Metabolic Syndrome and Stroke Risk

 

To evaluate the association between ischemic stroke and metabolic syndrome, DeBoer and Gurka reviewed more than 13,000 participants in prior studies and their stroke outcomes. Among that group, there were 709 ischemic strokes over a mean period of 18.6 years assessed in the studies. (Ischemic strokes are caused when blood flow to the brain is obstructed by blood clots or clogged arteries. Hemorrhagic strokes, on the other hand, are caused when blood vessels rupture.)

DeBoer developed the scoring tool, an online calculator to assess the severity of metabolic syndrome, with Matthew J. Gurka, PhD, of the Department of Health Outcomes and Biomedical Informatics at the University of Florida, Gainesville. The tool is available for free at https://metscalc.org/.

Journal Reference: Mark D. DeBoer, Stephanie L. Filipp, Mario Sims, Solomon K. Musani, Matthew J. Gurka. Risk of Ischemic Stroke Increases Over the Spectrum of Metabolic Syndrome Severity. Stroke, 2020; 51 (8): 2548 DOI: 10.1161/STROKEAHA.120.028944

This online calculator can predict your stroke risk

Presented with the following caveat:

I tried the calculator but I’m not quite sure how useful it will be in clinical settings.  As far as insurance underwriting is concerned I probably won’t use it.

Trends in excess mortality associated with atrial fibrillation over 45 years (Framingham Heart Study)

Conclusions

We found no evidence of a temporal trend in hazard ratios between newly diagnosed atrial fibrillation and all cause mortality. The hazard ratios for non-cardiovascular death declined over time but no evidence of a temporal trend for cardiovascular death was found. Mortality associated with newly diagnosed atrial fibrillation remained high compared with individuals without atrial fibrillation, despite showing some improvements over the past 45 years. More than 10 years after a diagnosis of atrial fibrillation, individuals with atrial fibrillation lose about two years of life compared with matched referents.

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2724 (Published 11 August 2020)

Cite this as: BMJ 2020;370:m2724

‘Staggering’ Increase in COVID-Linked Depression, Anxiety

Since the start of the COVID-19 pandemic, there has been a dramatic increase in depression, anxiety, psychosis, and suicidality, new research shows.

The most profound health problems were found among adults younger than 25 years. Roughly 90% screened positive for moderate to severe depression, and 80% screened positive for moderate to severe anxiety.

One of the most alarming findings was that in June, 25,498 participants who screened positive for depression reported thinking of suicide or self-harm on “more than half of days to nearly every day.” A total of 14,607 participants said they had these thoughts every day.

‘Staggering’ Increase in COVID-Linked Depression, Anxiety

Sadly, not surprising.

Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United States, 2012–2018

What is already known about this topic?

Falls are the leading cause of injury among adults aged ≥65 years, who in 2014 experienced an estimated 29 million falls, resulting in 7 million fall-related injuries.

What is added by this report?

In 2018, 27.5% of adults aged ≥65 years reported at least one fall in the past year (35.6 million falls) and 10.2% reported a fall-related injury (8.4 million fall-related injuries). From 2012 to 2016, the percentages of these adults reporting a fall increased, and from 2016 to 2018, the percentages decreased.

Citation for this article: Moreland B, Kakara R, Henry A. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United States, 2012–2018. MMWR Morb Mortal Wkly Rep 2020;69:875–881. DOI: http://dx.doi.org/10.15585/mmwr.mm6927a5external icon.

Watch Your Quarantini Intake

Nielsen reports alcohol sales in stores were up 54% in late March compared to that time last year, while online sales were up nearly 500% in late April. According to a Morning Consult poll of 2,200 U.S. adults conducted in early April, 16% of all adults said they were drinking more during the pandemic, with higher rates among younger adults: One in 4 Millennials and nearly 1 in 5 Gen Xers said they had upped their alcohol intake.

COVID-19 pandemic brings new concerns about excessive drinking

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I stumbled upon the same AHA news article in several other websites.  The entire article was reprinted in its entirety and just one website provided attribution to the source.  The copyright notice and proper attribution is included above.

Diabulimia

I live with “the world’s most dangerous” eating disorder

I have been struggling with diabulimia on and off since my diagnosis of type 1 diabetes in 2011, at age 30. I had just started a PhD and spent the first semester walking around campus with all the classic symptoms of type 1 diabetes: famished, dehydrated, constantly needing to urinate, and experiencing rapid weight loss. After my diabetes diagnosis, when I started injecting insulin, I gained the weight back—and then some. It didn’t take long to figure out that omitting insulin was not only an effective weight loss tool, compared with vomiting, it was a much less violent way to purge. Having a history of bulimia nervosa, I thought I had found the holy grail. I could eat what I wanted, not use insulin, and not gain weight.

And I thought Orthorexia Nervosa was bad.

Vulvar Melanoma Is Increasing in Older Women

Vulvar Melanoma Is Increasing in Older Women

The national incidence of vulvar melanoma is on the rise in women aged over 60 years, climbing by an average of 2.2% per year during 2000–2016, Maia K. Erickson reported in a poster at the virtual annual meeting of the American Academy of Dermatology.

These are often aggressive malignancies. The 5-year survival following diagnosis of vulvar melanoma in women aged 60 years or older was 39.7%, compared with 61.9% in younger women, according to Ms. Erickson, a visiting research fellow in the department of dermatology at Northwestern University, Chicago.

NEJM Journal Watch – 06.05.20

Prevalence of asymptomatic disease: An estimated 40–45% of people who test positive for SARS-CoV-2 do not have symptoms at the time of testing, according to a narrative review of 16 cohorts in the Annals of Internal Medicine. In four cohorts with longitudinal data, few of the asymptomatic patients (0–10%) went on to develop symptoms. But in one skilled nursing facility, 89% of initially asymptomatic patients became sick. The researchers say, “It is imperative that testing programs include those without symptoms.” They add, “The early data that we have assembled on the prevalence of asymptomatic SARS-CoV-2 infection suggest that this is a significant factor in the rapid progression of the COVID-19 pandemic.”

COVID-19: Asymptomatic Disease Prevalence / N95 Mask Reuse / Oxygen Management Strategies / Anti-Racism Demonstrations / Studies Retracted

Smoking cigarettes — even one or less per day — is associated with increased mortality risk, a JAMA Network Open study shows.  Researchers combined data from several federal smoking surveys performed between 1992 and 2011. In those surveys, some 500,000 adults reported their smoking histories. National mortality data showed that, compared with never-smokers, daily smokers (averaging 600 cigarettes per month) bore a 2.3-fold higher all-cause mortality risk, with non-daily smokers (averaging 40 per month) sustaining a 1.8-fold higher risk.  Heightened mortality risks became apparent even at levels of 6 to 10 cigarettes per month.  The researchers conclude: “Thus, all smokers should quit, regardless of how infrequently they smoke.”

Infrequent Smoking Carries Heightened Mortality Risk

Anorexia Nervosa – More Dangerous Than You Think

This article is written by an Emergency Medicine doctor for other Emergency Medicine doctors as a quick primer on recognizing and diagnosing anorexia.  While those of us in the life insurance business are not diagnosticians  you will definitely benefit from this short ten minute article on the next case you encounter where Momma Bear is applying for $2,000,000 on her skinny 15 year old daughter who can’t seem to gain weight no matter how much the kid eats.

AN is a common, severe psychiatric illness. It is often present with co-morbid psychiatric illnesses. There is a high mortality rate, 5.6% per decade. It is notoriously difficult to treat with psychotherapy and pharmacotherapy.

Anorexia Nervosa – More Dangerous Than You Think

Paediatric Multisystem Inflammatory Syndrome – (PIM-TS)

Citation:
DFTB, T. Paediatric Multisystem Inflammatory Syndrome, Don’t Forget the Bubbles, 2020. Available at:
http://doi.org/10.31440/DFTB.25760

There has clearly been a lot of media interest in PIMS-TS but it is still an extremely uncommon disease entity in the context of all children presenting to emergency and acute care services. The vast majority of children, including those who were critically ill, have made a good recovery.