Children and young adults with Down syndrome are 4 times more likely to be diagnosed with diabetes, according to the findings of a study published in 

The study, by Queen Mary University of London and King’s College London, examined just under 10,000 individuals with Down syndrome and almost 40,000 individuals without. Data from the UK Clinical Practice Research Datalink, from 1990 to 2020, were used.

This is the first time that investigators examined the incidence of diabetes and obesity in Down syndrome across one of the disorder’s biggest cohorts.

“This is the largest study ever conducted in Down syndrome patients to show that they have unique needs with regards to diabetes and obesity, and that screening and intervention, including a healthy diet and physical activity, at younger ages is required compared to the general population,” Andre Strydom, MRCPsych, MSc, PhD, professor in intellectual disabilities at King’s College London, said in a statement. “The results will help to inform the work of NHSE's LeDeR program to reduce inequalities and premature mortality in people with Down syndrome and learning disabilities.”

Investigators found that children aged 5 to 14 years with Down dyndrome have about a 10 times greater chance of having type 2 diabetes (T2D) than children without. They think, based on the results, that children with Down syndrome must be more closely monitored for early signs of diabetes, excess weight, and obesity.

Investigators emphasize that identifying diabetes as early as possible helps individuals with the complications that diabetes can bring later in life.

Despite the findings, investigators found that individuals with Down syndrome were typically diagnosed with diabetes much earlier. The average age of diagnosis of diabetes for an individual with Down syndrome was aged 38 years compared to with aged 53 years for those without the genetic disorder.

Excess body weight and genetics could be the reason behind the increased risk, investigators said.

Individuals with Down syndrome were found to have a higher body mass index and reach its peak at an earlier age, which increases the risk of T2D at a younger age.

Additionally, investigators found that there was also an increased risk of T1D, because of extra chromosomes and issues with the immune system for those with Down syndrome.

“This study highlights the importance of early screening for diabetes and weight issues in [individuals] with Down syndrome, especially children and young adults,” Li Chan, PhD, reader in Molecular Endocrinology and Metabolism and Consultant Pediatric Endocrinologist at Queen Mary University of London, said in the statement.

“Currently there is a sizeable gap in research into the condition, which affects around 40,000 people in the [United Kingdom],” Chan said. “To help plug this gap in knowledge, we are conducting further research into how genetics affects a[n individual] with Down syndrome’s predisposition to diabetes and obesity and hope to shed further light on this important medical issue."

Children and young adults with Down syndrome four times more likely to have diabetes. News release. Science Daily. October 4, 2022. Accessed October 17, 2022. https://www.sciencedaily.com/releases/2022/10/221004104957.htm

Articles

Investigators find that individuals aged 5 to 14 years with the genetic disorder are also at greater risk for TD2.

Study: Children, Young Adults With Down Syndrome Have 4 Times Greater Chance of Diabetes

New research from Baycrest Foundation suggests that the gut microbiome plays a role in how diet and exercise affect brain health and dementia risk. The findings could help experts optimize strategies to prevent dementia, according to the study authors.

Lifestyle interventions to reduce risk of dementia often include diet and exercise, which in turn affect the gut microbiome.

“We know that imbalances in the microbiome are associated with impaired cognition,” said lead author Noah Koblinsky, an exercise physiologist and project coordinator at Baycrest’s Rotman Research Institute (RRI), in a press release. “However, we don’t know much about the role of the microbiome when we use lifestyle interventions, such as diet and exercise, to support brain health. Can we tailor lifestyle interventions to specifically target the gut microbiome, and will this help to optimize their effects on cognition? In this review study, we aimed to address this gap in knowledge.”

The team reviewed any existing research on diet and exercise interventions that looked at both the microbiome and brain health and published their findings in 

According to the study, the gut microbiome does appear to play a role in how diet and exercise affect brain health, although more research is needed to understand exactly how.

Studies have shown that diets have a significant impact on the microbiome, with a Mediterranean-style diet appearing to have the greatest benefit to a healthy gut microbiome and brain, according to the study. For example, one study with 1200 older adults asked half the participants to follow a Mediterranean-style diet for 12 months, while the other half did not follow this diet. Those in the Mediterranean diet group showed significant improvements in cognition and had healthier microbiomes associated with better brain health.

In another study, investigators used antibiotics to “kill off” the gut microbiome in a sample of rats. They then gave the rats microbiome transplants from rats that had either been fed an unhealthy diet or a healthy diet. According to the study, the researchers found that the rats in the unhealthy diet group showed worse memory performance, as well as inflammation in the intestines and brain.

These findings support the idea that the microbiome plays a role in the way diet impacts brain health. The team found fewer studies examining exercise, but the studies that did suggest that starting exercise, specifically aerobic exercise, can lead to changes in the gut microbiome and brain health at the same time.

After this review of existing research, the team is now launching a randomized controlled trial focused on diet and exercise and are looking to secure funding to include analysis of microbiome changes.

“By better understanding how changes to the gut microbiome affect the relationship between lifestyle and brain health, we can strengthen existing lifestyle interventions and create new strategies to reduce dementia risk, helping older adults everywhere age fearlessly,” said senior author Nicole Anderson, PhD, senior scientist at the RRI, in the press release.

Research suggests gut microbiome plays a role in lifestyle’s effects on dementia risk. News release. Baycrest; October 11, 2022. Accessed October 26, 2022. 

https://www.baycrest.org/Baycrest-Pages/News-Media/News/Research/Research-suggests-gut-microbiome-plays-a-role

A Mediterranean-style diet appears to provide the greatest benefit to a healthy gut microbiome and brain.

Research Suggests Gut Microbiome Impacts Brain Health, Dementia Risk

A greater percentage of participants who worked many hours in a stressful job had scores that would qualify them for a diagnosis of moderate to severe depression compared with those working fewer hours, according to data presented in a recent study. Using advanced statistical methods, the research team created a clinical trial that accounts for multiple other factors in doctors’ personal and professional lives.

A “dose response” effect was found between hours worked and depression symptoms, with an average symptom increase of 1.8 points on a standard scale for those working 40 to 45 hours, ranging up to 5.2 points for those working more than 90 hours. The study authors concluded that among all stressors affecting physicians, working a lot of hours is a major contributor to depression.

The findings were based off studying 11 years’ worth of data on more than 17,000 first-year medical residents who were training in hundreds of hospitals across the United States. The Intern Health Study, based at the Michigan Neuroscience Institute and the Eisenberg Family Depression Center, recruits new medical school graduates each year to take part in a year of tracking their depressive symptoms, work hours, sleep, and more while completing their first year of residency, or their intern year.

The interns in the study reported a wide range of previous-week work hours, with the most common work hour levels between 65 to 80 hours per week. The Accreditation Council for Graduate Medical Education (ACGME), which sets national standards for residency programs, currently sets an 80-hour limit on residents’ work weeks, but that can be averaged over 4 weeks with possible exceptions.

Additionally, AGCME limits the length of a single shift and the number of days in a row that residents can work. The studies have shown mixed results about the impact these limits have had on resident wellness and patient safety risks.

The study authors noted that their findings point to a clear need to further reduce the number of hours residents work each week on average.

"This analysis suggests strongly that reducing the average number of work hours would make a difference in the degree to which interns' depressive symptoms increase over time, and reduce the number who develop diagnosable depression," said study senior author Amy Bohnert, PhD, a professor at the U-M Medical School, in a press release. "The key thing is to have people work fewer hours; you can more effectively deal with the stresses or frustrations of your job when you have more time to recover."

The recent study uses a design called an emulated clinical trial, which mimics a randomized clinical trial in scenarios where conducting a real randomized trial is not feasible. Due to the nature of all interns nationwide beginning at the same time of year and being subject to varying work schedules set by their programs, analyzing people going through this stage of medical trial is crucial for the clinical trial.

The study authors suggest that studies parallel to this work on physicians should be conducted in other high-stress and high-work-hour jobs.

"We would expect that the negative effect of long work hours on physician mental health would be present in other professions," Srijan Sen, MD, PhD, founder of the Intern Health Study, said in a press release.

The average age of physicians in the study was 27 years; additionally, 1 in 5 were training in surgical disciplines and 18% were from racial or ethnic groups traditionally underrepresented in the medical profession.

Furthermore, less than 1 in 20 met the criteria for moderate to severe depression at the start of the intern year. In total, 46% had a stressful life event such as family death or birth, or getting married, during their intern year. Moreover, 37% stated they had been involved in at least 1 medical error during the year.

The researchers noted that while analyzing the results, they adjusted for gender, neuroticism, pre-internship history of depression, early family environment, age, year they began internship, marital status, whether they had children, and stressful life events and medical errors during the intern year.

"National initiatives on clinician wellbeing have put increasing emphasis on the complex set of factors that affect clinician well-being, including the electronic health record, regulatory burden, resilience, workplace violence and culture," Sen said in a press release. "I think this emphasis has inadvertently led to the feeling that the problem is infinitely complicated and making real progress is hopeless. This paper demonstrates how big of an impact that the single factor of work hours has on clinician depression and wellbeing."

In stressful jobs, depression risk rises with hours worked, study in new doctors finds. ScienceDaily. October 19, 2022. Accessed October 25, 2022. 

https://www.sciencedaily.com/releases/2022/10/221019172305.htm

Data from a recent study show a clear need to further reduce the number of hours residents work each week on average to decrease the occurrence of depression.

Study: Depression Risk Rises With Hours Worked in Stressful Jobs

Estimates show sexual assault occurs every 68 seconds in the United States. In the past 10 years, there have been 15 times more sexual assault-related emergency department (ED) visits, according to the authors of a study published in 

This number is believed to outpace reports of sexual assault by law enforcement.

The number of adults (aged 18 to 65 years), who visited the ED for sexual assault increased by 51,689 between the years of 2006 and 2019.

"Sexual assault is a disturbing and prevalent trend in the U.S.,” said senior study author Erica Marsh, MD, chief of the division of reproductive endocrinology and infertility at the Center for Reproductive Medicine at the University of Michigan. “We know that people who experience sexual assault face numerous emergent health problems, but few seek emergency medical care."

The FBI reports that sexual assault (and rape) rose from 93,000 to 139,815 between 2006 and 2019. Victims are more prone to depression, suicidal thoughts, posttraumatic stress disorder, substance use, and chronic conditions than individuals who have not been assaulted.

The data shows that older people aged 46 to 65 years were more likely to be admitted to the hospital than younger people aged 18 to 25 years. Disproportionately, younger women with lower incomes sought ED help after assault.

Data suggests that 1 in 5 sexual assault survivors seek medical care, but care is often inadequate or incomplete. Additionally, few studies have looked at how individuals seek care after a sexual assault—that is what this study aimed to address.

Based on the study results, the investigators found that the number of individuals who sought ED care increased to 55,296 people in 2019—where social de-stigmatization of sexual assault during the #metoo movement of that year could be a contributing factor. The investigators noted that other factors may include how it is coded by emergency providers and a general increase in sexual assaults in the country, Marsh explained.

From 2006 to 2019, less than 1% of ED cases were classified as sexual assault.

"Although sexual assault comprises a small proportion of total emergency room visits, the magnitude of increase suggest that certain factors may be encouraging people who experience sexual assault to seek emergency care," Marsh said in the press release.

Furthermore, low-income, or government-insured, patients were found to be disproportionally admitted to the hospital. However, the disparity between visits and hospital charges related to sexual assault is stark—as of 2019, sexual assault-related costs were $233 million.

But hospital admission rates decreased in this time. Between the 13-year study period, sexual assault hospital admissions decreased by 8%, which may be due to lower-acuity cases. Also, patients chose to avoid the hospital for confidentiality purposes—or because there was less availability at the hospital.

The CDC suggest that more than 50% of women are affected by sexual assault, and more than 33% of men could be affected in their lifetimes.

"Tracking these trends will help inform policies and potential strategies for better supporting these individuals and for reaching others who may be less likely to seek emergency medical care for various reasons,” study authors wrote.

University of Michigan. Sexual assault-related ER visits increase more than tenfold. Science Daily. October 20, 2022. Accessed on October 25, 2022. https://www.sciencedaily.com/releases/2022/10/221020112820.htm

Data show that an increase in sexual assault-related emergency department visits in 2019 may be due to social de-stigmatization of sexual assault during the #metoo movement of that year.

De-Stigmatization of Sexual Assault May Contribute to Related Increase in Emergency Department Visits

Drinking 2 to 3 cups of coffee a day is linked to a longer lifespan compared with those who do not drink coffee, according to findings of a study published in the 

European Journal of Preventive Cardiology

The findings also demonstrated a lower risk of cardiovascular disease (CVD) compared with those who do not drink coffee and applies to decaffeinated, ground, and instant varieties of coffee.

“In this large, observational study, ground, instant, and decaffeinated coffee were associated with equivalent reductions in the incidence of cardiovascular disease and death from [CVD] or any cause,” Peter Kistler, PhD, FRACP, of the Baker Heart and Diabetes Research Institute in Melbourne, Australia, said in a statement. “The results suggest that mild to moderate intake of ground, instant, and decaffeinated coffee should be considered part of a healthy lifestyle.”

Investigators aimed to examine the associations between types of coffee and incident arrhythmias, CVD, and death using data from the UK Biobank, which recruited individuals between aged 40 and 69 years. They defined CVD as congestive heart failure, coronary heart disease, and ischemic stroke.

The study included 449,563 individuals, who were free of arrhythmias and other CVD. Participants completed a questionnaire to assess how many cups of coffee they drink each day and whether it was decaffeinated, ground, or instant.

They were split into 6 daily intake categories: no coffee; less than 1; 1; 2 to 3; 4 to 5, and more than 5 cups of coffee per day.

There were 44.1% of individuals who drank instant, 18.4% who drank ground, 15.2% who drank decaffeinated, and 22.4% who did not drink coffee.

All types of coffee were linked with a reduction in death from any cause, with the greatest reduction seen with 2 to 3 cups per day compared with non-coffee drinkers. An association was also found to a 14%, 27%, and 11% lower likelihood of death for decaffeinated, ground, and instant coffees, respectively.

All coffee types were associated with a reduction in incident CVD, with the lowest risk observed in 2 to 3 cups per day compared with non-coffee drinkers. Coffee drinking was also associated with a 6%, 20%, and 9% reduced likelihood of CVD, respectively.

Ground and instant coffee, but not decaffeinated, was associated with a reduction in arrhythmias, including atrial fibrillation. The lowest risks were observed with 4 to 5 cups of coffee for ground and 2 to 3 cups of coffee for instant, with 17% and 12% reductions seen, respectively.

“Caffeine is the most well-known constituent in coffee, but the beverage contains more than 100 biologically active components. It is likely that the non-caffeinated compounds were responsible for the positive relationships observed [among] coffee drinking, [CVD], and survival,” Kistler said.

“Our findings indicate that drinking modest amounts of coffee of all types should not be discouraged but can be enjoyed as a heart healthy behavior,” he said.

Individuals were adjusted for age, alcohol and tea consumption, diabetes, ethnicity, high blood pressure, obesity, obstructive sleep apnea, sex, and smoking status. The outcomes were obtained via death and medical records with a median follow-up of 12.5 years.

Coffee drinking is associated with increased longevity. News release. Science Daily. September 26, 2022. Accessed October 14, 2022. https://www.sciencedaily.com/releases/2022/09/220926200838.htm

Drinking 2 to 3 cups a day of the decaffeinated, ground, and instant varieties is associated with a longer lifespan and a lower risk of cardiovascular disease, new data show.

Study Results Link Coffee Drinking to Increased Longevity

Exposure to fluoridated water among young children did not show signs of a negative association with child emotional and behavioral development and executive functioning in their adolescence, according to the authors of a follow-up study conducted by the University of Queensland Faculty of Health and Behavioral Sciences School of Dentistry in Australia. During the study, the investigators examined the impact of early childhood exposure to water fluoridation on measures of school-age executive functioning and emotional and behavioral development in a population-based sample.

This follow-up study used information from Australia’s National Child Oral Health Study of 2012 to 2014, and then contacted the children who were between 5 to 10 years of age at baseline during the original study after 7 to 8 years. However, the investigators ensured they contacted the children for the follow up before they had turned 18 years of age.

Using residential history and postcode-level fluoride levels in public tap water, the investigators were able to calculate the percent lifetime exposed to fluoridated water (LEFW) from birth to age of 5 years. The measures of children’s emotional and behavioral development were assessed by the Strength and Difficulties Questionnaire (SDQ), and executive functioning was measured by the Behavior Inventory of Executive Functioning (BRIEF).

The multivariable regression models were created to compare the associations between the exposure and the primary outcomes, which were controlled for covariates. Further, an equivalence test was conducted to compare the primary outcomes of those who had 100%LEFW compared to those with 0%LEFW.

Additionally, a sensitivity analysis was conducted in which a total of 2682 children completed SDQ and BRIEF with mean scores of 7.0 and 45.3, respectively. Those with a lower percentage of LEFW were seen to have poorer scores on the SDQ and BRIEF. Further, multivariable regression models reported no association between exposure to fluoridated water and the SDQ and BRIEF scores. Some factors associated with poorer SDQ/BRIEF scores included low household income, indigenous identity, and having a neurodevelopment diagnosis.

Due to these results, the study authors concluded that exposure to fluoridated water during the first 5 years of life was not demonstrated to be associated with an impact on child emotional and behavioral development and executive functioning. Additionally, children who had been exposed to fluoridated water for their early childhood had their measures of emotional, behavioral development, and executive functioning at least equivalent to that of children who did not have the exposure to fluoridated water.

“Water fluoridation is unquestionably effective in preventing dental caries, and this study is an important addition to the body of literature documenting the safety of water fluoridation,” said International Association for Dental Research (IADR) president Brian O’Connell, Dean of the Faculty of Health Sciences at Trinity College Dublin in Ireland, in a press release. “The IADR recently reaffirmed its support for water fluoridation as this public health measure has a high benefit/cost ratio and benefits deprived communities the most, thus reducing health inequalities.”

Study Finds No Adverse Effects of Early Fluoride Exposure on Childhood Development. IADR. October 10, 2022. Accessed October 18, 2022. 

https://www.iadr.org/about/news-reports/press-releases/study-finds-no-adverse-effects-early-fluoride-exposure-childhood

The measures of children’s emotional and behavioral development were assessed by the Strength and Difficulties Questionnaire (SDQ), and executive functioning was measured by the Behavior Inventory of Executive Functioning (BRIEF).

Study: Early Fluoride Exposure Not Found to Have Impact on Childhood Development  

Women who joke about their bodies using self-enhancing humor and self-defeating humor were found to have a more positive body image than those who primarily turn to forms of self-deprecating humor. Women who use self-enhancing humor were also found to have better eating habits.

This study, which looks at humor types and body perception, is the first of its kind. Further, the study findings could equip clinical psychologists and providers working with patients with eating disorder with more knowledge about humor and its therapeutic benefits.

“Often people don't talk openly about how they view their bodies, but how a person speaks about themselves through humor can provide valuable insights into such feelings," said Fabio Fasoli of the University of Surrey, in a press release.

In the study, women who use self-enhancing humor reported having greater body appreciation, while the participants who reported joking with self-deprecating humor were observed to have a more negative outlook of their body. There may even be an association between aggressive, self-deprecating jokes and worse eating habits.

University of Surrey researchers decided to explore the association between styles of humor, eating behaviors, and body perception in women. The investigative team looked at 216 women and analyzed the relationship between their style of humor and body perception.

Researchers mainly looked at 2 forms of humor. The first style is called self-enhancing humor, which results in you being the target of humor that is positive and good-natured in fashion. The other humor-type is self-deprecating humor—this technique uses humor to put yourself down in an aggressive manner.

The results of the trial showed that women who turned to self-deprecating forms of humor were more critical of their bodies. These participants were further observed to be less satisfied with their bodies and had a strong desire to be slimmer.

"Having a negative body image can affect all areas of a person's life and lead to depression and social anxiety,” Fasoli said in the press release.

Among women who primarily turned to aggressive, self-deprecating forms of humor, there appeared to be a stronger association with emotional eating—this was associated with worse feelings surrounding the bodies—and in turn, this habit increased the participant’s risk of becoming obese and suffering from more associated illnesses.

In contrast, women who practiced a self-enhancing style of humor were seen to offer more kindness to their bodies. Additionally, these participants had greater body appreciation, healthier eating habits, and a more positive body image than those who only used self-deprecating humor.

"People using themselves as the butt of jokes is often a technique to get approval from others, but it can also signify that something more worrying is going on in that person's life,” said professor of health psychology at the University of Surrey, Jane Ogden, in the press release. “This type of humor can indicate that a person is struggling with their body image and self-esteem, which can have a long-lasting effect on their life."

University of Surrey. Humor and body image linked. Science Daily. October 12, 2022. Accessed October 17, 2022. https://www.sciencedaily.com/releases/2022/10/221012103125.htm

Body image is no joke. In a recent study, women who use good-natured humor to describe their body were found to foster more appreciation for their body.

Self-Enhancing Humor May Increase Positive Body Image, Create Better Eating Habits

Gastroesophageal reflux disease (GERD) is a common gastrointestinal (GI) disorder characterized by the regurgitation of stomach contents into the esophagus causing troublesome symptoms and/or damage to the esophageal mucosa.

GERD affects approximately 20% of the US population, and it is one of the most common GI disorders seen by health care practitioners in the outpatient setting.

The clinical manifestations of GERD are variable. Classic symptoms include heartburn and regurgitation or the flow of gastric contents into the upper esophagus and pharynx. Other clinical manifestations of GERD include belching, dysphagia, epigastric pain, nausea, and odynophagia. Extraesophageal symptoms can occur in an atypical GERD presentation, and they include asthma, chest pain, cough, dysphonia, hoarseness, and laryngitis.

Treatment of GERD requires a combination of lifestyle modifications and pharmacologic therapy. Lifestyle modifications for GERD include avoiding alcohol, avoiding foods that worsen symptoms, avoiding meals 2 to 3 hours before bedtime, elevating the head of one’s bed by 6 inches, and smoking cessation. Weight loss in patients who are obese or overweight also improves GERD.

The frequency and severity of GERD symptoms, and/or the presence of Barrett’s esophagus or erosive esophagitis guide pharmacologic therapy. Patients with mild symptoms that occur infrequently, such as less than twice per week, can use low-dose H2 receptor antagonists (H2RAs): cimetidine 200 mg twice daily; famotidine 10 mg twice daily; or nizatidine 75 mg twice daily. H2 antagonists can be used as needed, and they begin working within 60 to 90 minutes and last several hours.

 H2 antagonists are generally well-tolerated, though cimetidine can cause gynecomastia and impotence with long-term use. Cimetidine is a potent inhibitor of the P450 system and can cause drug interactions. Antacids can be used as needed for symptoms which occur less than once a week. Antacids containing aluminum hydroxide, calcium carbonate, or magnesium trisilicate combinations work within 5 to 10 minutes and last for up to an hour. Aluminum containing antacids may cause aluminum retention in patients with significant renal impairment.

Patients who have 2 or more episodes per week of GERD or with severe GERD symptoms who fail to improve with H2RAs and/or patients with erosive esophagitis require proton pump inhibitors (PPIs) therapy. Proton pump inhibitors, such as dexlansoprazole, esomeprazole lansoprazole, omeprazole, pantoprazole, and rabeprazole, taken once daily at standard dosages are recommended for 8 weeks.

PPIs are most effective when taken 30 to 60 minutes prior to meals, usually before breakfast. Patients who develop recurrent GERD symptoms after an 8-week PPI course can be retreated with repeated 8-week courses and may require long-term maintenance therapy. Patients with early (<3 months of discontinuing acid suppression) and/or refractory recurrent symptoms may require referral for an upper endoscopy.7

PPIs are associated with adverse effects, particularly with long-term therapy. GI effects include increased risk for enteric infections, including C. difficile and multi-drug resistant Enterobacterales colonization. Long-term PPIs can cause malabsorption of minerals and vitamins, specifically hypomagnesemia, and vitamin B12 and PPIs may affect oral iron absorption. Long-term PPI therapy may slightly increase the risk for fractures of the hip, spine, and wrist. Patients with risk factors for osteoporosis who require PPIs should take calcium citrate and vitamin D supplements.

 PPIs can cause acute interstitial nephritis, and they may increase the risk for the development or progression of chronic kidney disease.

 PPIs may increase the risk for pneumonia, particularly in patients who are hospitalized.

Lifestyle modifications are recommended for all patients with GERD. Patients with infrequent, intermittent, or mild symptoms can use low-dose histamine 2 receptor antagonists, such as antacids or famotidine, as needed. Patients with erosive esophagitis, failure to respond to H2As, or frequent or severe symptoms require once-daily standard dose PPIs for 8 weeks.

1. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. 

 2014;63(6):871-880. doi:10.1136/gutjnl-2012-304269

2. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. 

2012;143:1179-1187.e3. doi:10.1053/j.gastro.2012.08.002

3. Hom C, Vaezi MF. Extraesophageal manifestations of gastroesophageal reflux disease. 

 2013;42(1):71-91. doi:10.1016/j.gtc.2012.11.004

4. Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. 

. 2022;117(1):27-56. doi:10.14309/ajg.0000000000001538

5. Richter JE, Vaezi MF. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. 

Sleisenger and Fordtran's Gastrointestinal and Liver Disease.

6. Kahrilas PJ, Howden CW, Hughes N. Response of regurgitation to proton pump inhibitor therapy in clinical trials of gastroesophageal reflux disease. 

. 2011;106(8):1419-1425;quiz 1426. doi:10.1038/ajg.2011.146

Treatment of gastroesophageal reflux disease requires a combination of lifestyle modifications and medications. 

What Is the Pharmacotherapy of GERD? 

Data from an ongoing analysis of a phase 2a trial showed that adults with moderately to severely active ulcerative colitis (UC) administered 12 weeks of combination induction therapy with guselkumab (Janssen Pharmaceutical Companies of Johnson & Johnson) and golimumab, followed by a transition to guselkumab alone for maintenance, achieved a clinical remission rate at week 39 of 47.9%.

The rate of clinical remission for the combination therapy was higher than induction and maintenance treatment with either guselkumab alone at 31% or golimumab alone at 20.8%.

“Exploring combinations of advanced therapies is an important step in continuing to innovate for the many patients living with [UC],” Bruce Sands, MD, MS, chief of the Dr. Henry D. Janowitz Division of Gastroenterology at Mount Sinai and professor of medicine at the Icahn School of Medicine at Mount Sinai, said in a statement. “These new data from the VEGA [

] trial build upon and affirm our initial 12-week findings showing the potential clinical benefit of combining guselkumab and golimumab in treating adults with moderately to severely active [UC].”

Additionally, the endoscopic improvement and the composite histologic-endoscopic endpoint were higher in individuals who received combination therapy followed by treatment with guselkumab compared to those receiving either monotherapy.

Furthermore, endoscopic remission and histologic remission were higher in the combination therapy groups with treatment followed by guselkumab compared to individuals who received golimumab alone.

Individuals administered the combination therapy followed by maintenance treatment with guselkumab and those receiving guselkumab as a monotherapy achieved the same rate of symptomatic remission of 69% at week 38, greater than golimumab as a monotherapy at 59.7%.

The individuals had comparable rates of adverse events (AEs) across the different treatment groups. The combination therapy followed by guselkumab, guselkumab monotherapy, and golimumab monotherapy groups had AE rates of 63.4%, 64.8%, and 76.4%, respectively, and infection rates of 31%, 23.9%, and 31.9%, respectively.

All groups had serious AE rates of 5.6% and the same serious infection rates of 2.8%.

Overall, 13.1% of individuals discontinued their treatment prior to the final dose of study intervention.

The VEGA study was the first randomized controlled trial to evaluate the efficacy and safety of the combination therapy with an interleukin-23p19 subunit antagonist and a tumor necrosis factor-alpha antagonist for UC.

Individuals in the study, with moderately to severely active UC, were randomized 1:1:1 to receive combination therapy with guselkumab and golimumab, guselkumab monotherapy, or golimumab monotherapy. After the endpoints were evaluated at week 12, individuals in the monotherapy groups continued their initially assigned treatment and individuals who were randomized to combination therapy transitioned to guselkumab monotherapy as a maintenance therapy. Clinical remission rate was based on the modified Mayo score as well as the total May score.
The detailed results were presented as an oral presentation at the United European Gastroenterology Week 2022 congress.

Guselkumab alone and in combination with golimumab are under clinical investigation and not approved for the treatment of adults with UC in the United States.

Results of novel clinical study of guselkumab and golimumab combination therapy show adults with moderately to severely active ulcerative colitis maintained higher rates of clinical, histologic, and endoscopic remission at week 38. News release. Johnson and Johnson. October 10, 2022. Accessed October 12, 2022. https://www.jnj.com/results-of-novel-clinical-study-of-guselkumab-and-golimumab-combination-therapy-show-adults-with-moderately-to-severely-active-ulcerative-colitis-maintained-higher-rates-of-clinical-histologic-and-endoscopic-remission-at-week-38

The rate of clinical remission for adults with moderately to severely active ulcerative colitis was higher than induction and maintenance treatment with either guselkumab alone at 31% or golimumab alone at 20.8%.

Guselkumab, Golimumab Combination Therapy Achieves Clinical Remission Rate of 47.9% in Patients with Ulcerative Colitis

Psychotic disorders may have a stronger link with dementia than other mental health disorders, such as depression or anxiety, according to the authors of a recently published systematic review. The analysis is the first to assess a range of psychotic disorders and their association with dementia risk. Psychotic disorders, such as schizophrenia, are severe illnesses that involve symptoms such as hallucinations and delusions and social withdrawal, as well as impairments in cognitive and functional skills.

"We found that having a diagnosis of a psychotic disorder is linked to a much higher risk of developing dementia later in life,” said senior author Jean Stafford, MD, in a press release. "Our findings add to evidence that protecting people's mental health throughout life could help to prevent dementia."

The researchers analyzed evidence from 11 studies conducted in 9 countries on 4 continents, which included approximately 13 million participants. During their assessment of the data, the team observed a higher risk of dementia later in life across multiple psychotic disorders, regardless of the age of the mental illness was first developed. In some studies, there were participants who were diagnosed with psychotic disorders while young adults, with follow-up periods of multiple decades.

Additionally, the investigators observed that patients who have had a psychotic disorder tend to be younger than average at dementia diagnosis, with 2 studies finding that people with psychotic disorders were more likely to be diagnosed while still in their 60s.

Previous studies found that 4 in 10 cases of patients with dementia could be prevented or delayed by targeting risk factors from across their lifespans. In this study, the authors also found that experiencing post-traumatic stress disorder during a patient’s lifespan can increase the likelihood of dementia. However, the investigators observed that the strongest association with dementia risk was with psychotic disorders.

Furthermore, during the study the research team was still not able to confirm the cause of the association between dementia risk and psychotic disorders. Specifically, they were unable to determine whether the association is due to the psychotic disorder itself or due to these disorders potential for increasing the likelihood of conditions that increase the dementia risk.

"People with psychotic disorders are more likely to have other health conditions such as cardiovascular disease or obesity, which can increase the risk of dementia, while they are also more likely to have a poor diet, smoke or use drugs, which may harm their health in ways that could increase their likelihood of developing dementia,” Orgeta said in the press release.

The researchers were also not able to determine whether effective treatment for psychotic disorders could lessen the risk of dementia, or whether antipsychotic medication could be a factor due to limited and conflicting evidence.

"As people with psychotic disorders face a higher risk of numerous other health conditions, managing their overall physical and mental health is very important, and here we found that health professionals working with them should also be watchful for any signs of cognitive decline,” said lead study author Sara El Miniawi in a press release.

Schizophrenia may increase dementia risk by 2.5 times. ScienceDaily. October 6, 2022. Accessed October 12, 2022. 

https://www.sciencedaily.com/releases/2022/10/221006092313.htm

The researchers analyzed evidence from 11 studies conducted in 9 countries on 4 continents, which included approximately 13 million participants. 

All News