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https://www.readbyqxmd.com/read/29341865/evidence-of-genetic-predisposition-for-metabolically-healthy-obesity-and-metabolically-obese-normal-weight
#1
Lam Opal Huang, Ruth Loos, Tuomas Oskari Kilpeläinen
Obesity has evolved into a global pandemic, which constitutes a major threat to public health. The majority of obesity-related health care costs are due to cardiometabolic complications, such as insulin resistance, dyslipidemia, and hypertension, which are risk factors for type 2 diabetes and cardiovascular disease. However, many obese individuals, often called metabolically healthy obese (MHO), seem to be protected from these cardiometabolic complications. Conversely, there is a group of individuals who suffer from cardiometabolic complications despite being of normal weight; a condition termed metabolically obese normal weight (MONW)...
December 20, 2017: Physiological Genomics
https://www.readbyqxmd.com/read/29335013/fit-for-function-study-protocol-for-a-randomized-controlled-trial
#2
Julie Richardson, Ada Tang, Gordon Guyatt, Lehana Thabane, Feng Xie, Demetrios Sahlas, Robert Hart, Rebecca Fleck, Genevieve Hladysh, Louise Macrae
BACKGROUND: The current state of evidence suggests that community-based exercise programs are beneficial in improving impairment, function, and health status, and are greatly needed for persons with stroke. However, limitations of these studies include risk of bias, feasibility, and cost issues. METHODS/DESIGN: This single-blinded, randomized controlled trial (RCT) of 216 participants with stroke will compare the effectiveness of a 12-week YMCA community-based wellness program (FIT for FUNCTION) specifically designed for community-dwelling persons with stroke to persons who receive a standard YMCA membership...
January 15, 2018: Trials
https://www.readbyqxmd.com/read/29334983/an-individually-tailored-family-centered-intervention-for-pediatric-obesity-in-primary-care-study-protocol-of-a-randomized-type-ii-hybrid-effectiveness-implementation-trial-raising-healthy-children-study
#3
Justin D Smith, Cady Berkel, Neil Jordan, David C Atkins, Shrikanth S Narayanan, Carlos Gallo, Kevin J Grimm, Thomas J Dishion, Anne M Mauricio, Jenna Rudo-Stern, Mariah K Meachum, Emily Winslow, Meg M Bruening
BACKGROUND: Pediatric obesity is a multi-faceted public health concern that can lead to cardiovascular diseases, cancers, and early mortality. Small changes in diet, physical activity, or BMI can significantly reduce the possibility of developing cardiometabolic risk factors. Family-based behavioral interventions are an underutilized, evidence-based approach that have been found to significantly prevent excess weight gain and obesity in children and adolescents. Poor program availability, low participation rates, and non-adherence are noted barriers to positive outcomes...
January 15, 2018: Implementation Science: IS
https://www.readbyqxmd.com/read/29333146/cystatin-c-is-indispensable-for-evaluation-of-kidney-disease
#4
Anders Grubb
The present minireview of the place of cystatin C in clinical medicine emphasizes, and discuss the evidence, that cystatin C-based GFR-estimating equations do not require the use of vague terms like race and sex, that cystatin C-based GFR-esti mating equations are useful for both children and adults, including the elderly, that the best GFR-estimation requires simultaneous use of both cystatin C- and creatinine-based equations, that cystatin C-based GFR-estimating equations are superior to creatinine-based equations in predicting end-stage renal disease, cardiovascular manifestations, hospitalisation and death, and, finally that cystatin C is required to diagnose the new syndrome "Shrunken Pore Syndrome" with its high mortality and morbidity, even in the absence of reduced GFR...
December 2017: EJIFCC
https://www.readbyqxmd.com/read/29326146/prior-authorization-requirements-for-proprotein-convertase-subtilisin-kexin-type-9-inhibitors-across-us-private-and-public-payers
#5
Jalpa A Doshi, Justin T Puckett, Michael S Parmacek, Daniel J Rader
BACKGROUND: Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9is) are an innovative treatment option for patients with familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease who require further lowering of low-density lipoprotein cholesterol. However, the high costs of these agents have spurred payers to implement utilization management policies to ensure appropriate use. We examined prior authorization (PA) requirements for PCSK9is across private and public US payers...
January 2018: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/29321031/deprescribing-preventive-cardiovascular-medication-in-patients-with-predicted-low-cardiovascular-disease-risk-in-general-practice-the-ecstatic-study-a-cluster-randomised-non-inferiority-trial
#6
Clare H Luymes, Rosalinde K E Poortvliet, Nan van Geloven, Margot W M de Waal, Yvonne M Drewes, Jeanet W Blom, Nynke Smidt, Willem J J Assendelft, Wilbert B van den Hout, Wouter de Ruijter, Mattijs E Numans
BACKGROUND: The use of cardiovascular medication for the primary prevention of cardiovascular disease (CVD) is potentially inappropriate when potential risks outweigh the potential benefits. It is unknown whether deprescribing preventive cardiovascular medication in patients without a strict indication for such medication is safe and cost-effective in general practice. METHODS: In this pragmatic cluster randomised controlled non-inferiority trial, we recruited 46 general practices in the Netherlands...
January 11, 2018: BMC Medicine
https://www.readbyqxmd.com/read/29320602/when-metformin-is-not-enough-pros-and-cons-of-sglt2-and-dpp-4-inhibitors-as-a-second-line-therapy
#7
REVIEW
Angelo Avogaro, Elías Delgado, Ildiko Lingvay
The newer oral therapies for type 2 diabetes (T2DM); dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium glucose cotransporter 2 (SGLT2) inhibitors have advantages over older agents. DPP-4 inhibitors are weight neutral, and have few adverse effects. SGLT2 inhibitors have additional benefits; weight loss, blood pressure reduction, cardiovascular risk reduction, and renoprotective effects. SGLT2 inhibitors, have increased risk of urogenital infections and possible risk of "euglycaemic" diabetic ketoacidosis...
January 10, 2018: Diabetes/metabolism Research and Reviews
https://www.readbyqxmd.com/read/29319819/development-and-external-validation-of-risk-scores-for-cardiovascular-hospitalisation-and-rehospitalisation-in-diabetes-patients
#8
Dahai Yu, Yamei Cai, Jonathan Graffy, Daniel Holman, Zhanzheng Zhao, David Simmons
Context: Cardiovascular disease (CVD) is a common and costly reason for hospitalisation and re-hospitalisation among patients with type 2 diabetes. Objective: This study aimed to develop and externally validate two risk prediction models for cardiovascular hospitalisation and cardiovascular re-hospitalisation. Design: Two independent prospective cohorts. Setting: The derivation cohort includes 4,704 patients with type 2 diabetes from 18 general practices in Cambridgeshire...
January 8, 2018: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29319376/the-effect-of-physical-activity-on-ptsd
#9
Lauren M Oppizzi, Reba Umberger
Although physical activity (PA) is known to reduce anxiety and depression, less is known about the effects of PA on post-traumatic stress disorder (PTSD). The author examined the state of the science regarding the effect of PA on PTSD. Three themes emerged: PA characteristics, added benefits of PA as a PTSD intervention, and theories on the method of action. Physical activity seems to be an effective adjunct therapy to reduce PTSD symptom severity. Findings are inconsistent between observational and controlled studies...
January 10, 2018: Issues in Mental Health Nursing
https://www.readbyqxmd.com/read/29318963/nanodiagnostics-and-nanodelivery-applications-in-genetic-alterations
#10
Maria Sofia Falzarano, Cristina Flesia, Roberta Cavalli, Caterina Guiot, Alessandra Ferlini
Background Genetic alterations cause hereditary diseases (HDs) with a wide range of incidences. Some, like cystic fibrosi, occur frequently (1/1,000 newborns), whilst others, such as Pompe disease and other metabolic disorders are very rare (1/100,000 newborns). They are well under the threshold of 1/3,000, denoted by the European Community as rare diseases (RDs). Genetic alterations are also associated with multifactorial disorders like diabetes, and underline both somatic and germline mutations in cancer...
January 10, 2018: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/29316935/estimating-the-returns-to-united-kingdom-publicly-funded-musculoskeletal-disease-research-in-terms-of-net-value-of-improved-health-outcomes
#11
Matthew Glover, Erin Montague, Alexandra Pollitt, Susan Guthrie, Stephen Hanney, Martin Buxton, Jonathan Grant
BACKGROUND: Building on an approach applied to cardiovascular and cancer research, we estimated the economic returns from United Kingdom public- and charitable-funded musculoskeletal disease (MSD) research that arise from the net value of the improved health outcomes in the United Kingdom. METHODS: To calculate the economic returns from MSD-related research in the United Kingdom, we estimated (1) the public and charitable expenditure on MSD-related research in the United Kingdom between 1970 and 2013; (2) the net monetary benefit (NMB), derived from the health benefit in quality adjusted life years (QALYs) valued in monetary terms (using a base-case value of a QALY of £25,000) minus the cost of delivering that benefit, for a prioritised list of interventions from 1994 to 2013; (3) the proportion of NMB attributable to United Kingdom research; and (4) the elapsed time between research funding and health gain...
January 10, 2018: Health Research Policy and Systems
https://www.readbyqxmd.com/read/29316126/fixed-dose-combination-therapy-to-reduce-the-growing-burden-of-cardiovascular-disease-in-low-and-middle-income-countries-feasibility-and-challenges
#12
REVIEW
Jobert Richie Nansseu, Aurel T Tankeu, Joseph Kamtchum-Tatuene, Jean Jacques Noubiap
Cardiovascular disease (CVD) has become a major concern in low- and middle-income countries, which bear about 80% of the cardiovascular mortality worldwide. Curbing the burden of CVD implies the management and control of many cardiovascular risk factors that act synergistically to increase cardiovascular mortality. Such actions may require expensive polymedications in a context of limited resources. Therefore, alternative solutions for CVD prevention in low- and middle-income countries are urgently needed. In this context, the concept of a fixed-dose combination therapy, a polypill composed of drugs known to effectively treat or prevent CVD, has been proposed as a scalable strategy to overcome nonadherence to polymedications and reduce costs...
January 6, 2018: Journal of Clinical Hypertension
https://www.readbyqxmd.com/read/29307093/vasodilator-function-worsens-after-cessation-of-tumour-necrosis-factor-inhibitor-therapy-in-patients-with-rheumatoid-arthritis-only-if-a-flare-occurs
#13
Gerard A Rongen, Iris van Ingen, Marc Kok, Harald Vonkeman, Matthijs Janssen, Tim L Jansen
Vasodilator function is reported to be reduced in rheumatoid arthritis (RA), and is considered an early sign of vascular dysfunction, which is normalised by TNF inhibitors (TNFi). To optimise cost-effectiveness, tapering or interruption of TNFi therapy in established RA patients is advocated. We explored whether cessation of TNFi results in impaired vasodilator function and whether this relates to the development of a Disease Activity Score (DAS28)-based flare. Forty-one patients were assessed for eligibility as RA with at least 12 months of low disease activity (based on 28 joint counts); 35 enrolled into the randomised study: 8 were randomised to continue, 27 to stopping TNFi...
January 7, 2018: Clinical Rheumatology
https://www.readbyqxmd.com/read/29306457/cost-effectiveness-of-pcsk9-inhibition-in-addition-to-standard-lipid-lowering-therapy-in-patients-at-high-risk-for-vascular-disease
#14
Manon C Stam-Slob, Yolanda van der Graaf, Anthonius de Boer, Jacoba P Greving, Frank L J Visseren
BACKGROUND: As proprotein convertase subtilisin-kexin type 9 (PCSK9) monoclonal antibodies are entering the market, we assessed the cost-effectiveness of PCSK9 inhibition added to standard lipid-lowering therapy in patient groups at high risk for major adverse cardiovascular events (MACE). METHODS: A lifetime Markov Model was designed to estimate healthcare costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) for PCSK9 inhibition added to standard therapy in patients with Familial Hypercholesterolemia (FH), patients with vascular disease at high MACE recurrence risk, and patients with vascular disease with diabetes mellitus...
February 15, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29304049/cost-and-affordability-of-non-communicable-disease-screening-diagnosis-and-treatment-in-kenya-patient-payments-in-the-private-and-public-sectors
#15
Sujha Subramanian, Robai Gakunga, Joseph Kibachio, Gladwell Gathecha, Patrick Edwards, Elijah Ogola, Gerald Yonga, Naftali Busakhala, Esther Munyoro, Jeremiah Chakaya, Nancy Ngugi, Nyawira Mwangi, Daniel Von Rege, Lili-Marie Wangari, David Wata, Robert Makori, Julius Mwangi, Walter Mwanda
INTRODUCTION: The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients' ability to pay for the services. METHODS AND FINDINGS: We collected payment data on cardiovascular diseases, diabetes, breast and cervical cancer, and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital, and the Kibera South Health Center-a public outpatient facility, and private sector practitioners and hospitals...
2018: PloS One
https://www.readbyqxmd.com/read/29303070/is-there-a-role-for-lifestyle-interventions-in-obsessive-compulsive-and-related-disorders
#16
Leonardo F Fontenelle, Julliana N Quintas, Murat Yücel
Many of the currently available treatments for obsessive-compulsive and related disorders (OCRDs) such as pharmacotherapy augmentation strategies, partial hospitalization programs, deep brain stimulation, and neurosurgery are efficacious for individuals suffering from more severe forms of these conditions. Unfortunately, the application of these treatments in milder forms of illness and subclinical samples, which affect a substantial portion of the population, is not justifiable by their costs (e.g. cognitive-behavioral therapy) and/or potential for side effects (serotonin-reuptake inhibitors associated sexual side effects)...
January 4, 2018: Current Medicinal Chemistry
https://www.readbyqxmd.com/read/29302965/non-contact-heartbeat-and-respiration-monitoring-based-on-hollow-microstructure-self-powered-pressure-sensor
#17
Shuwen Chen, Nan Wu, Long Ma, Shizhe Lin, Fang Yuan, Zisheng Xu, Wenbo Li, Bo Wang, Jun Zhou
Advances in mobile networks and low-power electronics have driven smart mobile medical devices at a tremendous pace, evoking increased interest in household healthcare, especially for those with cardiovascular or respiratory disease. Thus, flexible, battery-free pressure sensors, with great potential for monitoring respiration and heartbeat in a smart way, are urgently demanded. However, traditional flexible battery-free pressure sensors for subtle physiological signals detecting, are mostly tightly adhered onto skin instead of working under the pressure of body weight in a non-contact mode, as the low sensitivity in high-pressure region can hardly meet the demands...
January 5, 2018: ACS Applied Materials & Interfaces
https://www.readbyqxmd.com/read/29301630/obesity-pathophysiology-and%C3%A2-management
#18
REVIEW
Kishore M Gadde, Corby K Martin, Hans-Rudolf Berthoud, Steven B Heymsfield
Obesity continues to be among the top health concerns across the globe. Despite our failure to contain the high prevalence of obesity, we now have a better understanding of its pathophysiology, and how excess adiposity leads to type 2 diabetes, hypertension, and cardiovascular disease. Lifestyle modification is recommended as the cornerstone of obesity management, but many patients do not achieve long-lasting benefits due to difficulty with adherence as well as physiological and neurohormonal adaptation of the body in response to weight loss...
January 2, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29301615/silent-myocardial-infarction-and-long-term-risk-of-heart-failure-the-aric-study
#19
Waqas T Qureshi, Zhu-Ming Zhang, Patricia P Chang, Wayne D Rosamond, Dalane W Kitzman, Lynne E Wagenknecht, Elsayed Z Soliman
BACKGROUND: Although silent myocardial infarction (SMI) accounts for about one-half of the total number of myocardial infarctions (MIs), the risk of heart failure (HF) among patients with SMI is not well established. OBJECTIVES: The purpose of this study was to examine the association of SMI and clinically manifested myocardial infarction (CMI) with HF, as compared with patients with no MI. METHODS: This analysis included 9,243 participants from the ARIC (Atherosclerosis Risk In Communities) study who were free of cardiovascular disease at baseline (ARIC visit 1: 1987 to 1989)...
January 2, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29301298/healthcare-expenditure-and-productivity-cost-savings-from-reductions-in-cardiovascular-disease-and-type-2-diabetes-associated-with-increased-intake-of-cereal-fibre-among-australian-adults-a-cost-of-illness-analysis
#20
Flavia Fayet-Moore, Alice George, Tim Cassettari, Lev Yulin, Kate Tuck, Lynne Pezzullo
An ageing population and growing prevalence of chronic diseases including cardiovascular disease (CVD) and type 2 diabetes (T2D) are putting increased pressure on healthcare expenditure in Australia. A cost of illness analysis was conducted to assess the potential savings in healthcare expenditure and productivity costs associated with lower prevalence of CVD and T2D resulting from increased intake of cereal fibre. Modelling was undertaken for three levels of increased dietary fibre intake using cereal fibre: a 10% increase in total dietary fibre; an increase to the Adequate Intake; and an increase to the Suggested Dietary Target...
January 2, 2018: Nutrients
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