and low-risk disease may not need to be treated immediately after diagnosis, if ever, and can instead be monitored under an active surveillance approach, Rose and his colleagues said.

However, because of the increased risk for prostate cancer and death from the disease among African-American men, active surveillance is used less frequently in this population, according to their researchers.

For this study, Rose and colleagues reviewed data on 8,726 men diagnosed with prostate cancer between 2001 and 2015.

About one in four of these study participants were African-American, the researchers said.

Just under 60% of African-American men included in the analysis experienced disease progression, compared to 48% of White men, the data showed.

In addition, 55% of African-American men in the study required treatment compared to just over 41% percent of White men.

Despite these differences, African-American and White men were diagnosed with metastatic prostate cancer at about the same rate — 1% versus 1.4% — and faced the same risk for death — about 1% — as one another.

“Physicians and patients should discuss active surveillance for African-American men with low-risk prostate cancer,” Rose said.

“However, due to the increased risk of progression, African-American men need to be carefully followed and promptly treated if their cancer progresses,” he said.

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health

Poverty affects brain development, cognitive performance in children, study finds

Nov. 3 (UPI) — Children living in poor neighborhoods don’t perform as well on cognitive function tests and have lower “brain volume” compared to those who reside in higher-income areas, an analysis published Tuesday by JAMA Network Open found.

Increased household income was associated with improved vocabulary, reading skills and memory, among other skills, the researchers said.

These differences were likely attributable to the fact that children in these settings had more developed prefrontal and hippocampal brain regions, they said.

The prefrontal cortex has been linked with behavior, personality and decision making, among other functions, while the hippocampus is believed to be involved in learning and memory skills, according to the researchers.

“This study found evidence for independent associations of household and neighborhood environment with brain and cognitive outcomes in preadolescent children,” the researchers, from Washington University in St. Louis, wrote.

“The study also provided evidence consistent with a pathway wherein variation in prefrontal and hippocampal volume partially explains the association between neighborhood poverty and scores on cognitive tests,” they said.

Earlier research has linked socioeconomic status with brain development and academic performance, according to the researchers.

However, much of this research has focused on the impact of the socioeconomic status of individual households and families on child development, rather than the effects of living in poorer neighborhoods, they said.

“Typically, studies of socioeconomic status and the brain focus on household characteristics,” researchers Bruce Ramphal told UPI. “This study shows … that neighborhood- and household-level socioeconomic factors are uniquely related to the structure of brain regions.”

Ramphal was not part of the JAMA study published Tuesday but has devoted much of his research work to related subjects.

“These findings … [suggest] that equitable child development may be best supported by intervention both at the household and neighborhood levels,” said Ramphal, a research assistant at Columbia University and the New York State Psychiatric Institute.

For this study, the Washington University researchers analyzed the cognitive performance and brain development of 11,875 9- and 10-year-old children.

Cognitive performance was assessed using an approach created by the National Institutes of Health to measure verbal ability, attention, executive functioning, working memory, brain processing speed, episodic memory and reading ability, the researchers said.

Brain development was measured using 3T magnetic resonance imaging, a more powerful version of MRI designed to provide highly detailed images, they said.

Household socioeconomic status was measured using both household income and the Parent-Reported Financial Adversity Questionnaire, which is used to determine “whether families generally have enough money to pay for basic life expenses, such as food and healthcare,” according to the researchers.

Using the addresses of study participants, the researchers identified those living in neighborhoods with higher poverty levels.

Children living in lower-income households and in poorer neighborhoods generally performed less well on cognitive function tests than those living in wealthier areas, the researchers said.

MRI scans of the children in the study also revealed less development in the prefontal cortex and hippocampus in the brains of those living in poorer

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health

More Americans on diets from a decade ago, report finds

More Americans said they’re on diets to lose weight or for other health reasons compared with a decade ago

NEW YORK — If it seems like more and more people are on diets these days, you might not be imagining it.

The increase comes as obesity rates have continued to climb. The CDC report found that 17% of Americans said they were on diets during the 2017-2018 survey period, up from 14% a decade earlier. Over the same period obesity rates rose in the U.S. to 42% of Americans, up from 34%.

The report notes that about half of American adults have diet-related chronic conditions, such as diabetes and heart disease, and that special diets are a way many people try to manage them. Hunnes cautioned, though, that many people might not consider the way they eat to be a diet.

The report also looked at responses between 2015 and 2018 to determine other characteristics of people on special diets:

—The heavier and more educated people were, the more likely they were to report being on a special diet. The report found 23% of Americans who are obese said they were on diets, compared with 17% of overweight people and 8% of people who were normal weight or underweight.

—More women reported being on a diet than men.

—18% of non-Hispanic white Americans, 16% of Hispanic Americans and 15% of Asian and Black Americans said they were diets.

—A higher percentage of people 40 and older said they were on diets than those ages 20 to 39.

—Between 2007-08 and 2017-18, diets described as “weight loss or low calorie” grew in popularity, and remained the top category of special diet. Low-carbohydrate diets gained in popularity, while low-fat and low-cholesterol saw a decline.

The findings were based on an ongoing national survey in which participants were asked: “Are you currently on any kind of diet, either to lose weight or for some other health-related reason?”

Becky Ramsing, a registered dietitian and senior program officer at Johns Hopkins Center for a Livable Future, said that the dietary changes people make in hopes of losing weight can vary greatly. And in some cases, she said people might not understand why the choices they’re making aren’t leading to weight loss.

“They won’t eat bread, but then they’ll go eat a lot of other things that are higher in calories,” she said.

Many diet trends

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health

Pregnant women with coronavirus at higher risk of severe illness, death, CDC finds

Pregnant women who contract the coronavirus are more at risk for severe illness and death than non-pregnant women, a Centers for Disease Control and Prevention (CDC) analysis found. The agency has previously warned that pregnant people might be at an increased risk for severe illness from COVID-19, but research is ongoing.

The new report, issued Monday, analyzed data collected from over 400,000 women ages 15-44 with symptomatic COVID-19.

Of the 409,462 women with symptomatic coronavirus, 23,434 were pregnant.

CORONAVIRUS FACE MASKS AT POLLS ENCOURAGED, BUT NOT REQUIRED IN SOME STATES

“After adjusting for age, race/ethnicity, and underlying medical conditions, pregnant women were significantly more likely than were non-pregnant women to be admitted to an intensive care unit, receive ventilation, receive extracorporeal membrane oxygenation and die,” the report said.

The CDC said the findings may be due to the physiologic changes associated with pregnancy.

The CDC said the findings may be due to the physiologic changes associated with pregnancy.
(iStock)

The CDC said the findings may be due to the physiologic changes associated with pregnancy, including increased heart rate and oxygen consumption, decreased lung capacity, immunity changes and increased risk for thromboembolic disease.

POSTPARTUM DEPRESSION MAY LAST 3 YEARS AFTER CHILDBIRTH, STUDY FINDS

Separately, the analysis also found racial and ethnic disparities in both risks for infection and disease severity among pregnant women, “indicating a need to address potential drivers of risk in these populations,” the report said.

The health agency said pregnant women should be counseled about the importance of seeking prompt medical care if they develop symptoms of coronavirus, and that there should be a strong emphasis on coronavirus prevention for pregnant women at each medical appointment.

OVER HALF OF CORONAVIRUS-INFECTED PREGNANT WOMEN SHOWED NO SYMPTOMS, CDC FINDS

“To minimize the risk for acquiring SARS-CoV-2 infection, pregnant women should limit unnecessary interactions with persons who might have been exposed to or are infected with SARS-CoV-2, including those within their household, as much as possible,” the CDC said. “When going out or interacting with others, pregnant women should wear a mask, social distance, avoid persons who are not wearing a mask, and frequently wash their hands.”

CLICK HERE FOR COMPLETE CORONAVIRUS COVERAGE 

The CDC also advised pregnant women stay up to date with flu shots and prenatal care.

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health

Rise in nighttime blood pressure increases heart disease risk, study finds

Nov. 2 (UPI) — People who have high blood pressure at night are at increased risk for heart disease, even if their blood pressure is within normal ranges during the day, according to a study published Monday by the journal Circulation.

A nighttime systolic blood pressure — the “top” number — that is 20 millimeters of mercury — or mm. Hg, the unit of measure for blood pressure — above daytime readings raises a person’s risk for heart disease by 18%, the data showed.

That same rise in nighttime blood pressure also increases a person’s risk for heart failure by 25%, the researchers said.

“Nighttime blood pressure is increasingly being recognized as a predictor of cardiovascular risk,” study co-author Dr. Kazuomi Kario said in a statement.

“This study provides much more in-depth information about the cardiovascular risk associated with high nighttime blood pressure,” said Kario, a professor of cardiovascular medicine at Jichi Medical University in Japan.

Nearly half of all adults in the United States — or 108 million people — have high blood pressure, the Centers for Disease Control and Prevention estimates.

Research suggests that up to 40% of people experience rises in systolic blood pressure at night, whether or not their blood pressure is considered normal or healthy — between 90 mm. Hg and 120 mm. Hg — during the day.

For this study, researchers measured daytime and nighttime systolic blood pressure in 6,359 adults from across Japan between 2009 and 2017, using an at-home, wearable, ambulatory monitor.

Blood pressure was recorded during daily activities and sleep for at least 24-hours at a time, and device data were periodically downloaded at a healthcare clinic, the researchers said.

Nearly half of the study participants were male, and more than half were aged 65 years and older, according to the researchers.

All of the study participants had at least one risk factor for heart disease — although none had been diagnosed with it — and 75% of them were taking blood pressure medications when the study began, the researchers said.

The study participants were instructed to rest or sleep during nighttime hours and maintain their usual daytime activities, and they recorded their daily activities and sleep and wake times in a diary.

Nearly every participant recorded 20 daytime and seven nighttime automated blood pressure measurements.

By the end of the study period, participants experienced a total of 306 cardiovascular events, including 119 strokes, 99 diagnoses of coronary artery disease and 88 diagnoses of heart failure.

Those with a disrupted circadian blood pressure rhythm — or higher blood pressure at night than during the day — had a 48% higher risk for heart disease and were nearly three times as likely to experience heart failure, the data showed.

Circadian rhythms are the body’s natural, internal process that regulates a person’s sleep-wake cycle and repeats with each rotation of the Earth, or roughly every 24 hours, according to the American Heart Association.

Blood pressure typically fluctuates with a pattern that follows the

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health

A Rapid Virus Test Falters in People Without Symptoms, Study Finds

Mr. Bryant, of Quidel, who received an early copy of the University of Arizona study, praised the results as “very, very good,” citing the Sofia’s ability to root out “people who are infectious.”

Quidel, which is running several studies of its own, does not yet have definitive results that show the Sofia works in people without Covid-19 symptoms. But “based on the data so far, it seems to be applicable to that population,” Mr. Bryant said of his company’s results.

Other experts advised caution.

Although C.T. values do tend to increase as virus levels diminish, exceptions to this trend exist — and there is no universal “magic-number cutoff” for infectiousness, Dr. Dien Bard said.

Failing to grow the coronavirus out of a person’s sample also does not guarantee that individual is not contagious to others, said Omai Garner, the associate director of clinical microbiology in the UCLA Health System, who was not involved in the study.

Several experts noted that the University of Arizona study did not track transmission among its participants, making it impossible to draw conclusions about how, and from whom, the virus spread.

Dr. Harris said that some of the concerns about the Sofia’s accuracy could be overcome with repeat testing. Screened frequently enough with a rapid test, infected people missed by one Sofia would probably be detected with the next, especially if the levels of virus in their bodies were rising, Dr. Harris said. He and his colleagues are now gathering data on University of Arizona athletes, who are tested daily, to investigate this possibility. Quidel has also partnered with the Pac-12 and Big Ten Conferences to conduct daily tests.

People with symptoms or known exposures to the coronavirus should still get the most precise and reliable tests available — those that use P.C.R., said Susan Butler-Wu, a clinical microbiologist at the University of Southern California who was not involved in the study. More data, she added, would be needed to figure out how rapid tests fit into the larger diagnostic landscape.

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