Jan Dyer

It is always good to look the patient in the eye, say researchers from Texas Tech University in Odessa, Texas, and Centro Policlinico Valencia in Venezuela. They report on the case of a patient with atheroembolism, a “rare but feared complication of arteriography.” Most commonly, it affects small-diameter vessels in the skin and kidneys.

The patient, a 69-year-old man, had a history of hypertension, type 2 diabetes, and unstable angina; he had a drug-eluting stent placed in the left anterior descending coronary artery 10 days before he was admitted to the hospital. He arrived at the emergency department with intense abdominal pain, nausea, vomiting, oliguria, and pain in his legs and feet.

Physical examination revealed livedo reticularis (which is caused by small blood clots) in his left foot, and a tender abdomen. His creatinine and blood urea nitrogen levels were increased. Funduscopy showed a Hollenhorst crystal in the right inferotemporal quadrant.

He was treated with methylprednisolone, which improved the abdominal symptoms, renal function, and skin findings; then prednisone. His initial symptoms resolved over the next year.

The clinicians say the usual treatment for atheroembolism is supportive and depends on the affected organ. To their knowledge, they say, no formal studies have evaluated the use of anti-inflammatory therapies for this complication.

Funduscopy was an essential part of their examination, the researchers note, and spared the patient from invasive diagnostic studies such as biopsies. They also say that contrast-induced renal failure might have been the cause of the majority of his symptoms, but the combination of physical exam and differential diagnosis led them to the appropriate cause, as well as allowing for opportune treatment.

It is always good to look the patient in the eye, say researchers from Texas Tech University in Odessa, Texas, and Centro Policlinico Valencia in Venezuela. They report on the case of a patient with atheroembolism, a “rare but feared complication of arteriography.” Most commonly, it affects small-diameter vessels in the skin and kidneys.

The patient, a 69-year-old man, had a history of hypertension, type 2 diabetes, and unstable angina; he had a drug-eluting stent placed in the left anterior descending coronary artery 10 days before he was admitted to the hospital. He arrived at the emergency department with intense abdominal pain, nausea, vomiting, oliguria, and pain in his legs and feet.

Physical examination revealed livedo reticularis (which is caused by small blood clots) in his left foot, and a tender abdomen. His creatinine and blood urea nitrogen levels were increased. Funduscopy showed a Hollenhorst crystal in the right inferotemporal quadrant.

He was treated with methylprednisolone, which improved the abdominal symptoms, renal function, and skin findings; then prednisone. His initial symptoms resolved over the next year.

The clinicians say the usual treatment for atheroembolism is supportive and depends on the affected organ. To their knowledge, they say, no formal studies have evaluated the use of anti-inflammatory therapies for this complication.

Funduscopy was an essential part of their examination, the researchers note, and spared the patient from invasive diagnostic studies such as biopsies. They also say that contrast-induced renal failure might have been the cause of the majority of his symptoms, but the combination of physical exam and differential diagnosis led them to the appropriate cause, as well as allowing for opportune treatment.

It is always good to look the patient in the eye, say researchers from Texas Tech University in Odessa, Texas, and Centro Policlinico Valencia in Venezuela. They report on the case of a patient with atheroembolism, a “rare but feared complication of arteriography.” Most commonly, it affects small-diameter vessels in the skin and kidneys.

The patient, a 69-year-old man, had a history of hypertension, type 2 diabetes, and unstable angina; he had a drug-eluting stent placed in the left anterior descending coronary artery 10 days before he was admitted to the hospital. He arrived at the emergency department with intense abdominal pain, nausea, vomiting, oliguria, and pain in his legs and feet.

Physical examination revealed livedo reticularis (which is caused by small blood clots) in his left foot, and a tender abdomen. His creatinine and blood urea nitrogen levels were increased. Funduscopy showed a Hollenhorst crystal in the right inferotemporal quadrant.

He was treated with methylprednisolone, which improved the abdominal symptoms, renal function, and skin findings; then prednisone. His initial symptoms resolved over the next year.

The clinicians say the usual treatment for atheroembolism is supportive and depends on the affected organ. To their knowledge, they say, no formal studies have evaluated the use of anti-inflammatory therapies for this complication.

Funduscopy was an essential part of their examination, the researchers note, and spared the patient from invasive diagnostic studies such as biopsies. They also say that contrast-induced renal failure might have been the cause of the majority of his symptoms, but the combination of physical exam and differential diagnosis led them to the appropriate cause, as well as allowing for opportune treatment.

With help from researchers from the University of Hertfordshire in the United Kingdom, The US Department of Health and Human Services (HHS) has updated guidance on how best to decontaminate after mass chemical exposure. This second edition of Primary Response Incident Scene Management (PRISM) incorporates new scientific evidence on emergency self-decontamination, hair decontamination, and the interactions of chemicals with hair.

The goal of working with the University of Hertfordshire was to help emergency managers and first responders make “fundamental and fast decisions on how to save the greatest number of lives in chemical emergencies,” says Rick Bright, PhD, director of the Biomedical Advanced Research and Development Authority (BARDA).

The study included a large-scale exercise in which > 80 volunteers were dosed with a chemical warfare agent simulant to quantify the efficacy of different forms of decontamination.

Notably, the research demonstrates that immediate “dry” decontamination—wiping down the victim with any absorbent material (eg, toilet paper, paper towels, wound dressings) can be highly effective on its own and can be done by affected individuals themselves under the instruction of first responders. The dry decontamination step removes up to 99% of contamination and minimizes the accumulation of hazardous material in the subsequent steps.

The new guidance also expands on the effects of the “triple protocol,” a combined decontamination strategy. The 3 steps of that protocol—dry decontamination, wet decontamination using water deluges from fire trucks, and technical decontamination—have been shown to remove 99.9% of chemical contamination. Moreover, the latest clinical evidence indicates that the 3-step approach is faster and more effective than traditional methods for treating chemically contaminated patients.

The guideline also addresses how communities can prepare for chemical emergencies and what to do after the event, such as providing washcloths, towels, blankets, and temporary clothing.

Federal experts and the researchers devised the Algorithm Suggesting Proportionate Incident Response Engagement (ASPIRE), a decision-support tool to help emergency management planners and responders decide which decontamination approach suits a given situation. Using the algorithm, they can tailor plans and responses based on the chemical and type of exposure, how quickly the chemical evaporates, and the amount of time passed since exposure.

ASPIRE and the guidance are integrated into the Chemical Hazards Emergency Medical Management (CHEMM), a web-based resource and suite of preparedness and emergency response tools. The developers also plan to incorporate them into a mobile app.

PRISM is available at www.medicalcountermeasures.gov.

With help from researchers from the University of Hertfordshire in the United Kingdom, The US Department of Health and Human Services (HHS) has updated guidance on how best to decontaminate after mass chemical exposure. This second edition of Primary Response Incident Scene Management (PRISM) incorporates new scientific evidence on emergency self-decontamination, hair decontamination, and the interactions of chemicals with hair.

The goal of working with the University of Hertfordshire was to help emergency managers and first responders make “fundamental and fast decisions on how to save the greatest number of lives in chemical emergencies,” says Rick Bright, PhD, director of the Biomedical Advanced Research and Development Authority (BARDA).

The study included a large-scale exercise in which > 80 volunteers were dosed with a chemical warfare agent simulant to quantify the efficacy of different forms of decontamination.

Notably, the research demonstrates that immediate “dry” decontamination—wiping down the victim with any absorbent material (eg, toilet paper, paper towels, wound dressings) can be highly effective on its own and can be done by affected individuals themselves under the instruction of first responders. The dry decontamination step removes up to 99% of contamination and minimizes the accumulation of hazardous material in the subsequent steps.

The new guidance also expands on the effects of the “triple protocol,” a combined decontamination strategy. The 3 steps of that protocol—dry decontamination, wet decontamination using water deluges from fire trucks, and technical decontamination—have been shown to remove 99.9% of chemical contamination. Moreover, the latest clinical evidence indicates that the 3-step approach is faster and more effective than traditional methods for treating chemically contaminated patients.

The guideline also addresses how communities can prepare for chemical emergencies and what to do after the event, such as providing washcloths, towels, blankets, and temporary clothing.

Federal experts and the researchers devised the Algorithm Suggesting Proportionate Incident Response Engagement (ASPIRE), a decision-support tool to help emergency management planners and responders decide which decontamination approach suits a given situation. Using the algorithm, they can tailor plans and responses based on the chemical and type of exposure, how quickly the chemical evaporates, and the amount of time passed since exposure.

ASPIRE and the guidance are integrated into the Chemical Hazards Emergency Medical Management (CHEMM), a web-based resource and suite of preparedness and emergency response tools. The developers also plan to incorporate them into a mobile app.

PRISM is available at www.medicalcountermeasures.gov.

With help from researchers from the University of Hertfordshire in the United Kingdom, The US Department of Health and Human Services (HHS) has updated guidance on how best to decontaminate after mass chemical exposure. This second edition of Primary Response Incident Scene Management (PRISM) incorporates new scientific evidence on emergency self-decontamination, hair decontamination, and the interactions of chemicals with hair.

The goal of working with the University of Hertfordshire was to help emergency managers and first responders make “fundamental and fast decisions on how to save the greatest number of lives in chemical emergencies,” says Rick Bright, PhD, director of the Biomedical Advanced Research and Development Authority (BARDA).

The study included a large-scale exercise in which > 80 volunteers were dosed with a chemical warfare agent simulant to quantify the efficacy of different forms of decontamination.

Notably, the research demonstrates that immediate “dry” decontamination—wiping down the victim with any absorbent material (eg, toilet paper, paper towels, wound dressings) can be highly effective on its own and can be done by affected individuals themselves under the instruction of first responders. The dry decontamination step removes up to 99% of contamination and minimizes the accumulation of hazardous material in the subsequent steps.

The new guidance also expands on the effects of the “triple protocol,” a combined decontamination strategy. The 3 steps of that protocol—dry decontamination, wet decontamination using water deluges from fire trucks, and technical decontamination—have been shown to remove 99.9% of chemical contamination. Moreover, the latest clinical evidence indicates that the 3-step approach is faster and more effective than traditional methods for treating chemically contaminated patients.

The guideline also addresses how communities can prepare for chemical emergencies and what to do after the event, such as providing washcloths, towels, blankets, and temporary clothing.

Federal experts and the researchers devised the Algorithm Suggesting Proportionate Incident Response Engagement (ASPIRE), a decision-support tool to help emergency management planners and responders decide which decontamination approach suits a given situation. Using the algorithm, they can tailor plans and responses based on the chemical and type of exposure, how quickly the chemical evaporates, and the amount of time passed since exposure.

ASPIRE and the guidance are integrated into the Chemical Hazards Emergency Medical Management (CHEMM), a web-based resource and suite of preparedness and emergency response tools. The developers also plan to incorporate them into a mobile app.

PRISM is available at www.medicalcountermeasures.gov.

Thoracic endovascular aortic repair (TEVAR) is a “young technology with several unknowns,” say researchers from Shantou University Medical College, and Wuhan Asia Heart Hospital, both China. One of those unknowns is the risk factors for prognosis after TEVAR.

After all, thyroid hormones are critical to many areas of heart health, such as vascular remodeling; hypothyroidism can aggravate hypertension; and low levels of free thyroxine (FT4) influence arterial stiffness and C-reactive protein. In spite of the many links, however, the relationship between subclinical hypothyroidism and cardiovascular disease has not been fully elucidated, the researchers say. They conducted a study to evaluate whether thyroid hormones predicted early (30 days) and mid-term (12 months) aorta-related adverse events (AEs), such as death, progression of aortic disease, organ failure, or lower limb ischemia; and aorta-related readmissions.

In their study, 338 patients were stratified according to their levels of FT4 before undergoing TEVAR. Of the enrolled patients, 288 were followed up at 12 months for readmission; 292 were followed up on AEs.

Patients with low normal levels of FT4 had a greater risk of readmission after thoracic endovascular aortic repair. Within 30 days, the incidence of AEs and readmission were 2.7% and 4.1%; within 12 months, 8.9% and 13.5%. After the researchers adjusted for confounders, the patients with the lowest FT4 quartile were at significantly greater risk for readmission than those in the highest-quartile group, at both early and mid-term follow-up. 

The same did not hold true for AEs. The researchers say this is not uncommon in studies of predictors of AEs and readmission: Factors that are weak predictors of readmission tend to be strong predictors of AEs, and vice versa.

Thoracic endovascular aortic repair (TEVAR) is a “young technology with several unknowns,” say researchers from Shantou University Medical College, and Wuhan Asia Heart Hospital, both China. One of those unknowns is the risk factors for prognosis after TEVAR.

After all, thyroid hormones are critical to many areas of heart health, such as vascular remodeling; hypothyroidism can aggravate hypertension; and low levels of free thyroxine (FT4) influence arterial stiffness and C-reactive protein. In spite of the many links, however, the relationship between subclinical hypothyroidism and cardiovascular disease has not been fully elucidated, the researchers say. They conducted a study to evaluate whether thyroid hormones predicted early (30 days) and mid-term (12 months) aorta-related adverse events (AEs), such as death, progression of aortic disease, organ failure, or lower limb ischemia; and aorta-related readmissions.

In their study, 338 patients were stratified according to their levels of FT4 before undergoing TEVAR. Of the enrolled patients, 288 were followed up at 12 months for readmission; 292 were followed up on AEs.

Patients with low normal levels of FT4 had a greater risk of readmission after thoracic endovascular aortic repair. Within 30 days, the incidence of AEs and readmission were 2.7% and 4.1%; within 12 months, 8.9% and 13.5%. After the researchers adjusted for confounders, the patients with the lowest FT4 quartile were at significantly greater risk for readmission than those in the highest-quartile group, at both early and mid-term follow-up. 

The same did not hold true for AEs. The researchers say this is not uncommon in studies of predictors of AEs and readmission: Factors that are weak predictors of readmission tend to be strong predictors of AEs, and vice versa.

Thoracic endovascular aortic repair (TEVAR) is a “young technology with several unknowns,” say researchers from Shantou University Medical College, and Wuhan Asia Heart Hospital, both China. One of those unknowns is the risk factors for prognosis after TEVAR.

After all, thyroid hormones are critical to many areas of heart health, such as vascular remodeling; hypothyroidism can aggravate hypertension; and low levels of free thyroxine (FT4) influence arterial stiffness and C-reactive protein. In spite of the many links, however, the relationship between subclinical hypothyroidism and cardiovascular disease has not been fully elucidated, the researchers say. They conducted a study to evaluate whether thyroid hormones predicted early (30 days) and mid-term (12 months) aorta-related adverse events (AEs), such as death, progression of aortic disease, organ failure, or lower limb ischemia; and aorta-related readmissions.

In their study, 338 patients were stratified according to their levels of FT4 before undergoing TEVAR. Of the enrolled patients, 288 were followed up at 12 months for readmission; 292 were followed up on AEs.

Patients with low normal levels of FT4 had a greater risk of readmission after thoracic endovascular aortic repair. Within 30 days, the incidence of AEs and readmission were 2.7% and 4.1%; within 12 months, 8.9% and 13.5%. After the researchers adjusted for confounders, the patients with the lowest FT4 quartile were at significantly greater risk for readmission than those in the highest-quartile group, at both early and mid-term follow-up. 

The same did not hold true for AEs. The researchers say this is not uncommon in studies of predictors of AEs and readmission: Factors that are weak predictors of readmission tend to be strong predictors of AEs, and vice versa.

“Time-specific” dosing of insulin can be an obstacle to adherence for patients with complicated, busy lives. More than half of patients with type 2 diabetes do not achieve their target HbA_1c of 7% after insulin is added to their treatment regimen. Researchers from CAPHRI School for Public Health and Primary Care, and CARIM Institute in The Netherlands, who surveyed 1,483 adults with diabetes suggest that it may be time to rethink both prescribing and patient education, in part because of who fell into the nonadherent group.

The researchers conducted a web-based self-report survey. Of the respondents, 58% used bolus insulin before meals, 24% after meals, and 18% before, during, or after meals. The researchers excluded the “mixed” cohort, including 1,218 in the analysis.

Half the respondents in the postmeal cohort reported experiencing minor hypoglycemic events at least once a week compared with 35% of the premeal cohort. Similarly, more in the postmeal group had had major hypoglycemic events (38% vs 26%). The postmeal respondents also were more likely to have HbA_1c ≥ 9% (40% vs 29%). And they were less likely to report always testing their blood glucose before injecting insulin (36% vs 54%).

Perhaps contrary to some expectations, the respondents who injected insulin postmeal were younger, had shorter duration of diabetes, had the highest level of college or university education, were more likely to be employed, and more frequently participated in diabetes education programs (including one-on-one programs).

The researchers say those data suggest that factors other than lack of diabetes education, education, or low socioeconomic status should be considered in explaining the nonadherence. They add that some research has shown that education programs have an “inconsistent relationship with patient adherence.” They suggest that such programs might be improved by placing greater emphasis on the importance of dosing insulin before meals.

Of the nearly 20% of patients who use insulin treatment, >  90% receive bolus insulin. The researchers note that respondents preferred a form of bolus insulin they can administer before, after, or during meals as they see fit. The respondents who injected postmeal were more likely than the premeal respondents to prefer this formulation.

“Time-specific” dosing of insulin can be an obstacle to adherence for patients with complicated, busy lives. More than half of patients with type 2 diabetes do not achieve their target HbA_1c of 7% after insulin is added to their treatment regimen. Researchers from CAPHRI School for Public Health and Primary Care, and CARIM Institute in The Netherlands, who surveyed 1,483 adults with diabetes suggest that it may be time to rethink both prescribing and patient education, in part because of who fell into the nonadherent group.

The researchers conducted a web-based self-report survey. Of the respondents, 58% used bolus insulin before meals, 24% after meals, and 18% before, during, or after meals. The researchers excluded the “mixed” cohort, including 1,218 in the analysis.

Half the respondents in the postmeal cohort reported experiencing minor hypoglycemic events at least once a week compared with 35% of the premeal cohort. Similarly, more in the postmeal group had had major hypoglycemic events (38% vs 26%). The postmeal respondents also were more likely to have HbA_1c ≥ 9% (40% vs 29%). And they were less likely to report always testing their blood glucose before injecting insulin (36% vs 54%).

Perhaps contrary to some expectations, the respondents who injected insulin postmeal were younger, had shorter duration of diabetes, had the highest level of college or university education, were more likely to be employed, and more frequently participated in diabetes education programs (including one-on-one programs).

The researchers say those data suggest that factors other than lack of diabetes education, education, or low socioeconomic status should be considered in explaining the nonadherence. They add that some research has shown that education programs have an “inconsistent relationship with patient adherence.” They suggest that such programs might be improved by placing greater emphasis on the importance of dosing insulin before meals.

Of the nearly 20% of patients who use insulin treatment, >  90% receive bolus insulin. The researchers note that respondents preferred a form of bolus insulin they can administer before, after, or during meals as they see fit. The respondents who injected postmeal were more likely than the premeal respondents to prefer this formulation.

“Time-specific” dosing of insulin can be an obstacle to adherence for patients with complicated, busy lives. More than half of patients with type 2 diabetes do not achieve their target HbA_1c of 7% after insulin is added to their treatment regimen. Researchers from CAPHRI School for Public Health and Primary Care, and CARIM Institute in The Netherlands, who surveyed 1,483 adults with diabetes suggest that it may be time to rethink both prescribing and patient education, in part because of who fell into the nonadherent group.

The researchers conducted a web-based self-report survey. Of the respondents, 58% used bolus insulin before meals, 24% after meals, and 18% before, during, or after meals. The researchers excluded the “mixed” cohort, including 1,218 in the analysis.

Half the respondents in the postmeal cohort reported experiencing minor hypoglycemic events at least once a week compared with 35% of the premeal cohort. Similarly, more in the postmeal group had had major hypoglycemic events (38% vs 26%). The postmeal respondents also were more likely to have HbA_1c ≥ 9% (40% vs 29%). And they were less likely to report always testing their blood glucose before injecting insulin (36% vs 54%).

Perhaps contrary to some expectations, the respondents who injected insulin postmeal were younger, had shorter duration of diabetes, had the highest level of college or university education, were more likely to be employed, and more frequently participated in diabetes education programs (including one-on-one programs).

The researchers say those data suggest that factors other than lack of diabetes education, education, or low socioeconomic status should be considered in explaining the nonadherence. They add that some research has shown that education programs have an “inconsistent relationship with patient adherence.” They suggest that such programs might be improved by placing greater emphasis on the importance of dosing insulin before meals.

Of the nearly 20% of patients who use insulin treatment, >  90% receive bolus insulin. The researchers note that respondents preferred a form of bolus insulin they can administer before, after, or during meals as they see fit. The respondents who injected postmeal were more likely than the premeal respondents to prefer this formulation.

Not all sedentary behavior is equal, say researchers from Universidad Autónoma de Madrid in Spain, who evaluated the sedentary habits of 5,459 women and 4,740 men.

The researchers note that several studies have found that, unlike, for example, computer use and reading, TV watching is consistently associated with adverse health outcomes, such as metabolic syndrome, obesity, and diabetes mellitus (DM). But different sedentary behaviors (SBs) have different health effects, they add. They cite research that suggests TV and other “passive” SBs (eg, listening or talking while sitting) could be more harmful than “mentally active” SBs, such as computer use and reading. In this study, “passive” sedentary time, such as TV watching, was associated with less recreational activity and higher body weight. Time at the computer and reading were linked to more recreational physical activity but less light-intensity activity at home.

Moreover, each type of SB has a distinct demographic and lifestyle profile, the researchers say. Older age, lower education, unhealthy lifestyle (smoking, worse diet, less physical activity, higher BMI) and chronic morbidity, such as DM or osteomuscular disease, were linked to more TV time. Longer time at the computer or in commuting was linked to younger age, male gender, higher education, and a sedentary job.

Watching TV had no association with total time spent on the rest of leisure-time SBs. The researchers also found that “mentally active” SBs, such as using the computer and reading, tend to cluster.

Many studies have looked at the effects of and connections between SB, lifestyle choices, and health. The researchers of this study say theirs extends knowledge in the field by considering more types of SB (using the computer, commuting, lying in the sun, listening to music, and reading). To their knowledge, they say, no previous study on a representative sample of an entire country has examined the association between TV watching time and the rest of SB, or has reported the full profile of sociodemographic, lifestyle, and health variables associated with each type of SB.

Watching TV was the predominant SB (45% of total sitting time), followed by sitting at the computer (23%), reading (15%), and commuting (12%). The participants spent a mean of 1.96 hours a day watching TV, vs > 1 hour for the other behaviors.

Not all sedentary behavior is equal, say researchers from Universidad Autónoma de Madrid in Spain, who evaluated the sedentary habits of 5,459 women and 4,740 men.

The researchers note that several studies have found that, unlike, for example, computer use and reading, TV watching is consistently associated with adverse health outcomes, such as metabolic syndrome, obesity, and diabetes mellitus (DM). But different sedentary behaviors (SBs) have different health effects, they add. They cite research that suggests TV and other “passive” SBs (eg, listening or talking while sitting) could be more harmful than “mentally active” SBs, such as computer use and reading. In this study, “passive” sedentary time, such as TV watching, was associated with less recreational activity and higher body weight. Time at the computer and reading were linked to more recreational physical activity but less light-intensity activity at home.

Moreover, each type of SB has a distinct demographic and lifestyle profile, the researchers say. Older age, lower education, unhealthy lifestyle (smoking, worse diet, less physical activity, higher BMI) and chronic morbidity, such as DM or osteomuscular disease, were linked to more TV time. Longer time at the computer or in commuting was linked to younger age, male gender, higher education, and a sedentary job.

Watching TV had no association with total time spent on the rest of leisure-time SBs. The researchers also found that “mentally active” SBs, such as using the computer and reading, tend to cluster.

Many studies have looked at the effects of and connections between SB, lifestyle choices, and health. The researchers of this study say theirs extends knowledge in the field by considering more types of SB (using the computer, commuting, lying in the sun, listening to music, and reading). To their knowledge, they say, no previous study on a representative sample of an entire country has examined the association between TV watching time and the rest of SB, or has reported the full profile of sociodemographic, lifestyle, and health variables associated with each type of SB.

Watching TV was the predominant SB (45% of total sitting time), followed by sitting at the computer (23%), reading (15%), and commuting (12%). The participants spent a mean of 1.96 hours a day watching TV, vs > 1 hour for the other behaviors.

Not all sedentary behavior is equal, say researchers from Universidad Autónoma de Madrid in Spain, who evaluated the sedentary habits of 5,459 women and 4,740 men.

The researchers note that several studies have found that, unlike, for example, computer use and reading, TV watching is consistently associated with adverse health outcomes, such as metabolic syndrome, obesity, and diabetes mellitus (DM). But different sedentary behaviors (SBs) have different health effects, they add. They cite research that suggests TV and other “passive” SBs (eg, listening or talking while sitting) could be more harmful than “mentally active” SBs, such as computer use and reading. In this study, “passive” sedentary time, such as TV watching, was associated with less recreational activity and higher body weight. Time at the computer and reading were linked to more recreational physical activity but less light-intensity activity at home.

Moreover, each type of SB has a distinct demographic and lifestyle profile, the researchers say. Older age, lower education, unhealthy lifestyle (smoking, worse diet, less physical activity, higher BMI) and chronic morbidity, such as DM or osteomuscular disease, were linked to more TV time. Longer time at the computer or in commuting was linked to younger age, male gender, higher education, and a sedentary job.

Watching TV had no association with total time spent on the rest of leisure-time SBs. The researchers also found that “mentally active” SBs, such as using the computer and reading, tend to cluster.

Many studies have looked at the effects of and connections between SB, lifestyle choices, and health. The researchers of this study say theirs extends knowledge in the field by considering more types of SB (using the computer, commuting, lying in the sun, listening to music, and reading). To their knowledge, they say, no previous study on a representative sample of an entire country has examined the association between TV watching time and the rest of SB, or has reported the full profile of sociodemographic, lifestyle, and health variables associated with each type of SB.

Watching TV was the predominant SB (45% of total sitting time), followed by sitting at the computer (23%), reading (15%), and commuting (12%). The participants spent a mean of 1.96 hours a day watching TV, vs > 1 hour for the other behaviors.

Immunocompromised patients can be at risk for complications long after the original health issue was resolved—a problem illustrated by a patient who had a heart transplant in 1986 but developed acute progressive disseminated histoplasmosis decades later.

The patient presented with altered mental status; a Mini-Mental State Exam showed confusion. A computed tomography scan of the patient’s head revealed lesions, raising the suspicion of metastatic malignancy, which was ruled out after biopsy of a medial right temporal brain lesion. MRIs of his chest, abdomen, and pelvis revealed bilateral masses on his adrenal glands. Guided adrenal biopsy showed necrotizing granulomas consistent with a diagnosis of disseminated histoplasmosis.

However, that diagnosis was questioned—the patient had lived in Arizona for years, not, for instance, the Midwest, where histoplasmosis is more common. Nor did he have a history of spelunking, prior exposure to bird or bat droppings. He did report a short visit to North Carolina 30 years earlier. And he had been on immunosuppressive drugs for years.

The patient was started on liposomal amphotericin B, which was discontinued when his renal function deteriorated. He was switched to itraconazole, then restarted on amphotericin B with close monitoring after the diagnosis was confirmed. His doses of immunosuppressive drugs were reduced.

The clinicians note that HIV/AIDS and use of immunosuppressive drugs are among the risk factors for disseminated infection. They cite 1 study that found immunosuppression was the single most common risk factor. In another study, the risk of histoplasmosis increased as CD4+ T cells dropped below 300/µL.

The patient’s case was complicated by the fact that it was > 30 years after his heart transplant, and he had made only a short visit to an endemic area. He also had no history of histoplasmosis—the clinicians say a database search turned up the fact that most reported cases were preceded by symptomatic infection.

When charting patient history, they advise placing emphasis on a history of travel to endemic areas and considering histoplasmosis in immunocompromised patients in nonendemic areas.

Immunocompromised patients can be at risk for complications long after the original health issue was resolved—a problem illustrated by a patient who had a heart transplant in 1986 but developed acute progressive disseminated histoplasmosis decades later.

The patient presented with altered mental status; a Mini-Mental State Exam showed confusion. A computed tomography scan of the patient’s head revealed lesions, raising the suspicion of metastatic malignancy, which was ruled out after biopsy of a medial right temporal brain lesion. MRIs of his chest, abdomen, and pelvis revealed bilateral masses on his adrenal glands. Guided adrenal biopsy showed necrotizing granulomas consistent with a diagnosis of disseminated histoplasmosis.

However, that diagnosis was questioned—the patient had lived in Arizona for years, not, for instance, the Midwest, where histoplasmosis is more common. Nor did he have a history of spelunking, prior exposure to bird or bat droppings. He did report a short visit to North Carolina 30 years earlier. And he had been on immunosuppressive drugs for years.

The patient was started on liposomal amphotericin B, which was discontinued when his renal function deteriorated. He was switched to itraconazole, then restarted on amphotericin B with close monitoring after the diagnosis was confirmed. His doses of immunosuppressive drugs were reduced.

The clinicians note that HIV/AIDS and use of immunosuppressive drugs are among the risk factors for disseminated infection. They cite 1 study that found immunosuppression was the single most common risk factor. In another study, the risk of histoplasmosis increased as CD4+ T cells dropped below 300/µL.

The patient’s case was complicated by the fact that it was > 30 years after his heart transplant, and he had made only a short visit to an endemic area. He also had no history of histoplasmosis—the clinicians say a database search turned up the fact that most reported cases were preceded by symptomatic infection.

When charting patient history, they advise placing emphasis on a history of travel to endemic areas and considering histoplasmosis in immunocompromised patients in nonendemic areas.

Immunocompromised patients can be at risk for complications long after the original health issue was resolved—a problem illustrated by a patient who had a heart transplant in 1986 but developed acute progressive disseminated histoplasmosis decades later.

The patient presented with altered mental status; a Mini-Mental State Exam showed confusion. A computed tomography scan of the patient’s head revealed lesions, raising the suspicion of metastatic malignancy, which was ruled out after biopsy of a medial right temporal brain lesion. MRIs of his chest, abdomen, and pelvis revealed bilateral masses on his adrenal glands. Guided adrenal biopsy showed necrotizing granulomas consistent with a diagnosis of disseminated histoplasmosis.

However, that diagnosis was questioned—the patient had lived in Arizona for years, not, for instance, the Midwest, where histoplasmosis is more common. Nor did he have a history of spelunking, prior exposure to bird or bat droppings. He did report a short visit to North Carolina 30 years earlier. And he had been on immunosuppressive drugs for years.

The patient was started on liposomal amphotericin B, which was discontinued when his renal function deteriorated. He was switched to itraconazole, then restarted on amphotericin B with close monitoring after the diagnosis was confirmed. His doses of immunosuppressive drugs were reduced.

The clinicians note that HIV/AIDS and use of immunosuppressive drugs are among the risk factors for disseminated infection. They cite 1 study that found immunosuppression was the single most common risk factor. In another study, the risk of histoplasmosis increased as CD4+ T cells dropped below 300/µL.

The patient’s case was complicated by the fact that it was > 30 years after his heart transplant, and he had made only a short visit to an endemic area. He also had no history of histoplasmosis—the clinicians say a database search turned up the fact that most reported cases were preceded by symptomatic infection.

When charting patient history, they advise placing emphasis on a history of travel to endemic areas and considering histoplasmosis in immunocompromised patients in nonendemic areas.

Per- and polyfluoroalkyl substances (PFAS) are manmade chemicals used in industry and consumer products, such as nonstick cookware, water-repellent clothing, and stain-resistant fabrics. Studies have shown that exposure to PFAS can—among other things—affect growth, learning, and behavior of infants and children; reduce a woman’s chance of getting pregnant; affect the immune system; and increase the risk of cancer.

The 2018 National Defense Authorization Act allowed the CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) to look at PFAS exposure in communities near current or former military bases that are known to have had PFAS in the drinking water. In a pilot study, researchers conducted assessments in Bucks and Montgomery counties in Pennsylvania (near Horsham Air Guard Station and former Naval Air Warfare Center), and in Westhampton, New York (near Gabreski Air National Guard Base).

Now, CDC/ATSDR have expanded the assessments to 8 other communities:

• Berkeley County (WV) near Shepherd Field Air National Guard Base
• El Paso County (CO) near Peterson Air Force Base
• Fairbanks North Star Borough (AK) near Eielson Air Force Base
• Hampden County (MA) near Barnes Air National Guard Base
• Lubbock County (TX) near Reese Technology Center
• Orange County (NY) near Stewart Air National Guard Base
• New Castle County (DE) near New Castle Air National Guard Base
• Spokane County (WA) near Fairchild Air Force Base

The researchers will randomly select people in each community to participate by having their PFAS levels checked in blood and urine samples. The sampling results will provide researchers and public health professionals with information about community-level exposure but also be used to help communities understand the level of risk and how to reduce PFAS exposure.

The assessments, expected to begin this year and continue through 2020, will also “lay the groundwork,” the CDC says, for a multisite health study that will examine the relationship between PFAS exposure and health outcomes.

For more information about PFAS and the Exposure Assessment, visit https://www.atsdr.cdc.gov/pfas/index.html.

Per- and polyfluoroalkyl substances (PFAS) are manmade chemicals used in industry and consumer products, such as nonstick cookware, water-repellent clothing, and stain-resistant fabrics. Studies have shown that exposure to PFAS can—among other things—affect growth, learning, and behavior of infants and children; reduce a woman’s chance of getting pregnant; affect the immune system; and increase the risk of cancer.

The 2018 National Defense Authorization Act allowed the CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) to look at PFAS exposure in communities near current or former military bases that are known to have had PFAS in the drinking water. In a pilot study, researchers conducted assessments in Bucks and Montgomery counties in Pennsylvania (near Horsham Air Guard Station and former Naval Air Warfare Center), and in Westhampton, New York (near Gabreski Air National Guard Base).

Now, CDC/ATSDR have expanded the assessments to 8 other communities:

• Berkeley County (WV) near Shepherd Field Air National Guard Base
• El Paso County (CO) near Peterson Air Force Base
• Fairbanks North Star Borough (AK) near Eielson Air Force Base
• Hampden County (MA) near Barnes Air National Guard Base
• Lubbock County (TX) near Reese Technology Center
• Orange County (NY) near Stewart Air National Guard Base
• New Castle County (DE) near New Castle Air National Guard Base
• Spokane County (WA) near Fairchild Air Force Base

The researchers will randomly select people in each community to participate by having their PFAS levels checked in blood and urine samples. The sampling results will provide researchers and public health professionals with information about community-level exposure but also be used to help communities understand the level of risk and how to reduce PFAS exposure.

The assessments, expected to begin this year and continue through 2020, will also “lay the groundwork,” the CDC says, for a multisite health study that will examine the relationship between PFAS exposure and health outcomes.

For more information about PFAS and the Exposure Assessment, visit https://www.atsdr.cdc.gov/pfas/index.html.

Per- and polyfluoroalkyl substances (PFAS) are manmade chemicals used in industry and consumer products, such as nonstick cookware, water-repellent clothing, and stain-resistant fabrics. Studies have shown that exposure to PFAS can—among other things—affect growth, learning, and behavior of infants and children; reduce a woman’s chance of getting pregnant; affect the immune system; and increase the risk of cancer.

The 2018 National Defense Authorization Act allowed the CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) to look at PFAS exposure in communities near current or former military bases that are known to have had PFAS in the drinking water. In a pilot study, researchers conducted assessments in Bucks and Montgomery counties in Pennsylvania (near Horsham Air Guard Station and former Naval Air Warfare Center), and in Westhampton, New York (near Gabreski Air National Guard Base).

Now, CDC/ATSDR have expanded the assessments to 8 other communities:

• Berkeley County (WV) near Shepherd Field Air National Guard Base
• El Paso County (CO) near Peterson Air Force Base
• Fairbanks North Star Borough (AK) near Eielson Air Force Base
• Hampden County (MA) near Barnes Air National Guard Base
• Lubbock County (TX) near Reese Technology Center
• Orange County (NY) near Stewart Air National Guard Base
• New Castle County (DE) near New Castle Air National Guard Base
• Spokane County (WA) near Fairchild Air Force Base

The researchers will randomly select people in each community to participate by having their PFAS levels checked in blood and urine samples. The sampling results will provide researchers and public health professionals with information about community-level exposure but also be used to help communities understand the level of risk and how to reduce PFAS exposure.

The assessments, expected to begin this year and continue through 2020, will also “lay the groundwork,” the CDC says, for a multisite health study that will examine the relationship between PFAS exposure and health outcomes.

For more information about PFAS and the Exposure Assessment, visit https://www.atsdr.cdc.gov/pfas/index.html.

Pain is becoming a fact of life for more and more people, and they are turning to opioids to treat it, according to a survey sponsored by the National Center for Complementary and Integrative Health.

Researchers looked at nearly 2 decades-worth of cumulative data from the Medical Expenditure Panel Survey (MEPS). They found that since 1997/1998, pain prevalence in US adults rose by 25%.

In 1997/1998, about 33% of American adults had at ≤ 1 painful health condition. In 2013/2014, that proportion was 41%. For about 68 million people, moderate-to-severe pain was interfering with normal work activities. And those people were turning more often to strong opioids—eg, fentanyl, morphine, oxycodone—for help. Use of opioids to manage pain more than doubled in just 10 years: from 4.1 million (11.5%) in 2001/2002 to 10.5 million (24.3%) in 2013/2014.

People with severe pain-related interference also were more likely to have had > 4 opioid prescriptions and to have visited a doctor’s office > 6 times for pain compared with those with minimal pain-related interference.

Opioid use peaked between 2005 and 2012, but since 2012, opioid use has slightly declined. The researchers say this ties to a reduction in use of weak opioids and in the number of patients reporting only 1 opioid prescription.

The survey also found some small downward shifts in health care visits. Ambulatory office visits plateaued between 2001/2002 and 2007/2008 and decreased through 2013/2014. The researchers also found small but statistically significant drops in pain-related emergency department visits and overnight hospital stays.

The researchers say their findings suggest more education about the risk/benefit ratio of opioids “appears warranted.”

Pain is becoming a fact of life for more and more people, and they are turning to opioids to treat it, according to a survey sponsored by the National Center for Complementary and Integrative Health.

Researchers looked at nearly 2 decades-worth of cumulative data from the Medical Expenditure Panel Survey (MEPS). They found that since 1997/1998, pain prevalence in US adults rose by 25%.

In 1997/1998, about 33% of American adults had at ≤ 1 painful health condition. In 2013/2014, that proportion was 41%. For about 68 million people, moderate-to-severe pain was interfering with normal work activities. And those people were turning more often to strong opioids—eg, fentanyl, morphine, oxycodone—for help. Use of opioids to manage pain more than doubled in just 10 years: from 4.1 million (11.5%) in 2001/2002 to 10.5 million (24.3%) in 2013/2014.

People with severe pain-related interference also were more likely to have had > 4 opioid prescriptions and to have visited a doctor’s office > 6 times for pain compared with those with minimal pain-related interference.

Opioid use peaked between 2005 and 2012, but since 2012, opioid use has slightly declined. The researchers say this ties to a reduction in use of weak opioids and in the number of patients reporting only 1 opioid prescription.

The survey also found some small downward shifts in health care visits. Ambulatory office visits plateaued between 2001/2002 and 2007/2008 and decreased through 2013/2014. The researchers also found small but statistically significant drops in pain-related emergency department visits and overnight hospital stays.

The researchers say their findings suggest more education about the risk/benefit ratio of opioids “appears warranted.”

Pain is becoming a fact of life for more and more people, and they are turning to opioids to treat it, according to a survey sponsored by the National Center for Complementary and Integrative Health.

Researchers looked at nearly 2 decades-worth of cumulative data from the Medical Expenditure Panel Survey (MEPS). They found that since 1997/1998, pain prevalence in US adults rose by 25%.

In 1997/1998, about 33% of American adults had at ≤ 1 painful health condition. In 2013/2014, that proportion was 41%. For about 68 million people, moderate-to-severe pain was interfering with normal work activities. And those people were turning more often to strong opioids—eg, fentanyl, morphine, oxycodone—for help. Use of opioids to manage pain more than doubled in just 10 years: from 4.1 million (11.5%) in 2001/2002 to 10.5 million (24.3%) in 2013/2014.

People with severe pain-related interference also were more likely to have had > 4 opioid prescriptions and to have visited a doctor’s office > 6 times for pain compared with those with minimal pain-related interference.

Opioid use peaked between 2005 and 2012, but since 2012, opioid use has slightly declined. The researchers say this ties to a reduction in use of weak opioids and in the number of patients reporting only 1 opioid prescription.

The survey also found some small downward shifts in health care visits. Ambulatory office visits plateaued between 2001/2002 and 2007/2008 and decreased through 2013/2014. The researchers also found small but statistically significant drops in pain-related emergency department visits and overnight hospital stays.

The researchers say their findings suggest more education about the risk/benefit ratio of opioids “appears warranted.”

Patients with schizophrenia may not always get the cardiac treatment they should following a myocardial infarction (MI), according to researchers from Aalborg University Hospital, Denmark.

Studies have already established that patients with schizophrenia have a higher prevalence of cardiovascular disease (CVD) and that there is a strong correlation between MI and schizophrenia, the researchers say. Patients with schizophrenia also undergo fewer cardiac procedures compared with the general population. To try to find out why that might be, the researchers focused on the 4-stage process from initial admission following MI: offer of examination, acceptance of examination, offer of treatment, and acceptance of treatment.

Of 141 patients with a first MI, 47 also had a diagnosis of schizophrenia.

The researchers say their data show a “clear difference” between the 2 groups studied. Patients with schizophrenia were statistically significantly less likely to be offered and accept examination and to be offered and accept treatment than were the psychiatrically healthy controls. However, when the researchers analyzed each stage separately, none of the secondary results were statistically significant. Still they say, as a whole the stages contribute to the primary outcome of less cardiac treatment for these patients.

The researchers did find 2 significant differences between the 2 groups: Patients with schizophrenia were more likely to be smokers and have a lower familial predisposition to CVD. They also were less likely to be in treatment for diabetes, hypercholesterolemia and hypertension at the first MI, although that did not reach statistical significance. The 2 groups also differed in the treatments offered. Patients with schizophrenia were less often offered invasive coronary angiography (CAG) and more often offered exercise-ECG. In contrast, the controls were more likely to be offered CAG.

Without statistical significance, the researchers could not pinpoint whether physician bias, patients’ unwillingness to receive health care, or both were at the root of the discrepancies. They note that the clinical manifestations of schizophrenia “may be seen as a complication for postoperative care” and influence decisions about cardiac procedures. Those decisions may be based on “tacit assumptions rather than on standard guidelines based on medical outcomes,” the researchers  add. Three patients in the study reported that they had previously visited the hospital complaining of typical chest pain but were sent home without examination. The researchers cite another study that found patients with schizophrenia receive care only when their symptoms are “severe enough.”

However, patients with schizophrenia also are known to be more likely to decline treatment, perhaps in part because they do not understand the importance of treatment, the researchers say.

The researchers suggest that the way patients are handled by the treating doctor “needs to be reformed.” It is important, they say, that health care providers are aware of the limits of dealing with a double-diagnosed patient and of the possibility of unintentional bias. A “more personalized approach,” they conclude, might make patients with schizophrenia more willing to cooperate with offers of treatment.

Patients with schizophrenia may not always get the cardiac treatment they should following a myocardial infarction (MI), according to researchers from Aalborg University Hospital, Denmark.

Studies have already established that patients with schizophrenia have a higher prevalence of cardiovascular disease (CVD) and that there is a strong correlation between MI and schizophrenia, the researchers say. Patients with schizophrenia also undergo fewer cardiac procedures compared with the general population. To try to find out why that might be, the researchers focused on the 4-stage process from initial admission following MI: offer of examination, acceptance of examination, offer of treatment, and acceptance of treatment.

Of 141 patients with a first MI, 47 also had a diagnosis of schizophrenia.

The researchers say their data show a “clear difference” between the 2 groups studied. Patients with schizophrenia were statistically significantly less likely to be offered and accept examination and to be offered and accept treatment than were the psychiatrically healthy controls. However, when the researchers analyzed each stage separately, none of the secondary results were statistically significant. Still they say, as a whole the stages contribute to the primary outcome of less cardiac treatment for these patients.

The researchers did find 2 significant differences between the 2 groups: Patients with schizophrenia were more likely to be smokers and have a lower familial predisposition to CVD. They also were less likely to be in treatment for diabetes, hypercholesterolemia and hypertension at the first MI, although that did not reach statistical significance. The 2 groups also differed in the treatments offered. Patients with schizophrenia were less often offered invasive coronary angiography (CAG) and more often offered exercise-ECG. In contrast, the controls were more likely to be offered CAG.

Without statistical significance, the researchers could not pinpoint whether physician bias, patients’ unwillingness to receive health care, or both were at the root of the discrepancies. They note that the clinical manifestations of schizophrenia “may be seen as a complication for postoperative care” and influence decisions about cardiac procedures. Those decisions may be based on “tacit assumptions rather than on standard guidelines based on medical outcomes,” the researchers  add. Three patients in the study reported that they had previously visited the hospital complaining of typical chest pain but were sent home without examination. The researchers cite another study that found patients with schizophrenia receive care only when their symptoms are “severe enough.”

However, patients with schizophrenia also are known to be more likely to decline treatment, perhaps in part because they do not understand the importance of treatment, the researchers say.

The researchers suggest that the way patients are handled by the treating doctor “needs to be reformed.” It is important, they say, that health care providers are aware of the limits of dealing with a double-diagnosed patient and of the possibility of unintentional bias. A “more personalized approach,” they conclude, might make patients with schizophrenia more willing to cooperate with offers of treatment.

Patients with schizophrenia may not always get the cardiac treatment they should following a myocardial infarction (MI), according to researchers from Aalborg University Hospital, Denmark.

Studies have already established that patients with schizophrenia have a higher prevalence of cardiovascular disease (CVD) and that there is a strong correlation between MI and schizophrenia, the researchers say. Patients with schizophrenia also undergo fewer cardiac procedures compared with the general population. To try to find out why that might be, the researchers focused on the 4-stage process from initial admission following MI: offer of examination, acceptance of examination, offer of treatment, and acceptance of treatment.

Of 141 patients with a first MI, 47 also had a diagnosis of schizophrenia.

The researchers say their data show a “clear difference” between the 2 groups studied. Patients with schizophrenia were statistically significantly less likely to be offered and accept examination and to be offered and accept treatment than were the psychiatrically healthy controls. However, when the researchers analyzed each stage separately, none of the secondary results were statistically significant. Still they say, as a whole the stages contribute to the primary outcome of less cardiac treatment for these patients.

The researchers did find 2 significant differences between the 2 groups: Patients with schizophrenia were more likely to be smokers and have a lower familial predisposition to CVD. They also were less likely to be in treatment for diabetes, hypercholesterolemia and hypertension at the first MI, although that did not reach statistical significance. The 2 groups also differed in the treatments offered. Patients with schizophrenia were less often offered invasive coronary angiography (CAG) and more often offered exercise-ECG. In contrast, the controls were more likely to be offered CAG.

Without statistical significance, the researchers could not pinpoint whether physician bias, patients’ unwillingness to receive health care, or both were at the root of the discrepancies. They note that the clinical manifestations of schizophrenia “may be seen as a complication for postoperative care” and influence decisions about cardiac procedures. Those decisions may be based on “tacit assumptions rather than on standard guidelines based on medical outcomes,” the researchers  add. Three patients in the study reported that they had previously visited the hospital complaining of typical chest pain but were sent home without examination. The researchers cite another study that found patients with schizophrenia receive care only when their symptoms are “severe enough.”

However, patients with schizophrenia also are known to be more likely to decline treatment, perhaps in part because they do not understand the importance of treatment, the researchers say.

The researchers suggest that the way patients are handled by the treating doctor “needs to be reformed.” It is important, they say, that health care providers are aware of the limits of dealing with a double-diagnosed patient and of the possibility of unintentional bias. A “more personalized approach,” they conclude, might make patients with schizophrenia more willing to cooperate with offers of treatment.