How useful is high-sensitivity CRP as a risk factor for coronary artery disease?

Little evidence supports the use of the high-sensitivity C-reactive protein assay (hs-CRP) as a screening test for cardiovascular disease (CVD) in the healthy adult population. There is significant debate about its use in populations at moderate risk for cardiovascular disease, with some evidence suggesting its use if the results of the test will alter treatment recommendations (strength of recommendation [SOR]: C, based on extrapolation of consistent level 2 studies). Research to date is inadequate to determine the role of hs-CRP in risk-stratification of patients when considered in light of other standard risk factors

What is the best treatment for diabetic neuropathy?

Tricyclic antidepressants, anticonvulsants, and capsaicin reduce the pain of diabetic neuropathy; limited data suggests that lidocaine patches may also be efficacious. Both tricyclic antidepressants and anticonvulsants are superior to placebo in relieving painful diabetic neuropathy. Compared with placebo, patients taking tricyclic antidepressants report reduced pain (number needed to treat [NNT] for at least 50% reduction= 3.5) (strength of recommendation [SOR]: A). Similarly, patients taking anticonvulsants report reduced pain (NNT for at least 50% reduction in pain=2.7) (SOR: A)

Is screening for lead poisoning justified?

Evidence is insufficient to recommend for or against universal screening of young children for lead poisoning in high- prevalence communities (strength of recommendation [SOR]: C). In low-prevalence communities, evidence is insufficient to recommend for or against a targeted screening approach, employing locale-specific demographic risk factors and personal risk questionnaires to inform screening decisions (SOR: C). Although evidence does not suggest that treatment of individuals with elevated blood lead levels improves individual outcomes, public health strategies aimed at decreasing lead in the environment appear to have resulted in a significant decline in the number of children with elevated blood lead levels in recent decades. One could thus argue that screening may identify communities with high rates of lead poisoning, where environmental strategies could be targeted. Because the epidemiology of lead poisoning continues to change, local and state health authorities must continuously update information on which to base decisions about screening

How should thyroid replacement be initiated?

Levothyroxine (LT4) should be used alone as initial replacement for patients with hypothyroidism (strength of recommendation [SOR]: A). The optimal initial dose is 1.6 μg/kg/d for healthy people aged 60 years or younger (SOR: B). Patients aged more than 60 years may require less levothyroxine to achieve therapeutic serum thyroid hormone replacement, so initial replacement should be decreased to 25 to 50 μg daily (SOR: C). Since patients with known heart disease may develop dysrhythmias, angina, and myocardial infarctions when started on full replacement doses, experts recommend starting 12.5 to 25 μg daily for this population (SOR: C). Brand-name (Synthroid, Levoxyl, etc) and generic LT4 are bioequivalent (SOR: B), although the US Food and Drug Administration (FDA) does not consider these products to be interchangeable until proven therapeutically equivalent

Psychosocial Interventions Delivered by Primary Care Physicians to Patients with Depression

Few high-quality studies have been conducted examining the effectiveness of psychosocial interventions performed by primary care physicians for patients with major depression. Two randomized controlled clinical trials (RCTs) found that a psychosocial intervention, specifically problem-solving therapy, is as effective as pharmacotherapy for symptoms of major depression. (Strength of recommendation: B) However, these results should be interpreted with some degree of caution because of the limited number of studies and their small sample size

Adolescent substance use: a prospective longitudinal model of substance use onset among South African adolescents

Substance use onset among Colored adolescents between eighth and ninth grades in an urban area of Cape Town, South Africa was examined using latent transition analysis. Longitudinal self-report data regarding substance use (N = 1118, 50.9% female) were collected in 2004 and 2005. Results indicated that the pattern of onset was similar across genders; adolescents first tried either alcohol or cigarettes, followed by both, then dagga (cannabis), and then inhalants. The prevalence of lifetime cigarette use was slightly greater for females; dagga (cannabis) and inhalant use were greater for males. The similarity of developmental onset in the current sample to previous international work supports the promise of adapting prevention programs across contexts. The study’s limitations are noted.Web of Scienc

Do statins delay onset or slow progression of Alzheimer's dementia?

Statins (coenzyme-A reductase inhibitors) should not be used with the single intent to delay the onset or slow the progression of dementia. Large randomized control trials (RCTs) found that the administration of a statin had no significant effect on preventing or slowing all-cause cognitive decline (strength of recommendation [SOR]: A, based on large RCTs with narrow confidence interval). Specifically, there is insufficient evidence that statins delay the onset or slow the progression of Alzheimer's dementia (SOR: B, based on systematic review with heterogeneity). While 3 epidemiologic studies have found a decreased incidence of dementia among those taking statins, these studies have significant methodological shortcomings and do not show a causal relationship (SOR: C, based on poor-quality studies)

Evaluation of Pneumonia Virus of Mice as a Possible Human Pathogen

Pneumonia virus of mice (PVM), a relative of human respiratory syncytial virus (RSV), causes respiratory disease in mice. There is serologic evidence suggesting widespread exposure of humans to PVM. To investigate replication in primates, African green monkeys (AGM) and rhesus macaques (n=4) were inoculated with PVM by the respiratory route. Virus was shed intermittently at low levels by a subset of animals, suggesting poor permissiveness. PVM efficiently replicated in cultured human cells and inhibited the type I interferon (IFN) response in these cells. This suggests that poor replication in nonhuman primates was not due to a general nonpermissiveness of primate cells or poor control of the IFN response. Seroprevalence in humans was examined by screening sera from 30 adults and 17 young children for PVM-neutralizing activity. Sera from a single child (6%) and 40% of adults had low neutralizing activity against PVM, which could be consistent with increasing incidence of exposure following early childhood. There was no cross-reaction of human or AGM sera between RSV and PVM and no cross-protection in the mouse model. In native Western blots, human sera reacted with RSV but not PVM proteins under conditions in which AGM immune sera reacted strongly. Serum reactivity was further evaluated by flow cytometry using unfixed Vero cells infected with PVM or RSV expressing green fluorescent protein (GFP) as a measure of viral gene expression. The reactivity of human sera against RSV-infected cells correlated with GFP expression, whereas reactivity against PVM-infected cells was low and uncorrelated with GFP expression. Thus, PVM specificity was not evident. Our results indicate that the PVM-neutralizing activity of human sera is not due to RSV- or PVM-specific antibodies but may be due to low-affinity, polyreactive natural antibodies of the IgG subclass. The absence of PVM-specific antibodies and restriction in nonhuman primates makes PVM unlikely to be a human pathogen

Provision of Outdoor Nature-Based Activity for Older People with Cognitive Impairment: A Scoping Review from the ENLIVEN Project

© 2023 Rachel Collins et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.The health and well-being benefits of outdoor nature-based activity are increasingly recognised, but older people with cognitive impairment face significant barriers to access. The ENLIVEN project aims to promote access by gathering evidence and coproducing guidance for activity providers. As part of this project, we conducted a scoping review to characterise the types of outdoor nature-based activity for older people with dementia and other forms of cognitive impairment for which research evidence is available and the range of outcomes is examined. The protocol is available online. We systematically searched relevant databases from 1st January, 2009, to 20th October, 2022, and screened articles against the following criteria: participants were older people aged 65 and above with cognitive impairment arising from dementia or another health condition. The study described the formal provision of outdoor nature-based activity away from the person’s usual place of residence, and at least one outcome of participation in the activity was evaluated. Twenty-eight articles met inclusion criteria, all focused on people living with dementia. In most cases, participants were attending day care or living in residential care, and sample sizes ranged from 4 to 136. Activities fell into three groups: green day care (fifteen articles), equine-assisted interventions (seven articles), and community nature-based activities (six articles). Outcome domains explored were connection with nature, activity engagement, impacts on clinical symptoms, functional ability, physical, psychological, and social health, and quality of life. Outdoor nature-based activity can be offered as an opportunity for meaningful occupation to enrich daily life, as a framework for day care provision, or as an intervention to address clinical needs. The evidence base for green day care is relatively established, but the potential for addressing specific clinical needs remains to be explored. The paucity of evidence regarding community provision, especially for those not attending formal care settings, suggests the need for effective knowledge exchange to stimulate initiatives in this area.Peer reviewe

Clinical and Economic Outcomes of Rabbit Antithymocyte Globulin Induction in Adults Who Received Kidney Transplants from Living Unrelated Donors and Received Cyclosporine‐Based Immunosuppression

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90167/1/phco.29.10.1166.pd