Factors such as climate change, widening distributions of host populations, and better clinician awareness are some of the main reasons for the geographic spread of Lyme disease over the past few months, according to recent data from epocrates.

Acey Albert, MD, director of clinical content at epocrates, is board certified in internal medicine and pediatrics with 15 years of experience in outpatient primary care and medical group leadership. He was able to combine his interest of technology, medicine, and physician leadership as a part of the epocrates team.

Albert explained how there was an increased interest in Lyme disease incidence compared to 2020 among clinicians who use epocrates’ medical application this summer, which measured at a 90% increase YoY.

“This was surprising because, while we know Lyme disease is becoming more common, this was a much steeper increase than we expected,” Albert said in an interview with 

. “For comparison, CDC data showed a doubling of Lyme disease cases between 1991 and 2018, while cases over the last 3 years of data (most recently, 2019) remained relatively flat.”

The increase in Americans traveling again this year and predictions of a warmer, wetter weather pattern could have also played a major factor in the uptick of Lyme disease this past summer, according to Albert.

As for the main implications that both providers and patients should know about in the spread of Lyme disease, Albert said diagnosis of the disease is highly dependent on the patient’s location and travel history.

“By current CDC and IDSA guidelines, patients with the pathognomonic rash, erythema migrans (EM), and tick exposure in an area where Lyme disease is common can be diagnosed and treated without further testing,” Albert said in an interview with 

. “Those exposed in areas with Lyme who don’t have EM but have other symptoms require testing.”

These guidelines also focus on when to empirically treat asymptomatic patients with tick bites in areas where Lyme disease is endemic, according to Albert.

“For clinicians, the possible geographic expansion of Lyme means that more of us might need to include it in the differential diagnoses of patients experiencing a fever, headache, myalgia, and joint pain. For patients, it means that more of us should take vital protective measures when venturing outdoors,” Albert said in an interview with 

At epocrates, an issue that was addressed in the summary of Lyme guidelines was how clinicians are often confronted by patients with concerns about chronic Lyme disease at the point-of-care. This term is not usually acknowledged by gold-standard medical organizations, but clinicians are still being asked about it, according to Albert.

Symptoms such as fatigue, pain, and “brain fog” are usually seen in 10% to 15% of patients who are fully treated for the disease, according to the CDC, which is also known as post-treatment Lyme disease syndrome. However, Albert said there have been some controversies around this condition. The society that promotes “Lyme literate” clinicians who believe the condition represents chronic, persistent 

 infection, despite a scarcity of evidence supporting this assertion is an example of this issue.

“Unsurprisingly, these tests and treatment aren’t typically covered by insurance, and they’re administered in the offices of those ‘Lyme literate’ providers on a cash-pay basis. (National Institutes of Health)-funded studies show this approach is no better than placebo, and that fatal complications of long-term antibiotic treatment have been observed,” Albert said in an interview with 

. “Nonetheless, this group is surrounded by large patient advocacy groups with scientific-sounding websites, aggressive social media campaigns, legislative lobbyists, and celebrity spokespeople. As we’ve seen in COVID-19, anti-science disinformation abounds and shapes patient interactions with health care.”

As for suggestions to know about combatting Lyme disease, Albert recommends knowing the evidence-based guidelines for treatment or having a quick, point-of-care reference that summarizes this guidance. Further, keeping an eye out for newer evidence in areas that are more generalized to the rest of the country is also highly recommended. 

 in ticks around the San Francisco Bay area doesn’t necessarily mean that clinicians in Denver need to think about Lyme disease right now. That said, the study is likely to raise interest in broader investigations of the current geographic range of the disease, and clinicians should be ready to adapt,” Albert said in an interview with 

Articles

Lyme Disease Continues to Be Top-Of-Mind for Clinicians Based on Past Summer Data

 interviewed Jennifer Andrews, MD, pediatric hematologist-oncologist at Vanderbilt University Medical and the medical director of the blood bank, on the national blood shortage in the United States. As the national inventory was beginning to recover toward the end of this summer, COVID-19 cases began to significantly increase as a result of the Delta variant, directly impacting donor turnout.

During the discussion, Andrews addressed what this blood shortage may mean for health systems, how this shortage may affect patient care and outcomes throughout the country, how the shortage may impact nurses caring for patients in health care settings, what nurses can do to help encourage patients to donate blood while receiving other health care services, and what health systems can do to further address this issue and increase blood donations.

Videos

Jennifer Andrews, MD, pediatric hematologist-oncologist at Vanderbilt University Medical and medical director of Vanderbilt University Medical’s blood bank, discusses the national blood shortage and its impact on health systems and patient care.

During National Blood Shortage, Nurses’ Efforts Can Make All the Difference

For a Contemporary Clinic interview, Anna Legreid-Dopp, PharmD, Senior Director of Clinical Guidelines and Quality Improvement at the American Society of Health-System Pharmacists discussed Pfizer’s request to approve their COVID-19 vaccine for children 5 to 11.

She talked about what parents should know, the benefits of the vaccine for children this young, and why the FDA proceeds with extreme caution when considering the approval for the 5 to 11 age group.

Anna Legreid-Dopp, PharmD, Senior Director of Clinical Guidelines and Quality Improvement at the American Society of Health-System Pharmacists discusses Pfizer’s request to approve their COVID-19 vaccine for children 5 to 11.

Expert: Pfizer Requests the Approval of COVID-19 Vaccine for Ages 5 to 11

New research has found that ketone supplements may be a novel strategy for protecting and improving brain health in people with obesity, according to a study published in 

Because those with obesity are known to be at a higher risk of developing cognitive impairment and neurodegenerative diseases, this study found that giving a ketone supplement 3 times a day for 14 days improves blood flow to the brain and enhanced aspects of cognitive function, such as working memory and processing speed.

The researchers also demonstrated that ketone supplements may be a novel therapy for protecting and improving brain health in people with obesity who are at risk of developing neurocognitive impairment, according to the researchers.

Volunteers included adults with obesity who consumed either a ketone supplement or a taste-matched placebo supplement 3 times per day 15 minutes before breakfast, lunch, and dinner. The participants were randomly assigned to take the supplement or the placebo for the first 14-day period before switching to the other condition for another 14-day period. All meals and snacks were provided by the researchers for both 14-day intervention periods.

Cognitive function was measured using validated tests via an iPad application and brain blood flow was measured using a duplex ultrasound of neck arteries. Following this, blood samples were taken to measure hormones that the study authors likened to fertilizer for the brain, helping neurons grow and improving cognitive function.

“Once validated with a larger group of people, we expect that these supplements can be used to protect and improve brain health in people with obesity,” said first study author Jeremy Walsh, MD, in the press release.

Ketone supplement might be a novel therapeutic for boosting brain function in obesity. EurekAlert! October 4, 2021. Accessed October 5, 2021. 

https://www.eurekalert.org/news-releases/930078

The researchers also demonstrated that ketone supplements may be a novel therapy for protecting and improving brain health in people with obesity who are at risk of developing neurocognitive impairment.

Study: Ketone Supplement May Be Therapeutic for Boosting Brain Function in Obesity

interviewed Lea Davis, PhD, an associate professor of medicine in the Department of Medicine at Vanderbilt University Medical Center and an investigator in the Vanderbilt Genetics Institute, on a recent study she co-authored that was published in 

 on the epidemiology of functional seizures among adults treated at a university hospital.

During the discussion, Davis explained why women have a higher statistical likelihood of experiencing functional seizures than men.

Lea Davis, PhD, of the Vanderbilt University Medical Center and Vanderbilt Genetics Institute, explained why women have a higher statistical likelihood of experiencing functional seizures than men. 

Expert: Women Have an Increased Likelihood of Experiencing Functional Seizures

A new study from researchers at the University of Cambridge and Addenbrooke’s Hospital found that most patients who contracted COVID-19 while in the hospital did so from other patients rather than from health care workers.

The research team analyzed data between March and June 2020 and identified 5 wards at Addenbrooke’s Hospital in which multiple individuals, including patients and health care workers, tested positive for COVID-19 within a short period of time, insinuating an inner outbreak may occurred, according to the study.

The team used new statistical methods that combine viral genome sequence data with clinical information about the locations of individuals to help look at where the data were consistent with transmission occurring between individuals in the hospital.

The results of the study showed that the patients who were infected in the hospital were mostly infected by other patients rather than by the hospital staff, according to the authors. Additionally, out of 22 cases in which the patients were infected in the hospital, 20 were the result of the virus spreading between patients, according to the study.

“The fact that the vast majority of infections were between patients suggests that measures taken by hospital staff to prevent staff transmitting the virus to patients, such as the wearing of masks, were likely to have been effective,” said lead study author Chris Illingworth, MD, in a press release. “But it also highlights why it is important that patients themselves are screened for COVID-19 regularly, even if asymptomatic, and wear face masks where possible.”

In contrast, health care workers were almost as likely to be infected by patients as they were by other health care workers, according to the study. Further, a trend was found toward individuals either infecting no one else or infecting multiple other people, with just over one-fifth of patients causing 80% of the infections.

“Preventing new cases of hospital-based infection is a critical part of our work.Here we have shown that analyzing clinical and viral genome sequence data can produce insights that inform infection control measures, which are so important for protecting patients and health care workers alike,” said co-lead author William Hamilton, MD, in the press release.

Hospital-acquired COVID-19 tends to be picked up from other patients, not from healthcare workers. University of Cambridge. August 24, 2021. Accessed August 25, 2021. 

https://www.cam.ac.uk/research/news/hospital-acquired-covid-19-tends-to-be-picked-up-from-other-patients-not-from-healthcare-workers

Study: Hospital-acquired COVID-19 Picked Up Through Other Patients Rather Than Health Care Workers

Children in the United States 15 years of age or younger living in the Midwest have the highest body mass index (BMI) levels on average, whereas those in the Western United States have the lowest, according to a study published in 

. The investigators said the results of the study suggest regional differences may play a role in the development of childhood obesity.

"If we know the factors that affect children's body size, we can help prevent them from becoming overweight or obese," said the study's senior author Dana Dabelea, MD, PhD, professor of pediatrics and epidemiology at the Colorado School of Public Health and director of the LEAD Center, in a press release. "This study looked at factors related to children's body size, like where children live, how much they weighed at birth, and their ethnic background."

The study also found that a higher birthweight and lower levels of formal education among mothers was associated with a higher BMI in children. Further, Black and Hispanic children had a higher BMI than non-Hispanic white children in some parts of the United States, but not all.

To conduct the research, investigators drew their study population from the Environmental influences on Child Health Outcomes Program, which investigates the effects of environmental exposures on the health of children. More than 14,000 children were enrolled in the study, with the investigators studying their height and weight between the years 2000 and 2018, calculating BMI based on these data.

According to the investigators, children in the Midwest had the highest average BMI, followed by the Northeast, the South, and the West. This connection between geographical regions and BMI is not well understood, according to the study, especially when studying the BMI of children.

Although adult data show diet quality and time doing moderate-to-vigorous exercise are higher in the West and Northeast compared to the South and Midwest, other studies have shown no regional variation in physical activity, according to the authors of the current study. Further, environmental factors such as density of fast food restaurants, supermarkets, and recreation facilities have been linked to childhood BMI, according to the investigators, but there is currently little evidence of regional variation. The study authors hope that their findings will lead to additional research further investigating why BMI varies by region.

"For example, researchers could study whether children's eating habits and their physical activity levels also vary based on the area they live in," Bekelman said in the release. "Another next step is to find out why there are racial and ethnic differences in BMI in some areas but not others."

Study finds body mass index for children greatest in Midwest, least in West [news release]. Science Daily; September 1, 2021. Accessed September 7, 2021. 

https://www.sciencedaily.com/releases/2021/09/210901142710.htm

The study also found that a higher birthweight and lower levels of formal education among mothers was associated with a higher BMI in children.

Body Mass Index of Children Highest in Midwest, May Be Linked to Regional Factors

For individuals driving with groups outside their households or using ride-share services, keeping the windows rolled down and wearing masks can decrease the risk of spreading COVID-19, according to research results from the University of Surrey in the United Kingdom.

A team at the university’s Global Centre for Clean Air Research (GCARE) used sensors to monitor the concentration of pollution particles to map how those particles varied during different settings in the vehicle and to evaluate exposure doses for 3 different ventilation settings. They evaluated scenarios with the air conditioning on and using fresh air, with air conditioning on and using air recirculation, and the windows open.

The team found that maintaining a continuous intake of fresh air by keeping the windows open while also wearing a mask is the best way to guard against the transmission of COVID-19, according to a statement.

However, this scenario also increases occupants’ exposure to toxic air pollution particles.

This creates a dilemma because guarding against air pollution in turn increases the risk of COVID-19. The study results showed that the probability of transmission increased by 28.5% when windows were closed and air recirculation was switched on.

To balance both these issues, the team found that the best chance of remaining safe from both air pollution and COVID-19 was to keep the windows closed while running the air conditioning on ambient mode, in which it draws in fresh air from outside. This approach avoids external air pollution while minimizing exposure to COVID-19.

Lead author Prashant Kumar, PhD, founding director of GCARE at the University of Surrey, said in the statement research like this is essential to end the COVID-19 pandemic.

“It’s vital that the scientific community provides society with the data it needs so we can learn from the painful experience of the past 2 years,” he said. “Our research found that if your priority is to reduce the risk of contracting COVID-19, wearing a mask and keeping car windows open is the ideal approach.”

The combination of mask wearing and keeping windows open is best for reducing COVID-19 risk in cars, finds a new study. University of Surrey. News release. August 24, 2021. Accessed August 27, 2021. 

https://www.surrey.ac.uk/news/combination-mask-wearing-and-keeping-windows-open-best-reducing-covid-19-risk-cars-finds-new-study

Guarding against external air pollution while reducing the risk of infection when driving presents a challenge. 

Keeping Windows Down, Wearing Masks Reduces COVID-19 Risk in Cars

 interviewed Melody Butler, BSN, RN, CIC, founding executive director of Nurses Who Vaccinate, on the FDA’s completion of its review of the biologics license application for the Pfizer-BioNTech COVID-19 vaccine and its potential impact on nurses who are working to support the COVID-19 vaccination process.

During the discussion, Butler addressed what the final approval of the Pfizer-BioNTech COVID-19 vaccine means for the ongoing vaccination process, whether anything will change for nurses involved in COVID-19 vaccinations with this FDA approval, how nurses have been able to help the country get through the struggles of the past year, and how a nurse interested in getting involved in COVID-19 vaccination efforts might be able to do so.

Melody Butler, BSN, RN, CIC, founding executive director of Nurses Who Vaccinate, discusses the FDA’s completion of its review of the BLA for the Pfizer-BioNTech COVID-19 vaccine, and its potential impact on nurses who are working to support the COVID-19 vaccination process.

How the FDA Approval of the Pfizer COVID-19 Vaccine May Impact the Work of Nurses Involved in Ongoing Vaccinations

Alcohol—in quantities as small as a single glass of wine—can quickly and significantly raise an individual’s risk for atrial fibrillation (AF), according to a study published in 

. The investigators said these findings run counter to existing theories that alcohol can be cardioprotective, and instead suggest that reducing or avoiding alcohol might help to mitigate adverse effects.

“Contrary to a common belief that atrial fibrillation is associated with heavy alcohol consumption, it appears that even 1 alcohol drink may be enough to increase the risk,” said Gregory Marcus, MD, MAS, professor of medicine in the Division of Cardiology at the University of California San Francisco (UCSF), in a press release. “Our results show that the occurrence of atrial fibrillation might be neither random nor unpredictable. Instead, there may be identifiable and modifiable ways of preventing an acute heart arrhythmia episode.”

AF is the most common heart arrhythmia observed clinically. However, until now, research has largely focused on therapies for treating the disease or risk factors for developing it, as opposed to factors that determine when and where an episode might occur, according to the investigators. AF can result in decreased quality of life, significant health care costs, stroke, and death.

The study authors analyzed data from 100 patients with documented AF who consumed at least 1 alcoholic drink a month. Participants were recruited from the general cardiology and cardiac electrophysiology outpatient clinics at UCSF. Individuals with a history of alcohol or substance use disorder, those with certain allergies, and those who were changing treatment for their heart condition were excluded from the study.

In order to conduct the study, participants wore an electrocardiogram (ECG) monitor for approximately 4 weeks and pressed a button whenever they had a standard alcoholic drink. Each individual was also fitted with a continuously recording alcohol sensor, and blood tests that reflected alcohol consumption over the previous weeks were administered periodically. Participants consumed a median of 1 drink per day throughout the study period.

The investigators found that 1 alcoholic drink resulted in a 2-fold increase in risk of an AF episode, with 2 or more drinks within the preceding 4 hours leading to a 3-fold increase in risk. AF episodes were also associated with an increased blood alcohol concentration.

“The effects seem to be fairly linear: the more alcohol consumed, the higher the risk of an acute AF event,” Marcus said in the release. “These observations mirror what has been reported by patients for decades, but this is the first objective, measurable evidence that a modifiable exposure may acutely influence the chance that an AF episode will occur.”

The authors note that the study was limited to patients with established AF and did not include the general population. Further, there is a potential limitation of participants possibly forgetting to press their monitor buttons or minimizing the number of button presses due to embarrassment. This would not influence alcohol sensor readings, however, minimizing the cause for concern.

Alcohol can cause immediate risk of atrial fibrillation [news release]. EurekAlert; August 30, 2021. Accessed August 31, 2021. 

https://www.eurekalert.org/news-releases/926795

The investigators said these findings run counter to existing theories that alcohol can be cardioprotective, and instead suggest that reducing or avoiding alcohol might help to mitigate adverse effects.

Alcohol Consumption Can Quickly Increase Risk of Atrial Fibrillation in Certain Patients

 found that the adverse effects (AEs) of the Pfizer-BioNTech vaccine against COVID-19 are likely to be mild to moderate and clear up quickly in 12- to 15-year-olds at high risk of complications from the infection because of certain co-existing conditions.

The data represent teens most likely to benefit from the vaccination and are meant to offer reassurance to parents and clinicians, even with small study numbers, according to the study authors.

Although healthy children with COVID-19 infection generally have a mild illness, some coexisting conditions, such as neurological conditions, are associated with severe disease. The high-risk children were then protected to reduce their risk of infection and would not have been included in the early vaccine safety studies.

Because there were unknown AEs of vaccination in the group, the study authors requested that the parents of 27 of these children report any AEs of subsequent COVID-19 vaccinations for each child. The children were between 12 and 15 years of age, 16 of whom were male and 21 were white, with 3 hospital inpatients. They had neurological conditions, such as cerebral palsy, and a range of coexisting medical conditions, such as epilepsy and immune deficiency, for which they were receiving drug treatment of various kinds, according to the study authors.

Reported AEs all were mild to moderate except for 1 child who experienced severe fatigue and discomfort combined with increased agitation. Further, 1 family reported that seizure type changed to clusters, but this was resolved in a week.

After the first dose, there were 8 events in 6 children, which were resolved within 72 hours. These symptoms included mild rash, headache, diarrhea, presumed sore throat, neck pain, difficulty sleeping, and low blood glucose. After the second dose, 8 additional events occurred in 5 children: diarrhea, vomiting, armpit swelling, and blisters around the mouth.

In addition, paracetamol use after the first dose was high and fever was more common than reported in studies of adults; however, all recorded AEs cleared up within a week, according to the study authors.

“Numbers were small, but these data are especially important as they are representative of the children who are most likely to benefit from vaccination, and parents and clinicians may have concerns regarding an increased risk of unexpected events,” the study authors said in a press release. “The parents choosing to take up this vaccination at a time when it was off-license, with little available safety data, did so because they [and their clinicians] believed their children to be at high risk of COVID-19 disease. Indeed, many had been shielding and felt that vaccination would make a significant difference to their lives.”

Pfizer jab side effects in 12-15 year olds at high risk of COVID-19 complications, mild to moderate. EurekAlert! August 26, 2021. Accessed August 27, 2021. 

https://www.eurekalert.org/news-releases/926429

Although healthy children with COVID-19 infection generally have a mild illness, some coexisting conditions, such as neurological conditions, are associated with severe disease. 

Study Finds Mild to Moderate Adverse Effects From Pfizer Vaccine in Youth at High Risk of COVID-19 Complications

A computational evaluation of drug delivery devices, such as inhalers, has found several ways that they can be improved, according to research published in 

By damaging environmental conditions in highly populated areas around the world, increased air pollution has exacerbated health risks for patients with pulmonary diseases, such as asthma or chronic obstructive pulmonary disease (COPD), according to the study authors. Many of these patients rely on pressurized metered-dose inhalers or drug powder inhalers to receive their medications, although these devices do not always optimally deliver the treatments.

“[Inhalers’] efficacy remains a great concern as only one-third of the total drug reaches the affected regions of the lungs,” said study co-author Suvash C. Saha, PhD, from the University of Technology Sydney, in a press release. “As a result, the drug loss and cost of the treatment become higher.”

To understand the efficacy of these systems, the researchers said predicting aerosolized or powdered drug deposition in the lungs is essential. To investigate this, the research team created a computational model to evaluate where improvements can be made.

They presented the findings in a realistic human lung model, according to the press release. Using computational fluid dynamics, the study found that more drug particles are deposited in the right bronchi than in the left, which is curved because of its proximity to the heart. The findings suggest that the drugs should contain smaller-sized particles to enable their reach in the distal bronchi.

“At higher flow rates, inertial impaction is found to be responsible for deposition of drug particles in the upper portion of the airways but with lesser availability of drug particles in the distal region of the airways,” said co-author Akshoy Ranjan Paul, PhD, in the press release. “Additionally, at lower flow rates, there is not enough momentum to carry particles to the distal region. As a result, there should be an optimum flow rate [to achieve] maximum reach of drug particles in the distal region.”

Computational Evaluation of Drug Delivery Reveals Room for Inhalers Improvement. News release. 

; August 10, 2021. Accessed August 25, 2021. 

https://publishing.aip.org/publications/latest-content/computational-evaluation-of-drug-delivery-reveals-room-for-inhalers-improvement/

Researchers found that more drug particles are deposited in the right bronchi than in the left bronchi, which is curved because of its proximity to the heart.

Evaluation of Inhaler Drug Delivery Finds Room for Improvement

New research from the American Heart Association (AHA) has found that cutting just 200 calories a day combined with moderate exercise had more of a benefit than exercise alone for older obese adults. Additionally, among this population, combining aerobic exercise with a moderate reduction in daily calories resulted in greater improvements in aortic stiffness versus exercise only or exercise plus a more restrictive diet.

Modifiable lifestyle factors, such as a healthy diet and regular physical activity, may help balance age-related increases in aortic stiffness. Although aerobic exercise generally has favorable effects on aortic structure and function, previous studies have shown that exercise alone may not be sufficient to improve aortic stiffness in older adults with obesity, according to the AHA.

“This is the first study to assess the effects of aerobic exercise training with and without reducing calories on aortic stiffness, which was measured via cardiovascular magnetic resonance imaging to obtain detailed images of the aorta,” said Tina E. Brinkley, PhD, lead author of the study, in a press release. “We sought to determine whether adding caloric restriction for weight loss would lead to greater improvements in vascular health compared to aerobic exercise alone in older adults with obesity.”

The controlled trial included 160 sedentary adults between 65 and 79 years of age with obesity, with 74% being female and 73% being white. The participants were randomly assigned to 1 of 3 intervention groups for 20 weeks: exercise only with their regular diet, exercise plus moderate calorie restriction (reduction of approximately 250 a day), or exercise plus more intensive calorie restriction (reduction of approximately 600 calories a day).

The 2 calorie-restricted groups received pre-made lunches and dinners with less than 30% of calories from fat and at least 0.8 grams of protein per kg of their ideal body weight. These meals were prepared under the direction of a registered dietitian, with participants making their own breakfasts according to the dietitian-approved menu. Further, all participants in the study received supervised aerobic exercise training 4 days per week for the duration of the 20-week study at the Geriatric Research Center at Wake Forest School of Medicine.

The results showed that weight loss of nearly 10% of total body weight or about 20 pounds over the 5-month study period was associated with significant improvements in aortic stiffness, only in the participants assigned to the exercise plus moderate calorie restriction group.

The exercise plus moderate calorie restriction group had a 21% increase in distensibility and an 8% decrease in pulse wave velocity.

None of the aortic stiffness measures changed drastically in either the exercise-only group or the exercise plus more intensive calorie restriction group.

Changes in body mass index, total fat mass, percent body fat, abdominal fat ,and waist circumference were greater in both of the calorie-restricted groups compared to the exercise-only group.

Weight loss was similar between the calorie-restricted groups despite nearly 2 times fewer calories in the intensive calorie restriction group.

“Our findings indicate that lifestyle changes designed to increase aerobic activity and moderately decrease daily calorie intake may help to reduce aortic stiffness and improve overall vascular health,” Brinkley said in a press release. “However, we were surprised to find that the group that reduced their calorie intake the most did not have any improvements in aortic stiffness, even though they had similar decreases in body weight and blood pressure as the participants with moderate calorie restriction.”

Brinkley added that these results indicate that combining exercise with modest calorie restriction versus a more intensive calorie restriction or no-calorie restriction likely maximizes the benefits on vascular health, while also optimizing weight loss and improvements in body composition and body fat distribution.

“The finding that higher-intensity calorie restriction may not be necessary or advised has important implications for weight loss recommendations to improve cardiovascular disease risk in older adults with obesity,” Brinkley said in a press release.

Cutting 200 calories daily and exercising may improve heart health in obese older adults. American Heart Association. August 2, 2021. Accessed August 2, 2021. 

https://newsroom.heart.org/news/cutting-200-calories-daily-and-exercising-may-improve-heart-health-in-obese-older-adults

Additionally, among this population, combining aerobic exercise with a moderate reduction in daily calories resulted in greater improvements in aortic stiffness versus exercise only or exercise plus a more restrictive diet.

Reducing Daily Calories by 200, Exercise Associated With Heart Health Improvements in Obese Older Adults

interviewed Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, on a recent study she co-authored that was published in the 

 on the use of cannabis in treating symptoms of obsessive-compulsive disorder (OCD).

During the discussion, Cuttler addressed the limitations of her research in relation to the analyzed data being pulled from a medical cannabis app, which is mainly used by experienced cannabis users to track their consumption, and thus may not be indicative of its efficacy for the broader public—specifically those who are naïve to cannabis.

Additionally, she explains that the findings may overrepresent individuals who find cannabis to be effective at the treatment of OCD symptoms, because people who don’t find cannabis effective would likely stop using it and subsequently also stop using the app to track their use of the drug.

Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, discusses some of the limitations present in her research into the use of cannabis to treat obsessive-compulsive disorder.

Expert: Variability is Present in the Efficacy of Cannabis as a Treatment for OCD

Osteoporosis is a systemic skeletal disease involving low bone mass and microarchitectural deterioration of bone tissue, resulting in increased bone fragility and fracture risk.

Bone density corresponds to the amount of mineral within a volume, and bone quality depends on architecture, bone matrix composition, bone turnover, damage accumulation, and mineralization.

 Osteoporosis develops silently over years before it becomes apparent through bone mineral density (BMD) screening or fractures. Fragility fractures are the main physical manifestation and occur at diverse sites, such as the distal radius, proximal femur, and vertebral bodies.

Recommend a dual-energy x-ray absorptiometry (DXA) to check BMD and screen for osteoporosis in the following patients at high risk

Adults on chronic glucocorticoid therapy, such as oral prednisone ≥5 mg/day for 3 or more months or an equivalent

Individuals aged 50 years and older with a recent low-trauma fracture

Other patients may also be good candidates for a DXA to check BMD, especially those with multiple risk factors. Assess risk factors to see if BMD testing is warranted with a thorough history in men aged 50 to 69 years or postmenopausal women younger than age 65 years with the following medical concerns

Excessive alcohol intake of 3 or more drinks per day

Radiographic osteopenia (DXA T-score between -1 and -2.5)

Taking medications that decrease BMD, such as aromatase inhibitors, glucocorticoids, GnRH agonists, phenobarbital, or phenytoin

There are 3 different categories of bone health for classification purposes:

: BMD 1 standard deviation or less below that of young white women reference mean (ie, T-score of −1 or greater)

: BMD between 1 and 2.5 standard deviations below that of young white women reference mean (ie, T-score between −1 and −2.5)

: BMD more than 2.5 standard deviations below that of young white women reference mean (ie, 

There are specific indications for pharmacotherapy:

T-score of −2.5 or less (ie, or worse) in distal third of radius, femoral neck, spine, or total hip

T-score from −1 down to −2.5 in distal third of radius, femoral neck, spine, or total hip, and fragility fracture of hip or spine

T-score from −1 down to −2.5 in distal third of radius, femoral neck, spine, or total hip, and FRAX score shows that that 10-year probability of hip fracture is 3% or greater or the 10-year probability of a major osteoporotic fracture is 20% or more

There are different approaches to screening. Some think that it is not necessary to check a DXA in patients who are receiving osteoporosis treatment because women receiving osteoporosis treatment may have reduced fractures, regardless of the impact on BMD. Others recommend continuing to check a DXA during treatment until BMD has stabilized or after 3 to 5 years of bisphosphonate therapy.

There are several pharmacotherapeutic options for osteoporosis treatment. Medications are classified mechanistically as antiresorptive agents that slow bone breakdown or anabolic “bone building” agents.

Antiresorptive medications include intravenous (IV) and oral bisphosphonates; selective estrogen receptor modulators (SERMs), specifically raloxifene and calcitonin nasal spray; and subcutaneous denosumab. Romosozumab-aqqg is a subcutaneously administered monoclonal antibody with anabolic/antiresorptive properties.

Anabolic agents are the subcutaneous parathyroid hormone analogs abaloparatide and teriparatide. Oral bisphosphonates, such as alendronate or risendronate, are generally preferred first-line agents for osteoporosis prevention and treatment in most patients. The choice of osteoporosis medication depends on multiple factors, including cost, osteoporosis fracture risk and severity, route of administration, and tolerability. The 

details the adverse effects (AEs), contraindications, and dosing of osteoporosis medications.

There are specific circumstances for which other osteoporosis medications may be considered.Raloxifene may be an option for women at high risk for breast cancer and in women who cannot tolerate bisphosphonates or denosumab.

 Calcitonin may be an option to reduce acute bone pain associated with vertebral fractures as well.

Patients with severe osteoporosis and very high fracture risk who cannot tolerate or respond poorly to IV and oral bisphosphonates may be candidates for anabolic agents abaloparatide or teriparatide or alternatively romosomuzab.

 Denosumab is an alternative to anabolic agents for high-risk older patients who cannot take or tolerate or respond poorly to bisphosphonates.

AE indicates adverse effect; BMD, bone mineral density; IV, intravenous; PTH, parathyroid hormone; PTHrP, parathyroid hormone-related protein; and SERM, selective estrogen receptor modulator.

Osteoporosis is a common medical condition that increases fracture risk and requires individualized screening and management. Lifestyle management includes adequate vitamin D and calcium intake, increased physical activity, and smoking cessation. Oral bisphosphonates are first line for most patients with osteoporosis. Other agents may be reserved for high-risk patients who are intolerant or poorly responsive to bisphosphonates. Follow-up BMD testing is recommended to monitor response to therapy.

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 is a clinical associate professor at Pace University’s College of Health Professions in New York, New York.

 is a clinical professor at a department chairperson at Pace University’s College of Health Professions.

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Osteoporosis is a common medical condition that increases fracture risk and may require patients to make lifestyle changes.


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