Antonceptivos combinados nuevos reducen riesgo de cancer de ovario

Newer Combination Hormonal Contraceptives Linked to Lower Ovarian Cancer Risk

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Use of combination hormonal contraceptives continues to be associated with reduced risk for ovarian cancer in younger women, according to a study in The BMJ.

Using Danish registries, researchers studied nearly 1.9 million women aged 15–49 between 1995 and 2014. The incidence rate of ovarian cancer was 4.3 per 100,000 person-years among women who'd ever used hormonal contraceptives, versus 7.5 per 100,000 among never-users.

After multivariable adjustment, use of hormonal contraceptives was associated with a 34% reduced risk for ovarian cancer. The risk reduction was greater with longer duration of use, and it persisted years after stopping use. Of note, most hormonal contraceptives were combined oral contraceptives, and progestogen-only contraceptives were not associated with reduced cancer risk.

The researchers conclude, "Contemporary combined hormonal contraceptives are still associated with a reduced risk of ovarian cancer in women of reproductive age, with patterns similar to those seen with older combined oral products."

The BMJ article (Free)

Background: NEJM Journal Watch Women's Health coverage of durable cancer prevention with combination oral contraceptives (Your NEJM Journal Watch registration required)

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Screen time vs cognition

Limited Screen Time Tied to Better Cognition in Kids

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Children who meet Canadian recommendations for screen time, sleep, and exercise have better cognition than their peers who don't meet the recommendations — and screen time seems to have the largest effect — suggests a study in the Lancet Child and Adolescent Health.

Canadian 24-Hour Movement Guidelines for Children and Youth call for no more than 2 hours of recreational screen time daily, 9 to 11 hours of sleep nightly for those ages 5–13, and at least 60 minutes of moderate-to-vigorous aerobic activity daily.

For the study, researchers examined survey data on roughly 4500 U.S. children aged 8 to 11 years. Some 37% met the screen time recommendation, 51% met the sleep recommendation, and 18% met the activity recommendation. Children who met all three recommendations (5%) had better global cognition scores than those who met none of the recommendations. Additionally, children who met the screen time recommendation alone, or both the screen time and sleep recommendation, had better cognition than those who met no recommendations. 

A commentator observes, "Each minute spent on screens necessarily displaces a minute from sleep or cognitively challenging activities."

The Lancet Child and Adolescent Health article (Free abstract)

The Lancet Child and Adolescent Health comment (Subscription required)

Canadian 24-Hour Movement Guidelines for Children and Youth (Free)

Background: Recent Physician's First Watch coverage of screen time soaring among U.S. kids (Free)

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Hdacs

CD4+ T cell help in cancer immunology and immunotherapy     Jannie Borst, Tomasz Ahrends, Nikolina Bąbała, Cornelis J. M. Melief & Wolfgang Kastenmüller pp635 - 647 | doi:10.1038/s41577-018-0044-0  CD4+ T cells provide help to CD8+ T cells via lymph node-resident dendritic cells. In this Review, the authors discuss the molecular nature of help signals and how they can be harnessed to improve cancer immunotherapy.  Full Text | PDF

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Aumenta sifilis congenita

Number Of Babies Born With Syphilis Has Reached Highest Level In 20 Years, CDC Says.

USA Today (9/25, Alltucker) reports that "the number of babies born with syphilis has more than doubled since 2013, according to the Centers for Disease Control and Prevention, a trend that medical professionals said shows the need to be vigilant about testing and treating the...disease."

        Reuters (9/25, Brice) reports, "The CDC said reported cases of congenital syphilis...jumped 153 percent between 2013 and 2017, from 362 cases to 918."

        TIME (9/25, Ducharme) reports that that "is the highest number in 20 years. Most of these cases were clustered in Western and Southern states."

        The AP (9/25, Stobbe) reports that "at least 77 of last year's cases were stillborn or died."

        On its website, NBC News (9/25, Fox) reports that the CDC said, "Women at high risk for syphilis or who live in high-prevalence areas should be tested not only at the first prenatal visit, but again early in the third trimester and at delivery."

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Altura y varices...

Height May Be Significant Risk Factor For Varicose Veins, Study Suggests.

CNN (9/24, Lamotte) reports on its website that researchers found that "a person's height" is "a significant risk factor for developing varicose veins." The article adds that "about 20% of all adults will develop varicose veins, according to the US National Library of Medicine." The findings were published in Circulation.

        HealthDay (9/24, Thompson) reports the researchers found that "every additional four inches in height increases your risk of varicose veins by about 25 percent."

        Cardiology Today (9/24, Webb) reports that the author of an accompanying editorial wrote, "One innovative aspect of the study was the use of unsupervised machine learning for agnostic interrogation of over 2,700 diverse clinical variables to identify those associated with incident varicose veins."

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Nuevo medicamento para hiperhidrosis.

Glycopyrronium Tosylate May Reduce Sweating Severity And Decrease Sweat Production In Patients With Primary Axillary Hyperhidrosis, Study Suggests.

Dermatology Advisor (9/18, Jacobs) reports researchers found in "2 replicate, randomized, double-blind, vehicle-controlled, 4-week, phase 3 trials" that "the use of daily, topical glycopyrronium tosylate (GT) over the course of 4 weeks reduces sweating severity and decreases sweat production in patients with primary axillary hyperhidrosis." The findings were published in the Journal of the American Academy of Dermatology.

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Secukinumab en HS

Many Patients With Hidradenitis Suppurativa May Respond To Secukinumab, Study Suggests.

MedPage Today (9/18, Bankhead) reports researchers found that "more than three fourths of patients with longstanding hidradenitis suppurativa (HS) responded to treatment with" Cosentyx (secukinumab). The findings were presented at the European Academy of Dermatology and Venereology meeting.

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Yogurts con mucha azúcar?

Most Supermarket Yogurts Contain More Sugar Than You Might Expect

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Most supermarket yogurts are not low in sugar, according to a U.K.-based study published in BMJ Open.

Researchers assessed the nutrient content of nearly 900 yogurt products purchased from five U.K. online supermarkets. The products were classified into eight categories: children's yogurts, dairy alternatives, desserts, drinks, flavored, fruit, natural/Greek, or organic.

Only natural/Greek yogurts met the U.K.'s cutoff for its "low-sugar" designation (5 g total sugars/100 g). The median sugar content in all other categories exceeded that cutoff. Dessert yogurts had the most sugar, at 16 g/100 g, but sugar content was still higher than recommended in children's yogurts (11 g/100 g) and organic yogurts (13 g/100 g).

The researchers write, "What is worrisome is that yogurt, as a perceived 'healthy food,' may be an unrecognized source of free/added sugars in the diet." Of note, U.S. dietary guidelines advise that less than 10% of daily calories come from added sugars (that is, <50 g of sugar daily for a 2000-calorie/day diet).

BMJ Open article (Free)

Background: Physician's First Watch coverage of 2015-2020 Dietary Guidelines for Americans (Free)

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Para expediente electrónico es mejor tener gente que escriba por uno...

Medical Scribes Can Reduce EHR Burden, Improve Job Satisfaction

By the Editors

Medical scribes can reduce clinician time using electronic health records and improve job satisfaction, according to a randomized, crossover trial in JAMA Internal Medicine.

Eighteen primary care physicians used medical scribes for two 3-month periods over the course of a year, and did not use scribes for the other two 3-month periods. Compared with periods when scribes weren't used, periods with scribes were associated with less physician time spent on EHR documentation on nights and weekends and during office visits. Physicians also reported more interaction with patients during scribed periods and greater job satisfaction.

Dr. Thomas Schwenk of NEJM Journal Watch General Medicine will weigh in on this study in the coming days. Stay tuned.

JAMA Internal Medicine article (Free)

JAMA Internal Medicine comment (Free)

Background: NEJM Journal Watch Emergency Medicine coverage of scribes in pediatric emergency departments (Your NEJM Journal Watch subscription required)

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Uso de silla

Children Should Remain in Rear-Facing Car Seats as Long as Possible

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

The American Academy of Pediatrics now recommends that children ride in rear-facing car seats for as long as possible. Previously, the group said that toddlers younger than 2 years who exceeded the weight and height restrictions for rear-facing seats could ride in forward-facing seats.

Most convertible seats can accommodate children in the rear-facing position until at least 2 years of age. The rear-facing weight limit is generally 35 to 40 pounds.

Among the other recommendations, published in Pediatrics:

• After they outgrow rear-facing seats, children should ride in forward-facing child safety seats until they are at least 4 years old.
• From ages 4 through at least age 8 — or until they are 4 feet, 9 inches tall — children should use belt-positioning booster seats.
• Children who have outgrown their booster seats should wear lap and shoulder seat belts.
• Children aged 12 and under should ride in the back seat.
• Clinicians should encourage parents to delay each transition for as long as possible.

Pediatrics policy statement (Free)

Pediatrics technical report (Free)

Background: Physician's First Watch coverage of AAP's previous car seat recommendations (Free)

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