Is Heart Failure Associated With Risk of Suicide?

Background

The high prevalence of heart failure (HF) in developed countries imposes a substantial burden on health care resources. Depression is widely recognized as a risk factor associated with HF. This study examined the relationship between suicide and HF after controlling for depression and other comorbidities.

Is High Job Strain Associated With Hypertension Genesis?

BACKGROUND: The aim of this analysis was to test, in a large sample of normotensive subjects, the short-term influence of job strain on the onset of hypertension. METHODS: According to the questionnaire of Karasek et al, job strain was divided into four modalities: (high strain, low strain, passive, and active) based on job demand (eg, the need to work hard and quickly) and job latitude (eg, control over skill use, time allocation, and organizational decisions) scores. High strain (HS) was defined by a high demand and a low job decision latitude. Individual data obtained in 926 (age 41 +/- 6 years) healthy normotensive or newly diagnosed hypertensive subjects were analyzed. Subjects participated in two prospective work site surveys designed to assess the influence of job strain on hypertension development. Relationships between job strain modalities and work site blood pressure (BP) levels were assessed using a general linear model. A complementary analysis using the the Pearson Phi coefficient (Z analysis) was implemented to explore nonlinear or scattered relationships between job strain and onset of hypertension. RESULTS: Systolic BP (SBP) was linearly related significantly to BMI and alcohol consumption, whereas diastolic BP (DBP) was related to age. The linear model did not find any relationship between SBP or DBP and job strain modalities. Using the Z analysis, development of systolic hypertension (SBP >140 mm Hg) was significantly associated with high job strain (P < .001). CONCLUSIONS: Our results suggest that there is no global relationship between job strain and BP levels. However our methodology revealed a significant association between job strain and work site BP in a predominantly male subgroup of newly diagnosed hypertensive subjects exposed to high job strain.     

Is Alcohol Use Associated With Cavitary Disease in Tuberculosis?

BACKGROUND: Alcohol mediates detrimental alterations in the immune response to Mycobacterium tuberculosis. The association between quantity and frequency of alcohol use and the prevalence of cavitary disease in tuberculosis (TB) has not been analyzed. To investigate the relationship of alcohol use and the prevalence of cavitary disease in a 6-year population-based data set of individuals with TB. METHODS: We assessed quantity and frequency of alcohol use (daily alcohol use, years of alcohol use, and lifetime alcohol use) with a standardized questionnaire. The study group consisted of 1,250 patients analyzed for cavitary disease (HIV sero-negative subjects that were 18 years or older). Significant covariates for cavitary disease were entered into multiple logistic regression models. RESULTS: Although daily alcohol use, years of alcohol use, and alcohol use 30 days or 6 months before symptom onset were significant predictors of cavitary disease in univariate analysis, no independent associations were found between alcohol use and cavitary disease in the multivariate analysis. Only diabetes mellitus was independently associated with cavitary disease at any level or frequency of alcohol use. CONCLUSION: Alcohol use is not independently associated with increased prevalence of cavitary disease in adult patients with TB.     

Is Elevated High‐density Lipoprotein Cholesterol Always Good for Coronary Heart Disease?

BACKGROUND: High-density lipoprotein (HDL) could enhance inflammation in atherogenesis when inflammatory response is present, and the activity of paraoxonase and antioxidant in HDL in the elderly is significantly decreased. There might be a different role for high-density lipoprotein cholesterol (HDL-C) between different age groups in patients with coronary heart disease (CHD). METHODS: For this study, 225 inpatients with CHD (coronary atherosclerosis stenosis >/= 50% on >/= 1 major coronary arteries by coronary angiography), and 80 without CHD; 120 resting unstable angina patients, and 68 with stable angina were consecutively recruited. Risk factors were analyzed for CHD and resting unstable angina. RESULTS: High-density lipoprotein cholesterol in resting unstable angina was higher than that in stable angina (1.24 +/- 1.05 versus 1.05 +/- 0.29 mmol/L, p = 0.032). After adjustment for age, sex, physical inactivity, hypertension, diabetes, C-reactive protein, triglycerides, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) the adjusted odds ratio (OR) (95% CI) of resting unstable angina was 10.19 (2.18-47.6, p = 0.003) for HDL-C. Risk factors were further investigated in different age groups. Adjusted OR of CHD associated with HDL-C in < 55-year-old group was 0.09 (0.01-0.66, p = 0.018), in >/= 55-year-old group it was 0.55 (0.08-3.82, p > 0.05). Adjusted OR of resting unstable angina associated with high HDL-C was 19.24 (2.86-129.4, p = 0.002) in patients aged >/= 55 years. CONCLUSIONS: Elevated HDL-C might be an independent risk factor for resting unstable angina, even though HDL-C could play a much more important role in protection against coronary stenosis in younger or middle-aged persons.     

The Measurement of Lipids Currently and 9 Years Ago—Which Is More Associated With Carotid Intima‐Media Thickness?

Background:

Massive evidence supports that increase of lipids bring more risk of atherosclerosis. However, it is not clear if lipids measured a long time ago bear more risk than the current measurement.

Hypothesis:

Lipids measured currently is more associated with carotid atherosclerosis than lipids measured long time ago.

Methods:

A cohort of 1195 participants age 35 to 64 years was examined in both 1993–1994 and 2002 for serum lipids, and in 2002 for carotid intima‐media thickness (CIMT) with B mode ultrasound. The associations of lipids at baseline and at reexamination with CIMT were analyzed and compared using multiple linear regressions.

Results:

All lipid variables, except for high‐density lipoprotein cholesterol (HDL‐C) both at baseline and reexamination, were significantly associated with age‐adjusted CIMT in both males and females (all P_trend <0.01). The age‐adjusted mean of CIMT in all of the population was 0.696 mm in those having low low‐density lipoprotein cholesterol (LDL‐C) at both examinations, 0.719 mm in those having high LDL‐C only at baseline, 0.706 mm in those having high LDL‐C only at reexamination, and 0.727 mm in those having high LDL‐C at both examinations. Further analysis showed that lipids measured at baseline remained significant, whereas lipids at reexamination became not significant in all models, except those for HDL‐C and total cholesterol (TC)/HDL‐C, which allow the lipids at different times to compete in association with CIMT.

Conclusions:

Both the current measurement of lipids (TC, LDL‐C, non‐HDL‐C, TC/HDL‐C, and LDL‐C/HDL‐C) and the measurement from 9 years ago are significantly associated with CIMT, but the measurement from 9 years ago had an even stronger association. Clin. Cardiol. 2012 doi: 10.1002/clc.22015 Additional Supporting Information may be found in the online version of this article. The authors have no funding, financial relationships, or conflicts of interest to disclose.     

High‐protein low‐carbohydrate diets: what is the rationale?

Dietary recommendations released by the large majority of international scientific committees and organizations suggest that the diet for the prevention and treatment of the most compelling health problems of our societies (obesity, diabetes, atherosclerosis, cardiovascular diseases and cancer) should be a diet moderately low in caloric content, low in fat content (particularly in saturated fat), poor in total cholesterol and rich in fibre. Despite this uniformity in official recommendations, alternative diets with low carbohydrate and high protein content continue to be extremely popular within consumers and patients. Recently, new studies seem to suggest that high‐protein low‐carbohydrate diets may have particularly positive effects on reducing body weight and other risk factors for heart disease 1 . Gannon and Nuttall 2 - 4 conducted direct comparisons of high‐protein low‐carbohydrate diets compared with high‐carbohydrate low‐protein diets in subjects with type 2 diabetes. They found that high‐protein low‐carbohydrate diets reduced fasting plasma glucose, 24‐h glucose area under the curve and haemoglobin A . On the basis of these results, a joint committee of the American Diabetes Association, North American Society for the Study of Obesity and the American Society for Clinical Nutrition suggested that a low‐carbohydrate diet may be preferred to a low‐fat diet for the induction of weight loss and glycaemic control in subjects with type 2 diabetes 5 . What is the rationale? What mechanisms are involved? Copyright © 2011 John Wiley & Sons, Ltd.     

Is Hospice Associated with Improved End‐of‐Life Care in Nursing Homes and Assisted Living Facilities?

OBJECTIVES: To examine whether hospice enrollment for nursing home (NH) and residential care/assisted living (RC/AL) residents near the end of life is associated with symptoms and symptom management, personal care, spiritual support, and family satisfaction. DESIGN: Structured, retrospective telephone interviews with family and staff who attended to NH and RC/AL residents in the last month of life. SETTING: A stratified sample of 26 NH and 55 RC/AL facilities in four states. Participants: Family members (n=97) and long-term care (LTC) staff (n=104) identified as most involved in care of 124 residents who died over a 15-month period. MEASUREMENTS: A variety of reported measures of care and symptoms before death, including the Discomfort Scale for Dementia of the Alzheimer's Type. RESULTS: Of 124 decedents, 27 (22%) received hospice services. Dementia was less common in hospice enrollees than in decedents who did not receive hospice care. Hospice enrollees more often had moderate/severe pain and dyspnea and received pain treatment and were more likely to receive assistance with mouth care and eating and drinking. There were no differences related to unmet need, and observed differences were largely eliminated when comparisons were limited to residents whose deaths were expected. CONCLUSION: Rates of hospice use observed in this study (22%) were considerably higher than previously reported, although persons with dementia may continue to be underreferred. Hospice use is targeted to dying residents with higher levels of reported pain and dyspnea. Because difference in care largely disappears in cases when death was expected, LTC staff seem to be well positioned to provide end-of-life care for their residents and are advised to remain sensitive to instances in which death may be expected.     

Is Patients’ Insurance Coverage Associated With Prescribing After Hospitalization for Severe,Poorly Controlled Hypertension?

High medication costs may be a significant cause of nonadherence and threaten recent gains in hypertension treatment. It is unclear whether prescribing patterns differ with patients' insurance coverage. The objective of this study was to determine whether insurance coverage, reported difficulty affording medications, or nonadherence were associated with antihypertensive prescribing in a high-risk population. The authors conducted a cross-sectional survey of 189 patients admitted to an inner-city academic hospital with severe, poorly controlled hypertension. Patients' poor medication access (one-third lacked insurance and half reported difficulty affording medications) was not associated with admission or discharge regimen costs. Substituting the least expensive drug within each class would have reduced costs by 42%, and reducing calcium channel blocker use would have significantly reduced costs. In conclusion, markers of poor medication access were not associated with prescribing patterns. Further research is needed to explore these patterns and their impact on vulnerable populations' financial burden and adherence.     

Albumin Leakage in Online Hemodiafiltration,More Convective Transport,More Losses?

Online hemodiafiltration (OL‐HDF) has now demonstrated some benefits in reducing mortality. It seems that rising convective volumes improve the outcomes, but the risks of it, such as albumin leakage, are not well defined yet. The aim of the present study was to evaluate the albumin leakage using two different filters with 20 and 30 L of post‐dilution OL‐HDF. In this cross‐sectional study, 20 prevalent patients receiving post‐dilution OL‐HDL were included. We analyzed two dialyzers: FX1000, FMC and Polyflux 210H, Gambro. During four consecutive dialysis sessions, monitors were programmed using control‐volume to obtain 20 or 30 L with both dialyzers. We collected albumin samples of the effluent at 5, 15, 30, 45 and 60 min and performed area under the curve (AUC) determinations for evaluating the losses. Mean patient age was 60 ± 9 years, and 70% were men. Albumin leakage was significant higher with Polyflux 210H when compared to FX 1000 FMC. A convective volume of 30 L produced greater albumin leakage than 20 L with both filters, though only with the FX 1000 FMC was it significant (minimum albumin leakage during first hour with FX 1000 FMC 20 L: 79.2 [0.0–175.7] mg; 30 liters: 403.3 [63.5–960.7] mg; with PF 210 Gambro 20 L: 869.1 [420.0–3214.7] mg; 30 L: 1841.7 [443.8–3417.5] mg). During OL‐HDF, convective transport causes albumin leakage at least during the first hour. The albumin concentration in the effluent differs according to the type of filter used and the convective volume.     

Hospice Care in Nursing Homes: Is Site of Care Associated with Visit Volume?

OBJECTIVES: To determine factors associated with hospice visit volume and to examine whether visit volume differs by nursing home (NH) versus non-NH setting. DESIGN: Retrospective cohort study. SETTING: Twenty-one hospices across seven states under the ownership of one parent provider. PARTICIPANTS: Hospice patients from October 1998 through September 1999 in NH (n=9,460) and non-NH (n=15,484) settings. MEASUREMENTS: Data were from the provider's centralized information system. Average daily visit volume was the number of visits divided by the number of hospice routine home care days (days not in hospice inpatient or continuous home care). Multivariate logistic regression tested the association between site of care and an individual's probability of having average daily visits above the sample median. RESULTS: Average daily visits+/-standard deviation were 1.1+/-1.1 for NH and 1.2+/-1.3 for non-NH hospice patients. Site of care was not significantly associated with having an average daily visit volume above the sample median, but patients in NH settings had a lower probability of having a nurse average daily visit volume above the median (adjusted odds ratio (AOR)=0.59, 95% confidence interval (CI)=0.46-0.74) and a greater probability of having social worker (AOR=2.46, 95% CI=1.87-3.24), aide (AOR=1.97; 95% CI=1.11-3.48), and clergy (AOR=3.23, 95% CI=2.21-4.44) average daily visits above the median than those in non-NH settings. CONCLUSION: A different mix, not volume, of services appears to be used to address the physical, psychosocial, and spiritual needs of hospice patients/families who reside in NH settings than of those in non-NH settings.     

Is Wolff‐Parkinson‐White Syndrome a Genetic Disease?

Family studies, and more recent molecular genetic investigations, indicate that the Wolff-Parkinson-White (WPW) syndrome and associated preexcitation disorders can have a substantial genetic component. Because preexcitation disorders are sometimes inherited as single gene disorders, key mechanistic insights can be gained that are expected to be relevant also to the more common multifactorial forms of these traits. Potentially, such insights will inform the future management of these conditions. Where WPW is inherited as a familial trait, with or without associated cardiac defects or a systemic syndrome, there are clinical genetic ramifications that are already of practical importance.     

What Imaging‐Detected Pathologies Are Associated With Shoulder Symptoms and Their Persistence? A Systematic Literature Review

Objective

Shoulder symptoms are common, and imaging is being increasingly used to help with management. However, the relationship between imaging and symptoms remains unclear. This review aims to understand the relationship between imaging‐detected pathologies, symptoms, and their persistence.

Methods

A systematic review using Medline, EMBASE, Cochrane, and grey literature was conducted to April 2017. The cross‐sectional and longitudinal relationships between imaging‐detected abnormalities and symptoms were analyzed and associations qualitatively characterized by a best‐evidence synthesis based on study design, covariate adjustment, and the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Modalities included ultrasound, magnetic resonance imaging (MRI), radiographs, positron emission tomography (PET), bone scintigraphy, and computed tomography.

Results

A total of 6,569 abstracts was screened and 56 articles were included. In total, 50 studies did not adjust for covariates and 36 analyzed individual pathologies only. The majority of studies showed conflicting results. There was no significant association between most imaging features and symptoms among high‐quality, cross‐sectional studies. There was low‐quality evidence that enhancement of the joint capsule on MRI and increased uptake on PET were associated with symptoms in adhesive capsulitis. Based on high‐quality longitudinal studies, enlarging rotator cuff tears were associated with an increased incidence of symptoms.

Conclusion

There were conflicting results on the association of imaging features with shoulder symptoms and their persistence. The existing evidence was very low in quality, based on the GRADE methodology. Further high‐quality studies are required to understand the relationship between imaging and shoulder symptoms and to determine the appropriate role of imaging in care pathways.