Medical News You May Have Missed - Week of March 25th

March 30, 2013

PCPs for sleep apnea?; mental illness and obesity; norovirus on the rise; global sodium overdose

Sleep Apnea Treatment Study: PCPs as Effective as Specialists

Patients who undergo treatment for sleep apnea show similar improvements in sleepiness scores when treated by a primary care physician or by a sleep specialist, according to data from an Australian study.

In the study, 155 patients with obstructive sleep apnea were treated at a primary care practice or at a university sleep medicine center. Both plans included continuous positive airway pressure, mandibular advancement splints, or conservative measures only.

Six-month change in the Epworth Sleepiness Scale (ESS) score-which ranges from 0, for no daytime sleepiness, to 24 for a high level of daytime sleepiness-was the primary outcome.

There were significant improvements in ESS scores from baseline to 6 months in both groups. The mean baseline scores decreased from 12.8 to 7.0 and from 12.5 to 7.0 in patients treated by primary care physicians and specialists, respectively.

In addition, the cost of treatment provided by a primary care physician was more than $1000 lower than that from a specialist.

The study, Primary Care vs Specialist Sleep Center Management of Obstructive Sleep Apnea and Daytime Sleepiness and Quality of Life, appeared in the Journal of the American Medical Association.

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Kidney Injury Risk Elevated By High-Dose Statins

The rate of diagnosis for acute kidney injury in hospital admissions is higher with the use of high potency statins than with low potency statins, according to a retrospective observation analysis.

Canadian researchers looked at rates of hospitalization for acute kidney injury among more than 2 million patients aged 40 years and older from 7 Canadian provinces and 2 UK and US data bases who had been newly prescribed statins. A high dose statin was defined as 10 mg or more of rosuvastatin, 20 mg or more of atorvastatin, and 40 mg or more of simvastatin.

Patients assigned to take high dose statins were 34% more likely to be hospitalized for acute kidney injury within 120 days of starting treatment than patients assigned low dose statins. Although an increased risk in hospitalization for acute kidney injury was found for patients with no previous disease, no increase was seen in patients who had chronic kidney injury before statin prescription.

“Given what is likely to be a small magnitude of incremental cardiovascular benefit of high potency statins over low potency statins in reality, a pressing question is how to identify patients for whom the risk-benefit balance for high potency statin treatment is unfavorable,” the researchers wrote.

The study, Use of High Potency Statins and Rates of Admission for Acute Kidney Injury: Multicenter, Retrospective Observational Analysis of Administrative Databases, was published recently in BMJ.

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Serious Mental Illness Not a Barrier to Weight Loss

Overweight and obese adults with serious mental illness who participate in a targeted behavioral weight-loss intervention are able to achieve significant weight loss, according to results of a study published online on March 21 in the New England Journal of Medicine.

Participants in the study, A Behavioral Weight-Loss Intervention in Persons with Serious Mental Illness, were recruited from 10 community psychiatric rehabilitation outpatient programs. Of the 291 adults who underwent randomization, 58.1% had schizophrenia or schizoaffective disorder, 22% had bipolar disorder, and 12% had major depression. Mean body mass index was 36.3 kg/m2 at baseline.

Participants assigned to the intervention arm attended group weight-management and exercise sessions and individual weight management sessions. The interventions were modeled on lifestyle changes shown to be effective in the general population and adapted to account for psychiatric symptoms and cognitive impairment highly prevalent in this population. The control group received standard nutrition and physical activity information at baseline.

During the 18-month study period, weight change was assessed at 6, 12, and 18 months. Weight loss in the intervention group increased steadily and differed significantly from the control group at each interval visit. At 18 months, the mean between group difference in weight was -3.2 kg (-7.0 lb; P=0.002); 37.8% of the participants in the intervention group lost at least 5% of their weight at baseline while 22.7% of participants in the control group achieved this goal (P=0.009).

Study authors note that more than 80% of people with serious mental illnesses are overweight or obese yet weight-loss trials exclude this vulnerable population. Of those that have been conducted, few have been randomized and most are short-term.

The results, say the researchers, demonstrate that this group at high risk for obesity-related illness can make substantial lifestyle changes despite the cognitive and emotional challenges they face.

Access the full study, here: A Behavioral Weight-Loss Intervention in Persons with Serious Mental Illnesss.

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Norovirus Top Cause of Gastroenteritis in U.S. Children

Norovirus was responsible for about 20% of acute gastroenteritis seen in children seeking medical attention for the condition, according to a study published March 21 in The New England Journal of Medicine

For the study, Norovirus and Medically Attended Gastroenteritis in U.S. Children, researchers conducted active surveillance of laboratory-confirmed cases of norovirus among children aged 5 years or younger with acute gastroenteritis in hospitals, outpatient clinics, and emergency departments during 2009 and 2010.

Data showed that 21% of children seeking medical attention for acute gastroenteritis in 2009 (22%) and 2010 (20%) had norovirus. In contrast, rotovirus was confirmed in only 12% of children presenting with acute symptoms during these years.

When researchers extrapolated the findings for this population to the U.S. at large, they found that
norovirus infections are associated with nearly 1 million health care visits per year. They estimate that, by their fifth birthday, 1 in 278 U.S. children are hospitalized for norovirus infection, 1 in 14 are seen in the emergency department, and 1 in 6 are seen by outpatient care providers.

As uptake of rotavirus vaccines continues to reduce the incidence of that infection, the study authors note, norovirus infection has become the leading cause of medically-attended acute gastroenteritis among U.S. children younger than age 5 years.

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World's Salt Intake is Double Recommended Levels

Approximately 75 per cent of the world’s population consumes twice as much salt as recommended by major health organizations. This data, from the first study to evaluate global sodium intake by country, age, and gender, was presented March 21 at the American Heart Association’s (AHA) Nutrition, Physical Activity and Metabolism and Cardiovascular Disease Epidemiology and Prevention 2013 Scientific Sessions.

The AHA currently recommends limiting sodium intake to 1,500 mg a day or less and World Health Organization (WHO) recommendations set the limit at 2,000 mg or less.  According to the 2010 Global Burden of Diseases Study, (first link, below) however, average global sodium intake from commercially prepared food, table salt, salt and soy sauce averaged more than 4,000 mg a day in 2010.

Among the 187 countries surveyed for the study, 181 exceeded the WHO’s recommended sodium intake, although not all doubled it. In the United States, the average daily intake was 3,600 mg a day. Only Kenya did not exceed the AHA’s recommended sodium intake levels.

Estimates were compiled from 247 surveys of adult sodium intake stratified by age, sex, region and nation between 1990 and 2010.

The full 2010 Global Burden of Disease report is available at The Lancet.

The news release from the AHA is available here.

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