Articles of Interest
JournalDoc is proud to work with a team of experts who understand the challenges faced by Healthcare Professionals and pleased to offer a weekly article of interest representing trends and new information affecting the study and practice of medicine.
What’s Interesting about this article?
- Vasomotor symptoms of night sweats and hot flashes are common during menopause and result in diminished quality of life, work productivity, mood, and sleep. Symptoms may persist for 7-10 years with an average of 4-5 episodes per day.
- Hormonal therapy for menopausal symptoms was approved by the FDA in 1942 but is now prescribed less frequently because of concerns over long-term side effects.
- The first non-hormonal therapy was approved in 2012 and led to a variety of anti-depressant like drugs for vasomotor symptoms. The FDA recently approved a new drug fezolinetant, an NK3R antagonist, as a non-hormonal treatment.
JournalDoc Comments:
- The approval of only the second non-hormonal drug for vasomotor symptoms in the last ten years is an indication of the difficulty in finding replacements for traditional hormonal therapy, which is highly effective for most women. Wholesale cost of the new medication is $550.00 for a 30- day supply.
- A variety of non-pharmaceutical compounds or “nutraceuticals” are available for night sweats and hot flashes, but none have been proven to be highly effective.
- Women experiencing vasomotor symptoms, either prior to or during menopause, should discuss risks and benefits of traditional hormonal therapy vs new alternatives with their own physician.
Annals of Internal Medicine Original Research Article
Annals of Internal Medicine, October 2023
A Prospective Cohort Study of 63,676 nurses in the Nurses’ Health Study II prospectively followed from 2009 to 2017.
What’s Interesting about this article?
- Chronotype or circadian preference is one’s preference for earlier or later sleeping or bedtimes. People who prefer to go to bed later at night, get up later in the day, and feel more energetic later in the day, have an evening chronotype.
- An estimated 8% of the population have a pronounced evening chronotype, with bedtimes at 3 AM and wake times at 12 noon. This sleep schedule has been linked to poor metabolic regulation with disrupted glycemic regulation and an increased incidence of type 2 diabetes.
- In this study, nurses aged 45 to 62 years with a preference for later sleep times had more unhealthy lifestyles and, an increased diabetes risk. Lower BMI, exercise, diet, and other healthy lifestyle behaviors decreased some, but not all of the risk.
JournalDoc Comments:
- This is an extremely large data set with self- reported behaviors by nurses trained to observe and record patient behaviors.
- It is difficult to separate out the impact of changing work shifts on sleep preferences.
- The adage of “early to bed and early to rise makes a (man) healthy, wealthy and wise” may also decrease the risk of developing diabetes if you are a middle-aged woman.
Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.
NEJM Original Investigation Article
The New England Journal of Medicine, September 21, 2023
A randomized, controlled trial in 529 patients with heart failure and obesity, assigned to receive medication or placebo, and followed for one year.
What’s Interesting about this article?
- Heart failure with preserved ejection fraction is increasing in prevalence and is associated with high symptom burden and functional impairment, especially in persons with obesity.
- The weekly dose of semaglutide (2.4 mg) resulted in larger reductions in symptoms, greater improvements in exercise function and greater weight loss than placebo.
- In an accompanying editorial, Yigal Pinto, MD, PhD speculates that heart failure with preserved ejection fraction may be a metabolic disease.
JournalDoc Comments:
- The class of incretin mimetics is gaining recognition as “new miracle drugs” for weight loss. This article suggests that they may have an effect on cardiovascular disorders as well as obesity.
- It is not clear whether the improvement in symptoms is due to a change in intracardiac pressures or weight loss.
- This study offers a new treatment option for a condition that has, in the past, been difficult to treat.
Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.
JAMA Original Investigation Article
Journal of the American Medical Association, September 12, 2023
Retrospective Study from the UK Biobank, including 49,841 adults > 60 years without an initial diagnosis of dementia.
What’s Interesting about this article?
- Individuals in the study wore a wrist accelerometer to measure sedentary (sitting) time each day.
- These older adults resided in England, Scotland or Wales and were followed for 6.72 years. During this time 414 individuals were diagnosed with dementia.
- More time spent in sedentary behavior was significantly associated with a higher incidence of dementia.
JournalDoc Comments:
- This is an extraordinarily large study group from one of the most respected data registries in the world.
- The retrospective study design does not allow a determination of whether this relationship is causal – i.e., that increased sitting time results in increased risk of dementia. However, it may be “associated with” the diagnosis of dementia.
- This study may add further weight to the adage that “sitting is the new smoking” in preventive medicine.
Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.
JAMA Original Investigation Article
Journal of the American Medical Association, September 5, 2023
A randomized, Phase 2 clinical trial at 11 research sites with 104 participants aged 21 to 65 with a diagnosis of major depressive disorder.
What’s Interesting about this article?
- A single 25 mg dose of synthetic psilocybin, with psychological support, resulted in a clinically significant and sustained reduction in depressive symptoms and functional disability.
- A placebo effect was excluded because controls received a vitamin capsule identical in appearance to the psilocybin pills.
- There were no serious adverse effects.
JournalDoc Comments:
- As pointed out in an accompanying editorial by Rachel Yehuda, PhD and Amy Lehrner, PhD, psychedelic therapy may represent “A New Paradigm of Care for Mental Health.”
- Most psychedelic compounds are illegal under federal law, therefore research with these compounds must be conducted under close supervision by trained individuals in accredited institutions.
- The psychedelic approach focuses on revealing the causes of depression through new insights during the induced visions or hallucinations, rather than suppression of symptoms through traditional antidepressants.
- As with most new treatments, we need to proceed slowly and carefully in evaluating the potential of psychedelics through additional experiments.
Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.
