Physician continuity after patients leave hospital for heart failure can help survival rates

Main Category: Primary Care / General Practice
Also Included In: Cardiovascular / Cardiology
Article Date: 19 Aug 2013 - 9:00 PDT Current ratings for:
Physician continuity after patients leave hospital for heart failure can help survival rates

Patients with heart failure who see a physician in the first month after leaving hospital are more likely to survive than those who do not see a doctor, reports a new study in CMAJ (Canadian Medical Association Journal). The effect is slightly more pronounced in patients who see their regular physician rather than an unfamiliar physician.

In the United States and Canada, more than $20 billion is spent every year on patients who are readmitted to hospital within 30 days after discharge. Heart failure is one of the most common reasons for hospitalization and has a high risk of readmission and early death.

To determine whether continuity of care resulted in better outcomes for patients with heart failure, researchers looked at data on all adults aged 20 years and over in Alberta who were discharged after hospitalization for heart failure. Patients were elderly with various health issues and had used the health care system in the year before their hospitalization for heart failure.

"Intuitively, one might consider physician continuity important for heart-failure patients discharged from hospital, given their age, high comorbidity burdens and complex therapy regimens," writes Dr. Finlay McAlister, University of Alberta, Edmonton, with coauthors. "However, a robust evidence base and multiple guidelines with consistent messaging on key management principles have made physician continuity potentially less important."

Of the total 24 373 discharged patients, 5336 (22%) did not see a physician within the first month, 16 855 (69%) saw a familiar physician (one they had seen at least twice in the year prior) and 2182 (9%) saw an unfamiliar physician. The researchers found that patients who saw a familiar physician had a lower risk of urgent readmission and death compared with patients who saw an unfamiliar physician or who did not visit a doctor.

"Early follow-up was associated with a lower risk of death or urgent readmission over 6 months, compared with no visits in the first month after discharge, regardless of whether the follow-up was with familiar or unfamiliar physicians. However, when we examined follow-up patterns throughout the 6 months after discharge, continuity with a familiar physician was associated with a significantly lower risk of death or readmission than follow-up with an unfamiliar physician, with similar effect estimates for specialist and nonspecialist follow-up," the authors write.

"The absolute reduction of 3% to 8% in risk of death or urgent readmission ... observed over 3?"12 months in association with follow-up in the first month after discharge was in the same range as the absolute benefits seen in placebo-controlled randomized trials of angiotensin-converting-enzyme inhibitor or b-blocker therapy. ... Thus, we believe that physicians should strive to optimize continuity with their heart-failure patients after discharge and that strategies are needed in the health care system to ensure early follow-up after discharge with the patient's regular physician," the authors conclude.

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Obesity rates hold steady, USA

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Main Category: Obesity / Weight Loss / Fitness
Also Included In: Public Health
Article Date: 18 Aug 2013 - 0:00 PDT Current ratings for:
Obesity rates hold steady, USA

Obesity rates hold steady throughout the USA, except for Arkansas, for the first time in 30 years, says a new study - "F as in Fat: How Obesity Threatens America's Future 2013"1 - from the Robert Wood Johnson Foundation and Trust for America's Health.

The United States no longer has the highest obesity rates in the world. It is now second to Mexico, according to a report by the FAO2 (Food and Agricultural Organization, United Nations). In that report, published in July 2013, Mexico's adult obesity rate of 32.8% was just above America's 31.8%.

According to the "F as in Fat" report, 13 US states have obesity rates above 30%. Highest rates were found in the Midwest, South and among baby boomers.

In forty-one states, obesity rates are 25% or more. Not one state in America has an obesity rate of 20% or less.

Compared to 1980, when obesity rates of 15% or more did not exist, health care authorities say the present prevalence is far too high, despite the recent encouraging news.

See below how obesity has mushroomed in America over the last three decades:

1980 - no state had an obesity rate of 15% or more1991 - no state had an obesity rate of 20% or more2000 - no state had an obesity rate of 25% or more2007 - only Mississippi had an obesity rate above 30%2013 - no state has an obesity rate of 20% or less2013 - 41 states have obesity rates of at least 25%
Arkansas was the only state to report an obesity rate rise

There is clear evidence that the obesity epidemic is losing steam.

Every state except one in 2005 saw obesity rates rise. However, in 2008 rates increased in 37 states, and then 28 states in 2010, and just 16 states in 2011.

Jeffrey Levi, PhD, executive director of Trust for America's Health, said

"While stable rates of adult obesity may signal prevention efforts are starting to yield some results, the rates remain extremely high. Even if the nation holds steady at the current rates, Baby Boomers - who are aging into obesity-related illnesses - and the rapidly rising numbers of extremely obese Americans are already translating into a cost crisis for the healthcare system and Medicare.

In order to decrease obesity and related costs, we must ensure that policies at every level support healthy choices, and we must focus investments on prevention."

Below are some key findings from the 2013 F as in Fat report:

Obesity rates vary by region - Pennsylvania is the only non-South/non-Midwest state among the top 20 fattest states.

Louisiana at 34.7% has the highest obesity rate, followed by Mississippi at 34.6%. Mississippi had been America's fattest state for several years.

The slimmest state is Colorado at 20.5%.

Obesity rates vary according to age group - in Alabama and Louisiana obesity rates among baby boomers (aged 45 to 64) have reached 40%. In 41 states the obesity rates among baby boomers are at least 30%.

Among seniors (65+ years of age), only Louisiana recorded an obesity rate higher than 30%.

Obesity rates among young adults (18 to 25) are less than 28% in every state.

Obesity rates for men and women have converged - men and women have virtually identical obesity rates today (35.8% and 35.5% respectively). Ten years ago there was a difference of 6 percentage points (women 33.4% - men 27.5%).

Since 2000, male obesity rates have been rising faster.

Morbid obesity rates have grown significantly - a person with a body mass index (BMI) of 30 or more is obese. People with a BMI of 40 or more are morbidly obese (extremely obese).

Thirty years ago, 1.4% of people were morbidly obese, compared to 6.3% today - a rise of 350%.

Among 2 to 19 year-olds, 5.1% of boys and 4.7% of girls are morbidly obese in America today.

Obesity rates and people's academic levels - 21.3% of college graduates aged 26 years or more are obese, compared to 35% among their counterparts who did not graduate from high school.
Obesity rates and socioeconomic status - 25.4% of adults earning $50,000 per year or more are obese today, compared to 31% of people earning less than $25,000.

A Centers for Disease Control and Prevention (CDC) Vital Signs report - Progress in Childhood Obesity3 - published at the beginning of this month, showed that obesity rates among preschool children from low-income households went down in 18 states and one US territory. In South Dakota, New Jersey, Missouri, Georgia, Florida and the US Virgin Islands obesity rates in that age group fell by at least 1%.

Risa Lavizzo-Mourey, MD, Robert Wood Johnson Foundation president and CEO, said:

"After decades of unrelenting bad news, we're finally seeing signs of progress. In addition to today's news about the steady rates for adults, we've seen childhood obesity rates declining in cities and states that were among the first to adopt a comprehensive approach to obesity prevention. But no one should believe the nation's work is done. We've learned a lot in the last decade about how to prevent obesity. Now it's time to take that knowledge to scale."

Louisiana - 34.7%Mississippi - 34.6%Arkansas - 34.5%West Virginia - 33.8%Alabama - 33%Oklahoma - 32.2%South Carolina - 31.6%Indiana - 31.4%Kentucky - 31.3%Michigan and Tennessee - 31.1%Iowa - 30.4%Ohio - 30.1%Kansas - 29.9%North Dakota and Wisconsin - 29.7%Missouri and North Carolina - 29.6%Texas - 29.2%Georgia and Pennsylvania - 29.1%Nebraska - 28.6%Maine - 28.4%Illinois and South Dakota - 28.1%Maryland - 27.6%Virginia - 27.4%New Hampshire and Oregon - 27.3%New Mexico - 27.1%Delaware - 26.9%Idaho and Washington - 26.8%Nevada - 26.2%Arizona - 26%Alaska and Minnesota and Rhode Island - 25.7%Connecticut - 25.6%Florida - 25.2%California - 25%New Jersey and Wyoming - 24.6%Montana and Utah - 24.3%Vermont - 23.7%Hawaii and New York - 23.6%Massachusetts - 22.9%District of Columbia - 21.9%Colorado - 20.5%

Flawed gene may drive 1 in 6 people to become obese - scientists from University College London reported in the Journal of Clinical Investigation that a defective gene affects the production of a hormone that is linked to feelings of fullness.

People who carry a variant of the gene FTO are more likely to overeat, become obese, and show a preference for high-fat, energy-dense foods.

Written by Christian Nordqvist

Copyright: Medical News Today
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Leap in survival rates for childhood leukaemia patients with rare genetic abnormality

Main Category: Lymphoma / Leukemia / Myeloma
Article Date: 15 Aug 2013 - 2:00 PDT Current ratings for:
Leap in survival rates for childhood leukaemia patients with rare genetic abnormality

A pioneering genetic study means that children with a rare subtype of leukaemia have 75% less chance of their leukaemia recurring.

A study by Newcastle University scientists, published online on August 12th in the Journal of Clinical Oncology, has shown that lives have already been saved as a result of identifying children carrying a chromosomal abnormality known as iAMP21 and giving these patients a very intensive treatment regimen.

Overall survival for acute lymphoblastic leukaemia (ALL) patients, a cancer of the white blood cells, is now very high, with up to 90% of children being cured. A minority of patients, however, still do not respond to standard treatment.

A decade ago, the same scientists, funded by the blood cancer charity Leukaemia & Lymphoma Research, discovered the genetic error known as iAMP21. This abnormality occurs when parts of chromosome 21 - one of 23 pairs of chromosomes that contain our genetic instructions - are copied and shuffled around, resulting in extra copies of some genes. The researchers found that this abnormality was present in around 2% of children diagnosed with ALL and that it gave them a much greater chance of suffering a relapse.

The team, led by Professor Christine Harrison and Professor Anthony Moorman from the Leukaemia Research Cytogenetics Group, tracked the progress of patients with iAMP21 using samples from clinical trials between 1997 and 2002. They found that more than 80% of patients with iAMP21 had relapsed, compared to less than for 25% for children overall. The long-term survival for the iAMP21 group was also much lower.

Since 2003, bone marrow samples from every child diagnosed with ALL have been tested for the presence of iAMP21 using a genetic test known as 'fluorescence in situ hybridisation' (FISH), which binds glowing tags to DNA and "lights-up" the abnormal sequences. Children with iAMP21 registered on the UKALL2003 trial, which was funded by Leukaemia & Lymphoma Research and the Medical Research Council, were immediately recommended for treatment using a very intensive protocol.

The results of the UKALL2003 trial show that if children with iAMP21 are treated with intensive chemotherapy they have a dramatically reduced risk of relapse. In addition the proportion surviving for five years or more increased to nearly 90%.

Anthony Moorman, Professor of Genetic Epidemiology at Newcastle University, said: "Although using the presence of genetic abnormalities to guide treatment is not new within childhood leukaemia, such a clear demonstration of its beneficial impact on survival is extremely rare. In time we may be able to design drugs to actually target the iAMP21 abnormality, sparing these children from toxic treatment."

Professor Chris Bunce, Research Director at Leukaemia & Lymphoma Research, said: "By establishing how different genetic abnormalities found in leukaemia cells dictate how well the child will respond to treatment, we can identify high-risk patients early on. These new results demonstrate the huge potential of personalised medicine."

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The report is published online in the Journal of Clinical Oncology under the title, ‘Risk directed treatment intensification significantly reduces the risk of relapse among children and adolescents with acute lymphoblastic leukaemia and intrachromosomal amplification of chromosome 21: A comparison of MRC ALL97/99 and UKALL2003 trials’. Principal authors: Prof Anthony V Moorman, Professor Ajay Vora and Prof Christine J Harrison, Leukaemia Research Cytogenetics Group, Northern Institute for Cancer Research, Newcastle University, UK, doi: 10.1200/JCO.2013.48.9377

Newcastle University

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New Mums with Polycystic Ovary Syndrome - substantial link between high BMI's and low breastfeeding rates

Main Category: Women's Health / Gynecology
Also Included In: Endocrinology;  Obesity / Weight Loss / Fitness;  Pregnancy / Obstetrics
Article Date: 14 Aug 2013 - 2:00 PDT Current ratings for:
New Mums with Polycystic Ovary Syndrome - substantial link between high BMI's and low breastfeeding rates

New Mums with Polycystic Ovary Syndrome (PCOS) are more likely to be overweight and less likely to breastfeed than their counterparts in the healthy weight range, say scientists.

Already known to affect 1 in 5 Australian women, approximately one million women of childbearing age, PCOS is a growing concern and scientists are calling for further research into the clinical features including fertility issues associated with the condition.

PCOS is still one of the country's most underdiagnosed conditions and is well-known for being linked to other health issues such as a high BMI, Type II Diabetes and infertility.

A new study conducted by scientists at Monash University investigating the link between breastfeeding habits and body mass index in women with and without PCOS has found a substantial link between high BMI's and low breastfeeding rates.

Professor Helena Teede, Natalie Nanayakkara, Dr Anju Joham, Dr Sophia Zoungas, Associate Professor Deborah Loxton and Professor Eszter Vanky undertook the study using data from the Australian Longitudinal Women's Health Study.

Working at the School of Public Health and Preventive Medicine, they aimed to ascertain the link between breastfeeding, PCOS and pregnant women who are overweight or obese.

The findings are just one of the many research abstracts to be discussed at the Annual Scientific Meeting of the Endocrine Society of Australia and the Society for Reproductive Biology 2013, from August 25-28 at the Sydney Convention and Exhibition Centre.

Professor Helena Teede said research into PCOS is much needed. "There is a widespread under-diagnosis of this condition and symptoms are often overlooked by health practitioners up until a woman has difficulty conceiving," said Professor Teede.

"Recent figures show that approximately 72 per cent of women diagnosed with PCOS require costly fertility assistance, but when provided with this assistance, family sizes are similar to women without PCOS - " These startling new figures prompted us to conduct research into reproductive issues associated with the condition," she said.

The researchers conducted a cross-sectional analysis of very large community based dataset from the government-funded, Australian Longitudinal Study on Women's Health. Participants were women aged 31 to 36 years old, and were randomly selected from the Medicare database.

"There is significant existing evidence that women who suffer from PCOS are more likely to be overweight. Small studies also suggested that women with PCOS had lower breastfeeding rates.

"Breast feeding is important in limiting weight retention after pregnancy in new mothers. With this study, we wanted to find whether there was a further link between PCOS and breastfeeding behaviours.

"The study discovered that, while there was no definitive link between PCOS and breastfeeding, there was a strong link between weight and breast feeding and for every five unit increase in BMI there was an approximate 20 day reduction in breastfeeding duration.

"What we want to see happening as a result of this study is increased lactation support for women who are overweight," she said.

Obesity is a growing concern in Australia with recent ABS statistics showing 62.8 per cent of all Australians fall in the overweight or obese categories, defined by a minimum BMI rating of 25.

"Ultimately, rising obesity rates are now the primary cause of chronic disease in Australia and are at the root of some of our growing health issues including PCOS. As a nation we are leading increasingly sedentary lives, which serves to further compound the issue," said Professor Teede.

"On average, women gain 700g per year but recent research has shown that women diagnosed with PCOS gain almost three times that amount.

"The figures are eye-opening and further highlight the need for more study in the area to help provide greater support to women affected by PCOS.

"By addressing things such as breastfeeding habits of women with PCOS we can better understand how to tackle the growing public health issue of the condition," she said.

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