Archive for the ‘Guidelines’ Category

A new study in this month’s issue of the journal Obstetrics & Gynecology demonstrates that excessive weight gain during pregnancy, especially in the first trimester, can increase a woman’s risk of developing gestational diabetes mellitus (GDM). Although it’s known that too much weight gain can lead to GDM (which is one of the reasons why doctors carefully follow a pregnant woman’s weight), results from the current study shows that women who gained more weight during pregnancy than recommended by the US Institute of Medicine were 50% more likely to develop the disorder. GDM can lead to early delivery, increased risk of c-sections, type 2 diabetes in the mother post-partum, and even increases the likelihood that the child will develop diabetes and obesity later in life. [HealthDay via Yahoo! News]

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After tackling high-calorie fast foods and trans fats, the New York City Health Department is teaming up with other municipalities and companies to reduce the amount of salt in prepackaged and restaurant foods over the next five years. “Salt is a huge problem in our diets,” said Dr. Sonia Angell, director of the Cardiovascular Disease Prevention and Control Program at the New York City Department of Health and Mental Hygiene. “The majority of us consume too much salt, which increases blood pressure and puts us at risk for heart attack and stroke.” Most people need about 1,500 mg of salt per day. However, the average American adult consumes upwards of 3,500 mg, mostly from prepackaged and restaurant-served meals. The goal of the New York City initiative is to reduce sodium levels in prepared foods, so as to allow consumers to add salt if desired. Subway, one of the participating restaurants, has already committed to reducing salt in their sandwiches nationwide. “If salt is reduced gradually, we won’t notice a difference in our palate,” Angell said. “Our palate will adjust and we’ll enjoy foods as much as we do now.” [via CNN]

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Using surface disinfectants may contribute to bacterial antibiotic resistance, according to new research in January’s issue of Microbiology. We already know that the use of consumer-grade antimicrobial hand soaps contribute to the rise of antibiotic resistance. Similarly, the study demonstrated that when non-lethal amounts of disinfectant were added to bacteria in culture, the adapted bacteria were more likely to survive compared to the non-adapted bacteria. “In principle this means that residue from incorrectly diluted disinfectants left on hospital surfaces could promote the growth of antibiotic-resistant bacteria,” said Dr. Gerard Fleming who led the study. Bacteria that can resist both surface disinfectants and antibiotics could pose a very serious health concern to not only hospitalized patients, but the general public as well. [via Science Daily]

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This week the British Medical Journal is warning physicians regarding high blood pressure (hypertension) treatment in people over 80 years of age. Despite limited evidence about treatment of hypertension in this age group, UK and US guidelines continue to recommend applying the same target blood pressures to people over 80 as to any other age group (the current target blood pressure for uncomplicated hypertension is 140/90). However, based on some new reviews of up-to-date data, there is evidence that mortality may likely be decreased by being more conservative with the number of drugs and the dosages of medications used in this group, in addition to allowing a higher target systolic blood pressure of 150. Trials are now needed to compare this conservative approach with the more aggressive treatment strategies currently in use. [via Medical News Today]

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A new study published in the current issue of the Archives of Pediatrics and Adolescent Medicine shows that the number of parents placing their infants “back to sleep” have been diminishing since 2001. The Back To Sleep campaign was started in 1994 by the National Institute of Child Health and Human Development (NICHD) in an effort to reduce Sudden Infant Death Syndrome (SIDS). Putting infants to sleep on their backs (rather than their stomachs) reduces the risk of SIDS, which occurs most commonly between the ages of 2 to 4 months. Since the launch of the Back to Sleep campaign the number of babies placed on their backs to sleep jumped from 25% to about 70% and the SIDS rate declined by more than 50%. However, this trend has fallen off since the year 2001. Not only are more parents not educated about placing their babies on their backs (almost half of the mothers surveyed said they had received no advice at all from their physician or that he/she had recommended stomach sleeping), the study also shows that black mothers and caregivers are more likely than whites to place infants on their stomachs to sleep. The take-home message? Physicians need to be more proactive in educating parents and caretakers and we, as individuals, need to be proactive about educating our friends and families. [via MedlinePlus]

Learn more in the Guide to SIDS.

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Earlier this month the US Preventive Services Task Force (USPSTF), an independent panel of respected experts in primary care and prevention, caused an uproar when they presented evidence that routine mammogram screening for breast cancer should not begin until the age of 50. The group based their recommendation on evidence showing that the “additional benefit gained by starting screening at age 40 years rather than at age 50 years is small, and that moderate harms from screening remain at any age”.  Essentially, the number of women we need to screen in order to extend one woman’s life is far higher for the group between the ages of 40 to 49 than for the group aged 50 to 59. However, current US Health and Human Services secretary, Kathleen Sebelius, issued a statement yesterday stating that there will not be any changes to government policy on mammography: screening mammograms should continue to start at the age of 40. [via Medical News Today]

Additional USPSTF recommendations include:

• Regular biennial screening mammography for women aged 50 to 74.
• No teaching of breast self-examination (BSE).
• There is not enough evidence to assess whether clinical breast examination (CBE) does more harm than good, beyond screening mammography in women 40 years or older.
• Current evidence is not enough to assess whether digital mammography or magnetic resonance imaging (MRI) would be better or worse than film mammography.

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The Drug and Therapeutics Bulletin, a monthly review of pharmacotherapeutics in medicine published by the British Medical Journal, is recommending that physicians take a second look before prescribing daily low-dose aspirin to patients. A recent review of European data questions whether there is any benefit at all for those without a history of cardiovascular disease to be taking a daily aspirin, especially since long-term low-dose aspirin therapy almost doubles the likelihood of gastrointestinal bleeding (a potentially serious side effect). The journal authors support continued use of aspirin in those with known cardiovascular disease, such as diabetes, high blood pressure and heart attacks. But, in light of current evidence, is not recommending daily low-dose aspirin for prevention of cardiovascular disease. [via Drug and Therapeutics Bulletin]

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This is going to be a busy flu season, especially considering that there will be two different flu vaccines available – one for the seasonal flu and the other for H1N1 (swine) flu. There are different recommendations for both vaccines, but only the seasonal flu vaccine is currently available. The Centers for Disease Control and Prevention recommends any adult who wants to reduce their risk of becoming ill with influenza to get the vaccine. However, if you are on the fence about the decision here is an up-to-date list from the CDC of high risk groups that should not think twice about getting the vaccine:

• persons aged 50 years and older;
• women who will be pregnant during the influenza season;
• persons who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematological or metabolic disorders (including diabetes mellitus);
• persons who have immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus;
• residents of nursing homes and other long-term care facilities;
• health-care personnel;
• household contacts and caregivers of children aged <5 years and adults aged 50 years and older, with particular emphasis on vaccinating contacts of children aged <6 months; and
• household contacts and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza.

*If you have concerns about thimerosal or other vaccine preservatives, this year’s flu vaccine only comes in two flavors – latex-containing and latex-free. Neither contains thimerosal.

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As the start of another school year is upon us, parents are asking what to do should their children come down with symptoms of influenza. The World Health Organization just released updated guidelines with regards to children and the H1N1 (swine) flu. The current recommendation is prompt treatment for children who show severe or deteriorating illness, and those at risk of more severe or complicated disease. This includes all children under 5 years of age because this age group is at an increased risk of severe H1N1 infection. Children who are otherwise healthy and older than the age of 5 do not need to be given antiviral medication unless their illness persists or worsen. Most patients, including children, who are infected with the pandemic H1N1 virus will experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. The two antivirals currently used are oseltamivir and zanamivir. They can help to reduce disease severity and reduce the need for hospitalization. [via WHO]

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A recent study presented at the 56th annual meeting of the American College of Sports Medicine (ACSM) suggests that the mood enhancing effects of exercise can last longer than an hour, as previously thought. Compared with a control group that did not exercise, the survey group of healthy men and women who exercised reported enhanced moods up to 12 hours post-exercise. volunteers performed exercise at 60% of aerobic capacity, which indicates that moderate-intensity exercise is enough to boost mood. Because these effects appear to fade after 12 hours, the researchers are recommending daily exercise. Current ACSM guidelines recommend at least 150 minutes of moderate-intensity exercise each week, which can be achieved in 30 minute segments five days a week.

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