Category Archives: Studies

Health Studies: High Milk & Dairy Consumption Not Related To Lower Heart Disease, Diabetes (NEJM)

From the New England Journal of Medicine (February 13, 2020):

Milk and Dairy Product Health NEJMIn our opinion, the current recommendation to greatly increase consumption of dairy foods to 3 or more servings per day does not appear to be justified…When consumption of milk is low, the two nutrients of primary concern, calcium and vitamin D (which is of particular concern at higher latitudes), be obtained from other foods or supplements without the potential negative consequences of dairy foods.

For calcium, alternative dietary sources include kale, broccoli, tofu, nuts, beans, and fortified orange juice for vitamin D, supplements can provide adequate intake at far lower cost than fortified milk. Pending additional research, guidelines for milk and equivalent dairy foods ideally should designate an acceptable intake (such as 0 to 2 servings per day for adults), deemphasize reduced-fat milk as preferable to whole milk, and discourage consumption of sugar-sweetened dairy foods in populations with high rates of overweight and obesity.

For adults, the overall evidence does not support high dairy consumption for reduction of fractures, which has been a primary justification for current U.S. recommendations. Moreover, total dairy consumption has not been clearly related to weight control or to risks of diabetes and cardiovascular disease. High consumption of dairy foods is likely to increase the risks of prostate cancer and possibly endometrial cancer but reduce the risk of colorectal cancer.

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Study: 20% Of Surgery Patients Get “Surprise” Out-Of-Network Bills Averaging Over $2000

From a JAMA Network online study (February 11, 2020):

JAMA Network NewsIn this analysis of commercially insured patients who had undergone elective surgery with an in-network surgeon at an in-network facility, approximately 1 in 5 received an out-of-network bill, with a mean potential balance bill of $2011.

In this retrospective analysis of 347 356 surgical episodes among commercially insured patients who had undergone elective surgery with in-network primary surgeons and facilities, 20% of episodes involved out-of-network charges.

The patterns of out-of-network bills varied with the clinical scenario. Simpler ambulatory procedures that tend to involve 1 surgeon (arthroscopic meniscal repair, breast lumpectomy) had fewer out-of-network bills (13%-15% of cases), whereas inpatient procedures (hysterectomy, knee replacement, colectomy, CABG surgery) had more frequent out-of-network bills (24%-33% of cases). These more complex procedures were also associated with larger potential balance bills, in the range of $2000 to $4000.

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Research: CalTech Scientists Target Cancer Cells With Ultrasound

From a CalTech news article (February 4, 2020):

Ultrasonic-Cancer-Treat-14-50.2e16d0ba.fill-310x200-c100The hope, Lee says, is that ultrasound will kill cancer cells in a specific way that will also engage the immune system and arouse it to attack any cancer cells remaining after the treatment.

A new technique could offer a targeted approach to fighting cancer: low-intensity pulses of ultrasound have been shown to selectively kill cancer cells while leaving normal cells unharmed.

CalTech logoUltrasound waves—sound waves with frequencies higher than humans can hear—have been used as a cancer treatment before, albeit in a broad-brush approach: high-intensity bursts of ultrasound can heat up tissue, killing cancer and normal cells in a target area. Now, scientists and engineers are exploring the use of low-intensity pulsed ultrasound (LIPUS) in an effort to create a more selective treatment.

A study describing the effectiveness of the new approach in cell models was published in Applied Physics Letters on January 7. The researchers behind the work caution that it is still preliminary—it still has not been tested in a live animal let alone in a human, and there remain several key challenges to address—but the results so far are promising.

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Heart Health: “Marine Omega-3s” Are “Greatest Protection Against Arrhythmic Events” (BMJ)

From a British Medical Journal (BMJ) Open Heart online article:

BMJ Open Heart Journal February 2020The intake of marine omega-3s has consistently been found to have antiarrhythmic effects. When marine omega-3s are consumed, there is an increase in cellular membrane fluidity, inhibition of L-type calcium channels and a reduction in the chance of arrhythmic events during susceptible times. Prospective data suggest that maintaining an omega-3 index of about 8%, which requires consuming seafood rich in omega-3 up to five times per week or consuming over 3 g of EPA and DHA per day, may provide the greatest protection against arrhythmic events.

Marine omega-3s for the prevention of arrhythmias

Omega-3s have been theorised to increase membrane fluidity by reducing compression of the acyl chains of membrane phospholipid fatty acids, which can lead to a reduction in the ‘spring-like’ tension on membrane ion channels. This spring-like tension can reduce the ability of ions to freely move in and out of the ion channel and hence reduce its conductance. This is known as the ‘Andersen membrane spring-like tension hypothesis’ and is just one way marine omega-3s may prevent arrhythmias.

Dietary omega-3s are mainly consumed as triglycerides, which are absorbed as free fatty acids and monoglycerides. These fats then get rapidly resynthesised in the intestine and liver back to triglycerides with subsequent integration into chylomicrons, very low-density lipoprotein and low-density lipoprotein (LDL) (LDL can actually deliver omega-3s to tissues via LDL receptors).

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Intense (VO2peak) Aerobic Exercise Raises Cognition, Alzheimer’s Disease Risks Lowered In Older Adults

From the Brain Plasticity Journal (Dec 26, 2019):

Brain Plasticity Journal 2020In conclusion, increased CRF (cardiorespiratory fitness) following this six-month intervention was associated with enhanced brain glucose metabolism in the PCC (posterior cingulate cortex), a region linked to AD, and cognition among late-middle-aged individuals at risk for AD. If these findings are supported by a larger-scale study, this would provide strong evidence that adults at risk for AD may enhance brain function and cognition by engaging in aerobic exercise training.

PCC glucose metabolism correlated positively with change in VO2peak (the highest value of VO2 attained upon an incremental or other high-intensity exercise test, designed to bring the sub- ject to the limit of tolerance)…Improvement in executive function correlated with increased VO2peak. Favorable CRF adaptation after 26 weeks of aerobic exercise training was associated with improvements in PCC glucose metabolism and executive function, important markers of AD.

Aerobic exercise has been associated with reduced burden of brain and cognitive changes related to Alzheimer’s disease (AD). However, it is unknown whether exercise training in asymptomatic individuals harboring risk for AD improves outcomes associated with AD. We investigated the effect of 26 weeks of supervised aerobic treadmill exercise training on brain glucose metabolism and cognition among 23 late-middle-aged adults from a cohort enriched with familial and genetic risk of AD.

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High, Non-Transparent Prices And Aggressive Collection Tactics Erode Trust In Healthcare (JAMA)

From a JAMA Network online article (February 4, 2020):

Billing Quality is Medical Quality JAMA Network ViewpointHigh medical prices and billing practices may reduce public trust in the medical profession and can result in the avoidance of care. In a survey of 1000 patients, 64% reported that they delayed or neglected seeking medical care in the past year because of concern about high medical bills. The field of quality science in health care has developed measures of medical complications; however, there are no standardized metrics of billing quality.

JAMA NetworkA recent study found that only 53 of 101 hospitals were able to provide a price for standard coronary artery bypass graft surgery. Notably, among the hospitals that provided a price, the price ranged from approximately $44 000 and $448 000 and was not associated with quality of care as measured by risk-adjusted outcomes and the Society of Thoracic Surgeons composite quality score.

Possible metrics of assessing billing quality JAMA

In the same way that there is wide variation in pricing, aggressive collection tactics also can be highly variable by institution. In a recent analysis, 36% (48/135) of hospitals in Virginia garnished wages of patients with unpaid medical bills, and 5 hospitals accounted for 4690 garnishment cases in 2017, representing 51% of all cases.7 In total, 20 054 lawsuits were filed in Virginia against patients for unpaid debt. For many hospitals that sue patients, legal action follows multiple attempts to contact patients through letters and calls, and some hospitals may offer to set up payment plans or even negotiate charges.

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Sleep Studies: Even Low-Levels Of Light At Night Causes Diabetes In Elderly

From a Sleep Medicine online release (January 2020):

Sleep Medicine January 2020Our findings suggest that LAN (low-level light at night) exposure increases the incidence of diabetes in a general elderly population. Further research involving a large cohort with new-onset diabetes is warranted to elucidate these findings.

Highlights

  • Humans are commonly exposed to light at night.
  • Higher light exposure at night was significantly associated with higher incidence rate of diabetes.
  • The association was consistent in the analysis using the cut-off values of LAN as 3 and 5 lux.
  • Strengths include large samples adjusting a number of confounders.

The circadian timing system, located within the suprachiasmatic nucleus of the hypothalamus, controls fundamental energy homeostasis. Clock gene mutations induce obesity in mice, and the disruption of internal circadian rhythms decreases daily energy expenditures and leptin levels in humans. Light information received by the brain influences human circadian timing and metabolism; low-level light at night (LAN) significantly increased body mass and led to prediabetes in mice. In humans, bedroom LAN affected obesity parameters; however, the association between LAN and the incidence of diabetes in humans has not been studied.

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