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Science says this is the ‘most boring person in the world’
Apologies up front to anyone who spends their weekends bird-watching or doing math for fun. They are among the people expected to be boring, based on stereotypes about what they do for work or how they spend their spare time, new research reveals.
Researchers surveyed more than 500 people across five related experiments to identify what people perceive as the most boring jobs, traits, and hobbies. They also report how we could all be missing out by spending as little time as possible with our tax consultant, accountant, or financial adviser outside of work.
People who work in banking, finance, accounting, data analytics, and cleaning topped the most boring list in the study, published earlier this month in Personality and Social Psychology Bulletin.
Sleeping, religion, watching television, observing animals, and spending spare time on mathematics were the stereotypical most boring hobbies and activities. The “observing animals” group includes people who bird-watch or study ants.
On the flip side, the top five most exciting jobs, in order, were in the performing arts, science, journalism, health professions, and teaching.
The researchers also looked at the how likely people are to avoid spending time with stereotypical dullards.
“Are people who are stereotyped as being boring avoided, if possible? Our current research shows that this is likely,” says Wijnand A.P. Van Tilburg, PhD, one of the researchers who did the study.
Beyond specific traits and stereotypes, Dr. Van Tilburg and colleagues found that boring people are seen as lacking skills and warmth.
“To our surprise, it appears that they are seen as both unfriendly and incompetent,” says Dr. Van Tilburg, an experimental social psychologist at the University of Essex in the United Kingdom.
What qualities do people most often ascribe to boring people? Besides being “dull,” “dry,” “bland,” and “not interesting,” common stereotypes include thinking someone who is likely boring will have no sense of humor, lack opinions, or complain.
The people surveyed also were more likely to place boring people in towns and small cities rather than large metropolitan areas.
A vicious cycle?
What’s the possible harm of relying on boring stereotypes? If people are stereotyped as being boring solely based on professions and hobbies, “then that suggests that they will incur the negative consequences associated with being a stereotypically boring person -- even when others haven’t actually interacted with them,” Dr. Van Tilburg says.
“Having a stereotypically boring profession or hobby may come with the inability to prove the biased perceivers wrong,” he says.
So making distinctions between stereotypes and realities is important, Dr. Van Tilburg says. “Those who have hobbies or occupations that are stereotypically boring do, of course, not actually have to be boring.”
Mark Leary, PhD, a professor in the department of psychology and neuroscience at Duke University in Durham, N.C., agrees. “The research actually dealt with stereotypes about the kinds of people who hold certain jobs, have certain hobbies, and live in certain places -- and not about boring people per se,” he says.
Dr. Leary points out that few people encounter bankers, tax experts, and others perceived as most boring outside a professional setting.
“When we have interactions with data analysts, accountants, insurance agents, and bankers, for example, those interactions are often boring not because the people are boring, but rather because the context is not interesting.”
To get past the preconceptions, “the best advice might be to get people to try to separate people from their roles when forming impressions of them.”
“We need to recognize that many of our interactions with other people are tied up in particular roles and topics and, thus, don’t reveal much about the other people themselves,” Dr. Leary says. “Maybe my accountant is the life of the party in other contexts.”
Dollars to avoid the dull?
The researchers also found that as the perception of how boring a person is increased, people were more likely to say they would avoid them.
To find a way to measure this avoidance, they asked people in the study how much money they would have to be paid to pal around with a perceived bore for 1 to 7 days. The payments people said they would need varied by perceptions that their boredom would be low, intermediate, or high.
As an example, they would require an average of $50 to spend one day with a highly boring person. That amount would double to $100 to spend almost 4 days in their company, and up to $230 for the week.
Dr. Leary says boredom happens when people try to pay attention to an experience or event. This means boredom goes beyond simple disinterest or trying to pay attention to someone that is not “intrinsically captivating.” When it takes more brain power to pay attention, you’ll perceive the experience as even more boring.
“Perhaps the best way to see if other people are actually boring is to talk about interesting things and see how they respond,” Dr. Leary says. “But, be careful: The topics you think make interesting conversations may be boring to others.”
A version of this article first appeared on WebMD.com.
Apologies up front to anyone who spends their weekends bird-watching or doing math for fun. They are among the people expected to be boring, based on stereotypes about what they do for work or how they spend their spare time, new research reveals.
Researchers surveyed more than 500 people across five related experiments to identify what people perceive as the most boring jobs, traits, and hobbies. They also report how we could all be missing out by spending as little time as possible with our tax consultant, accountant, or financial adviser outside of work.
People who work in banking, finance, accounting, data analytics, and cleaning topped the most boring list in the study, published earlier this month in Personality and Social Psychology Bulletin.
Sleeping, religion, watching television, observing animals, and spending spare time on mathematics were the stereotypical most boring hobbies and activities. The “observing animals” group includes people who bird-watch or study ants.
On the flip side, the top five most exciting jobs, in order, were in the performing arts, science, journalism, health professions, and teaching.
The researchers also looked at the how likely people are to avoid spending time with stereotypical dullards.
“Are people who are stereotyped as being boring avoided, if possible? Our current research shows that this is likely,” says Wijnand A.P. Van Tilburg, PhD, one of the researchers who did the study.
Beyond specific traits and stereotypes, Dr. Van Tilburg and colleagues found that boring people are seen as lacking skills and warmth.
“To our surprise, it appears that they are seen as both unfriendly and incompetent,” says Dr. Van Tilburg, an experimental social psychologist at the University of Essex in the United Kingdom.
What qualities do people most often ascribe to boring people? Besides being “dull,” “dry,” “bland,” and “not interesting,” common stereotypes include thinking someone who is likely boring will have no sense of humor, lack opinions, or complain.
The people surveyed also were more likely to place boring people in towns and small cities rather than large metropolitan areas.
A vicious cycle?
What’s the possible harm of relying on boring stereotypes? If people are stereotyped as being boring solely based on professions and hobbies, “then that suggests that they will incur the negative consequences associated with being a stereotypically boring person -- even when others haven’t actually interacted with them,” Dr. Van Tilburg says.
“Having a stereotypically boring profession or hobby may come with the inability to prove the biased perceivers wrong,” he says.
So making distinctions between stereotypes and realities is important, Dr. Van Tilburg says. “Those who have hobbies or occupations that are stereotypically boring do, of course, not actually have to be boring.”
Mark Leary, PhD, a professor in the department of psychology and neuroscience at Duke University in Durham, N.C., agrees. “The research actually dealt with stereotypes about the kinds of people who hold certain jobs, have certain hobbies, and live in certain places -- and not about boring people per se,” he says.
Dr. Leary points out that few people encounter bankers, tax experts, and others perceived as most boring outside a professional setting.
“When we have interactions with data analysts, accountants, insurance agents, and bankers, for example, those interactions are often boring not because the people are boring, but rather because the context is not interesting.”
To get past the preconceptions, “the best advice might be to get people to try to separate people from their roles when forming impressions of them.”
“We need to recognize that many of our interactions with other people are tied up in particular roles and topics and, thus, don’t reveal much about the other people themselves,” Dr. Leary says. “Maybe my accountant is the life of the party in other contexts.”
Dollars to avoid the dull?
The researchers also found that as the perception of how boring a person is increased, people were more likely to say they would avoid them.
To find a way to measure this avoidance, they asked people in the study how much money they would have to be paid to pal around with a perceived bore for 1 to 7 days. The payments people said they would need varied by perceptions that their boredom would be low, intermediate, or high.
As an example, they would require an average of $50 to spend one day with a highly boring person. That amount would double to $100 to spend almost 4 days in their company, and up to $230 for the week.
Dr. Leary says boredom happens when people try to pay attention to an experience or event. This means boredom goes beyond simple disinterest or trying to pay attention to someone that is not “intrinsically captivating.” When it takes more brain power to pay attention, you’ll perceive the experience as even more boring.
“Perhaps the best way to see if other people are actually boring is to talk about interesting things and see how they respond,” Dr. Leary says. “But, be careful: The topics you think make interesting conversations may be boring to others.”
A version of this article first appeared on WebMD.com.
Apologies up front to anyone who spends their weekends bird-watching or doing math for fun. They are among the people expected to be boring, based on stereotypes about what they do for work or how they spend their spare time, new research reveals.
Researchers surveyed more than 500 people across five related experiments to identify what people perceive as the most boring jobs, traits, and hobbies. They also report how we could all be missing out by spending as little time as possible with our tax consultant, accountant, or financial adviser outside of work.
People who work in banking, finance, accounting, data analytics, and cleaning topped the most boring list in the study, published earlier this month in Personality and Social Psychology Bulletin.
Sleeping, religion, watching television, observing animals, and spending spare time on mathematics were the stereotypical most boring hobbies and activities. The “observing animals” group includes people who bird-watch or study ants.
On the flip side, the top five most exciting jobs, in order, were in the performing arts, science, journalism, health professions, and teaching.
The researchers also looked at the how likely people are to avoid spending time with stereotypical dullards.
“Are people who are stereotyped as being boring avoided, if possible? Our current research shows that this is likely,” says Wijnand A.P. Van Tilburg, PhD, one of the researchers who did the study.
Beyond specific traits and stereotypes, Dr. Van Tilburg and colleagues found that boring people are seen as lacking skills and warmth.
“To our surprise, it appears that they are seen as both unfriendly and incompetent,” says Dr. Van Tilburg, an experimental social psychologist at the University of Essex in the United Kingdom.
What qualities do people most often ascribe to boring people? Besides being “dull,” “dry,” “bland,” and “not interesting,” common stereotypes include thinking someone who is likely boring will have no sense of humor, lack opinions, or complain.
The people surveyed also were more likely to place boring people in towns and small cities rather than large metropolitan areas.
A vicious cycle?
What’s the possible harm of relying on boring stereotypes? If people are stereotyped as being boring solely based on professions and hobbies, “then that suggests that they will incur the negative consequences associated with being a stereotypically boring person -- even when others haven’t actually interacted with them,” Dr. Van Tilburg says.
“Having a stereotypically boring profession or hobby may come with the inability to prove the biased perceivers wrong,” he says.
So making distinctions between stereotypes and realities is important, Dr. Van Tilburg says. “Those who have hobbies or occupations that are stereotypically boring do, of course, not actually have to be boring.”
Mark Leary, PhD, a professor in the department of psychology and neuroscience at Duke University in Durham, N.C., agrees. “The research actually dealt with stereotypes about the kinds of people who hold certain jobs, have certain hobbies, and live in certain places -- and not about boring people per se,” he says.
Dr. Leary points out that few people encounter bankers, tax experts, and others perceived as most boring outside a professional setting.
“When we have interactions with data analysts, accountants, insurance agents, and bankers, for example, those interactions are often boring not because the people are boring, but rather because the context is not interesting.”
To get past the preconceptions, “the best advice might be to get people to try to separate people from their roles when forming impressions of them.”
“We need to recognize that many of our interactions with other people are tied up in particular roles and topics and, thus, don’t reveal much about the other people themselves,” Dr. Leary says. “Maybe my accountant is the life of the party in other contexts.”
Dollars to avoid the dull?
The researchers also found that as the perception of how boring a person is increased, people were more likely to say they would avoid them.
To find a way to measure this avoidance, they asked people in the study how much money they would have to be paid to pal around with a perceived bore for 1 to 7 days. The payments people said they would need varied by perceptions that their boredom would be low, intermediate, or high.
As an example, they would require an average of $50 to spend one day with a highly boring person. That amount would double to $100 to spend almost 4 days in their company, and up to $230 for the week.
Dr. Leary says boredom happens when people try to pay attention to an experience or event. This means boredom goes beyond simple disinterest or trying to pay attention to someone that is not “intrinsically captivating.” When it takes more brain power to pay attention, you’ll perceive the experience as even more boring.
“Perhaps the best way to see if other people are actually boring is to talk about interesting things and see how they respond,” Dr. Leary says. “But, be careful: The topics you think make interesting conversations may be boring to others.”
A version of this article first appeared on WebMD.com.
FROM PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN
Reporting from: 48th annual scientific meeting of the Society of Gynecologic Surgeons
Wednesday, March 30. Day 3 of SGS.
The final day of #SGS2022 began with the last round of oral and video presentations on topics including: the efficacy and safety of restrictive blood transfusion protocols in gynecologic surgical patients, restricted opioid use following midurethral sling procedures, and the efficacy of trigger point injections for myofascial pelvic pain. Next, the prestigious Distinguished Surgeon Award was presented to Dr. Jeffrey Cornella, professor of Obstetrics and Gynecology at Mayo Clinic College of Medicine, for his contributions to the field of gynecologic surgery.
This was followed by the passing of the presidential gavel from current SGS president Dr. Carl Zimmerman to incoming president Dr. Cheryl Iglesia, Director of Female Pelvic Medicine and Reconstructive Surgery at MedStar Washington Hospital Center, Washington DC, and Director of the National Center for Advanced Pelvic Surgery (NCAPS) at Medstar Health. Dr. Iglesia has been internationally and nationally recognized for her work in advancing the field of pelvic surgery and urogynecology through extensive research, clinical excellence, and support of medical education.
Needless to say, #SGS2022 was a huge success! While many of us are sad to leave San Antonio today, we are returning to our respective programs feeling motivated and rejuvenated. There is nothing more inspiring than spending time with such a highly committed group of physicians who strive to improve patient care through their excellent contributions to research and medical education. I am grateful for the new mentors, colleagues, and friends I have met at this meeting.
Thank you to the Society of Gynecologic Surgeons and OBG Management for giving me the opportunity to reflect on my experience at #SGS2022, as well as the companies that support the Fellows Scholar program.
I can’t wait to attend the 49th Annual Scientific Meeting in Tuscon, Arizona, in 2023!
Tuesday, March 29, 2022. Day 2 of SGS.
The second day of #SGS2022 began with several academic roundtables on a variety of topics including hysteroscopy, uterine-preserving prolapse surgeries, how to select patients for vaginal hysterectomy, and the role of minimally invasive surgery in transabdominal cerclage. The general session continued with more outstanding poster and video presentations that were followed by the annual presidential address. SGS president Dr. Carl Zimmerman spoke about the changing surgical landscape and SGS’s commitment to improving surgical education: “The women of America and the world deserve better.” He went on to announce the creation of a presidential task force on surgical training, whose members will include: Dr. Ted Anderson, Dr. Emily Weber LeBrun, and Dr. Mike Moen.
This year’s TeLinde Lecture was given by the executive director of the American College of Surgeons, Dr. Dr. Patricia Turner. Her talk was entitled, “Surgeons: More to Unite Us Than Divide Us.” Dr. Turner began by reminding us of the shared history between general surgery and gynecologic surgery. In fact, the American College of Surgeons was founded by gynecologist Dr. Franklin H. Martin. She went on to thoughtfully discuss the need to rethink surgical training and the way we assess surgical trainees. She highlighted the importance of collaboration between all surgical specialties to improve surgical education, improve outcomes, and advocate for patients. “In order to heal all, we have to have ALL surgeons at the table.”
Today’s general session was concluded with a panel discussion on “Operating Room Safety and Efficiency” in which Dr. Kenneth Catchpole, Dr. Teodor Grantcharov, and Dr. Jason Wright shared some interesting ideas on how we can improve patient care in the operating room. The afternoon continued with a number of social activities, providing an opportunity to enjoy the beautiful landscape of San Antonio, Texas, including: a tour of Eisenhower park, kayaking on the Guadelupe River, and the SGS golf tournament.
The fun continued into the evening at the annual “SGS’ Got Talent” in which participants could be spotted in cowboy hats, bandanas, and boots. The night was filled with food, drinks, laughter, and line dancing! #SGS2022
Monday, March 28, 2022. Day 1 of SGS.
“How do you become brave? How do you become an advocate? How do you make a change?” These are just some of the questions asked during our thought-provoking early morning session entitled, “Healthcare Inequity Awareness—A Conversation to Empower Providers and Enhance the Patient Experience” at this year’s annual scientific meeting of the Society of Gynecologic Surgeons #SGS2022. The panelists, which included Dr. Olivia Cardenas-Trowers, Dr. Maria Florian-Rodriguez, and Dr. Tristi Muir, emphasized the importance of acknowledging our own bias as physicians, as well as the role structural racism plays in the health care access and outcomes of our patients. We were reminded that “Diversity, Equity, Inclusion (aka DEI) is a journey. It is progress over time, not over night.”
Following the early morning panel, the 48th annual scientific meeting officially began with a brief welcome and recognition of new SGS members by current president Dr. Carl Zimmerman and scientific program committee chair Dr. Oz Harmanli. The rest of the morning session was filled with outstanding oral and video presentations on topics ranging from the role of oophorectomy in patients with breast cancer, creating simulation models to enhance medical education, and tips for navigating the altered retroperitoneum.
Next, the Mark D. Walters endowed lecture was given by Dr. Marta A. Crispens, entitled “Restructuring Gynecologic Surgical Education: It’s a Matter of Equity.” In her exceptionally powerful address, Dr. Crispens began by discussing the historical context in which the fields of obstetrics and gynecology were combined and comparing it to a shift in current practice toward a national decrease in number of hysterectomies and an increase in the complexity of surgical cases. She highlighted the well-studied fact that low-volume surgeons have higher complication rates and that many new ObGyn residency graduates perform only 3 to 4 hysterectomies annually during the first few years of practice. Finally, she asserted that, by separating the practices of obstetrics and gynecology, we can improve surgical education and the quality of surgical care for our patients. The audience’s enthusiasm was undeniable, resulting in resounding applause and a standing ovation.
The afternoon was filled with unique opportunities for fellows, including: the Fellow’s Pelvic Research Network (FPRN) meeting, an incredibly informative panel on how to navigate the first year out of fellowship with Dr. Mireille Truong, Dr. Christine Foley, and Dr. Jon Pennycuff, and finally, the Mentorship Mingle.
The first day was concluded with the President’s Award Ceremony in which Dr. John DeLancey was presented with the illustrious President’s Award, followed by the President’s Reception with food, drinks, and lively conversation. Looking forward to day 2 of #SGS2022. @gynsurgery
Wednesday, March 30. Day 3 of SGS.
The final day of #SGS2022 began with the last round of oral and video presentations on topics including: the efficacy and safety of restrictive blood transfusion protocols in gynecologic surgical patients, restricted opioid use following midurethral sling procedures, and the efficacy of trigger point injections for myofascial pelvic pain. Next, the prestigious Distinguished Surgeon Award was presented to Dr. Jeffrey Cornella, professor of Obstetrics and Gynecology at Mayo Clinic College of Medicine, for his contributions to the field of gynecologic surgery.
This was followed by the passing of the presidential gavel from current SGS president Dr. Carl Zimmerman to incoming president Dr. Cheryl Iglesia, Director of Female Pelvic Medicine and Reconstructive Surgery at MedStar Washington Hospital Center, Washington DC, and Director of the National Center for Advanced Pelvic Surgery (NCAPS) at Medstar Health. Dr. Iglesia has been internationally and nationally recognized for her work in advancing the field of pelvic surgery and urogynecology through extensive research, clinical excellence, and support of medical education.
Needless to say, #SGS2022 was a huge success! While many of us are sad to leave San Antonio today, we are returning to our respective programs feeling motivated and rejuvenated. There is nothing more inspiring than spending time with such a highly committed group of physicians who strive to improve patient care through their excellent contributions to research and medical education. I am grateful for the new mentors, colleagues, and friends I have met at this meeting.
Thank you to the Society of Gynecologic Surgeons and OBG Management for giving me the opportunity to reflect on my experience at #SGS2022, as well as the companies that support the Fellows Scholar program.
I can’t wait to attend the 49th Annual Scientific Meeting in Tuscon, Arizona, in 2023!
Tuesday, March 29, 2022. Day 2 of SGS.
The second day of #SGS2022 began with several academic roundtables on a variety of topics including hysteroscopy, uterine-preserving prolapse surgeries, how to select patients for vaginal hysterectomy, and the role of minimally invasive surgery in transabdominal cerclage. The general session continued with more outstanding poster and video presentations that were followed by the annual presidential address. SGS president Dr. Carl Zimmerman spoke about the changing surgical landscape and SGS’s commitment to improving surgical education: “The women of America and the world deserve better.” He went on to announce the creation of a presidential task force on surgical training, whose members will include: Dr. Ted Anderson, Dr. Emily Weber LeBrun, and Dr. Mike Moen.
This year’s TeLinde Lecture was given by the executive director of the American College of Surgeons, Dr. Dr. Patricia Turner. Her talk was entitled, “Surgeons: More to Unite Us Than Divide Us.” Dr. Turner began by reminding us of the shared history between general surgery and gynecologic surgery. In fact, the American College of Surgeons was founded by gynecologist Dr. Franklin H. Martin. She went on to thoughtfully discuss the need to rethink surgical training and the way we assess surgical trainees. She highlighted the importance of collaboration between all surgical specialties to improve surgical education, improve outcomes, and advocate for patients. “In order to heal all, we have to have ALL surgeons at the table.”
Today’s general session was concluded with a panel discussion on “Operating Room Safety and Efficiency” in which Dr. Kenneth Catchpole, Dr. Teodor Grantcharov, and Dr. Jason Wright shared some interesting ideas on how we can improve patient care in the operating room. The afternoon continued with a number of social activities, providing an opportunity to enjoy the beautiful landscape of San Antonio, Texas, including: a tour of Eisenhower park, kayaking on the Guadelupe River, and the SGS golf tournament.
The fun continued into the evening at the annual “SGS’ Got Talent” in which participants could be spotted in cowboy hats, bandanas, and boots. The night was filled with food, drinks, laughter, and line dancing! #SGS2022
Monday, March 28, 2022. Day 1 of SGS.
“How do you become brave? How do you become an advocate? How do you make a change?” These are just some of the questions asked during our thought-provoking early morning session entitled, “Healthcare Inequity Awareness—A Conversation to Empower Providers and Enhance the Patient Experience” at this year’s annual scientific meeting of the Society of Gynecologic Surgeons #SGS2022. The panelists, which included Dr. Olivia Cardenas-Trowers, Dr. Maria Florian-Rodriguez, and Dr. Tristi Muir, emphasized the importance of acknowledging our own bias as physicians, as well as the role structural racism plays in the health care access and outcomes of our patients. We were reminded that “Diversity, Equity, Inclusion (aka DEI) is a journey. It is progress over time, not over night.”
Following the early morning panel, the 48th annual scientific meeting officially began with a brief welcome and recognition of new SGS members by current president Dr. Carl Zimmerman and scientific program committee chair Dr. Oz Harmanli. The rest of the morning session was filled with outstanding oral and video presentations on topics ranging from the role of oophorectomy in patients with breast cancer, creating simulation models to enhance medical education, and tips for navigating the altered retroperitoneum.
Next, the Mark D. Walters endowed lecture was given by Dr. Marta A. Crispens, entitled “Restructuring Gynecologic Surgical Education: It’s a Matter of Equity.” In her exceptionally powerful address, Dr. Crispens began by discussing the historical context in which the fields of obstetrics and gynecology were combined and comparing it to a shift in current practice toward a national decrease in number of hysterectomies and an increase in the complexity of surgical cases. She highlighted the well-studied fact that low-volume surgeons have higher complication rates and that many new ObGyn residency graduates perform only 3 to 4 hysterectomies annually during the first few years of practice. Finally, she asserted that, by separating the practices of obstetrics and gynecology, we can improve surgical education and the quality of surgical care for our patients. The audience’s enthusiasm was undeniable, resulting in resounding applause and a standing ovation.
The afternoon was filled with unique opportunities for fellows, including: the Fellow’s Pelvic Research Network (FPRN) meeting, an incredibly informative panel on how to navigate the first year out of fellowship with Dr. Mireille Truong, Dr. Christine Foley, and Dr. Jon Pennycuff, and finally, the Mentorship Mingle.
The first day was concluded with the President’s Award Ceremony in which Dr. John DeLancey was presented with the illustrious President’s Award, followed by the President’s Reception with food, drinks, and lively conversation. Looking forward to day 2 of #SGS2022. @gynsurgery
Wednesday, March 30. Day 3 of SGS.
The final day of #SGS2022 began with the last round of oral and video presentations on topics including: the efficacy and safety of restrictive blood transfusion protocols in gynecologic surgical patients, restricted opioid use following midurethral sling procedures, and the efficacy of trigger point injections for myofascial pelvic pain. Next, the prestigious Distinguished Surgeon Award was presented to Dr. Jeffrey Cornella, professor of Obstetrics and Gynecology at Mayo Clinic College of Medicine, for his contributions to the field of gynecologic surgery.
This was followed by the passing of the presidential gavel from current SGS president Dr. Carl Zimmerman to incoming president Dr. Cheryl Iglesia, Director of Female Pelvic Medicine and Reconstructive Surgery at MedStar Washington Hospital Center, Washington DC, and Director of the National Center for Advanced Pelvic Surgery (NCAPS) at Medstar Health. Dr. Iglesia has been internationally and nationally recognized for her work in advancing the field of pelvic surgery and urogynecology through extensive research, clinical excellence, and support of medical education.
Needless to say, #SGS2022 was a huge success! While many of us are sad to leave San Antonio today, we are returning to our respective programs feeling motivated and rejuvenated. There is nothing more inspiring than spending time with such a highly committed group of physicians who strive to improve patient care through their excellent contributions to research and medical education. I am grateful for the new mentors, colleagues, and friends I have met at this meeting.
Thank you to the Society of Gynecologic Surgeons and OBG Management for giving me the opportunity to reflect on my experience at #SGS2022, as well as the companies that support the Fellows Scholar program.
I can’t wait to attend the 49th Annual Scientific Meeting in Tuscon, Arizona, in 2023!
Tuesday, March 29, 2022. Day 2 of SGS.
The second day of #SGS2022 began with several academic roundtables on a variety of topics including hysteroscopy, uterine-preserving prolapse surgeries, how to select patients for vaginal hysterectomy, and the role of minimally invasive surgery in transabdominal cerclage. The general session continued with more outstanding poster and video presentations that were followed by the annual presidential address. SGS president Dr. Carl Zimmerman spoke about the changing surgical landscape and SGS’s commitment to improving surgical education: “The women of America and the world deserve better.” He went on to announce the creation of a presidential task force on surgical training, whose members will include: Dr. Ted Anderson, Dr. Emily Weber LeBrun, and Dr. Mike Moen.
This year’s TeLinde Lecture was given by the executive director of the American College of Surgeons, Dr. Dr. Patricia Turner. Her talk was entitled, “Surgeons: More to Unite Us Than Divide Us.” Dr. Turner began by reminding us of the shared history between general surgery and gynecologic surgery. In fact, the American College of Surgeons was founded by gynecologist Dr. Franklin H. Martin. She went on to thoughtfully discuss the need to rethink surgical training and the way we assess surgical trainees. She highlighted the importance of collaboration between all surgical specialties to improve surgical education, improve outcomes, and advocate for patients. “In order to heal all, we have to have ALL surgeons at the table.”
Today’s general session was concluded with a panel discussion on “Operating Room Safety and Efficiency” in which Dr. Kenneth Catchpole, Dr. Teodor Grantcharov, and Dr. Jason Wright shared some interesting ideas on how we can improve patient care in the operating room. The afternoon continued with a number of social activities, providing an opportunity to enjoy the beautiful landscape of San Antonio, Texas, including: a tour of Eisenhower park, kayaking on the Guadelupe River, and the SGS golf tournament.
The fun continued into the evening at the annual “SGS’ Got Talent” in which participants could be spotted in cowboy hats, bandanas, and boots. The night was filled with food, drinks, laughter, and line dancing! #SGS2022
Monday, March 28, 2022. Day 1 of SGS.
“How do you become brave? How do you become an advocate? How do you make a change?” These are just some of the questions asked during our thought-provoking early morning session entitled, “Healthcare Inequity Awareness—A Conversation to Empower Providers and Enhance the Patient Experience” at this year’s annual scientific meeting of the Society of Gynecologic Surgeons #SGS2022. The panelists, which included Dr. Olivia Cardenas-Trowers, Dr. Maria Florian-Rodriguez, and Dr. Tristi Muir, emphasized the importance of acknowledging our own bias as physicians, as well as the role structural racism plays in the health care access and outcomes of our patients. We were reminded that “Diversity, Equity, Inclusion (aka DEI) is a journey. It is progress over time, not over night.”
Following the early morning panel, the 48th annual scientific meeting officially began with a brief welcome and recognition of new SGS members by current president Dr. Carl Zimmerman and scientific program committee chair Dr. Oz Harmanli. The rest of the morning session was filled with outstanding oral and video presentations on topics ranging from the role of oophorectomy in patients with breast cancer, creating simulation models to enhance medical education, and tips for navigating the altered retroperitoneum.
Next, the Mark D. Walters endowed lecture was given by Dr. Marta A. Crispens, entitled “Restructuring Gynecologic Surgical Education: It’s a Matter of Equity.” In her exceptionally powerful address, Dr. Crispens began by discussing the historical context in which the fields of obstetrics and gynecology were combined and comparing it to a shift in current practice toward a national decrease in number of hysterectomies and an increase in the complexity of surgical cases. She highlighted the well-studied fact that low-volume surgeons have higher complication rates and that many new ObGyn residency graduates perform only 3 to 4 hysterectomies annually during the first few years of practice. Finally, she asserted that, by separating the practices of obstetrics and gynecology, we can improve surgical education and the quality of surgical care for our patients. The audience’s enthusiasm was undeniable, resulting in resounding applause and a standing ovation.
The afternoon was filled with unique opportunities for fellows, including: the Fellow’s Pelvic Research Network (FPRN) meeting, an incredibly informative panel on how to navigate the first year out of fellowship with Dr. Mireille Truong, Dr. Christine Foley, and Dr. Jon Pennycuff, and finally, the Mentorship Mingle.
The first day was concluded with the President’s Award Ceremony in which Dr. John DeLancey was presented with the illustrious President’s Award, followed by the President’s Reception with food, drinks, and lively conversation. Looking forward to day 2 of #SGS2022. @gynsurgery
TikTok trends: Sleepy lettuce water, cyst smacking, and prostaglandin pain
Spring is the time for new beginnings, cleaning out your dusty musty basement, battling seasonal allergies, and, of course, discovering the latest TikTok trends.
With potentially permanent daylight savings on the table, that extra time spent luxuriating in the sunshine could mean more time to scroll (and scroll and scroll) through the latest health fads on the platform – for better or for worse.
The good: Doctor explains menstrual pain in an unexpected place
For a long time, menstrual cycles were considered taboo, and discussing them is still seen as inappropriate in many parts of the world. Organizations and online resources such as Clue or Flo are seeking to normalize period-talk. Pixar has jumped on board with its latest film, Turning Red, which depicts a 13-year-old’s experience getting her first period. With a 95% rating on Rotten Tomatoes, it’s clear that the public is willing to talk about periods.
Many people feel shame around discussing their periods, but this is something that social media has actually handled positively (for once).
Karan Raj, MD, a National Health Service surgeon and educator at Imperial College London, uses his TikTok account to educate his followers and explain health concerns and issues. Dr. Raj stitched this video from someone else that was captioned, “When you’re on your [period] and feel the stab in your booty.”
In his video, Dr. Raj uses anatomical diagrams to explain exactly what’s going on with this pain in the butt. The pain, which Dr. Raj says is called proctalgia fugax, is caused by a type of hormone released during menstruation called prostaglandins. Prostaglandins tell the uterus to contract and shed its lining, but the uterus isn’t the only part of the body receiving that message from the prostaglandins.
“The prostaglandins also cause contraction of the rectum, pelvic floor muscles, and muscles around the anal canal,” Dr. Raj tells viewers. “These intense contractions can cause muscle spasms and anal cramps.”
The bad: Lettuce water sleep aid
This video from Elliott Norris (@callmebelly) shows him preparing an unusual sleep aid. It’s one of many videos of people trying the same trend, usually with the tag #lettucewater attached.
As Mr. Elliott explains, the rumor is that boiling romaine lettuce and then drinking the water is a way to help one fall asleep faster, or sleep better at night. At the end of the video, Mr. Elliott even said that it worked for him. So where does this come from, and is it just a placebo?
Videos on TikTok recreating this trend cite a 2017 study titled, “Sleep-inducing effect of lettuce (Lactuca sativa) varieties on pentobarbital-induced sleep” (there’s even a New York Times article about it). The star of the study is lactucarium, a milky white substance that›s found in lettuce, usually visible if you squeeze it or break the stalks. The study suggests that lactucarium has “sedative-hypnotic” properties after lettuce extract was used in tandem with pentobarbital on mice, and it was found that the mice›s sleep latency then decreased.
In an article from Parade discussing the trend, Rachel Salas, MD, MEd, weighs in. Dr. Salas is the assistant medical director at Johns Hopkins Center for Sleep and Wellness in Baltimore, so you could say she knows a thing or two about sleep. Her response to the mice study was that its limitations made the results not entirely reliable.
According to Dr. Salas, there was no control group, the extract the mice were given is much more concentrated than what’s found in lettuce, and the mice were given a sedative that was going to make them sleepy anyway: “The mice were drugged to put the animals to sleep soon after they took the lettuce water.”
So while Dr. Salas thinks it’s good that people are open to talking about sleeping solutions, “lettuce tea” just doesn’t have any evidence to back up what people claim it does.
The ugly: Using a book to pop ganglion cysts
Everyone knows how popular pimple popping, blackhead squeezing, and cyst squashing are on social media. Dermatologist Sandra Lee, better known as Dr. Pimple Popper, used her YouTube platform of the same name – which boasts over 7.42 million subscribers – to cinch a reality television show on TLC. Viewers on TikTok are no different and love the satisfying (and often gross) relief of clearing out a nasty pimple or two.
In this stitched TikTok from emergency medicine physician Fayez Ajib, DO, aka @lifeofadoctor, Dr. Ajib reacts to an original video of someone popping a ganglion cyst with a textbook.
There are plenty of other videos on TikTok of people using books to smack ganglion cysts, which develop on the wrist. People have looked for remedies for ganglion cysts since the 1700s, at which point many strange options arose, as discussed in BBC Future. The one that still holds up, however, is smacking the cyst with a heavy book, like a Bible (hence the ganglion cyst’s nickname, “Bible bump”).
In his video, Dr. Ajib explains why smacking the cyst is a bad idea, even if it appears to temporarily resolve the issue.
“Not only have people broken the delicate bones in their wrist from getting hit,” Dr. Ajib says, “but they actually have a high chance of recurrence. A doctor will actually remove the sac itself rather than just draining it from being hit.”
The lessons we glean from TikTok remain the same: Leave it up to the professionals.
A version of this article first appeared on Medscape.com.
Spring is the time for new beginnings, cleaning out your dusty musty basement, battling seasonal allergies, and, of course, discovering the latest TikTok trends.
With potentially permanent daylight savings on the table, that extra time spent luxuriating in the sunshine could mean more time to scroll (and scroll and scroll) through the latest health fads on the platform – for better or for worse.
The good: Doctor explains menstrual pain in an unexpected place
For a long time, menstrual cycles were considered taboo, and discussing them is still seen as inappropriate in many parts of the world. Organizations and online resources such as Clue or Flo are seeking to normalize period-talk. Pixar has jumped on board with its latest film, Turning Red, which depicts a 13-year-old’s experience getting her first period. With a 95% rating on Rotten Tomatoes, it’s clear that the public is willing to talk about periods.
Many people feel shame around discussing their periods, but this is something that social media has actually handled positively (for once).
Karan Raj, MD, a National Health Service surgeon and educator at Imperial College London, uses his TikTok account to educate his followers and explain health concerns and issues. Dr. Raj stitched this video from someone else that was captioned, “When you’re on your [period] and feel the stab in your booty.”
In his video, Dr. Raj uses anatomical diagrams to explain exactly what’s going on with this pain in the butt. The pain, which Dr. Raj says is called proctalgia fugax, is caused by a type of hormone released during menstruation called prostaglandins. Prostaglandins tell the uterus to contract and shed its lining, but the uterus isn’t the only part of the body receiving that message from the prostaglandins.
“The prostaglandins also cause contraction of the rectum, pelvic floor muscles, and muscles around the anal canal,” Dr. Raj tells viewers. “These intense contractions can cause muscle spasms and anal cramps.”
The bad: Lettuce water sleep aid
This video from Elliott Norris (@callmebelly) shows him preparing an unusual sleep aid. It’s one of many videos of people trying the same trend, usually with the tag #lettucewater attached.
As Mr. Elliott explains, the rumor is that boiling romaine lettuce and then drinking the water is a way to help one fall asleep faster, or sleep better at night. At the end of the video, Mr. Elliott even said that it worked for him. So where does this come from, and is it just a placebo?
Videos on TikTok recreating this trend cite a 2017 study titled, “Sleep-inducing effect of lettuce (Lactuca sativa) varieties on pentobarbital-induced sleep” (there’s even a New York Times article about it). The star of the study is lactucarium, a milky white substance that›s found in lettuce, usually visible if you squeeze it or break the stalks. The study suggests that lactucarium has “sedative-hypnotic” properties after lettuce extract was used in tandem with pentobarbital on mice, and it was found that the mice›s sleep latency then decreased.
In an article from Parade discussing the trend, Rachel Salas, MD, MEd, weighs in. Dr. Salas is the assistant medical director at Johns Hopkins Center for Sleep and Wellness in Baltimore, so you could say she knows a thing or two about sleep. Her response to the mice study was that its limitations made the results not entirely reliable.
According to Dr. Salas, there was no control group, the extract the mice were given is much more concentrated than what’s found in lettuce, and the mice were given a sedative that was going to make them sleepy anyway: “The mice were drugged to put the animals to sleep soon after they took the lettuce water.”
So while Dr. Salas thinks it’s good that people are open to talking about sleeping solutions, “lettuce tea” just doesn’t have any evidence to back up what people claim it does.
The ugly: Using a book to pop ganglion cysts
Everyone knows how popular pimple popping, blackhead squeezing, and cyst squashing are on social media. Dermatologist Sandra Lee, better known as Dr. Pimple Popper, used her YouTube platform of the same name – which boasts over 7.42 million subscribers – to cinch a reality television show on TLC. Viewers on TikTok are no different and love the satisfying (and often gross) relief of clearing out a nasty pimple or two.
In this stitched TikTok from emergency medicine physician Fayez Ajib, DO, aka @lifeofadoctor, Dr. Ajib reacts to an original video of someone popping a ganglion cyst with a textbook.
There are plenty of other videos on TikTok of people using books to smack ganglion cysts, which develop on the wrist. People have looked for remedies for ganglion cysts since the 1700s, at which point many strange options arose, as discussed in BBC Future. The one that still holds up, however, is smacking the cyst with a heavy book, like a Bible (hence the ganglion cyst’s nickname, “Bible bump”).
In his video, Dr. Ajib explains why smacking the cyst is a bad idea, even if it appears to temporarily resolve the issue.
“Not only have people broken the delicate bones in their wrist from getting hit,” Dr. Ajib says, “but they actually have a high chance of recurrence. A doctor will actually remove the sac itself rather than just draining it from being hit.”
The lessons we glean from TikTok remain the same: Leave it up to the professionals.
A version of this article first appeared on Medscape.com.
Spring is the time for new beginnings, cleaning out your dusty musty basement, battling seasonal allergies, and, of course, discovering the latest TikTok trends.
With potentially permanent daylight savings on the table, that extra time spent luxuriating in the sunshine could mean more time to scroll (and scroll and scroll) through the latest health fads on the platform – for better or for worse.
The good: Doctor explains menstrual pain in an unexpected place
For a long time, menstrual cycles were considered taboo, and discussing them is still seen as inappropriate in many parts of the world. Organizations and online resources such as Clue or Flo are seeking to normalize period-talk. Pixar has jumped on board with its latest film, Turning Red, which depicts a 13-year-old’s experience getting her first period. With a 95% rating on Rotten Tomatoes, it’s clear that the public is willing to talk about periods.
Many people feel shame around discussing their periods, but this is something that social media has actually handled positively (for once).
Karan Raj, MD, a National Health Service surgeon and educator at Imperial College London, uses his TikTok account to educate his followers and explain health concerns and issues. Dr. Raj stitched this video from someone else that was captioned, “When you’re on your [period] and feel the stab in your booty.”
In his video, Dr. Raj uses anatomical diagrams to explain exactly what’s going on with this pain in the butt. The pain, which Dr. Raj says is called proctalgia fugax, is caused by a type of hormone released during menstruation called prostaglandins. Prostaglandins tell the uterus to contract and shed its lining, but the uterus isn’t the only part of the body receiving that message from the prostaglandins.
“The prostaglandins also cause contraction of the rectum, pelvic floor muscles, and muscles around the anal canal,” Dr. Raj tells viewers. “These intense contractions can cause muscle spasms and anal cramps.”
The bad: Lettuce water sleep aid
This video from Elliott Norris (@callmebelly) shows him preparing an unusual sleep aid. It’s one of many videos of people trying the same trend, usually with the tag #lettucewater attached.
As Mr. Elliott explains, the rumor is that boiling romaine lettuce and then drinking the water is a way to help one fall asleep faster, or sleep better at night. At the end of the video, Mr. Elliott even said that it worked for him. So where does this come from, and is it just a placebo?
Videos on TikTok recreating this trend cite a 2017 study titled, “Sleep-inducing effect of lettuce (Lactuca sativa) varieties on pentobarbital-induced sleep” (there’s even a New York Times article about it). The star of the study is lactucarium, a milky white substance that›s found in lettuce, usually visible if you squeeze it or break the stalks. The study suggests that lactucarium has “sedative-hypnotic” properties after lettuce extract was used in tandem with pentobarbital on mice, and it was found that the mice›s sleep latency then decreased.
In an article from Parade discussing the trend, Rachel Salas, MD, MEd, weighs in. Dr. Salas is the assistant medical director at Johns Hopkins Center for Sleep and Wellness in Baltimore, so you could say she knows a thing or two about sleep. Her response to the mice study was that its limitations made the results not entirely reliable.
According to Dr. Salas, there was no control group, the extract the mice were given is much more concentrated than what’s found in lettuce, and the mice were given a sedative that was going to make them sleepy anyway: “The mice were drugged to put the animals to sleep soon after they took the lettuce water.”
So while Dr. Salas thinks it’s good that people are open to talking about sleeping solutions, “lettuce tea” just doesn’t have any evidence to back up what people claim it does.
The ugly: Using a book to pop ganglion cysts
Everyone knows how popular pimple popping, blackhead squeezing, and cyst squashing are on social media. Dermatologist Sandra Lee, better known as Dr. Pimple Popper, used her YouTube platform of the same name – which boasts over 7.42 million subscribers – to cinch a reality television show on TLC. Viewers on TikTok are no different and love the satisfying (and often gross) relief of clearing out a nasty pimple or two.
In this stitched TikTok from emergency medicine physician Fayez Ajib, DO, aka @lifeofadoctor, Dr. Ajib reacts to an original video of someone popping a ganglion cyst with a textbook.
There are plenty of other videos on TikTok of people using books to smack ganglion cysts, which develop on the wrist. People have looked for remedies for ganglion cysts since the 1700s, at which point many strange options arose, as discussed in BBC Future. The one that still holds up, however, is smacking the cyst with a heavy book, like a Bible (hence the ganglion cyst’s nickname, “Bible bump”).
In his video, Dr. Ajib explains why smacking the cyst is a bad idea, even if it appears to temporarily resolve the issue.
“Not only have people broken the delicate bones in their wrist from getting hit,” Dr. Ajib says, “but they actually have a high chance of recurrence. A doctor will actually remove the sac itself rather than just draining it from being hit.”
The lessons we glean from TikTok remain the same: Leave it up to the professionals.
A version of this article first appeared on Medscape.com.
Avocados linked to lower cardiovascular risk
A prospective study that followed more than 110,000 men and women for more than 30 years suggests that .
Researchers also found that replacing half a serving of butter, cheese, bacon, or other animal product with an equivalent amount of avocado was associated with up to 22% lower risk for CVD events.
The findings add to evidence from other studies that has shown that avocados – which contain multiple nutrients, including fiber and unsaturated, healthy fats – have a positive impact on cardiovascular risk factors, first author Lorena S. Pacheco, PhD, a postdoctoral research fellow at the Harvard T.H. Chan School of Public Health, Boston, said in an interview.
“This research complements and expands on the current literature that we have on unsaturated fats and reduced risk of cardiovascular disease and also underscores how bad saturated fats, like butter, cheese, and processed meats are for the heart,” Dr. Pacheco said.
“For the most part, we have known that avocados are healthy, but I think this study, because of its numbers and duration, adds a little more substance to that knowledge now,” Dr. Pacheco said.
The findings were published online March 30 in the Journal of the American Heart Association.
Avocados are dense with nutrients. They are high in fat, but in monounsaturated fats (MUFAs) and polyunsaturated fats (PUFAs), which are viewed as good.
A medium-sized (136 g) Haas avocado, which is the most commonly consumed avocado in the United States, contains roughly 13 g of oleic acid. Avocados also contain dietary fiber, potassium, magnesium, phytonutrients, and bioactive compounds.
To see the effect avocados can have on cardiovascular health, Dr. Pacheco and her team turned to two large, long-running cohort studies: the Nurses’ Health Study (NHS), which began in the early 1970s with 68,786 women 30-55 years of age; and the Health Professionals Follow-up Study (HPFS), which ran from 1986 to 2016 and followed 41,701 men 40-75 years of age.
All were free of cancer, coronary heart disease, and stroke at study entry.
Participants completed a validated food frequency questionnaire at baseline and every 4 years thereafter. The questionnaire asked about the amount and frequency of avocado consumed. One serving equaled half an avocado, or half a cup.
In the early days of the NHS, very few participants said they ate avocados, but that began to change over the years, as the popularity of avocados grew.
“The NHS cohort was recruited back in the late ‘70s, and the health professionals cohort did not start until the mid 1980s, when avocado consumption was really low,” Dr. Pacheco said.
“What is beautiful about these cohorts is we are able to ask participants questions and then save the answers that they give us throughout the years to answer questions that might arise whenever the question is right. So it just depends on when you accrue enough data to ask those questions about potential cardiovascular benefit with avocados,” she said.
There were 9,185 coronary heart disease events and 5,290 strokes documented over 30 years of follow-up.
After adjustment for lifestyle and other dietary factors, those with a higher avocado intake – at least two servings per week – had a 16% lower risk for CVD (pooled hazard ratio, 0.84; 95% CI, 0.75-0.95) and a 21% lower risk for coronary heart disease (pooled HR, 0.79; 95% CI, 0.68-0.91).
No significant associations were seen for stroke, but this is because the study did not have sufficient numbers, Dr. Pacheco explained.
A statistical model also determined that replacing half a serving daily of margarine, butter, egg, yogurt, cheese, or processed meats, such as bacon, with the same amount of avocado was associated with a 16%-22% lower risk for CVD events.
“I want to emphasize that the study is an epidemiological observational study and cannot prove cause and effect,” Dr. Pacheco said.
“It’s not a clinical trial – it’s based on observational epidemiology – but we saw patterns in the model: Avocado consumption and substituting avocado for other unhealthy fats reduced the risk of having a cardiovascular event or coronary heart disease,” she said.
The findings are significant “because a healthy dietary pattern is the cornerstone for cardiovascular health; however, it can be difficult for many Americans to achieve and adhere to healthy eating patterns,” Cheryl Anderson, PhD, professor and dean of the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California, San Diego, who is chair of the AHA’s Council on Epidemiology and Prevention, said in a statement.
“We desperately need strategies to improve intake of AHA-recommended healthy diets, such as the Mediterranean diet, that are rich in vegetables and fruits. Although no one food is the solution to routinely eating a healthy diet, this study is evidence that avocados have possible health benefits. This is promising because it is a food item that is popular, accessible, desirable, and easy to include in meals eaten by many Americans at home and in restaurants,” said Dr. Anderson, who was not part of the study.
Dr. Pacheco and Dr. Anderson report no relevant financial relationships.
A version of this article first appeared on Medscape.com.
A prospective study that followed more than 110,000 men and women for more than 30 years suggests that .
Researchers also found that replacing half a serving of butter, cheese, bacon, or other animal product with an equivalent amount of avocado was associated with up to 22% lower risk for CVD events.
The findings add to evidence from other studies that has shown that avocados – which contain multiple nutrients, including fiber and unsaturated, healthy fats – have a positive impact on cardiovascular risk factors, first author Lorena S. Pacheco, PhD, a postdoctoral research fellow at the Harvard T.H. Chan School of Public Health, Boston, said in an interview.
“This research complements and expands on the current literature that we have on unsaturated fats and reduced risk of cardiovascular disease and also underscores how bad saturated fats, like butter, cheese, and processed meats are for the heart,” Dr. Pacheco said.
“For the most part, we have known that avocados are healthy, but I think this study, because of its numbers and duration, adds a little more substance to that knowledge now,” Dr. Pacheco said.
The findings were published online March 30 in the Journal of the American Heart Association.
Avocados are dense with nutrients. They are high in fat, but in monounsaturated fats (MUFAs) and polyunsaturated fats (PUFAs), which are viewed as good.
A medium-sized (136 g) Haas avocado, which is the most commonly consumed avocado in the United States, contains roughly 13 g of oleic acid. Avocados also contain dietary fiber, potassium, magnesium, phytonutrients, and bioactive compounds.
To see the effect avocados can have on cardiovascular health, Dr. Pacheco and her team turned to two large, long-running cohort studies: the Nurses’ Health Study (NHS), which began in the early 1970s with 68,786 women 30-55 years of age; and the Health Professionals Follow-up Study (HPFS), which ran from 1986 to 2016 and followed 41,701 men 40-75 years of age.
All were free of cancer, coronary heart disease, and stroke at study entry.
Participants completed a validated food frequency questionnaire at baseline and every 4 years thereafter. The questionnaire asked about the amount and frequency of avocado consumed. One serving equaled half an avocado, or half a cup.
In the early days of the NHS, very few participants said they ate avocados, but that began to change over the years, as the popularity of avocados grew.
“The NHS cohort was recruited back in the late ‘70s, and the health professionals cohort did not start until the mid 1980s, when avocado consumption was really low,” Dr. Pacheco said.
“What is beautiful about these cohorts is we are able to ask participants questions and then save the answers that they give us throughout the years to answer questions that might arise whenever the question is right. So it just depends on when you accrue enough data to ask those questions about potential cardiovascular benefit with avocados,” she said.
There were 9,185 coronary heart disease events and 5,290 strokes documented over 30 years of follow-up.
After adjustment for lifestyle and other dietary factors, those with a higher avocado intake – at least two servings per week – had a 16% lower risk for CVD (pooled hazard ratio, 0.84; 95% CI, 0.75-0.95) and a 21% lower risk for coronary heart disease (pooled HR, 0.79; 95% CI, 0.68-0.91).
No significant associations were seen for stroke, but this is because the study did not have sufficient numbers, Dr. Pacheco explained.
A statistical model also determined that replacing half a serving daily of margarine, butter, egg, yogurt, cheese, or processed meats, such as bacon, with the same amount of avocado was associated with a 16%-22% lower risk for CVD events.
“I want to emphasize that the study is an epidemiological observational study and cannot prove cause and effect,” Dr. Pacheco said.
“It’s not a clinical trial – it’s based on observational epidemiology – but we saw patterns in the model: Avocado consumption and substituting avocado for other unhealthy fats reduced the risk of having a cardiovascular event or coronary heart disease,” she said.
The findings are significant “because a healthy dietary pattern is the cornerstone for cardiovascular health; however, it can be difficult for many Americans to achieve and adhere to healthy eating patterns,” Cheryl Anderson, PhD, professor and dean of the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California, San Diego, who is chair of the AHA’s Council on Epidemiology and Prevention, said in a statement.
“We desperately need strategies to improve intake of AHA-recommended healthy diets, such as the Mediterranean diet, that are rich in vegetables and fruits. Although no one food is the solution to routinely eating a healthy diet, this study is evidence that avocados have possible health benefits. This is promising because it is a food item that is popular, accessible, desirable, and easy to include in meals eaten by many Americans at home and in restaurants,” said Dr. Anderson, who was not part of the study.
Dr. Pacheco and Dr. Anderson report no relevant financial relationships.
A version of this article first appeared on Medscape.com.
A prospective study that followed more than 110,000 men and women for more than 30 years suggests that .
Researchers also found that replacing half a serving of butter, cheese, bacon, or other animal product with an equivalent amount of avocado was associated with up to 22% lower risk for CVD events.
The findings add to evidence from other studies that has shown that avocados – which contain multiple nutrients, including fiber and unsaturated, healthy fats – have a positive impact on cardiovascular risk factors, first author Lorena S. Pacheco, PhD, a postdoctoral research fellow at the Harvard T.H. Chan School of Public Health, Boston, said in an interview.
“This research complements and expands on the current literature that we have on unsaturated fats and reduced risk of cardiovascular disease and also underscores how bad saturated fats, like butter, cheese, and processed meats are for the heart,” Dr. Pacheco said.
“For the most part, we have known that avocados are healthy, but I think this study, because of its numbers and duration, adds a little more substance to that knowledge now,” Dr. Pacheco said.
The findings were published online March 30 in the Journal of the American Heart Association.
Avocados are dense with nutrients. They are high in fat, but in monounsaturated fats (MUFAs) and polyunsaturated fats (PUFAs), which are viewed as good.
A medium-sized (136 g) Haas avocado, which is the most commonly consumed avocado in the United States, contains roughly 13 g of oleic acid. Avocados also contain dietary fiber, potassium, magnesium, phytonutrients, and bioactive compounds.
To see the effect avocados can have on cardiovascular health, Dr. Pacheco and her team turned to two large, long-running cohort studies: the Nurses’ Health Study (NHS), which began in the early 1970s with 68,786 women 30-55 years of age; and the Health Professionals Follow-up Study (HPFS), which ran from 1986 to 2016 and followed 41,701 men 40-75 years of age.
All were free of cancer, coronary heart disease, and stroke at study entry.
Participants completed a validated food frequency questionnaire at baseline and every 4 years thereafter. The questionnaire asked about the amount and frequency of avocado consumed. One serving equaled half an avocado, or half a cup.
In the early days of the NHS, very few participants said they ate avocados, but that began to change over the years, as the popularity of avocados grew.
“The NHS cohort was recruited back in the late ‘70s, and the health professionals cohort did not start until the mid 1980s, when avocado consumption was really low,” Dr. Pacheco said.
“What is beautiful about these cohorts is we are able to ask participants questions and then save the answers that they give us throughout the years to answer questions that might arise whenever the question is right. So it just depends on when you accrue enough data to ask those questions about potential cardiovascular benefit with avocados,” she said.
There were 9,185 coronary heart disease events and 5,290 strokes documented over 30 years of follow-up.
After adjustment for lifestyle and other dietary factors, those with a higher avocado intake – at least two servings per week – had a 16% lower risk for CVD (pooled hazard ratio, 0.84; 95% CI, 0.75-0.95) and a 21% lower risk for coronary heart disease (pooled HR, 0.79; 95% CI, 0.68-0.91).
No significant associations were seen for stroke, but this is because the study did not have sufficient numbers, Dr. Pacheco explained.
A statistical model also determined that replacing half a serving daily of margarine, butter, egg, yogurt, cheese, or processed meats, such as bacon, with the same amount of avocado was associated with a 16%-22% lower risk for CVD events.
“I want to emphasize that the study is an epidemiological observational study and cannot prove cause and effect,” Dr. Pacheco said.
“It’s not a clinical trial – it’s based on observational epidemiology – but we saw patterns in the model: Avocado consumption and substituting avocado for other unhealthy fats reduced the risk of having a cardiovascular event or coronary heart disease,” she said.
The findings are significant “because a healthy dietary pattern is the cornerstone for cardiovascular health; however, it can be difficult for many Americans to achieve and adhere to healthy eating patterns,” Cheryl Anderson, PhD, professor and dean of the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California, San Diego, who is chair of the AHA’s Council on Epidemiology and Prevention, said in a statement.
“We desperately need strategies to improve intake of AHA-recommended healthy diets, such as the Mediterranean diet, that are rich in vegetables and fruits. Although no one food is the solution to routinely eating a healthy diet, this study is evidence that avocados have possible health benefits. This is promising because it is a food item that is popular, accessible, desirable, and easy to include in meals eaten by many Americans at home and in restaurants,” said Dr. Anderson, who was not part of the study.
Dr. Pacheco and Dr. Anderson report no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Below the belt: sexual dysfunction overlooked in women with diabetes
Among patients with diabetes, women are just as likely as men to suffer from sexual dysfunction, but their issues are overlooked, with the narrative focusing mainly on the impact of this issue on men, say experts.
Women with diabetes can experience reduced sexual desire, painful sex, reduced lubrication, and sexual distress, increasing the risk of depression, and such issues often go unnoticed despite treatments being available, said Kirsty Winkley, PhD, diabetes nurse and health psychologist, King’s College London.
There is also the “embarrassment factor” on the side of both the health care professional and the patient, she said in a session she chaired at the Diabetes UK Professional Conference 2022. Many women with diabetes “wouldn’t necessarily know” that their sexual dysfunction “is related to their diabetes,” she told this news organization.
For women, sexual health conversations are “often about contraception and pregnancy,” as well as menstrual disorders, genital infections, and hormone replacement therapy. “As health care professionals, you’re trained to focus on those things, and you’re not really considering there might be sexual dysfunction. If women aren’t aware that it’s related to diabetes, you’ve got the perfect situation where it goes under the radar.”
However, cochair Debbie Cooke, PhD, health psychologist at the University of Surrey in Guildford, explained that having psychotherapy embedded within the diabetes team and “integrated throughout the whole service” means that the problem can be identified and treatment offered.
The issue is that such integration is “very uncommon” and access needs to be improved, Dr. Cooke said in an interview.
Sexual dysfunction major predictor of depression in women
Jacqueline Fosbury, psychotherapy lead at Diabetes Care for You, Sussex Community NHS Foundation Trust, said that “intimate activity is clearly beneficial for emotional and physical health,” as it is associated with increased oxytocin release, the burning of calories, better immunity, and improved sleep.
Sexual dysfunction is common in people with diabetes, she noted. Poor glycemic control can “damage” blood vessels and nerves, causing reduced blood flow and loss of sensation in sexual organs.
A recent study led by Belgian researchers found that among more than 750 adults with diabetes, 36% of men and 33% of women reported sexual dysfunction.
Sexual dysfunction was more common in women with type 1 diabetes, at 36%, compared with 26% for those with type 2 diabetes. The most commonly reported issues were decreased sexual desire, lubrication problems, orgasmic dysfunction, and pain. Body image problems and fear of hypoglycemia also affect sexuality and intimacy, leading to “sexual distress.”
Moreover, Ms. Fosbury said female sexual dysfunction has been identified as a “major predictor” of depression, which in turn reduces libido.
Treatments for women can include lubricants, local estrogen, and medications that are prescribed off-label, such as sildenafil. The same is true of testosterone therapy, which can be used to boost libido.
Couples therapy?
Next, Trudy Hannington, a psychosexual therapist with Leger Clinic, Doncaster, U.K., talked about how to use an integrated approach to address sexuality overall in people with diabetes.
She said this should be seen in a biopsychosocial context, with emphasis on the couple, on sensation and communication, and sexual growth, as well as changes in daily routines.
There should be a move away from “penetrative sex,” Ms. Hannington said, with the goal being “enjoyment, not orgasm.” Pleasure should be facilitated and the opportunities for “performance pressure and/or anxiety” reduced.
She discussed the case of Marie, a 27-year-old woman with type 1 diabetes who had been referred with painful sex and vaginal dryness. Marie had “never experienced orgasm,” despite being in a same-sex relationship with Emily.
Marie’s treatment involved a sexual growth program, to which Emily was invited, as well as recommendations to use lubricants, vibrators, and to try sildenafil.
Prioritize women
Ms. Fosbury reiterated that, in men, sexual dysfunction is “readily identified as a complication of diabetes” and is described as “traumatic” and “crucial to well-being.” It is also seen as “easy to treat” with medication, such as that for erectile dysfunction.
It is therefore crucial to talk to women with diabetes about possible sexual dysfunction, and the scene must be set before the appointment to explain that the subject will be broached. In addition, handouts and leaflets should be available for patients in the clinic so they can read about female sexual health and to lower the stigma around discussing it.
“Cultural stereotypes diminish the importance of female sexuality and prevent us from providing equal consideration to the sexual difficulties of our patients,” she concluded.
No funding declared. No relevant financial relationships declared.
A version of this article first appeared on Medscape.com.
Among patients with diabetes, women are just as likely as men to suffer from sexual dysfunction, but their issues are overlooked, with the narrative focusing mainly on the impact of this issue on men, say experts.
Women with diabetes can experience reduced sexual desire, painful sex, reduced lubrication, and sexual distress, increasing the risk of depression, and such issues often go unnoticed despite treatments being available, said Kirsty Winkley, PhD, diabetes nurse and health psychologist, King’s College London.
There is also the “embarrassment factor” on the side of both the health care professional and the patient, she said in a session she chaired at the Diabetes UK Professional Conference 2022. Many women with diabetes “wouldn’t necessarily know” that their sexual dysfunction “is related to their diabetes,” she told this news organization.
For women, sexual health conversations are “often about contraception and pregnancy,” as well as menstrual disorders, genital infections, and hormone replacement therapy. “As health care professionals, you’re trained to focus on those things, and you’re not really considering there might be sexual dysfunction. If women aren’t aware that it’s related to diabetes, you’ve got the perfect situation where it goes under the radar.”
However, cochair Debbie Cooke, PhD, health psychologist at the University of Surrey in Guildford, explained that having psychotherapy embedded within the diabetes team and “integrated throughout the whole service” means that the problem can be identified and treatment offered.
The issue is that such integration is “very uncommon” and access needs to be improved, Dr. Cooke said in an interview.
Sexual dysfunction major predictor of depression in women
Jacqueline Fosbury, psychotherapy lead at Diabetes Care for You, Sussex Community NHS Foundation Trust, said that “intimate activity is clearly beneficial for emotional and physical health,” as it is associated with increased oxytocin release, the burning of calories, better immunity, and improved sleep.
Sexual dysfunction is common in people with diabetes, she noted. Poor glycemic control can “damage” blood vessels and nerves, causing reduced blood flow and loss of sensation in sexual organs.
A recent study led by Belgian researchers found that among more than 750 adults with diabetes, 36% of men and 33% of women reported sexual dysfunction.
Sexual dysfunction was more common in women with type 1 diabetes, at 36%, compared with 26% for those with type 2 diabetes. The most commonly reported issues were decreased sexual desire, lubrication problems, orgasmic dysfunction, and pain. Body image problems and fear of hypoglycemia also affect sexuality and intimacy, leading to “sexual distress.”
Moreover, Ms. Fosbury said female sexual dysfunction has been identified as a “major predictor” of depression, which in turn reduces libido.
Treatments for women can include lubricants, local estrogen, and medications that are prescribed off-label, such as sildenafil. The same is true of testosterone therapy, which can be used to boost libido.
Couples therapy?
Next, Trudy Hannington, a psychosexual therapist with Leger Clinic, Doncaster, U.K., talked about how to use an integrated approach to address sexuality overall in people with diabetes.
She said this should be seen in a biopsychosocial context, with emphasis on the couple, on sensation and communication, and sexual growth, as well as changes in daily routines.
There should be a move away from “penetrative sex,” Ms. Hannington said, with the goal being “enjoyment, not orgasm.” Pleasure should be facilitated and the opportunities for “performance pressure and/or anxiety” reduced.
She discussed the case of Marie, a 27-year-old woman with type 1 diabetes who had been referred with painful sex and vaginal dryness. Marie had “never experienced orgasm,” despite being in a same-sex relationship with Emily.
Marie’s treatment involved a sexual growth program, to which Emily was invited, as well as recommendations to use lubricants, vibrators, and to try sildenafil.
Prioritize women
Ms. Fosbury reiterated that, in men, sexual dysfunction is “readily identified as a complication of diabetes” and is described as “traumatic” and “crucial to well-being.” It is also seen as “easy to treat” with medication, such as that for erectile dysfunction.
It is therefore crucial to talk to women with diabetes about possible sexual dysfunction, and the scene must be set before the appointment to explain that the subject will be broached. In addition, handouts and leaflets should be available for patients in the clinic so they can read about female sexual health and to lower the stigma around discussing it.
“Cultural stereotypes diminish the importance of female sexuality and prevent us from providing equal consideration to the sexual difficulties of our patients,” she concluded.
No funding declared. No relevant financial relationships declared.
A version of this article first appeared on Medscape.com.
Among patients with diabetes, women are just as likely as men to suffer from sexual dysfunction, but their issues are overlooked, with the narrative focusing mainly on the impact of this issue on men, say experts.
Women with diabetes can experience reduced sexual desire, painful sex, reduced lubrication, and sexual distress, increasing the risk of depression, and such issues often go unnoticed despite treatments being available, said Kirsty Winkley, PhD, diabetes nurse and health psychologist, King’s College London.
There is also the “embarrassment factor” on the side of both the health care professional and the patient, she said in a session she chaired at the Diabetes UK Professional Conference 2022. Many women with diabetes “wouldn’t necessarily know” that their sexual dysfunction “is related to their diabetes,” she told this news organization.
For women, sexual health conversations are “often about contraception and pregnancy,” as well as menstrual disorders, genital infections, and hormone replacement therapy. “As health care professionals, you’re trained to focus on those things, and you’re not really considering there might be sexual dysfunction. If women aren’t aware that it’s related to diabetes, you’ve got the perfect situation where it goes under the radar.”
However, cochair Debbie Cooke, PhD, health psychologist at the University of Surrey in Guildford, explained that having psychotherapy embedded within the diabetes team and “integrated throughout the whole service” means that the problem can be identified and treatment offered.
The issue is that such integration is “very uncommon” and access needs to be improved, Dr. Cooke said in an interview.
Sexual dysfunction major predictor of depression in women
Jacqueline Fosbury, psychotherapy lead at Diabetes Care for You, Sussex Community NHS Foundation Trust, said that “intimate activity is clearly beneficial for emotional and physical health,” as it is associated with increased oxytocin release, the burning of calories, better immunity, and improved sleep.
Sexual dysfunction is common in people with diabetes, she noted. Poor glycemic control can “damage” blood vessels and nerves, causing reduced blood flow and loss of sensation in sexual organs.
A recent study led by Belgian researchers found that among more than 750 adults with diabetes, 36% of men and 33% of women reported sexual dysfunction.
Sexual dysfunction was more common in women with type 1 diabetes, at 36%, compared with 26% for those with type 2 diabetes. The most commonly reported issues were decreased sexual desire, lubrication problems, orgasmic dysfunction, and pain. Body image problems and fear of hypoglycemia also affect sexuality and intimacy, leading to “sexual distress.”
Moreover, Ms. Fosbury said female sexual dysfunction has been identified as a “major predictor” of depression, which in turn reduces libido.
Treatments for women can include lubricants, local estrogen, and medications that are prescribed off-label, such as sildenafil. The same is true of testosterone therapy, which can be used to boost libido.
Couples therapy?
Next, Trudy Hannington, a psychosexual therapist with Leger Clinic, Doncaster, U.K., talked about how to use an integrated approach to address sexuality overall in people with diabetes.
She said this should be seen in a biopsychosocial context, with emphasis on the couple, on sensation and communication, and sexual growth, as well as changes in daily routines.
There should be a move away from “penetrative sex,” Ms. Hannington said, with the goal being “enjoyment, not orgasm.” Pleasure should be facilitated and the opportunities for “performance pressure and/or anxiety” reduced.
She discussed the case of Marie, a 27-year-old woman with type 1 diabetes who had been referred with painful sex and vaginal dryness. Marie had “never experienced orgasm,” despite being in a same-sex relationship with Emily.
Marie’s treatment involved a sexual growth program, to which Emily was invited, as well as recommendations to use lubricants, vibrators, and to try sildenafil.
Prioritize women
Ms. Fosbury reiterated that, in men, sexual dysfunction is “readily identified as a complication of diabetes” and is described as “traumatic” and “crucial to well-being.” It is also seen as “easy to treat” with medication, such as that for erectile dysfunction.
It is therefore crucial to talk to women with diabetes about possible sexual dysfunction, and the scene must be set before the appointment to explain that the subject will be broached. In addition, handouts and leaflets should be available for patients in the clinic so they can read about female sexual health and to lower the stigma around discussing it.
“Cultural stereotypes diminish the importance of female sexuality and prevent us from providing equal consideration to the sexual difficulties of our patients,” she concluded.
No funding declared. No relevant financial relationships declared.
A version of this article first appeared on Medscape.com.
Pneumococcal pneumonia outcomes worse than those of Legionnaires disease
Outcomes for patients with bacteremic Streptococcus pneumoniae were significantly worse than those for patients with Legionnaires disease (LD), based on data from 106 individuals.
Reported cases of LD in the United States have increased in recent decades, but they are likely under-reported, wrote Sima Salahie, MD, of Wayne State University School of Medicine, Detroit, and Central Michigan University College of Medicine, Grosse Pointe Woods, and colleagues.
Clinical presentations may be similar for both conditions, but different antimicrobial therapies are needed; therefore, identifying distinguishing factors can promote better management of hospitalized patients, they reported.
In a retrospective case companion study published in the American Journal of the Medical Sciences, the researchers reviewed data from 51 adults with LD and 55 with bacteremic S. pneumoniae pneumonia (SP) who were hospitalized at a single center between 2013 and 2018. Diagnoses were confirmed by laboratory and radiology results. In addition, data were collected on clinical features including body mass index, systolic and diastolic blood pressure, pulse, respiratory rate, and temperature.
Overall, patients with SP were significantly more likely than those with LD to require mechanical ventilation (P = .04), intensive care unit stay (P = .004), and to die (P = .002). Patients with SP also had higher rates of septic shock compared to LD patients, although this difference fell short of statistical significance (49.1% vs. 30.4%; P = .06).
In a multivariate analysis, male sex, diarrhea, higher body mass index, hyponatremia, and lower Charleston Weighted Index of Comorbidity (CWIC) score were significant independent predictors of LD, with odds ratios of 21.6, 4.5, 1.13, 5.6, and 0.61, respectively.
The incidence of LD peaked in summer, while the incidence of SP peaked in the winter, the researchers noted. “Seasonality is a variable that has not always been included in previous scoring systems but should be considered in future modeling,” they said.
“Noteworthy is that LD represented almost as many cases as documented bacteremic pneumococcal pneumonia,” the researchers wrote in their discussion. “This occurred at a time when there was no outbreak of L. pneumophila in our community, and as these were all community acquired, there was no evidence of a nosocomial outbreak in our institution,” they said.
The study findings were limited by several factors, including the possible underestimation of SP because of the requirement for positive blood cultures and the lack of other methods of diagnosing SP, the researchers noted.
“However, the data suggest variables to distinguish LD from SP,” they said. “Establishing reliable clinical and laboratory parameters embedded in a simple diagnostic score that can accurately identify patients with LD may be helpful in aiding physicians’ early diagnosis in distinguishing LD from SP but will need to be defined.”
The study received no outside funding. The researchers disclosed no financial conflicts.
A version of this article first appeared on Medscape.com.
Outcomes for patients with bacteremic Streptococcus pneumoniae were significantly worse than those for patients with Legionnaires disease (LD), based on data from 106 individuals.
Reported cases of LD in the United States have increased in recent decades, but they are likely under-reported, wrote Sima Salahie, MD, of Wayne State University School of Medicine, Detroit, and Central Michigan University College of Medicine, Grosse Pointe Woods, and colleagues.
Clinical presentations may be similar for both conditions, but different antimicrobial therapies are needed; therefore, identifying distinguishing factors can promote better management of hospitalized patients, they reported.
In a retrospective case companion study published in the American Journal of the Medical Sciences, the researchers reviewed data from 51 adults with LD and 55 with bacteremic S. pneumoniae pneumonia (SP) who were hospitalized at a single center between 2013 and 2018. Diagnoses were confirmed by laboratory and radiology results. In addition, data were collected on clinical features including body mass index, systolic and diastolic blood pressure, pulse, respiratory rate, and temperature.
Overall, patients with SP were significantly more likely than those with LD to require mechanical ventilation (P = .04), intensive care unit stay (P = .004), and to die (P = .002). Patients with SP also had higher rates of septic shock compared to LD patients, although this difference fell short of statistical significance (49.1% vs. 30.4%; P = .06).
In a multivariate analysis, male sex, diarrhea, higher body mass index, hyponatremia, and lower Charleston Weighted Index of Comorbidity (CWIC) score were significant independent predictors of LD, with odds ratios of 21.6, 4.5, 1.13, 5.6, and 0.61, respectively.
The incidence of LD peaked in summer, while the incidence of SP peaked in the winter, the researchers noted. “Seasonality is a variable that has not always been included in previous scoring systems but should be considered in future modeling,” they said.
“Noteworthy is that LD represented almost as many cases as documented bacteremic pneumococcal pneumonia,” the researchers wrote in their discussion. “This occurred at a time when there was no outbreak of L. pneumophila in our community, and as these were all community acquired, there was no evidence of a nosocomial outbreak in our institution,” they said.
The study findings were limited by several factors, including the possible underestimation of SP because of the requirement for positive blood cultures and the lack of other methods of diagnosing SP, the researchers noted.
“However, the data suggest variables to distinguish LD from SP,” they said. “Establishing reliable clinical and laboratory parameters embedded in a simple diagnostic score that can accurately identify patients with LD may be helpful in aiding physicians’ early diagnosis in distinguishing LD from SP but will need to be defined.”
The study received no outside funding. The researchers disclosed no financial conflicts.
A version of this article first appeared on Medscape.com.
Outcomes for patients with bacteremic Streptococcus pneumoniae were significantly worse than those for patients with Legionnaires disease (LD), based on data from 106 individuals.
Reported cases of LD in the United States have increased in recent decades, but they are likely under-reported, wrote Sima Salahie, MD, of Wayne State University School of Medicine, Detroit, and Central Michigan University College of Medicine, Grosse Pointe Woods, and colleagues.
Clinical presentations may be similar for both conditions, but different antimicrobial therapies are needed; therefore, identifying distinguishing factors can promote better management of hospitalized patients, they reported.
In a retrospective case companion study published in the American Journal of the Medical Sciences, the researchers reviewed data from 51 adults with LD and 55 with bacteremic S. pneumoniae pneumonia (SP) who were hospitalized at a single center between 2013 and 2018. Diagnoses were confirmed by laboratory and radiology results. In addition, data were collected on clinical features including body mass index, systolic and diastolic blood pressure, pulse, respiratory rate, and temperature.
Overall, patients with SP were significantly more likely than those with LD to require mechanical ventilation (P = .04), intensive care unit stay (P = .004), and to die (P = .002). Patients with SP also had higher rates of septic shock compared to LD patients, although this difference fell short of statistical significance (49.1% vs. 30.4%; P = .06).
In a multivariate analysis, male sex, diarrhea, higher body mass index, hyponatremia, and lower Charleston Weighted Index of Comorbidity (CWIC) score were significant independent predictors of LD, with odds ratios of 21.6, 4.5, 1.13, 5.6, and 0.61, respectively.
The incidence of LD peaked in summer, while the incidence of SP peaked in the winter, the researchers noted. “Seasonality is a variable that has not always been included in previous scoring systems but should be considered in future modeling,” they said.
“Noteworthy is that LD represented almost as many cases as documented bacteremic pneumococcal pneumonia,” the researchers wrote in their discussion. “This occurred at a time when there was no outbreak of L. pneumophila in our community, and as these were all community acquired, there was no evidence of a nosocomial outbreak in our institution,” they said.
The study findings were limited by several factors, including the possible underestimation of SP because of the requirement for positive blood cultures and the lack of other methods of diagnosing SP, the researchers noted.
“However, the data suggest variables to distinguish LD from SP,” they said. “Establishing reliable clinical and laboratory parameters embedded in a simple diagnostic score that can accurately identify patients with LD may be helpful in aiding physicians’ early diagnosis in distinguishing LD from SP but will need to be defined.”
The study received no outside funding. The researchers disclosed no financial conflicts.
A version of this article first appeared on Medscape.com.
Drugs used for nausea/vomiting linked to stroke risk
Antidopaminergic antiemetics (ADAs) that are widely used for nausea and vomiting, including that related to chemotherapy, have been associated with an increased risk of ischemic stroke in a new study from France.
The authors found that ADA users could be at a threefold increased risk of stroke shortly after the initiation of treatment.
Further analysis showed that all three ADAs studied (domperidone, metopimazine, and metoclopramide) were associated with an increased risk, especially in the first days of use, but the highest increase was found for metopimazine and metoclopramide.
The study was published online March 23, 2022, in the BMJ.
“Our results show that the risk of ischemic stroke appears to be associated with ADA use,” wrote the authors, led by Anne Bénard-Laribière, PharmD, MS, of the University of Bordeaux (France). They emphasized, however, that this is an observational study and cannot therefore establish causation.
One important note about this study is that patients with a history of cancer were specifically excluded. The authors did not elaborate on what the ADAs were being used for, other than to say that ADAs are used for nausea and vomiting of “variable origins,” and a press release noted that these drugs are often used by patients with migraine.
Hence it is not clear what relevance these findings have for patients with cancer, suggested an expert unrelated to the study, Ian Olver, MD, PhD, professorial research fellow, faculty of health and medical sciences, University of Adelaide.
“So the best that can be said, from my viewpoint, is that the ADAs studied have been associated with an increased risk of stroke in patients other than cancer patients,” he told this news organization.
In addition, he also emphasized that an observational study cannot establish causation.
For their study, the authors used data from the nationwide reimbursement database. Hence, they “needed to make the assumption that the date of reimbursement approximated to the date of administration, and that would not be the case for drugs used prophylactically prior to chemotherapy or radiotherapy,” Dr. Olver commented.
The authors were also unable to make any statement about dose and schedule. “Certainly chemotherapy-induced nausea and vomiting would require more intermittent dosing compared to noncancer uses,” Dr. Olver said. In addition, “metoclopramide in conventional doses is not very effective for this purpose and metopimazine is mainly used in Europe.”
Most patients with cancer would not be receiving these drugs, he suggested: “These days they would be receiving 5HT3 receptor antagonists and NK1 receptor antagonists and steroids.”
Study details
The French study investigated the risk of ischemic stroke associated with ADA use in a real-world setting. The authors conducted a case-time-control study using data from the nationwide French reimbursement health care system database Système National des Données de Santé.
They identified 2,612 patients from the database who had experienced a first ischemic stroke between 2012 and 2016 and had also received at least one reimbursement for domperidone, metopimazine, or metoclopramide during the 70-day period prior to their stroke.
The frequency of reimbursements for ADAs was compared with a risk period (1-14 days before a stroke) and three matched reference periods (57-70 days, 43-56 days, and 29-42 days before stroke).
Patients who had experienced a stroke were matched to a control group of 21,859 randomly selected healthy people who also received an ADA in the same time period.
Within the stroke cohort, 1,250 patients received an ADA at least once during the designated risk period and 1,060 in the reference periods. Among the controls, 5,128 and 13,165 received an ADA at least one time in the risk and reference periods, respectively.
This yielded a case-time-control ratio of adjusted odds ratios of 3.12, of a risk of stroke among new users. Stratification by age (<70 years and ≥70 years), sex, history of dementia, and gastroenteritis epidemic periods revealed similar results, although the highest case-time-control ratio observed in men(aOR, 3.59).
The risk of stroke appeared to increase for all ADAs, but the highest was for metopimazine (3.62-fold increase) and metoclopramide (a 3.53-fold increase), which are both drugs that have the ability to cross the blood-brain barrier.
The study was funded by Agence Nationale de Sécurité du Médicament et des Produits de Santé through a partnership with the Health Product Epidemiology Scientific Interest Group. All authors had financial support from ANSM for the submitted work; one coauthor disclosed relationships with Pfizer and Roche. Dr. Olver disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Antidopaminergic antiemetics (ADAs) that are widely used for nausea and vomiting, including that related to chemotherapy, have been associated with an increased risk of ischemic stroke in a new study from France.
The authors found that ADA users could be at a threefold increased risk of stroke shortly after the initiation of treatment.
Further analysis showed that all three ADAs studied (domperidone, metopimazine, and metoclopramide) were associated with an increased risk, especially in the first days of use, but the highest increase was found for metopimazine and metoclopramide.
The study was published online March 23, 2022, in the BMJ.
“Our results show that the risk of ischemic stroke appears to be associated with ADA use,” wrote the authors, led by Anne Bénard-Laribière, PharmD, MS, of the University of Bordeaux (France). They emphasized, however, that this is an observational study and cannot therefore establish causation.
One important note about this study is that patients with a history of cancer were specifically excluded. The authors did not elaborate on what the ADAs were being used for, other than to say that ADAs are used for nausea and vomiting of “variable origins,” and a press release noted that these drugs are often used by patients with migraine.
Hence it is not clear what relevance these findings have for patients with cancer, suggested an expert unrelated to the study, Ian Olver, MD, PhD, professorial research fellow, faculty of health and medical sciences, University of Adelaide.
“So the best that can be said, from my viewpoint, is that the ADAs studied have been associated with an increased risk of stroke in patients other than cancer patients,” he told this news organization.
In addition, he also emphasized that an observational study cannot establish causation.
For their study, the authors used data from the nationwide reimbursement database. Hence, they “needed to make the assumption that the date of reimbursement approximated to the date of administration, and that would not be the case for drugs used prophylactically prior to chemotherapy or radiotherapy,” Dr. Olver commented.
The authors were also unable to make any statement about dose and schedule. “Certainly chemotherapy-induced nausea and vomiting would require more intermittent dosing compared to noncancer uses,” Dr. Olver said. In addition, “metoclopramide in conventional doses is not very effective for this purpose and metopimazine is mainly used in Europe.”
Most patients with cancer would not be receiving these drugs, he suggested: “These days they would be receiving 5HT3 receptor antagonists and NK1 receptor antagonists and steroids.”
Study details
The French study investigated the risk of ischemic stroke associated with ADA use in a real-world setting. The authors conducted a case-time-control study using data from the nationwide French reimbursement health care system database Système National des Données de Santé.
They identified 2,612 patients from the database who had experienced a first ischemic stroke between 2012 and 2016 and had also received at least one reimbursement for domperidone, metopimazine, or metoclopramide during the 70-day period prior to their stroke.
The frequency of reimbursements for ADAs was compared with a risk period (1-14 days before a stroke) and three matched reference periods (57-70 days, 43-56 days, and 29-42 days before stroke).
Patients who had experienced a stroke were matched to a control group of 21,859 randomly selected healthy people who also received an ADA in the same time period.
Within the stroke cohort, 1,250 patients received an ADA at least once during the designated risk period and 1,060 in the reference periods. Among the controls, 5,128 and 13,165 received an ADA at least one time in the risk and reference periods, respectively.
This yielded a case-time-control ratio of adjusted odds ratios of 3.12, of a risk of stroke among new users. Stratification by age (<70 years and ≥70 years), sex, history of dementia, and gastroenteritis epidemic periods revealed similar results, although the highest case-time-control ratio observed in men(aOR, 3.59).
The risk of stroke appeared to increase for all ADAs, but the highest was for metopimazine (3.62-fold increase) and metoclopramide (a 3.53-fold increase), which are both drugs that have the ability to cross the blood-brain barrier.
The study was funded by Agence Nationale de Sécurité du Médicament et des Produits de Santé through a partnership with the Health Product Epidemiology Scientific Interest Group. All authors had financial support from ANSM for the submitted work; one coauthor disclosed relationships with Pfizer and Roche. Dr. Olver disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Antidopaminergic antiemetics (ADAs) that are widely used for nausea and vomiting, including that related to chemotherapy, have been associated with an increased risk of ischemic stroke in a new study from France.
The authors found that ADA users could be at a threefold increased risk of stroke shortly after the initiation of treatment.
Further analysis showed that all three ADAs studied (domperidone, metopimazine, and metoclopramide) were associated with an increased risk, especially in the first days of use, but the highest increase was found for metopimazine and metoclopramide.
The study was published online March 23, 2022, in the BMJ.
“Our results show that the risk of ischemic stroke appears to be associated with ADA use,” wrote the authors, led by Anne Bénard-Laribière, PharmD, MS, of the University of Bordeaux (France). They emphasized, however, that this is an observational study and cannot therefore establish causation.
One important note about this study is that patients with a history of cancer were specifically excluded. The authors did not elaborate on what the ADAs were being used for, other than to say that ADAs are used for nausea and vomiting of “variable origins,” and a press release noted that these drugs are often used by patients with migraine.
Hence it is not clear what relevance these findings have for patients with cancer, suggested an expert unrelated to the study, Ian Olver, MD, PhD, professorial research fellow, faculty of health and medical sciences, University of Adelaide.
“So the best that can be said, from my viewpoint, is that the ADAs studied have been associated with an increased risk of stroke in patients other than cancer patients,” he told this news organization.
In addition, he also emphasized that an observational study cannot establish causation.
For their study, the authors used data from the nationwide reimbursement database. Hence, they “needed to make the assumption that the date of reimbursement approximated to the date of administration, and that would not be the case for drugs used prophylactically prior to chemotherapy or radiotherapy,” Dr. Olver commented.
The authors were also unable to make any statement about dose and schedule. “Certainly chemotherapy-induced nausea and vomiting would require more intermittent dosing compared to noncancer uses,” Dr. Olver said. In addition, “metoclopramide in conventional doses is not very effective for this purpose and metopimazine is mainly used in Europe.”
Most patients with cancer would not be receiving these drugs, he suggested: “These days they would be receiving 5HT3 receptor antagonists and NK1 receptor antagonists and steroids.”
Study details
The French study investigated the risk of ischemic stroke associated with ADA use in a real-world setting. The authors conducted a case-time-control study using data from the nationwide French reimbursement health care system database Système National des Données de Santé.
They identified 2,612 patients from the database who had experienced a first ischemic stroke between 2012 and 2016 and had also received at least one reimbursement for domperidone, metopimazine, or metoclopramide during the 70-day period prior to their stroke.
The frequency of reimbursements for ADAs was compared with a risk period (1-14 days before a stroke) and three matched reference periods (57-70 days, 43-56 days, and 29-42 days before stroke).
Patients who had experienced a stroke were matched to a control group of 21,859 randomly selected healthy people who also received an ADA in the same time period.
Within the stroke cohort, 1,250 patients received an ADA at least once during the designated risk period and 1,060 in the reference periods. Among the controls, 5,128 and 13,165 received an ADA at least one time in the risk and reference periods, respectively.
This yielded a case-time-control ratio of adjusted odds ratios of 3.12, of a risk of stroke among new users. Stratification by age (<70 years and ≥70 years), sex, history of dementia, and gastroenteritis epidemic periods revealed similar results, although the highest case-time-control ratio observed in men(aOR, 3.59).
The risk of stroke appeared to increase for all ADAs, but the highest was for metopimazine (3.62-fold increase) and metoclopramide (a 3.53-fold increase), which are both drugs that have the ability to cross the blood-brain barrier.
The study was funded by Agence Nationale de Sécurité du Médicament et des Produits de Santé through a partnership with the Health Product Epidemiology Scientific Interest Group. All authors had financial support from ANSM for the submitted work; one coauthor disclosed relationships with Pfizer and Roche. Dr. Olver disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
FROM THE BMJ
Does evidence support benefits of omega-3 fatty acids?
Dietary supplements that contain omega-3 fatty acids have been widely consumed for years. Researchers have been investigating the benefits of such preparations for cardiovascular, neurologic, and psychological conditions. A recently published study on omega-3 fatty acids and depression inspired neurologist Hans-Christoph Diener, MD, PhD, of the Institute for Epidemiology at the University Duisburg-Essen (Germany), to examine scientific publications concerning omega-3 fatty acids or fish-oil capsules in more detail.
Prevention of depression
Dr. Diener told the story of how he stumbled upon an interesting article in JAMA in December 2021. It was about a placebo-controlled study that investigated whether omega-3 fatty acids can prevent incident depression.
As the study authors reported, treatment with omega-3 preparations in adults aged 50 years or older without clinically relevant symptoms of depression at study initiation was associated with a small but statistically significant increase in the risk for depression or clinically relevant symptoms of depression. There was no difference in mood scale value, however, over a median follow-up of 5.3 years. According to the study authors, these results did not support the administration of omega-3 preparations for the prevention of depression.
This study was, as Dr. Diener said, somewhat negative, but it did arouse his interest in questions such as what biological effects omega-3 fatty acids have and what is known “about this topic with regard to neurology,” he said. When reviewing the literature, he noticed that there “were association studies, i.e., studies that describe that the intake of omega-3 fatty acids may possibly be associated with a lower risk of certain diseases.”
Beginning with the Inuit
It all started “with observations of the Inuit [population] in Greenland and Alaska after World War II, because it was remarked upon that these people ate a lot of fish and seal meat and had a very low incidence of cardiovascular diseases.” Over the years, a large number of association studies have been published, which may have encouraged the assumption that omega-3 fatty acids have positive health effects on various conditions, such as cardiovascular diseases, hyperlipidemia, type 2 diabetes, various malignancies, cognitive impairments, Alzheimer’s disease, depression and anxiety disorders, heart failure, slipped disks, ADHD, symptoms of menopause, rheumatoid arthritis, asthma, periodontitis, epilepsy, chemotherapy tolerance, premenstrual syndrome, and nonalcoholic fatty liver disease.
Dr. Diener believes that the problem is that these are association studies. But association does not mean that there is a causal relationship.
Disappointing study results
On the contrary, the results from the randomized placebo-controlled studies are truly frustrating, according to the neurologist. A meta-analysis of the use of omega-3 fatty acids in cardiovascular diseases included 86 studies with over 162,000 patients. According to Dr. Diener, it did not reveal any benefit for overall and cardiovascular mortality, nor any benefit for the reduction of myocardial infarction and stroke.
The results did indicate a trend, however, for reduced mortality in coronary heart disease. Even so, the number needed to treat for this was 334, which means that 334 people would have to take omega-3 fatty acids for years to prevent one fatal cardiac event.
Aside from this study, Dr. Diener found six studies on Alzheimer’s disease and three studies on dementia with patient populations between 600 and 800. In these studies, too, a positive effect of omega-3 fatty acids could not be identified. Then he discovered another 31 placebo-controlled studies of omega-3 fatty acids for the treatment or prevention of depression and anxiety disorder. Despite including 50,000 patients, these studies also did not show any positive effect.
“I see a significant discrepancy between the promotion of omega-3 fatty acids, whether it’s on television, in the ‘yellow’ [journalism] press, or in advertisements, and the actual scientific evidence,” said Dr. Diener. “At least from a neurological perspective, there is no evidence that omega-3 fatty acids have any benefit. This is true for strokes, dementia, Alzheimer’s disease, depression, and anxiety disorders.”
Potential adverse effects
Omega-3 fatty acids also have potentially adverse effects. The VITAL Rhythm study recently provided evidence that, depending on the dose, preparations with omega-3 fatty acids may increase the risk for atrial fibrillation. As the authors wrote, the results do not support taking omega-3 fatty acids to prevent atrial fibrillation.
In 2019, the global market for omega-3 fatty acids reached a value of $4.1 billion. This value is expected to double by 2025, according to a comment by Gregory Curfman, MD, deputy editor of JAMA and lecturer in health care policy at Harvard Medical School, Boston.
As Dr. Curfman wrote, this impressive amount of expenditure shows how beloved these products are and how strongly many people believe that omega-3 fatty acids are beneficial for their health. It is therefore important to know the potential risks of such preparations. One such example for this would be the risk for atrial fibrillation.
According to Dr. Curfman, in the last 2 years, four randomized clinical studies have provided data on the risk for atrial fibrillation associated with omega-3 fatty acids. In the STRENGTH study, 13,078 high-risk patients with cardiovascular diseases were randomly assigned to one of two groups. The subjects received either a high dose (4 g/day) of a combination of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or corn oil. After a median of 42 months, there was no significant difference between the two groups in the primary composite cardiovascular endpoint, but more frequent atrial fibrillation in the omega-3 fatty acid group, compared with the corn oil group (2.2% vs. 1.3%; hazard ratio, 1.69; 95% confidence interval, 1.29-2.21; P < .001).
In the REDUCE-IT study, 8179 subjects were randomly assigned to a high dose (4 g/day, as in STRENGTH) of an omega-3 fatty acid preparation consisting of a purified EPA (icosapent ethyl) or mineral oil. After a median observation period of 4.9 years, icosapent ethyl was associated with a relative reduction of the primary composite cardiovascular endpoint by 25%, compared with mineral oil. As in the STRENGTH study, this study found that the risk for atrial fibrillation associated with omega-3 fatty acids, compared with mineral oil, was significantly higher (5.3% vs. 3.9%; P = .003).
In a third study (OMEMI), as Dr. Curfman reported, 1027 elderly patients who had recently had a myocardial infarction were randomly assigned to receive either a median dose of 1.8 g/day of omega-3 fatty acids (a combination of EPA and DHA) or corn oil. After 2 years, there was no significant difference between the two groups in primary composite cardiovascular endpoints, but 7.2% of the patients taking omega-3 fatty acids developed atrial fibrillation. In the corn oil group, this proportion was 4% (HR, 1.84; 95% CI, 0.98-3.45; P = .06).
The data from the four studies together indicate a potential dose-dependent risk for atrial fibrillation associated with omega-3 fatty acids, according to Dr. Curfman. At a dose of 4.0 g/day, there is a highly significant risk increase (almost double). With a median dose of 1.8 g/day, the risk increase (HR, 1.84) did not reach statistical significance. At a daily standard dose of 840 mg/day, an increase in risk could not be determined.
Dr. Curfman’s recommendation is that patients who take, or want to take, preparations with omega-3 fatty acids be informed of the potential development of arrhythmia at higher dosages. These patients also should undergo cardiological monitoring.
A version of this article first appeared on Medscape.com.
Dietary supplements that contain omega-3 fatty acids have been widely consumed for years. Researchers have been investigating the benefits of such preparations for cardiovascular, neurologic, and psychological conditions. A recently published study on omega-3 fatty acids and depression inspired neurologist Hans-Christoph Diener, MD, PhD, of the Institute for Epidemiology at the University Duisburg-Essen (Germany), to examine scientific publications concerning omega-3 fatty acids or fish-oil capsules in more detail.
Prevention of depression
Dr. Diener told the story of how he stumbled upon an interesting article in JAMA in December 2021. It was about a placebo-controlled study that investigated whether omega-3 fatty acids can prevent incident depression.
As the study authors reported, treatment with omega-3 preparations in adults aged 50 years or older without clinically relevant symptoms of depression at study initiation was associated with a small but statistically significant increase in the risk for depression or clinically relevant symptoms of depression. There was no difference in mood scale value, however, over a median follow-up of 5.3 years. According to the study authors, these results did not support the administration of omega-3 preparations for the prevention of depression.
This study was, as Dr. Diener said, somewhat negative, but it did arouse his interest in questions such as what biological effects omega-3 fatty acids have and what is known “about this topic with regard to neurology,” he said. When reviewing the literature, he noticed that there “were association studies, i.e., studies that describe that the intake of omega-3 fatty acids may possibly be associated with a lower risk of certain diseases.”
Beginning with the Inuit
It all started “with observations of the Inuit [population] in Greenland and Alaska after World War II, because it was remarked upon that these people ate a lot of fish and seal meat and had a very low incidence of cardiovascular diseases.” Over the years, a large number of association studies have been published, which may have encouraged the assumption that omega-3 fatty acids have positive health effects on various conditions, such as cardiovascular diseases, hyperlipidemia, type 2 diabetes, various malignancies, cognitive impairments, Alzheimer’s disease, depression and anxiety disorders, heart failure, slipped disks, ADHD, symptoms of menopause, rheumatoid arthritis, asthma, periodontitis, epilepsy, chemotherapy tolerance, premenstrual syndrome, and nonalcoholic fatty liver disease.
Dr. Diener believes that the problem is that these are association studies. But association does not mean that there is a causal relationship.
Disappointing study results
On the contrary, the results from the randomized placebo-controlled studies are truly frustrating, according to the neurologist. A meta-analysis of the use of omega-3 fatty acids in cardiovascular diseases included 86 studies with over 162,000 patients. According to Dr. Diener, it did not reveal any benefit for overall and cardiovascular mortality, nor any benefit for the reduction of myocardial infarction and stroke.
The results did indicate a trend, however, for reduced mortality in coronary heart disease. Even so, the number needed to treat for this was 334, which means that 334 people would have to take omega-3 fatty acids for years to prevent one fatal cardiac event.
Aside from this study, Dr. Diener found six studies on Alzheimer’s disease and three studies on dementia with patient populations between 600 and 800. In these studies, too, a positive effect of omega-3 fatty acids could not be identified. Then he discovered another 31 placebo-controlled studies of omega-3 fatty acids for the treatment or prevention of depression and anxiety disorder. Despite including 50,000 patients, these studies also did not show any positive effect.
“I see a significant discrepancy between the promotion of omega-3 fatty acids, whether it’s on television, in the ‘yellow’ [journalism] press, or in advertisements, and the actual scientific evidence,” said Dr. Diener. “At least from a neurological perspective, there is no evidence that omega-3 fatty acids have any benefit. This is true for strokes, dementia, Alzheimer’s disease, depression, and anxiety disorders.”
Potential adverse effects
Omega-3 fatty acids also have potentially adverse effects. The VITAL Rhythm study recently provided evidence that, depending on the dose, preparations with omega-3 fatty acids may increase the risk for atrial fibrillation. As the authors wrote, the results do not support taking omega-3 fatty acids to prevent atrial fibrillation.
In 2019, the global market for omega-3 fatty acids reached a value of $4.1 billion. This value is expected to double by 2025, according to a comment by Gregory Curfman, MD, deputy editor of JAMA and lecturer in health care policy at Harvard Medical School, Boston.
As Dr. Curfman wrote, this impressive amount of expenditure shows how beloved these products are and how strongly many people believe that omega-3 fatty acids are beneficial for their health. It is therefore important to know the potential risks of such preparations. One such example for this would be the risk for atrial fibrillation.
According to Dr. Curfman, in the last 2 years, four randomized clinical studies have provided data on the risk for atrial fibrillation associated with omega-3 fatty acids. In the STRENGTH study, 13,078 high-risk patients with cardiovascular diseases were randomly assigned to one of two groups. The subjects received either a high dose (4 g/day) of a combination of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or corn oil. After a median of 42 months, there was no significant difference between the two groups in the primary composite cardiovascular endpoint, but more frequent atrial fibrillation in the omega-3 fatty acid group, compared with the corn oil group (2.2% vs. 1.3%; hazard ratio, 1.69; 95% confidence interval, 1.29-2.21; P < .001).
In the REDUCE-IT study, 8179 subjects were randomly assigned to a high dose (4 g/day, as in STRENGTH) of an omega-3 fatty acid preparation consisting of a purified EPA (icosapent ethyl) or mineral oil. After a median observation period of 4.9 years, icosapent ethyl was associated with a relative reduction of the primary composite cardiovascular endpoint by 25%, compared with mineral oil. As in the STRENGTH study, this study found that the risk for atrial fibrillation associated with omega-3 fatty acids, compared with mineral oil, was significantly higher (5.3% vs. 3.9%; P = .003).
In a third study (OMEMI), as Dr. Curfman reported, 1027 elderly patients who had recently had a myocardial infarction were randomly assigned to receive either a median dose of 1.8 g/day of omega-3 fatty acids (a combination of EPA and DHA) or corn oil. After 2 years, there was no significant difference between the two groups in primary composite cardiovascular endpoints, but 7.2% of the patients taking omega-3 fatty acids developed atrial fibrillation. In the corn oil group, this proportion was 4% (HR, 1.84; 95% CI, 0.98-3.45; P = .06).
The data from the four studies together indicate a potential dose-dependent risk for atrial fibrillation associated with omega-3 fatty acids, according to Dr. Curfman. At a dose of 4.0 g/day, there is a highly significant risk increase (almost double). With a median dose of 1.8 g/day, the risk increase (HR, 1.84) did not reach statistical significance. At a daily standard dose of 840 mg/day, an increase in risk could not be determined.
Dr. Curfman’s recommendation is that patients who take, or want to take, preparations with omega-3 fatty acids be informed of the potential development of arrhythmia at higher dosages. These patients also should undergo cardiological monitoring.
A version of this article first appeared on Medscape.com.
Dietary supplements that contain omega-3 fatty acids have been widely consumed for years. Researchers have been investigating the benefits of such preparations for cardiovascular, neurologic, and psychological conditions. A recently published study on omega-3 fatty acids and depression inspired neurologist Hans-Christoph Diener, MD, PhD, of the Institute for Epidemiology at the University Duisburg-Essen (Germany), to examine scientific publications concerning omega-3 fatty acids or fish-oil capsules in more detail.
Prevention of depression
Dr. Diener told the story of how he stumbled upon an interesting article in JAMA in December 2021. It was about a placebo-controlled study that investigated whether omega-3 fatty acids can prevent incident depression.
As the study authors reported, treatment with omega-3 preparations in adults aged 50 years or older without clinically relevant symptoms of depression at study initiation was associated with a small but statistically significant increase in the risk for depression or clinically relevant symptoms of depression. There was no difference in mood scale value, however, over a median follow-up of 5.3 years. According to the study authors, these results did not support the administration of omega-3 preparations for the prevention of depression.
This study was, as Dr. Diener said, somewhat negative, but it did arouse his interest in questions such as what biological effects omega-3 fatty acids have and what is known “about this topic with regard to neurology,” he said. When reviewing the literature, he noticed that there “were association studies, i.e., studies that describe that the intake of omega-3 fatty acids may possibly be associated with a lower risk of certain diseases.”
Beginning with the Inuit
It all started “with observations of the Inuit [population] in Greenland and Alaska after World War II, because it was remarked upon that these people ate a lot of fish and seal meat and had a very low incidence of cardiovascular diseases.” Over the years, a large number of association studies have been published, which may have encouraged the assumption that omega-3 fatty acids have positive health effects on various conditions, such as cardiovascular diseases, hyperlipidemia, type 2 diabetes, various malignancies, cognitive impairments, Alzheimer’s disease, depression and anxiety disorders, heart failure, slipped disks, ADHD, symptoms of menopause, rheumatoid arthritis, asthma, periodontitis, epilepsy, chemotherapy tolerance, premenstrual syndrome, and nonalcoholic fatty liver disease.
Dr. Diener believes that the problem is that these are association studies. But association does not mean that there is a causal relationship.
Disappointing study results
On the contrary, the results from the randomized placebo-controlled studies are truly frustrating, according to the neurologist. A meta-analysis of the use of omega-3 fatty acids in cardiovascular diseases included 86 studies with over 162,000 patients. According to Dr. Diener, it did not reveal any benefit for overall and cardiovascular mortality, nor any benefit for the reduction of myocardial infarction and stroke.
The results did indicate a trend, however, for reduced mortality in coronary heart disease. Even so, the number needed to treat for this was 334, which means that 334 people would have to take omega-3 fatty acids for years to prevent one fatal cardiac event.
Aside from this study, Dr. Diener found six studies on Alzheimer’s disease and three studies on dementia with patient populations between 600 and 800. In these studies, too, a positive effect of omega-3 fatty acids could not be identified. Then he discovered another 31 placebo-controlled studies of omega-3 fatty acids for the treatment or prevention of depression and anxiety disorder. Despite including 50,000 patients, these studies also did not show any positive effect.
“I see a significant discrepancy between the promotion of omega-3 fatty acids, whether it’s on television, in the ‘yellow’ [journalism] press, or in advertisements, and the actual scientific evidence,” said Dr. Diener. “At least from a neurological perspective, there is no evidence that omega-3 fatty acids have any benefit. This is true for strokes, dementia, Alzheimer’s disease, depression, and anxiety disorders.”
Potential adverse effects
Omega-3 fatty acids also have potentially adverse effects. The VITAL Rhythm study recently provided evidence that, depending on the dose, preparations with omega-3 fatty acids may increase the risk for atrial fibrillation. As the authors wrote, the results do not support taking omega-3 fatty acids to prevent atrial fibrillation.
In 2019, the global market for omega-3 fatty acids reached a value of $4.1 billion. This value is expected to double by 2025, according to a comment by Gregory Curfman, MD, deputy editor of JAMA and lecturer in health care policy at Harvard Medical School, Boston.
As Dr. Curfman wrote, this impressive amount of expenditure shows how beloved these products are and how strongly many people believe that omega-3 fatty acids are beneficial for their health. It is therefore important to know the potential risks of such preparations. One such example for this would be the risk for atrial fibrillation.
According to Dr. Curfman, in the last 2 years, four randomized clinical studies have provided data on the risk for atrial fibrillation associated with omega-3 fatty acids. In the STRENGTH study, 13,078 high-risk patients with cardiovascular diseases were randomly assigned to one of two groups. The subjects received either a high dose (4 g/day) of a combination of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or corn oil. After a median of 42 months, there was no significant difference between the two groups in the primary composite cardiovascular endpoint, but more frequent atrial fibrillation in the omega-3 fatty acid group, compared with the corn oil group (2.2% vs. 1.3%; hazard ratio, 1.69; 95% confidence interval, 1.29-2.21; P < .001).
In the REDUCE-IT study, 8179 subjects were randomly assigned to a high dose (4 g/day, as in STRENGTH) of an omega-3 fatty acid preparation consisting of a purified EPA (icosapent ethyl) or mineral oil. After a median observation period of 4.9 years, icosapent ethyl was associated with a relative reduction of the primary composite cardiovascular endpoint by 25%, compared with mineral oil. As in the STRENGTH study, this study found that the risk for atrial fibrillation associated with omega-3 fatty acids, compared with mineral oil, was significantly higher (5.3% vs. 3.9%; P = .003).
In a third study (OMEMI), as Dr. Curfman reported, 1027 elderly patients who had recently had a myocardial infarction were randomly assigned to receive either a median dose of 1.8 g/day of omega-3 fatty acids (a combination of EPA and DHA) or corn oil. After 2 years, there was no significant difference between the two groups in primary composite cardiovascular endpoints, but 7.2% of the patients taking omega-3 fatty acids developed atrial fibrillation. In the corn oil group, this proportion was 4% (HR, 1.84; 95% CI, 0.98-3.45; P = .06).
The data from the four studies together indicate a potential dose-dependent risk for atrial fibrillation associated with omega-3 fatty acids, according to Dr. Curfman. At a dose of 4.0 g/day, there is a highly significant risk increase (almost double). With a median dose of 1.8 g/day, the risk increase (HR, 1.84) did not reach statistical significance. At a daily standard dose of 840 mg/day, an increase in risk could not be determined.
Dr. Curfman’s recommendation is that patients who take, or want to take, preparations with omega-3 fatty acids be informed of the potential development of arrhythmia at higher dosages. These patients also should undergo cardiological monitoring.
A version of this article first appeared on Medscape.com.
Late to the game: Parenting after 40
As they rolled me down the hallway to the OR, ceiling lights rhythmically passing above, I zoned out into a 1,000-mile stare. How did I get here? I started humming “Swing Low, Sweet Chariot,” praying for a miracle to happen. I thought back to my birth plan, meticulously crafted, a one-pager so that the no-nonsense labor and delivery nurses wouldn›t think me completely off my rocker. No C-section unless medically necessary. Those words laughed back at me – cackling, even. I’d planned out the whole birthing process and here we were, my team almost jogging me to the OR. I lay still, utterly gobsmacked and partially anesthetized.
If I squint my eyes and hallucinate just a bit, that is sort of what motherhood has been like.
It’s about knowing all the things that could go wrong and meeting the unplanned head-on. Motherhood has indeed been a whirlwind – so many physical, psychological, and emotional transformations. And to top it off, the added effort of giving birth in a pandemic. As an over-40 physician, you’d think I would have been better prepared.
I was, but in a sense, I was not. The knowledge, the wisdom, the experience of my medical training surrounded me, but even I panicked at times in the beginning: Am I feeding her correctly? Am I making enough food for her? Am I doing the best that I can for her? What more could I be doing for her?
Over time, I’ve learned to lighten up. Some. In those teachable moments with my daughter Gia, I’ve learned to not sugarcoat reality but encourage the hopeful. If Gia falls on the ground? “You’re okay, sweetie. Now get back up.” If Gia has a tantrum and starts hitting herself? “Honey, our hands are for hugs, not hurting ourselves. Let’s go play.” Eighty percent of motherhood right now is redirection and the other 20% is patience.
I remember this one time I was rushing out the door for work. After getting in the car with my keys, I realized I forgot my coffee back in the house. I left the car, went back in the house to grab the blessed joe, went back to the car, and couldn’t get in because it was locked. I panicked at that moment, went back inside the house, and found Gia playing with my extra key fob. My own daughter locked me out of my car. Of course, it wasn’t her fault. Deep breath and I offered her another kiss while simultaneously taking the key fob from her.
Before Gia could walk, she could climb the stairs in our home. Her father and I sometimes refer to her as “Lil Bamm-Bamm” because she is so strong. One day, Daddy was supposed to be watching her while Mommy was folding laundry upstairs. She was not allowed on the stairs, but what should I hear? Literally, the pitter-patter of little feet, running down the upstairs hallway. Her father had drifted off watching yet another episode of something Star Wars–related. My strong little girl made it up the stairs all by herself and Dad received a strong word. The Force was with me that day.
I would say that I feel like having a child ages you, but what does that really mean when you’re already old? I’ve become acutely aware of my lack of endurance, stamina, and bodily strength. My knees will creak when taking her upstairs to bed, an osseous dirge of a lullaby. Date nights become unintentionally less and less frequent. Friday night dress-up becomes Friday night dress-down. I’ve replaced stiletto heels with comfy sweats.
Once we put Gia down for the night, we are usually exhausted from the day, and the couch and TV are welcome respites. We exhale. As over-40 parents, we knew that having children late in life would bring its challenges. But I’d like to think that we are meeting them the best way that we can. Often I encourage my body to meet Gia at her eye level, see what she sees, play with her on her own terms, and match her energy. She absolutely loves it when I do this. I’m out of breath and my knees are sore by the end of our play session, but I wouldn’t have it any other way.
We are learning from each other. She has a bright and assertive personality, and I am protective of that innocence. Her innocence is without fear. I often wonder what she is thinking when I see her facial expressions. A side-eye, a fleeting giggle. Is she secretly contemplating the chronicity of the cosmos, or is it just gas? I look at her in stolen moments and still can’t believe that I grew a human inside me, and said human was extracted from me and is now walking around my house commanding her bidding. So surreal. The unromanticized, scientific ingredients that are at play from conception to delivery are nothing short of miraculous. And the miracles of parenting over 40 are present every day.
Dr. Tolliver is a family medicine physician at The Ohio State University Wexner Medical Center in Columbus. A version of this article first appeared on Medscape.com.
As they rolled me down the hallway to the OR, ceiling lights rhythmically passing above, I zoned out into a 1,000-mile stare. How did I get here? I started humming “Swing Low, Sweet Chariot,” praying for a miracle to happen. I thought back to my birth plan, meticulously crafted, a one-pager so that the no-nonsense labor and delivery nurses wouldn›t think me completely off my rocker. No C-section unless medically necessary. Those words laughed back at me – cackling, even. I’d planned out the whole birthing process and here we were, my team almost jogging me to the OR. I lay still, utterly gobsmacked and partially anesthetized.
If I squint my eyes and hallucinate just a bit, that is sort of what motherhood has been like.
It’s about knowing all the things that could go wrong and meeting the unplanned head-on. Motherhood has indeed been a whirlwind – so many physical, psychological, and emotional transformations. And to top it off, the added effort of giving birth in a pandemic. As an over-40 physician, you’d think I would have been better prepared.
I was, but in a sense, I was not. The knowledge, the wisdom, the experience of my medical training surrounded me, but even I panicked at times in the beginning: Am I feeding her correctly? Am I making enough food for her? Am I doing the best that I can for her? What more could I be doing for her?
Over time, I’ve learned to lighten up. Some. In those teachable moments with my daughter Gia, I’ve learned to not sugarcoat reality but encourage the hopeful. If Gia falls on the ground? “You’re okay, sweetie. Now get back up.” If Gia has a tantrum and starts hitting herself? “Honey, our hands are for hugs, not hurting ourselves. Let’s go play.” Eighty percent of motherhood right now is redirection and the other 20% is patience.
I remember this one time I was rushing out the door for work. After getting in the car with my keys, I realized I forgot my coffee back in the house. I left the car, went back in the house to grab the blessed joe, went back to the car, and couldn’t get in because it was locked. I panicked at that moment, went back inside the house, and found Gia playing with my extra key fob. My own daughter locked me out of my car. Of course, it wasn’t her fault. Deep breath and I offered her another kiss while simultaneously taking the key fob from her.
Before Gia could walk, she could climb the stairs in our home. Her father and I sometimes refer to her as “Lil Bamm-Bamm” because she is so strong. One day, Daddy was supposed to be watching her while Mommy was folding laundry upstairs. She was not allowed on the stairs, but what should I hear? Literally, the pitter-patter of little feet, running down the upstairs hallway. Her father had drifted off watching yet another episode of something Star Wars–related. My strong little girl made it up the stairs all by herself and Dad received a strong word. The Force was with me that day.
I would say that I feel like having a child ages you, but what does that really mean when you’re already old? I’ve become acutely aware of my lack of endurance, stamina, and bodily strength. My knees will creak when taking her upstairs to bed, an osseous dirge of a lullaby. Date nights become unintentionally less and less frequent. Friday night dress-up becomes Friday night dress-down. I’ve replaced stiletto heels with comfy sweats.
Once we put Gia down for the night, we are usually exhausted from the day, and the couch and TV are welcome respites. We exhale. As over-40 parents, we knew that having children late in life would bring its challenges. But I’d like to think that we are meeting them the best way that we can. Often I encourage my body to meet Gia at her eye level, see what she sees, play with her on her own terms, and match her energy. She absolutely loves it when I do this. I’m out of breath and my knees are sore by the end of our play session, but I wouldn’t have it any other way.
We are learning from each other. She has a bright and assertive personality, and I am protective of that innocence. Her innocence is without fear. I often wonder what she is thinking when I see her facial expressions. A side-eye, a fleeting giggle. Is she secretly contemplating the chronicity of the cosmos, or is it just gas? I look at her in stolen moments and still can’t believe that I grew a human inside me, and said human was extracted from me and is now walking around my house commanding her bidding. So surreal. The unromanticized, scientific ingredients that are at play from conception to delivery are nothing short of miraculous. And the miracles of parenting over 40 are present every day.
Dr. Tolliver is a family medicine physician at The Ohio State University Wexner Medical Center in Columbus. A version of this article first appeared on Medscape.com.
As they rolled me down the hallway to the OR, ceiling lights rhythmically passing above, I zoned out into a 1,000-mile stare. How did I get here? I started humming “Swing Low, Sweet Chariot,” praying for a miracle to happen. I thought back to my birth plan, meticulously crafted, a one-pager so that the no-nonsense labor and delivery nurses wouldn›t think me completely off my rocker. No C-section unless medically necessary. Those words laughed back at me – cackling, even. I’d planned out the whole birthing process and here we were, my team almost jogging me to the OR. I lay still, utterly gobsmacked and partially anesthetized.
If I squint my eyes and hallucinate just a bit, that is sort of what motherhood has been like.
It’s about knowing all the things that could go wrong and meeting the unplanned head-on. Motherhood has indeed been a whirlwind – so many physical, psychological, and emotional transformations. And to top it off, the added effort of giving birth in a pandemic. As an over-40 physician, you’d think I would have been better prepared.
I was, but in a sense, I was not. The knowledge, the wisdom, the experience of my medical training surrounded me, but even I panicked at times in the beginning: Am I feeding her correctly? Am I making enough food for her? Am I doing the best that I can for her? What more could I be doing for her?
Over time, I’ve learned to lighten up. Some. In those teachable moments with my daughter Gia, I’ve learned to not sugarcoat reality but encourage the hopeful. If Gia falls on the ground? “You’re okay, sweetie. Now get back up.” If Gia has a tantrum and starts hitting herself? “Honey, our hands are for hugs, not hurting ourselves. Let’s go play.” Eighty percent of motherhood right now is redirection and the other 20% is patience.
I remember this one time I was rushing out the door for work. After getting in the car with my keys, I realized I forgot my coffee back in the house. I left the car, went back in the house to grab the blessed joe, went back to the car, and couldn’t get in because it was locked. I panicked at that moment, went back inside the house, and found Gia playing with my extra key fob. My own daughter locked me out of my car. Of course, it wasn’t her fault. Deep breath and I offered her another kiss while simultaneously taking the key fob from her.
Before Gia could walk, she could climb the stairs in our home. Her father and I sometimes refer to her as “Lil Bamm-Bamm” because she is so strong. One day, Daddy was supposed to be watching her while Mommy was folding laundry upstairs. She was not allowed on the stairs, but what should I hear? Literally, the pitter-patter of little feet, running down the upstairs hallway. Her father had drifted off watching yet another episode of something Star Wars–related. My strong little girl made it up the stairs all by herself and Dad received a strong word. The Force was with me that day.
I would say that I feel like having a child ages you, but what does that really mean when you’re already old? I’ve become acutely aware of my lack of endurance, stamina, and bodily strength. My knees will creak when taking her upstairs to bed, an osseous dirge of a lullaby. Date nights become unintentionally less and less frequent. Friday night dress-up becomes Friday night dress-down. I’ve replaced stiletto heels with comfy sweats.
Once we put Gia down for the night, we are usually exhausted from the day, and the couch and TV are welcome respites. We exhale. As over-40 parents, we knew that having children late in life would bring its challenges. But I’d like to think that we are meeting them the best way that we can. Often I encourage my body to meet Gia at her eye level, see what she sees, play with her on her own terms, and match her energy. She absolutely loves it when I do this. I’m out of breath and my knees are sore by the end of our play session, but I wouldn’t have it any other way.
We are learning from each other. She has a bright and assertive personality, and I am protective of that innocence. Her innocence is without fear. I often wonder what she is thinking when I see her facial expressions. A side-eye, a fleeting giggle. Is she secretly contemplating the chronicity of the cosmos, or is it just gas? I look at her in stolen moments and still can’t believe that I grew a human inside me, and said human was extracted from me and is now walking around my house commanding her bidding. So surreal. The unromanticized, scientific ingredients that are at play from conception to delivery are nothing short of miraculous. And the miracles of parenting over 40 are present every day.
Dr. Tolliver is a family medicine physician at The Ohio State University Wexner Medical Center in Columbus. A version of this article first appeared on Medscape.com.
Histologic remission predicts relapse-free survival in UC
Histologic remission using the Nancy Histologic Index (NHI) was superior to endoscopic mucosal healing in predicting relapse-free survival in ulcerative colitis (UC), based on data from 74 patients.
A growing body of evidence suggests that UC patients in both histologic and endoscopic remission experience longer relapse-free survival and improved outcomes, but data on specific histologic assessments are limited, wrote Hunter Wang, MBBS, of Canberra Hospital, Australia, and colleagues. The NHI is a validated score drawing interest as an option for predicting survival, they said.
In a retrospective cohort study published Feb. 28 in the Journal of Clinical Gastroenterology, the researchers identified 74 adults aged 18 years and older with UC who were treated at a single center between 2009 and 2017. All patients were in clinical and endoscopic remission without concurrent corticosteroid use. Mucosal healing was defined as Mayo endoscopic subscore (MES) of 1 or less, and clinical remission was defined as partial Mayo score (MSp) less than 2. The median age of the participants was 41 years, and the median disease duration was 8 years at the time of surveillance colonoscopy.
Over a median follow-up of 42 months, patients with an MES of 0 and histologic remission had significantly longer relapse-free survival compared to those with MES 1 and NHI 2 to 4, respectively.
Thirty-three patients relapsed during the study period. Clinical relapse rates were similar for patients with MES 0 and MES 1 (40% and 52%, respectively), but only 29% of patients in histologic remission at baseline relapsed vs. 64% of those with histologic activity at baseline (P = 0.0064).
Risk factors for earlier relapse on univariate analysis included MES 1 and NHI 2 to 4. Only histologic activity predicted future relapse in a multivariate analysis (hazard ratio, 4.36, P = 0.002).
The study findings reflect data from previous research supporting the prognostic value of histologic remission using NHI, the researchers noted in their discussion. Barriers to adoption of histologic indices include “their multiplicity, complexity, lack of validation, and inconsistent incorporation in randomized controlled trials,” which create challenges in interpreting and comparing research outcomes, they wrote.
The study findings were limited by several factors, including the retrospective design, collection of clinical and endoscopic variables from electronic medical records without objective measures of relapse, lack of standardization of colonic biopsies, and lack of power to detect differences in dysplasia and colectomy, the researchers noted.
The results suggest that histologic remission using the NHI serves as an effective predictor of longer relapse-free survival in UC patients with clinical and endoscopic remission, they said.
“Further prospective trials are needed to clarify whether histologic remission as a therapeutic endpoint in addition to endoscopic remission will alter disease course and patient outcomes,” while helping guide treatment management decisions for patients and clinicians, the researchers concluded.
Not the ultimate endpoint?
“There is ongoing interest in whether histological findings (biopsies) of the mucosa are a clinically important and reachable treatment goal in ulcerative colitis,” David T. Rubin, MD, of the University of Chicago, who was not involved in the study, said in an interview.
Questions about this approach remain, such as how findings should be incorporated into clinical care and whether histology offers advantages over patient-reported symptoms, endoscopic findings, or other surrogates of inflammation like calprotectin, a protein related to histology detected in stool, Dr. Rubin explained.
“A number of retrospective studies have demonstrated the clinical importance of achieving histological remission, but the details of how to get there are not yet clearly defined. In this study, using one of the established indices of histological activity, the Nancy Histological Index, those patients who achieved histological remission had better clinical outcomes (stable remission) than symptoms alone or endoscopy alone.”
According to Dr. Rubin, clinicians can inform patients that histological remission supports that the therapy is working and they have a very good likelihood of staying in remission over the next year.
“Importantly, this is not the same as saying we should treat to get to this endpoint,” Dr. Rubin emphasized. “If a patient is in clinical remission with normalized labs and endoscopy (or calprotectin) that show healing, we do not yet recommend adjusting therapy for histological endpoints. This was edified in the consensus paper called STRIDE 2, published in Gastroenterology in 2021.”
As for additional research, the ongoing prospective randomized VERDICT trial is exploring different endpoints of treatment, “one of which is the combination of symptoms, endoscopy, and histology to assess whether this is better than symptoms or endoscopy alone,” said Dr. Rubin. “We also need more work to understand the timing of this finding, the number of biopsies that may be required to get an adequate assessment of the bowel, how pathologists should read and interpret our findings, when we should relook if we adjust therapy, and whether some therapies are more or less likely to achieve this endpoint,” he said.
The study received no outside funding. Neither the researchers nor Dr. Rubin reported any financial disclosures.
Histologic remission using the Nancy Histologic Index (NHI) was superior to endoscopic mucosal healing in predicting relapse-free survival in ulcerative colitis (UC), based on data from 74 patients.
A growing body of evidence suggests that UC patients in both histologic and endoscopic remission experience longer relapse-free survival and improved outcomes, but data on specific histologic assessments are limited, wrote Hunter Wang, MBBS, of Canberra Hospital, Australia, and colleagues. The NHI is a validated score drawing interest as an option for predicting survival, they said.
In a retrospective cohort study published Feb. 28 in the Journal of Clinical Gastroenterology, the researchers identified 74 adults aged 18 years and older with UC who were treated at a single center between 2009 and 2017. All patients were in clinical and endoscopic remission without concurrent corticosteroid use. Mucosal healing was defined as Mayo endoscopic subscore (MES) of 1 or less, and clinical remission was defined as partial Mayo score (MSp) less than 2. The median age of the participants was 41 years, and the median disease duration was 8 years at the time of surveillance colonoscopy.
Over a median follow-up of 42 months, patients with an MES of 0 and histologic remission had significantly longer relapse-free survival compared to those with MES 1 and NHI 2 to 4, respectively.
Thirty-three patients relapsed during the study period. Clinical relapse rates were similar for patients with MES 0 and MES 1 (40% and 52%, respectively), but only 29% of patients in histologic remission at baseline relapsed vs. 64% of those with histologic activity at baseline (P = 0.0064).
Risk factors for earlier relapse on univariate analysis included MES 1 and NHI 2 to 4. Only histologic activity predicted future relapse in a multivariate analysis (hazard ratio, 4.36, P = 0.002).
The study findings reflect data from previous research supporting the prognostic value of histologic remission using NHI, the researchers noted in their discussion. Barriers to adoption of histologic indices include “their multiplicity, complexity, lack of validation, and inconsistent incorporation in randomized controlled trials,” which create challenges in interpreting and comparing research outcomes, they wrote.
The study findings were limited by several factors, including the retrospective design, collection of clinical and endoscopic variables from electronic medical records without objective measures of relapse, lack of standardization of colonic biopsies, and lack of power to detect differences in dysplasia and colectomy, the researchers noted.
The results suggest that histologic remission using the NHI serves as an effective predictor of longer relapse-free survival in UC patients with clinical and endoscopic remission, they said.
“Further prospective trials are needed to clarify whether histologic remission as a therapeutic endpoint in addition to endoscopic remission will alter disease course and patient outcomes,” while helping guide treatment management decisions for patients and clinicians, the researchers concluded.
Not the ultimate endpoint?
“There is ongoing interest in whether histological findings (biopsies) of the mucosa are a clinically important and reachable treatment goal in ulcerative colitis,” David T. Rubin, MD, of the University of Chicago, who was not involved in the study, said in an interview.
Questions about this approach remain, such as how findings should be incorporated into clinical care and whether histology offers advantages over patient-reported symptoms, endoscopic findings, or other surrogates of inflammation like calprotectin, a protein related to histology detected in stool, Dr. Rubin explained.
“A number of retrospective studies have demonstrated the clinical importance of achieving histological remission, but the details of how to get there are not yet clearly defined. In this study, using one of the established indices of histological activity, the Nancy Histological Index, those patients who achieved histological remission had better clinical outcomes (stable remission) than symptoms alone or endoscopy alone.”
According to Dr. Rubin, clinicians can inform patients that histological remission supports that the therapy is working and they have a very good likelihood of staying in remission over the next year.
“Importantly, this is not the same as saying we should treat to get to this endpoint,” Dr. Rubin emphasized. “If a patient is in clinical remission with normalized labs and endoscopy (or calprotectin) that show healing, we do not yet recommend adjusting therapy for histological endpoints. This was edified in the consensus paper called STRIDE 2, published in Gastroenterology in 2021.”
As for additional research, the ongoing prospective randomized VERDICT trial is exploring different endpoints of treatment, “one of which is the combination of symptoms, endoscopy, and histology to assess whether this is better than symptoms or endoscopy alone,” said Dr. Rubin. “We also need more work to understand the timing of this finding, the number of biopsies that may be required to get an adequate assessment of the bowel, how pathologists should read and interpret our findings, when we should relook if we adjust therapy, and whether some therapies are more or less likely to achieve this endpoint,” he said.
The study received no outside funding. Neither the researchers nor Dr. Rubin reported any financial disclosures.
Histologic remission using the Nancy Histologic Index (NHI) was superior to endoscopic mucosal healing in predicting relapse-free survival in ulcerative colitis (UC), based on data from 74 patients.
A growing body of evidence suggests that UC patients in both histologic and endoscopic remission experience longer relapse-free survival and improved outcomes, but data on specific histologic assessments are limited, wrote Hunter Wang, MBBS, of Canberra Hospital, Australia, and colleagues. The NHI is a validated score drawing interest as an option for predicting survival, they said.
In a retrospective cohort study published Feb. 28 in the Journal of Clinical Gastroenterology, the researchers identified 74 adults aged 18 years and older with UC who were treated at a single center between 2009 and 2017. All patients were in clinical and endoscopic remission without concurrent corticosteroid use. Mucosal healing was defined as Mayo endoscopic subscore (MES) of 1 or less, and clinical remission was defined as partial Mayo score (MSp) less than 2. The median age of the participants was 41 years, and the median disease duration was 8 years at the time of surveillance colonoscopy.
Over a median follow-up of 42 months, patients with an MES of 0 and histologic remission had significantly longer relapse-free survival compared to those with MES 1 and NHI 2 to 4, respectively.
Thirty-three patients relapsed during the study period. Clinical relapse rates were similar for patients with MES 0 and MES 1 (40% and 52%, respectively), but only 29% of patients in histologic remission at baseline relapsed vs. 64% of those with histologic activity at baseline (P = 0.0064).
Risk factors for earlier relapse on univariate analysis included MES 1 and NHI 2 to 4. Only histologic activity predicted future relapse in a multivariate analysis (hazard ratio, 4.36, P = 0.002).
The study findings reflect data from previous research supporting the prognostic value of histologic remission using NHI, the researchers noted in their discussion. Barriers to adoption of histologic indices include “their multiplicity, complexity, lack of validation, and inconsistent incorporation in randomized controlled trials,” which create challenges in interpreting and comparing research outcomes, they wrote.
The study findings were limited by several factors, including the retrospective design, collection of clinical and endoscopic variables from electronic medical records without objective measures of relapse, lack of standardization of colonic biopsies, and lack of power to detect differences in dysplasia and colectomy, the researchers noted.
The results suggest that histologic remission using the NHI serves as an effective predictor of longer relapse-free survival in UC patients with clinical and endoscopic remission, they said.
“Further prospective trials are needed to clarify whether histologic remission as a therapeutic endpoint in addition to endoscopic remission will alter disease course and patient outcomes,” while helping guide treatment management decisions for patients and clinicians, the researchers concluded.
Not the ultimate endpoint?
“There is ongoing interest in whether histological findings (biopsies) of the mucosa are a clinically important and reachable treatment goal in ulcerative colitis,” David T. Rubin, MD, of the University of Chicago, who was not involved in the study, said in an interview.
Questions about this approach remain, such as how findings should be incorporated into clinical care and whether histology offers advantages over patient-reported symptoms, endoscopic findings, or other surrogates of inflammation like calprotectin, a protein related to histology detected in stool, Dr. Rubin explained.
“A number of retrospective studies have demonstrated the clinical importance of achieving histological remission, but the details of how to get there are not yet clearly defined. In this study, using one of the established indices of histological activity, the Nancy Histological Index, those patients who achieved histological remission had better clinical outcomes (stable remission) than symptoms alone or endoscopy alone.”
According to Dr. Rubin, clinicians can inform patients that histological remission supports that the therapy is working and they have a very good likelihood of staying in remission over the next year.
“Importantly, this is not the same as saying we should treat to get to this endpoint,” Dr. Rubin emphasized. “If a patient is in clinical remission with normalized labs and endoscopy (or calprotectin) that show healing, we do not yet recommend adjusting therapy for histological endpoints. This was edified in the consensus paper called STRIDE 2, published in Gastroenterology in 2021.”
As for additional research, the ongoing prospective randomized VERDICT trial is exploring different endpoints of treatment, “one of which is the combination of symptoms, endoscopy, and histology to assess whether this is better than symptoms or endoscopy alone,” said Dr. Rubin. “We also need more work to understand the timing of this finding, the number of biopsies that may be required to get an adequate assessment of the bowel, how pathologists should read and interpret our findings, when we should relook if we adjust therapy, and whether some therapies are more or less likely to achieve this endpoint,” he said.
The study received no outside funding. Neither the researchers nor Dr. Rubin reported any financial disclosures.
FROM THE JOURNAL OF CLINICAL GASTROENTEROLOGY