Brandon May

and ulcerative colitis (UC) or Crohn’s disease (CD) is associated with higher in-hospital mortality and greater health care costs and resource utilization, according to a study from California researchers published in the

European Journal of Gastroenterology & Hepatology

Considering mortality outcomes and health care costs are generally higher among patients with later disease diagnosis and co-occurring diseases, the findings from this study indicate the importance of early screening strategies for inflammatory bowel disease (IBD) or other gastrointestinal-related disorders in patients with

“IBD is a chronic inflammatory disease of the gastrointestinal tract that is associated with increased risks of infections as a result of both the disease process itself as well as the immunosuppressive therapies we use to treat the disease, [and] hospitalized patients with IBD are at particularly high risk of concurrent infectious complications, especially with

infection,” lead study author Robert Wong, MD, MS, of the Highland Hospital in Oakland, California, told

. “Our study demonstrates that infection with

among hospitalized IBD patients is associated with significantly increased risk of death and significantly increased risk of health care resource utilization.”

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The co-occurrence of Clostridium difficile (C. difficile) and ulcerative colitis or Crohnâ€™s disease is associated with higher in-hospital mortality and greater health care costs and resource utilization, according to a recent study.

In-Hospital Mortality, Higher Costs Linked to Clostridium difficile with Ulcerative Colitis/Crohn's Disease

In 2006, a 2-dose varicella vaccine schedule was implemented in the United States to prevent childhood contraction of the varicella-zoster virus, the main herpesvirus that infects humans and causes chickenpox.

Researchers from the CDC recently pooled retrospective data that demonstrated an 85% decrease in US chickenpox cases between 2005 and 2006, as well as between 2013 and 2014, related to this updated vaccine schedule.

Vaccination is widely accepted as the cornerstone of

prevention. According to CDC’s report, children between 5 and 14 years received the 2 vaccine doses more frequently and also showed the greatest reduction of chickenpox cases. CDC data also showed that 3.5 million cases of chickenpox have been prevented each year thanks to vaccination, and around 9000 hospitalizations and 100 deaths have also been prevented.

Vaccination measures have been increasingly implemented to ensure elimination of this common childhood illness. In addition, the effectiveness of the 2-dose vaccination schedule has improved understanding of the condition.

“Further reduction in the number of varicella cases will provide states with increased opportunities for enhancing varicella surveillance and improving completeness of reporting to monitor impact of the vaccination program,” wrote the authors of the study, which was published in the CDC’s

The incubation stage of chickenpox is about 10 to 21 days after exposure to the virus. Fever is typically the initial symptom, followed by the pruritic vesicular rash. Lesions that form from the rash develop crusts that fall off about 1 to 2 weeks later. Following crusting of these lesions, the patient is no longer contagious. Those who have experienced chickenpox tend to have lifelong immunity against the disease.

Complications from chickenpox range from minor to severe and depend on a number of individualized factors, most importantly the patient’s health status prior to the development of the condition. Chickenpox complications include meningitis, pneumonia, sepsis, secondary bacterial skin infection, and death. Pregnant women who contract chickenpox during pregnancy can also place the unborn fetus at risk for congenital varicella syndrome, a condition known to cause birth defects. Congenital varicella syndrome also has a 30% mortality rate.

For otherwise healthy children who develop chickenpox, symptomatic management of the condition is standard. Medications that may ease symptoms include antihistamines and acetaminophen. To discourage scratching of the lesions while assisting in reducing the development of secondary skin infections, trimming the child’s fingernails is important. Additionally, infected individuals should avoid contact with unvaccinated children to prevent transmission.

Although chickenpox tends to be more severe for infants, adults, and individuals with compromised immune systems, children are still the prime recipients of the chickenpox vaccine. Even though this disease has been reduced, infection with herpes zoster virus still affects around 1 in 3 individuals. For children who are relatively healthy, chickenpox is a mild disease.

The CDC recently pooled retrospective data that demonstrated an 85% decrease in US chickenpox cases between 2005 and 2006, as well as between 2013 and 2014, related to this updated vaccine schedule.

2-Dose Varicella Vaccine Drastically Curbing Chickenpox

Past research has shown that conditions such as heart disease, obesity, and diabetes occur more frequently following menopause. However, recent study results suggest the exact opposite.

According to study findings recently published in the

Journal of the American Heart Association

, women are at greater risk for developing stroke, heart disease, and diabetes prior to the onset of menopausal symptoms.

Menopause is a natural process characterized by the marked and steady decline of female reproductive hormones, namely estrogen and progesterone. This process typically occurs in women between ages 45 and 55 and produces symptoms such as hot flashes, vaginal dryness, night sweats, and sometimes, weight gain.

Menopause is also linked to an increased risk of metabolic syndrome, with obesity being a prime condition related to the disorder. It’s well known that obesity increases the risk of heart disease as well as stroke and diabetes. A history of physical inactivity and smoking may also increase the risk of developing these diseases prior to menopause.

The 10-year study involved 1470 white and African-American women with the aim of evaluating the causes and effects of typical heart disease symptoms. Each participant experienced menopause at some point during the duration of the study.

Researchers took into account the women who used hormone-replacement therapy (HRT) during the study period. Following analysis of the data, they saw greater changes in serum cholesterol, blood glucose, and triglycerides prior to menopause onset. African-American women showed a greater increase in blood pressure after menopause, while white American women saw a noticeable jump in waist circumference.

The researchers are still unsure why they saw a greater cardiovascular risk in premenopausal versus postmenopausal women.

“This may mean that the higher cardiovascular risk seen among postmenopausal women could be related to changes in that time before menopause and less so to the changes after menopause has occurred,” theorized Mark DeBoer, MD, of the University of Virginia School of Medicine.

Dr. DeBoer and his colleagues suggested that clinicians should counsel premenopausal patients on the importance of lifestyle changes for reducing cardiovascular disease risk following menopause. Diet, exercise, smoking cessation, and stress reduction are all important educational facets of an integrated and holistic game plan for heart disease prevention, regardless of age or gender.

Notably, the study didn’t take into account specific HRTs that the women used or the hormonal levels of participants. It’s well known that some treatments for menopause symptoms have been linked to an increased risk of stroke and heart attack, so prescribing clinicians should be aware of the effects of certain HRTs and their patients’ health status and history before prescribing an artificial hormone treatment.

Patient education and cardiovascular screening are integral aspects of heart disease prevention for both genders, and they should be increasingly emphasized to women between ages 45 and 55 during the perimenopausal interval. Still, further research is required to determine more probable causes of heart disease and diabetes among menopausal women.

Cardiovascular Risks May Be Greater Before Menopause

Stress reduction may be an undervalued strategy in helping patients avoid cardiac-related event recurrence.

Current approaches to cardiac rehabilitation typically center on the use of prescription medications, the introduction of daily light-to-moderate physical activity, and adopting a heart-friendly diet. Stress management, while complementary, may also provide powerful benefit when incorporated into a multifaceted cardiac rehabilitation approach.

The findings of a recent study published in

suggest that a fourth component—stress reduction&mdash;is an important strategy for maintaining long-term recovery and reducing the incidence of a second cardiac-related event.

Researchers from Duke Health and UNC Health Care reviewed data from 151 patients with coronary heart disease. Half the cohort received the standard of care, while the remaining half attended a supplementary 90-minute stress management class weekly. These classes consisted of:

After a 3-year follow-up, a third of patients (33%) who received standard care alone experienced a second adverse cardiac event, including chest pain, stroke, heart attack, or all-cause death. Meanwhile, just 18% of patients who underwent stress management classes experienced adverse events.

To assess the magnitude of the benefit of cardiac rehabilitation programs, the researchers also evaluated a second patient group that had the same eligibility requirements but chose to forgo cardiac rehabilitation altogether. Of those patients, 47% either experienced a second heart attack of died.

“There is not a single gold standard for measuring stress, which is part of the problem,” Dr. admitted noted study co-author James Blumenthal, PhD, clinical psychologist and professor in psychiatry and behavioral science at Duke University, in a press release. “The stress factor was more nebulous and patients were reluctant to admit they were stressed. Clinicians should get patients to recognize stress is important to their recovery. Simply recognizing how stressful having heart disease can be is an important step.”

Clinicians can play an integral role in a patient’s cardiac rehabilitation, as they understand the importance of both standard and complementary approaches to heart disease management.

Nurse practitioners (NP) in the retail setting can utilize their position in the community and provide much-needed education to cardiac patients regarding the significance of diet, exercise, and stress management for reducing the likelihood of a subsequent cardiac episode.

NPs can also advise patients on the value of behavioral changes that can help to improve cardiac outcomes, including reducing alcohol, the importance of smoking cessation, eliminating the consumption of trans fats, and the value of managing stress.

Although the events that cause stress may be unavoidable, the way a patient responds to these situations is what determines the amount of stress he or she experiences.

Beyond lifestyle changes NPs can encourage patients to take part in stress management courses or refer them to another provider for more in-depth psychological stress therapy.

Brandon May

Articles

In-Hospital Mortality, Higher Costs Linked to Clostridium difficile with Ulcerative Colitis/Crohn's Disease

2-Dose Varicella Vaccine Drastically Curbing Chickenpox

Cardiovascular Risks May Be Greater Before Menopause

Clinicians Prove Useful in Helping Cardiac Rehab Patients Reduce Stress