POPULARITY
3 episodes with health related quality
2 episodes with health related quality
3 episodes with health related quality
6 episodes with health related quality
2 episodes with health related quality
2 episodes with health related quality
2 episodes with health related quality
2 episodes with health related quality
3 episodes with health related quality
Dr. Priya Vart discusses the results of his study, "Effects of Dapagliflozin on Health-Related Quality of Life in Patients with CKD," with JASN Deputy Editor Manjula Kurella Tamura.
I write a lot here about the fallacy of blaming health issues on body size. Today I want to talk about the tendency to credit weight loss for physical, psychological, and social benefits. For example, someone will (at least short term) lose weight and offer a testimonial about how much better they feel, how much more they are doing in the world etc. Or a study will determine that Health Related Quality of Life (HRQoL) has improved after weight loss.Just like a weight-centric healthcare system (and world) tends to completely uncritically blame weight for health issues, it also completely uncritically credits weight loss for health, life, and HRQoL improvements. Today I want to take a critical look at this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
PodChatLive 191: Revisiting unread research (an archive dive)Contact us: getinvolved@podchatlive.comLinks from this weeks episode:Risk of subsequently developing lower urinary tract symptoms in patients with plantar fasciitisOne-Year Trajectory of Pain, Function, and Health-Related Quality of Life in Patients With Plantar FasciopathyRelationship between the abdominal wall and chronic ankle instabilityCorrelation of Wearing-out Patterns of Shoes and Lower-Limb Alignment among Traffic Police ConstablesHow much running is too much?Arch support insoles reduce fatigue of the lower extremity muscles in people with flatfoot during a walking task
“The proteasome itself, it really helps us unfold or get rid of misfolded proteins or degradations of different cells. We used to have garbage disposals in our sinks, and we used to put food product in there. If your garbage disposal is clogged, then everything backs up. So that's kind of what's really going on in the cell itself, is that I'm building up these unnecessary proteins that we should be getting rid of, and it actually causes apoptosis or cell death,” ONS member Daniel Verina, DNP, RN, ACNP-BC, nurse practitioner for the multiple myeloma program at Mount Sinai Medical Center in New York, NY, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about the proteasome inhibitor drug class. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.75 contact hours (including 40 minutes of pharmacotherapeutic content) of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by July 18, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learner will report an increase in knowledge related to the use of proteasome inhibitors in the treatment of cancer. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ Pharmacology 101 series ONS Voice article: AI Multiple Myeloma Model Predicts Individual Risk, Outcomes, and Genomic Implications ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (fourth edition) Guide to Cancer Immunotherapy (second edition) Multiple Myeloma: A Textbook for Nurses (third edition) Clinical Journal of Oncology Nursing article: Optimizing Transitions of Care in Multiple Myeloma Immunotherapy: Nurse Roles Oncology Nursing Forum articles: Changes in Health-Related Quality of Life During Multiple Myeloma Treatment: A Qualitative Interview Study Facilitators of Multiple Myeloma Treatment: A Qualitative Study ONS Guidelines™ and Symptom Interventions Adherence to Oral Anticancer Medication Peripheral neuropathy ONS Hematology, Cellular Therapy, and Stem Cell Transplantation Learning Library American Society of Hematology International Myeloma Foundation Leukemia and Lymphoma Society Multiple Myeloma Research Foundation To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode “When we look at the administration, we also want to make sure that we're looking at the blood counts, right? Because proteasome inhibitors are well known for causing thrombocytopenia and neutropenia. So making sure that the patients do meet eligibility for the treatment for that day, and do they have anemia or lower red blood cell counts. You want to make sure that, because of these therapies, that the patient has no symptoms or infections going into each therapy for that day.” TS 10:19 “[Bortezomib], interesting enough, it can cause hypotension, cardiac failure, and sometimes pulmonary edema. Switching that up a little bit, what makes it slightly different, carfilzomib … a lot of times we saw, even in the clinical trial, that there was a lot of hypertension or cardiomyopathies, or arrythmias that we saw with carfilzomib and different dosages that they have indicated from the FDA. So again, monitoring the hypertension … or heart failure.” TS 15:16 “We also want to keep in mind another adverse effect, and especially in myeloma—our patients come in the door already immunocompromised just by the disease state alone. But now I'm giving them therapies that can drop their neutrophil count, so neutropenia and thrombocytopenia, so they are at a higher risk of having serious infections, even including like pneumonia or having outbreaks of herpes zoster or shingles.” TS 16:50 “If the patient has shortness of breath or symptoms, hold the therapy. I think that's one of my biggest messages when it comes to cancer treatments and educating other healthcare providers, or even educating our patients and their caregivers or the care partners with them, is that we need to sometimes hold the therapy for safety.” TS 22:02 “I say keep a log, keep a book. Let me know when the symptoms happen. Are they happening the day of treatment? Are they happening two days later from the treatment? Are they happening a week later from the treatment? And being able to kind of guide which therapy is causing some of these adverse events or side effects alone. So, making them have calendars. When did you take the drug, when did you get your last infusion or your last [subcutaneous] injection? Always talk to your care team, whether it's in the academic center or next to your house in the community.” TS 26:17 “It's us learning how to listen to the patient going forward. We have tasks to do—we all have tasks to do in our lives—but we have to take a breath, be mindful who's in front of us, listen to them first, and then be able to talk to them and care for them upfront and see what the symptoms are. I think that's what we need to do. We have to take a breath in cancer.” TS 39:35
In dieser Folge spreche ich mit Florent Crépin, Geschäftsführer von Neurolite. Er stellt eine Depressions-Behandlung vor, die ohne Medikamente auskommt.Links :LinkedIn Instagram NeuroliteYoutube Instagram FlowFacebook FlowÜBER DEPRESSIONDepressionen.ch Stiftung Deutsche DepressionshilfeREFERENZENBarker et al. Non-invasive magnetic stimulation of human motor cortex. Lancet. 1985 May. Zur PublikationRush et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006 Nov. Zur PublikationFregni et al. Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders. Int J Neuropsychopharmacol. 2021 Apr. Zur PublikationWoodham et al. Home-based transcranial direct current stimulation treatment for major depressive disorder: a fully remote phase 2 randomized sham-controlled trial. Nat Med. 2025 Jan. Zur PublikationCipriani et al. Comparative Efficacy and Acceptability of 21 Antidepressant Drugs for the Acute Treatment of Adults With Major Depressive Disorder: A Systematic Review and Network Meta-Analysis. Focus (Am Psychiatr Publ). 2018 Oct. Zur PublikationSaelens et al. Relative effectiveness of antidepressant treatments in treatment-resistant depression: a systematic review and network meta-analysis of randomized controlled trials. Neuropsychopharmacology. 2024 Dec. Zur PublikationGriffiths et al. Self-Administered “Flow” Transcranial Direct Current Stimulation (tDCS) Depression Treatment in a Crisis Resolution & Home Treatment (CRT) Service: Functioning, and Health-Related Quality of Life Outcomes. Open Journal of Psychiatry. 2024 Nov. Zur PublikationTomonaga et al. The economic burden of depression in Switzerland. Pharmacoeconomics. 2013 Mar. Zur PublikationDeutsche S3-Leitlinie und Nationale VersorgungsLeitlinie (NVL) Kurzfassung – Lass mir Feedback da :)Hat dir die Folge gefallen? Ich würde mich über eine 5-Sterne-Bewertung sehr freuen! :)Webseite: https://www.psychologieunddenn.ch/Whatsapp-Gruppe (offen für alle): https://chat.whatsapp.com/JBcjpAaIaSeCRxmQMQWGXuMöchtest du Werbung schalten oder mit mir zusammenarbeiten. Dann schau hier vorbei.
In part one we looked at the 2022 article by Sierżantowicz et al., “Quality of Life after Bariatric Surgery A Systematic Review.” I do recommend reading that to understand the issues with the way “Health Related Quality of Life or HRQOL” is used in the studies we'll examine today as we take a deeper diver into two of the studies Sierżantowicz et al. included.Content note for discussion of suicide and self-harm. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. Welcome to diabetes core update where every month we go over the most important articles to come out in the field of diabetes. Articles that are important for practicing clinicians to understand to stay up with the rapid changes in the field. This issue will review: 1. Coronary Artery Calcium-Guided Primary Prevention Strategy 2. Health-Related Quality of Life and Health Utility after Metabolic/Bariatric Surgery vs. Medical/Lifestyle Intervention in Individuals with Type 2 Diabetes and Obesity 3. Suicide and suicide attempt in users of GLP-1 receptor agonists: a nationwide case-time-control study 4. Self-Monitored Blood Glucose and Continuous Glucose Monitoring in Youth with Type 1 Diabetes and Medicaid Insurance 5. Gestational Diabetes to Type 2 Diabetes—Is Poor Sleep to Blame? For more information about each of ADA's science and medical journals, please visit Diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health
En lo último en salud y fitness edición de diciembre 2024, damos un paseo por las últimas tendencias, investigaciones y noticias en el mundo de la salud y el fitness. En este episodio vamos a platicar sobre cómo sacarle el máximo provecho al entrenamiento de resistencia combinándolo con los horarios de comida, una estrategia que está dando resultados muy concretos. También veremos qué dice la ciencia sobre mantener los músculos fuertes mientras envejecemos (y por qué es más importante de lo que crees). Le daremos un vistazo al cafestol, ese compuesto del café que genera tanto debate, y exploraremos una combinación interesante de nutrientes que podría ayudar a mantener la memoria aguda. Atajos Del Episodio 01:20 - Una combinación ganadora: Comer en horario restringido y entrenamiento de resistencia1 03:56 - La proteína y el entrenamiento de resistencia: clave para envejecer con vitalidad2 10:21 - El cafestol: beneficios inciertos y riesgos claros en la salud metabólica3 15:18 - Ácido fólico y vitamina D: una dupla prometedora para la memoria4 19:00 - DYG-400: Un extracto natural que ayuda a controlar el peso y los antojos5 Referencias: 1. Ho, Y., Hou, X., Sun, F., Wong, S. H. S. & Zhang, X. Synergistic Effects of Time-Restricted Feeding and Resistance Training on Body Composition and Metabolic Health: A Systematic Review and Meta-Analysis. Nutrients (2024). 2. Li, J., Wang, Y., Liu, F. & Miao, Y. Effect of Protein Supplementation Combined With Resistance Training in Gait Speed in Older Adults: A Systematic Review and Meta-Analysis of Randomized …. Journal of Aging and … (2024). 3. Mellbye, F. D., Nguyen, M. D., Hermansen, K. & Jeppesen…, P. B. Effects of 12-Week Supplementation with Coffee Diterpene Cafestol in Healthy Subjects with Increased Waist Circumference: A Randomized, Placebo …. Nutrients (2024). 4. Liu, W. et al. Effects of Vitamin D3 Combined with Folic Acid on Domain and Specific Cognitive Function among Patients with Mild Cognitive Impairment: A Randomized Clinical …. The Journal of … (2024). 5. Hausenblas, H. A., Lynch, T. A. & Befus…, S. M. Efficacy of Dichrostachys Glomerata Supplementation on Overweight and Mildly Obese Adult's Weight, Mood, and Health-Related Quality of Life: A Randomized …. Journal of Dietary … (2024).
Dr. Richard Matulewicz is a urologic surgeon at Memorial Sloan Kettering Cancer Center (MSKCC). Dr. Matulewicz talks about health-related quality of life (HRQoL) considerations for testicular cancer patients and survivors, including what the future might hold for personalizing care based on a person's specific situation. Sponsored by Dee's Nuts. Use code "nutcheck" at checkout on https://grabdeesnuts.com Want to be a guest? Apply here: https://www.testicularcancerawarenessfoundation.org/it-takes-balls-submissions Follow Testicular Cancer Awareness Foundation: https://www.testescancer.org https://www.twitter.com/testescancer https://www.instagram.com/testescancer https://www.facebook.com/tca.org Connect with Dr. Matulewicz: https://www.mskcc.org/cancer-care/doctors/richard-matulewicz Follow Steven Crocker: https://www.twitter.com/stevencrocker https://www.instagram.com/stevencrocker https://www.facebook.com/steven.crocker2 Theme song: No Time Like Now - Tom Willner www.tomwillner.com
In this podcast, Janelle Hart, Managing Editor at Citeline, teams up with industry experts Mai Yee Mishir, Senior Director of Global Regulatory Affairs, and Sally-Ann McDowell, Senior Director of Clinical Development Strategy at Advanced Clinical, to discuss the vital role of HRQoL in clinical trials. Listen now.
Jane Anderson, FRCP, PhD - Health-Related Quality of Life: What Works Best for People Living With HIV?
Jane Anderson, FRCP, PhD - Health-Related Quality of Life: What Works Best for People Living With HIV?
Jane Anderson, FRCP, PhD - Health-Related Quality of Life: What Works Best for People Living With HIV?
Jane Anderson, FRCP, PhD - Health-Related Quality of Life: What Works Best for People Living With HIV?
Jane Anderson, FRCP, PhD - Health-Related Quality of Life: What Works Best for People Living With HIV?
Jane Anderson, FRCP, PhD - Health-Related Quality of Life: What Works Best for People Living With HIV?
On this episode of Oncology Unscripted, patient advocates Julie Johnson and Katie Coleman and radiation oncologist Dr. Matt Spraker host physical therapist Dr. Hillary Hinrichs and researcher Dr. Kelley Wood (@kcwood_phd on X) to discuss exercise and cancer rehabilitation. We kick off our discussion with an important question. What is cancer rehabilitation, and how is this different than exercise? Then, we discuss how patients can find out how cancer rehabilitation and exercise can play a role in their care. How can you ask your doctor whether you need a cancer rehab evaluation? How are doctors learning how to best use exercise and cancer rehab in their treatment plans? We close the discussion by examining the benefits that cancer rehabilitation can provide throughout a patients course of diagnosis, treatment, and beyond. Also, we review the risks and restrictions that may be important in the context of a cancer diagnosis. Here are some resources that can help you find a rehabilitation therapist, such as a physical, occupational, or speech/swallow therapist:American Physical Therapy Association - Find a Physical Therapist or Specialist Therapist Lymphology Association of North America - Find a Lymphedema TherapistReVital Cancer Rehab – Find a locationCheck out the ACSM Exercise Is Medicine, Moving Through Cancer website, it's a great patient resource! Here are some other things we discussed during the show:Schmitz et al., Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. (free access)Pergolotti et al., Impact of Real-World Outpatient Cancer Rehabilitation Services on Health-Related Quality of Life of Cancer Survivors. (free access)ECOG Performance Status 6-Minute Walk TestTimed Up and Go TestOncology Unscripted is a Photon Media production. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.Additional content from Katie Coleman can be found at her website, https://www.katiekickscancer.com/. This show and our opinions are meant for general informational purposes and are not medical advice. We encourage you to reach out to your doctors to discuss your individual case.
In this episode of the CPCJ podcast series, Multimedia Editor Pat Chibbaro interviews Julieta Moreno-Villagómez, author of the article entitled, "Health-Related Quality of Life in Mexican Children and Adolescents with Non-Syndromic Craniosynostosis" (coauthored by Miguel Castillo-Mimila, Guillermina Yáñez-Téllez, Belén Prieto-Corona and Antonio García-Méndez).
Is surgery for pediatric epilepsy "worth it"? What factors determine quality of life in families with a child who has epilepsy? Dr. Kette Valente talks with Dr. Mary Lou Smith, whose work has implications for clinical treatment decisions, as well as expectations for the impact of treatments in children with epilepsy. Support the showSharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.We welcome feedback and episode ideas at podcast@ilae.org.The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.
Today, you'll learn about how hearing aids may help you live longer, a potential breakthrough that could help usher in the age of quantum computing, and the incredible power of simply saying, “Hi”. Hearing Aids “Hearing aids may help people live longer.” EurekAlert! 2024. “Association between hearing aid use and mortality in adults with hearing loss in the USA: a mortality follow-up study of a cross-sectional cohort.” by Janet S. Choi, M.D. et al. 2024. “The Impact of Hearing Loss and Its Treatment on Health-Related Quality of Life Utility: a Systematic Review with Meta-analysis.” by Ethan D. Borre, et al. 2023. Quantum Error Eraser “Quantum computers inch closer to viability with new ‘error eraser'.” by H. Hannan. 2024. “40 years of quantum computing.” Nature Reviews Physics. 2022. “Erasure conversion in a high-fidelity Rydberg quantum simulator.” by Pascal Scholl, et al. 2023. Smalltalk “New study highlights the psychological power of minimal social interactions.” by Eric W. Dolan. 2023. “Minimal Social Interactions and Life Satisfaction: The Role of Greeting, Thanking, and Conversing.” by Esra Ascigil, et al. 2023. Follow Curiosity Daily on your favorite podcast app to get smarter with Calli and Nate — for free! Still curious? Get exclusive science shows, nature documentaries, and more real-life entertainment on discovery+! Go to https://discoveryplus.com/curiosity to start your 7-day free trial. discovery+ is currently only available for US subscribers. Hosted on Acast. See acast.com/privacy for more information.
2023 was an exciting year for Surgical Palliative Care research! Join Drs. Katie O'Connell, Ali Haruta, Lindsay Dickerson, and Virginia Wang from the University of Washington to discuss two seminal randomized controlled trials in the Surgical Palliative Care space. Hosts: · Dr. Katie O'Connell (@katmo15) is an Assistant Professor of Surgery at the University of Washington. She is a trauma surgeon, palliative care physician, Director of Surgical Palliative Care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA. · Dr. Ali Haruta is a PGY7 Hospice & Palliative Care fellow at the University of Washington, formerly a UW General Surgery resident and Parkland Trauma/Critical Care fellow. · Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY5 General Surgery resident and current Surgical Oncology fellow at the University of Washington. · Dr. Virginia Wang is a PGY2 General Surgery resident at the University of Washington. Learning Objectives: · Discuss the current state of the RCT literature in Palliative Care & Surgical Palliative Care · Understand the primary outcomes of the Shinall and Aslakson trials as related to perioperative specialty palliative care intervention · Identify limitations in existing surgical palliative care RCTs & further opportunities for study · Identify underlying differences between medical oncology and surgical oncology patient populations References: 1. Shinall MC, Martin SF, Karlekar M, et al. Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer: A Randomized Clinical Trial. JAMA Surg. 2023;158(7):747–755. doi:10.1001/jamasurg.2023.1396 https://pubmed.ncbi.nlm.nih.gov/37163249/ 2. Aslakson RA, Rickerson E, Fahy B, et al. Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(5):e2314660. doi:10.1001/jamanetworkopen.2023.14660 https://pubmed.ncbi.nlm.nih.gov/37256623/ 3. Ingersoll LT, Alexander SC, Priest J, et al. Racial/ethnic differences in prognosis communication during initial inpatient palliative care consultations among people with advanced cancer. Patient Educ Couns. 2019;102(6):1098-1103. doi:10.1016/j.pec.2019.01.002 https://pubmed.ncbi.nlm.nih.gov/30642715/ 4. Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302(7):741-749. doi:10.1001/jama.2009.1198 https://pubmed.ncbi.nlm.nih.gov/19690306/ 5. Corn BW, Feldman DB, Hull JG, O'Rourke MA, Bakitas MA. Dispositional hope as a potential outcome parameter among patients with advanced malignancy: An analysis of the ENABLE database. Cancer. 2022;128(2):401-409. doi:10.1002/cncr.33907 https://pubmed.ncbi.nlm.nih.gov/34613617/ 6. El-Jawahri A, LeBlanc TW, Kavanaugh A, et al. Effectiveness of Integrated Palliative and Oncology Care for Patients With Acute Myeloid Leukemia: A Randomized Clinical Trial. JAMA Oncol. 2021;7(2):238-245. doi:10.1001/jamaoncol.2020.6343 https://pubmed.ncbi.nlm.nih.gov/33331857/ 7. More about the metrics from both the Shinall and Aslakson studies: a. FACT-G – https://www.facit.org/measures/fact-g b. FACIT-Pal – https://www.facit.org/measures/facit-pal c. PROMIS-29 – https://heartbeat-med.com/resources/promis-29/ d. PROPr (PROMIS-Preference) score – https://www.proprscore.com/ ***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9*** Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other surgical palliative care episodes here: https://app.behindtheknife.org/podcast-category/palliative-care
Drs Sandhya Srinivas and Tanya B. Dorff discuss metastatic hormone-sensitive prostate cancer, which patients are the best candidates for doublets vs triplets, and how we pick these patients. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/988737). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Prostate Cancer https://emedicine.medscape.com/article/1967731-overview Metastatic Hormone-Sensitive Prostate Cancer: Toward an Era of Adaptive and Personalized Treatment https://pubmed.ncbi.nlm.nih.gov/37220335/ Triplet or Doublet Therapy in Metastatic Hormone-Sensitive Prostate Cancer: Updated Network Meta-Analysis Stratified by Disease Volume https://pubmed.ncbi.nlm.nih.gov/37055323/ PSMA PET in Imaging Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/35155262/ Risks and Cancer Associations of Metachronous and Synchronous Multiple Primary Cancers: a 25-Year Retrospective Study https://pubmed.ncbi.nlm.nih.gov/34556087/ The Promise of Metastasis-Directed Therapy for Oligometastatic Prostate Cancer: Going Beneath the Surface With Molecular Imaging https://pubmed.ncbi.nlm.nih.gov/35058322/ Gleason Score https://www.ncbi.nlm.nih.gov/books/NBK553178/ Luteinizing Hormone-Releasing Hormone (LHRH) Receptor Agonists Vs Antagonists: a Matter of the Receptors? https://pubmed.ncbi.nlm.nih.gov/23418666/ The Role of CYP17A1 in Prostate Cancer Development: Structure, Function, Mechanism of Action, Genetic Variations and Its Inhibition https://pubmed.ncbi.nlm.nih.gov/29372682/ Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer: Long-Term Survival Analysis of the Randomized Phase III E3805 CHAARTED Trial https://pubmed.ncbi.nlm.nih.gov/29384722/ Abiraterone for Prostate Cancer Not Previously Treated With Hormone Therapy https://pubmed.ncbi.nlm.nih.gov/28578639/ Abiraterone Plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/28578607/ Health-Related Quality of Life in Metastatic, Hormone-Sensitive Prostate Cancer: ENZAMET (ANZUP 1304), an International, Randomized Phase III Trial Led by ANZUP https://pubmed.ncbi.nlm.nih.gov/34928708/ Darolutamide and Survival in Metastatic, Hormone-Sensitive Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/35179323/ Abiraterone Plus Prednisone Added to Androgen Deprivation Therapy and Docetaxel in De Novo Metastatic Castration-Sensitive Prostate Cancer (PEACE-1): a Multicentre, Open-Label, Randomised, Phase 3 Study With a 2 × 2 Factorial Design https://pubmed.ncbi.nlm.nih.gov/35405085/
In this episode, Nikos Dedes, Jeff Taylor, and Bernadette Sharp—people living with HIV—discuss how switching to long-acting ART has affected their quality of life. They are joined by 2 healthcare professionals—Iskandar Azwa,MBChB, MRCP, and Beng Eu, MBBS—who provide insights on how they assess and document health-related quality of life for their patients. The discussion focuses on personal experiences with how LA ART has improved health-related quality of life, including:Avoidance of drug–drug interactionsImproved confidentiality Decreased stigmaPresenters:Iskandar Azwa, MBChB, MRCPAssociate ProfessorInfectious DiseasesFaculty of MedicineUniversity of MalayaKuala Lumpur, MalaysiaNikos DedesPositive VoiceAthens, GreeceBeng Eu, MBBSDoctorPrahran Market Clinic Melbourne, Victoria, AustraliaBernadette SharpAdvocateJeff TaylorExecutive DirectorHIV+Aging Research ProjectPalm Springs, CaliforniaContent based on an online CME program supported by an independent educational grant from ViiV Healthcare.ViiV Healthcare was not involved in the development of content or selection of faculty for this educational activity.Link to downloadable slides: https://bit.ly/488WwT7Link to full program: bit.ly/3EwEnRJ
Diet treatments are often used with the aim of reducing seizure frequency and severity — but they may have other benefits as well. Findings from a recent study conducted in Norway suggest that dietary treatments may normalize emotional symptoms and that health-related quality of life (HRQOL) might be an indicator of successful diet treatment in the future. Joy Mazur spoke with Dr. Magnhild Kverneland about the study's results and its implications. Health-related quality of life in adults with drug-resistant focal epilepsy treated with modified Atkins diet in a randomized clinical trial was published in Epilepsia in March 2023. Related studies: Anxiety and depressive disorders in people with epilepsy: A meta-analysis Scott A, et al., 2017 Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life Roehl K, et al., 2019 Support the showSharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.
Dr. H. Tarik Kani talks to Dr. Axel Dignass (Germany) about his recent publication about the impact of Ustekinumab on health-related quality of life in moderate-to-severe Crohn's disease which was an open-label, multicenter, randomized study evaluated the quality of life prospectively in Crohn's patients who treated with Ustekinumab.
The July 2023 replay of past episodes showcases five interviews on social determinants of health in neurology. The episode begins with an interview with Dr. Heather Leeper on the links between pain and depression with unemployment due to CNS cancer. The episode continues with an interview with Dr. Wyatt Bensken on racial and ethnic difference in antiseizure medication prescription. The next interview is with Dr. Scott Mendelson on race-ethnic disparities in stroke thrombolysis. The fourth interview is with Dr. Vikas Kotagal on neighborhood socioeconomic factors in people with various movement disorders. The final episode is with Dr. Daniel Di Luca on racial and ethnic differences in quality of life among people with Parkinson's disease. Related Podcast Links: Links Between Pain & Depression with Unemployment Due to CNS Cancer: https://directory.libsyn.com/episode/index/id/26356875 Racial and Ethnic Differences in Antiseizure Medications Among People with Epilepsy on Medicaid: https://directory.libsyn.com/episode/index/id/25916646 Race-Ethnic Disparities in Stroke Thrombolysis: https://directory.libsyn.com/episode/index/id/23377391 Social Determinants of Health in Patients with Movement Disorders: https://directory.libsyn.com/episode/index/id/26531040 Racial and Ethnic Differences in Quality of Life in Parkinson Disease: https://directory.libsyn.com/episode/index/id/27196008 Related Article Links: Association of Employment Status With Symptom Burden and Health-Related Quality of Life in People Living With Primary CNS Tumors: https://n.neurology.org/content/100/16/e1723 Racial and Ethnic Differences in Antiseizure Medications Among People With Epilepsy on Medicaid: A Case of Potential Inequities: https://cp.neurology.org/content/13/1/e200101 Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke: https://n.neurology.org/content/98/16/e1596 Neighborhood Social Determinants of Health in Patients Seen in Neurology Movement Disorders Clinics: https://cp.neurology.org/content/13/2/e200142 Racial and Ethnic Differences in Health-Related Quality of Life for Individuals With Parkinson Disease Across Centers of Excellence: https://n.neurology.org/content/100/21/e2170 Visit NPUb.org/Podcast for associated article links
Patients may be the experts on their own conditions, but data that captures health-related quality of life is often underutilized in research. The PKD Foundation is working with IQVIA to create a registry of patients with autosomal dominant polycystic kidney disease, a rare kidney condition. The ADPKD registry focuses on patient-reported, health-related quality of life data. The organization believes the registry will not only provide new insights into the condition but help with the design of efficient clinical trials and accelerate the development of new treatments. We spoke to President and CEO of the PKD Foundation Susan Bushnell, Vice President of Research Programs at PKD Foundation Elise Hoover, and Senior Director of Global Strategic Planning for IQVIA's Integrated Health Practice David Voccola, about the new registry, how it is leveraging technology to enable patients to drive insights into their condition, and the challenges it needs to overcome.
Dr Matt Ellington from Central Texas Pediatric Orthopedics joins the show this month! We discuss pain management for ACL reconstruction and the danger of opioid use disorders, as well as grit scores and Dr Ellington's pearls for a variety of sports cases. The lightning round highlights the outcomes of THA in pediatric patients, spinal trauma classification systems, and long term outcomes after scoliosis surgery. Your hosts are Julia Sanders from Children's Hospital Colorado, Carter Clement from Children's Hospital of New Orleans, Craig Louer from Vanderbilt, and Josh Holt from University of Iowa. This episode is sponsored by Nuvasive. Music by A. A. Alto. References: Akazawa et al. Health-Related Quality of Life of Patients With Adolescent Idiopathic Scoliosis at Least 40 Years After Surgery. Spine (Phila Pa 1976). 2023. Pascual-Leone N et al. Higher Grit Scores Are Associated With Earlier Increases in Knee Flexion Following Anterior Cruciate Ligament Reconstruction With Meniscus Repair in Pediatric Patients. JPO. 2023. Sborov KD et al. Thoracolumbar Injury Classification and Severity Scale Can Help Identify Intra-Abdominal Injury in Children Injured in an MVC. JPOSNA. 2023. Whitmarsh-Brown MA et al. Modernizing Our Understanding of Total Hip Arthroplasty in the Pediatric and Young Adult Patient: A Single-center Experience. JPO. 2023.. Cahan et al. Opioid Represcriptions After ACL Reconstruction in Adolescents Are Associated With Subsequent Opioid Use Disorder. JPO. 2023.. O'Neill NP et al. The Reliability of the AO Spine Upper Cervical Classification System in Children: Results of a Multi-Center Study. JPO. 2023. Wagner et al. Variability in Pain Management Practices for Pediatric Anterior Cruciate Ligament Reconstruction. JPO. 2023.
This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In part 1 we talked about a request that has been submitted for the World Health Organization (WHO) to add diet drugs (specifically GLP1 agonists like Novo Nordisk's Saxenda and Wegovy) to their list of “essential medicines.” We discussed who was making this request and the justification that they were using. In part 2 we took a deeper dive into the research that they used to try to support this request, and in this final installment, we will look at the research around efficacy, harm, and cost-effectiveness.First I'll offer a summary for each issue and then I'll give a breakdowns of the research that they cite. Just a quick reminder that this request is asking the World Health Organization (WHO) to add these drugs to their list of “essential medications” globally.Before we get into the sections, I want to mention two overarching issues that are found throughout the entirety of this request and the studies that are used to support it.First, in general, a belief has been fomented (predominantly by those in the weight loss industry) that being higher-weight is so terrible then it's worth “throwing anything at the problem.” This leads to acceptance of poor, short-term, and/or incomplete data as “good enough” to foist recommendations onto higher-weight people, which means that part of weight stigma in healthcare is that higher-weight people are afforded less right to ethical, evidence-based medicine than thinner people.Second, is clinging to correlation (without any mechanism of causation) when it comes to weight, health, and health outcomes, including the abject failure to consider confounding variables. So throughout these studies “being higher-weight is associated with [health issue(s)]” stated uncritically in support of weight loss interventions. There is an utter failure to explore the idea that the reason for the outcome differences is not weight itself but, instead, exposure to weight stigma, weight cycling (which these medications actually perpetuate by their own admission,) and healthcare inequalities. Issues with research supporting effectiveness, harms, and benefitsStudy Duration:This is the main issue. While there was one study that went up to 106 weeks, the vast majority of the studies are between 14 and 56 weeks. We know that these drugs can have significant, even life-threatening side effects (earning them the FDA's strongest warning.) 14-56 weeks is not not nearly enough time to capture the danger of long-term effects, or to capture long-term trends around weight loss/weight regain.Study PopulationMany of the studies included have small samples. Many have study populations are overwhelmingly white, which is a huge issue when making a global recommendations.Small effect and overlapMany of the studies show only a bit of weight loss (often 15lbs or less) and often there was overlap in weight lost between the treatment group and the placebo group. Even using the “ob*sity” construct that this request is based on, for many people, this amount of weight loss wouldn't even change their “class” of “ob*sity.”Failure to capture adverse eventsMuch of the research they use to support their claims of safety didn't actually capture individual adverse events or serious adverse events. Often they only captured subjects who reported leaving treatment due to side effects.Issues with research supporting cost effectivenessThe cost-effectiveness analyses they cite are based on Quality Adjusted Life Years (QALYs). This is a measurement of the effectiveness of a medical intervention to lengthen and/or improve patients' lives.The calculation for this is [Years of Life * Utility Value = #QALY]So if a treatment gives someone 3 extra years of life with a Health-Related Quality of Life (HRQL) score of 0.7, then the treatment is said to generate 2.1 [3 x 0.7] QALYs.This is a complicated and problematic concept that deserves its own post sometime in the future, but looking just at this request I think it's important to note that they are working on two main unproven assumptions:1. That being higher weight causes lower health-related quality of life and/or shorter life span (rather than any lower HRQL being related to experiences that higher-weight people have including weight stigma, weight cycling, healthcare inequalities et al.) 2. That this treatment induces weight loss and/or health benefits that increase the life span and/or health-related quality of life of those who take it.I don't believe either of these assumptions are proven by the material cited in the request to the WHO. Specifically, it's very possible that it's not living in a higher-weight body, but rather the experiences that higher-weight people are more likely to have (weight stigma, weight cycling, healthcare inequalities) that impact their HRQL.Further, the short-term efficacy data available (and Novo Nordisk's own admission about high rates of regain) fall far short of proving any assumptions about these drugs ability to actually improve or extend life. Further, the failure of the literature to adequately capture negative side effects of the drugs, both short and long-term, means that this calculation cannot be properly made.Incremental Cost-Effectiveness Ratio (ICER)ICER is how QALYs are turned into a monetary value. It is calculated by dividing the difference in total costs by the difference in the chosen measure of health outcome or effect.[(Cost of intervention A -Cost of Intervention B) / (Effectiveness of Intervention A – Effectiveness of Intervention B)]The result is a ratio of extra cost per extra unit of health effect of a more vs less expensive treatment which can then be measured in QALYs.Again, this is worthy of its own post because there are all kinds of ethical issues around things like how we value life, how we define “healthy” and the ethics of determining whether or not prolonging someone's life is “cost effective.” I'm not going to do a deep dive into that today, but I do want to note that it is a serious issue in these kinds of calculations.In this specific case, even if one was to get past the ethical issues, an accurate calculation is impossible to make on both of the measures of the equation.Cost of these drugs varies wildly between countries and sometimes within countries because, for example, Novo Nordisk is a for-profit corporation whose goal is to create as much profit as possible. Per the WHO request letter, the monthly cost of liraglutide is $126 in Norway and $709 in the US. Semaglutide is $95 per 30 days in Turkey, but $804 per 30 days in US.When it comes to effectiveness of the treatment, again, there is virtually no long-term data. We do know that in Novo Nordisk's own studies, weight is regained rapidly and cardiometabolic benefits are lost when the drugs are discontinued and even when people stay on the drugs, weight loss levels off after about a year, at 68 weeks weight cycling begins, and at 104 weeks (when follow-up ended) weight was trending up. It's possible that these drugs are utterly ineffective over the long-term and/or that the prevalence of long-term side effects renders any treatment effects moot. We simply do not know.I do not think that this is a remotely appropriate basis from which to request that these drugs be declared globally essential by the WHO.Here are the citation breakdowns. These are not deep dives since there are enough issues with the research on a simple surface analysis.Breakdowns of evidence of comparative effectivenessEffects of liraglutide in the treatment of ob*sity: a randomised, double-blind, placebo-controlled study, Astrup et al.)This is a 20-week study funded by Novo Nordisk. It included 564 people on various doses of liraglutide and a placebo group who didn't get the drug and a group on orlistat. There were no more than 90-98 people in each group.The study explains “Participants on liraglutide lost significantly more weight than did those on placebo” by which they meant that those on the highest dose of liraglutide lose about 9.7lbs more than those on the placebo over the 20 weeks.III LEAD studiesThese are four studies that look at liraglutide in combination with other drugs for the treatment of Type 2 Diabetes that also included some information on weight changes. One was 52 weeks, the others were 26, the maximum amount of weight lost was only about 5lbs. The first [Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with Type 2 diabetes (LEAD-1 SU), Marre et al] was a study that looked at the efficacy of adding liraglutide or rosiglitazone 4 to glimiperide in subjects with Type 2 Diabetes to test effects on blood sugar and body size.The study followed 1041 adults for 26 weeks. The study found that those on .6mg of liraglutide gained 0.7kg, those on 1.2mg gained 0.3kg, and those on 1.8mg of liraglutide lost 0.2kg, while those on placebo lost 0.1kg.The second [Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care, 2009. 32(1): p. 84-90. Nauck, M., et al.,]looked at the efficacy of adding liraglutide to metformin therapy for those with Type 2 Diabetes. They found that over the 26-week study those on liraglutide lost 1.8 ± 0.2, 2.6 ± 0.2, and 2.8 ± 0.2 kg for 0.6, 1.2, and 1.8 mg doses. Those on placebo lost 1.5 ± 0.3kg.The third [Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): a randomised, 52-week, phase III, double-blind, parallel-treatment trial. Lancet, 2009. 373(9662): p. 473-81. Garber, A., et al.,] This was a study of the comparative effectiveness of Liraglutide versus glimepiride for type 2 diabetes, with small weight loss as an ancillary finding. Those in the liraglutide group lost an average of 2kg.The final study [Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 Met+TZD), Zinman et al.] was a 26-week study with 533 total subjects. The goal was to study the efficacy of liraglutide when added to metformin and rosiglitazone for people with type 2 diabetes. They found that those on liraglutide lost between 0.7 and 2.3kg (1.5lbs to 5.1lbs) in 26 weeks.Meta-Analyses and Systematic Review FindingsEfficacy of Liraglutide in Non-Diabetic Ob*se Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Barboza, J.J., et al., None of the included studies were more than 56 weeks and one was only 14 weeks. One had as many as 3731 subjects, but one had only 40. Some had body weight loss as a primary outcome, but some did not. Maximum doses ranged from 1.8 to 3.0mg. The mean body weight reduction was 3.35 kg (7.4lbs) but in one study there was no difference in weight loss. The maximum difference was 6.3kg (13.9lbs)They also refer to Iqbal et al which we discussed in part 2.Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials. Vilsbøll, T., et al.The included studies are between 20 and 53 weeks long, and include some of the studies they already cited individually above. Of the 25 included studies only 3 had “ob*sity” as the main inclusion criteria, the rest were Type 2 Diabetes.The mean weight loss for those on the highest dose of the drug was between 0.2kg and 7.2kg. For those in the control group it was 2.9 kg, so there was actually overlap between the treatment and placebo groups.Summary of evidence of safety and harmsThey begin with the claim “The safety profile of GLP-1 receptor agonists is also well studied”To support this they cite: Efficacy and Safety of Liraglutide 3.0 mg in Patients with Overweight and Ob*se with or without Diabetes: A Systematic Review and Meta-Analysis, Konwar, M., et al.,This included 14 total studies, many of which the authors of the WHO request had cited individually and were included in other systematic reviews and meta-analyses above. The smallest study included 19 people, the largest included 2,487. The total number of subjects was 4,142.Their conclusion was “Liraglutide in 3.0 mg subcutaneous dose demonstrated significant weight reduction with a reasonable safety profile for patients with overweight or ob*sity regardless of diabetic status compared to placebo.”Their methodology says that they omitted studies from analysis due to “short duration.” They included studies that had a minimum of 12 weeks and a maximum of 56 weeks of follow-up.While they included 14 studies, only 11 of them actually included information about adverse events.In terms of adverse effects (AEs,) they found that the pooled estimate of nine studies in nondiabetic patients and two studies in diabetic patients revealed a significant proportion of patients experiencing the adverse events in liraglutide 3.0 mg group when compared with placebo., and the pooled estimate of the eleven studies showed that liraglutide 3.0 mg had higher risk of AEs compared to placebo.When it came to “serious adverse events” they found that there was a similar risk level between the drug and placebo groups, but remember that's for only 12 to 56 weeks, and Novo Nordisk is recommending that people take these drugs for the rest of their lives. A few months to a little over a year is not enough time to capture long-term serious adverse events.The efficacy and safety of liraglutide in the ob*se, non-diabetic individuals: a systematic review and meta-analysis. Zhang, P., et al.,This included five RCTs (which were included in various of the above systemic reviews and meta-analyses) ranging in follow-up from 14 to 56 weeks.The only adverse event information captured was the number of people who withdrew from treatment due to adverse events (which they found was similar between drug and placebo) and nausea (which was experienced more by people on the drug.)So, in addition to being short in duration, this was far from a comprehensive list of side effects. They made no attempt to capture serious adverse side effects and their short-term nature would have made this difficult anyway.Association of Pharmacological Treatments for Ob*sity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. Khera, R., et al.This looked at weight loss and adverse events with a number of different weight loss drugs. Interestingly liraglutide did not show the highest amount of weight loss but was associated with the highest odds of adverse event–related treatment discontinuation. It should also be noted that high drop-out rates of 30-45% plagued all of the trials which the study authors admit means that “studies were considered to be at high risk of bias.“Given that those who drafted the WHO request are asking that these drugs be considered essential globally, it is disappointing that they included this study and didn't bother to mention this issue in their written request.This included 28 RCTs (most of which were included in other citations above) and only 3 that included liraglutide. They didn't capture individual adverse events, but only “Discontinuation of Therapy Due to Adverse Events.” They only evaluated a year of data so, again, while it is likely that these studies would have captured common adverse events had they bothered to try, there isn't long enough follow-up to have any information about serious (possibly life-threatening) long-term adverse events.Association of Glucagon-like Peptide 1 Analogs and Agonists Administered for Ob*sity with Weight Loss and Adverse Events: A Systematic Review and Network Meta-analysis. Vosoughi, K., et al.,This study included 64 RCTs with durations from 12 to 160 weeks, with a median of 26 weeks. As is common in these studies, the majority of the sample (74.9%) was white.Like those above, they only looked at treatment discontinuation from adverse events, they did not capture specific adverse events (common or serious.) Of the seven GLP-1 drugs they tested, liraglutide was tied with taspoglutide for the highest discontinuation of treatment due to adverse events.The study authors also note that “Risk of bias was high or unclear for random sequence generation (29.7%), allocation concealment (26.6%), and incomplete outcome data (26.6%).”Breakdowns for Comparative Cost-effectiveness StudiesFirst, the WHO request authors themselves admit that when it comes to cost-effectiveness, “the analyses have generally been performed only for high-income countries.” This is significant since they are asking the WHO to consider these drugs essential for the entire world.It's also important to understand that none of the data looks at a comparison of cost effectiveness for weight-neutral health interventions to these drugs. Without that information there is no way to calculate actual “cost effectiveness” since it's possible that weight-neutral health interventions would have greater benefits with less risk and dramatically lower cost. NICE's guidance: Liraglutide for managing overweight and ob*sity Technology appraisal guidance [TA664]Published: 09 December 2020.Do recall that NICE is involved in the current scandal with Novo Nordisk for influence peddling.These guidelines are created based on a submission of evidence by Novo Nordisk. The committee's understanding of “clinical need” was based on the testimony of a single “patient expert” who “explained that living with ob*sity is challenging and restrictive. There is stigma associated with being ob*se.”Once again we see a rush to blame body size for any “challenges” and “restrictions” of living in a higher-weight body, accompanied by the immediate decision that those bodies should be subjected to healthcare interventions that risk their lives and quality of life in order to be made (temporarily, by Novo and NICE's own admission) thinner. There did not seem to be a patient expert to discuss the weight-neutral options.It was not immediately apparent if the patient expert was provided/paid by Novo Nordisk, but they certainly forwarded their narrative that simply living in a higher-weight body is a disease requiring treatment.It should be noted that while the trial Novo Nordisk submitted covered a wider range of people, they specifically submitted for this recommendation only the subgroup of that population who were diagnosed with “ob*sity,” pre-diabetes, and a “high risk of cardiovascular disease based on risk factors such as hypertension and dyslipidaemia.”So, even if we accept this guidance as true, the WHO Essential Medicines request applies to a population much wider than this and so this fails to justify the cost-effectiveness for that population.This guidance is also based on the costs associated with obtaining the drugs through a “specialist weight management service” since an agreement is in place for Novo Nordisk to give a discount to these services.In calculating the ICER per QALY gained, the recommendations note that “Because of the uncertainties in the modelling assumptions, particularly what happens after stopping liraglutide and the calculation of long-term benefits, the committee agreed that an acceptable ICER would not be higher than £20,000 per QALY gained”Again, this recommendation is based on a trial submitted by Novo Nordisk that included 3,721 people and lasted for three years, but only 800 met the criteria for this cost-effectiveness recommendation. The trial failed to show a significant reduction in cardiovascular events. Novo's calculation of risk reduction was based on surrogate outcomes, which NICE points out “introduces uncertainty because causal inference requires direct evidence that liraglutide reduces cardiovascular events. This was not provided in the company submission because of lack of long-term evidence.”The NICE committee admits “relying on surrogates is uncertain but accepted that surrogate outcomes were the only available evidence to estimate cardiovascular benefits.”I just want to point out that another option would be to refuse to experiment on higher-weight people without appropriate evidence.These cost-effectiveness calculations are based on someone using the drug for two years, with no actual data on reduction in cardiovascular events, and with the admitted assumption that “any weight loss returned to the base weight 3 years after treatment discontinuation.” Said another way, this committee decided that it was cost effective to spend up to £20,000 per QALY for people to take a weight loss drug with significant side effects for two years, with no direct evidence of reduced cardiovascular events, and with the acknowledgment that people will be gaining all of their weight back when they stop taking it.Those who wrote the request for WHO to consider these drugs “essential” chose to characterize this as “At the chosen threshold of £20,000 per quality-adjusted life year (QALY) gained, the report concluded that liraglutide is cost-effective for the management of ob*sity.” I do not think that is an accurate characterization of the findings.The request cites “A report by the Canadian Agency for Drugs and Technologies in Health (CADTH) found that compared to standard care, the ICER for liraglutide was $196,876 per QALY gained”For the US, they cite a study that found that to achieve ICERs between $100,000 and $150,000 perQALY or evLY gained, the health-benefit price benchmark range for semaglutide was estimated as $7500 - $9800 per year, which would require a discount of 28-45% from the current US net price.They also cite “Cost-effectiveness analysis of semaglutide 2.4 mg for the treatment of adult patients with overweight and ob*sity in the United States, Kim et al.Let's take a look at their conflict of interest disclosure (emphasis mine)“Financial support for this research was provided by Novo Nordisk Inc. The study sponsor [that means Novo Nordisk] was involved in several aspects of the research, including the study design, the interpretation of data, the writing of the manuscript, and the decision to submit the manuscript for publication.Dr Kim and Ms Ramasamy are employees of Novo Nordisk Inc. Ms Kumar and Dr Burudpakdee were employees of Novo Nordisk Inc at the time this study was conducted. Dr Sullivan received research support from Novo Nordisk Inc for this study. Drs Wang, Song, Wu, Ms Xie, and Ms Sun are employees of Analysis Group, Inc, who received consultancy fees from Novo Nordisk Inc in connection with this study.”Given that, you probably won't be shocked to learn that this concluded that Novo Nordisk's drug, semaglutide, was cost-effective. The reason I bolded the text above is that this study is based on modeling – they are taking what is, by their own admission, a “new drug” and making predictions for 30 years. Everything was simulated based on trial data (you know, those trials that we've been discussing that often have horrendous methodology…) and “other relevant literature.” The construction of the modeling and the interpretation of the results was directed by the company who stands to benefit financially from the findings, and carried out by that company's employees and consultants. Also, and I'll just quote again here since I don't think I can improve on their text “Cost-effectiveness was examined with a willingness-to-pay (WTP) threshold of $150,000 per QALY gained” I do not think that this WTP is based on a global assessment.In their (and by their I mean Novo Nordisk's) modeling they find that semaglutide was estimated to improve QALYs by 0.138 to 0.925 and incur higher costs by $3,254 to $25,086 over the 30-year time horizon vs comparators.And, again, this is without any kind of actual long-term data. I think that the best way to characterize this information is “back of the envelope calculations” at best.To sum up, I do not think that the research they cite comes anywhere close to proving that these drugs have levels of efficacy, safety, or cost-effectiveness that warrant their addition to the WHO list of essential medicines. I believe that if the WHO grants this request I think it will be an affront to medical science, it will cheapen the concept of “essential medicines,” and it will harm untold numbers of higher-weight people all over the world.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
Drs Jeffrey Swigris and Ayodeji Adegunsoye discuss fibrosing interstitial lung disease and treatment challenges for individuals with idiopathic pulmonary fibrosis. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/982422). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Idiopathic Pulmonary Fibrosis (An Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline https://pubmed.ncbi.nlm.nih.gov/35486072/ Health-Related Quality of Life and Symptoms in Patients With IPF Treated With Nintedanib: Analyses of Patient-Reported Outcomes From the INPULSIS® Trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990488/ Acute Exacerbation of Idiopathic Pulmonary Fibrosis: A Clinical Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7089322/
Join me for a conversation with Dr. Lacretia Carroll, Assistant Professor in the College of Nursing at the University of Tennessee Health Science Center about the importance of health informatics. Learn more about what health and nursing informatics mean to you as a patient or as a provider. Dr. Carroll especially relates health informatics to her research on health disparities in the LGBTQ+ community.More about Dr. Carroll:Lacretia Carroll joined the faculty of the UTHSC College of Nursing in October 2019. Her research focuses on social determinants of health, health equity and disparities, and health outcomes in sexual and gender minority adolescent populations.Dr. Carroll earned her Bachelor's Degree in nursing in 2011 from the University of Alabama-Huntsville and her Master's Degree in nursing from the University of Memphis in 2013. She has clinical experience in pediatric intensive care and endocrinology and research expertise as a clinical research coordinator in pediatric allergy, immunology, and endocrinology. She received her PhD in 2018 from the University of Tennessee Health Science Center for her dissertation titled “Health-Related Quality of Life of Female Children with Congenital Adrenal Hyperplasia: A Mixed Methods Study.” Prior to assuming her faculty role, Dr. Carroll completed postdoctoral training at UTHSC.Dr. Carroll has received several small grants from organizations such as Sigma Theta Tau and the CARES Foundation. She is a member of Southern Nursing Research Society and Pediatric Endocrinology Nursing Society. Dr. Carroll has authored and co-authored peer-reviewed papers and regularly presents at scientific meetings.Follow That's Healthful and like or comment on this or any episode of this podcast.
In this podcast, Thomas John from the Department of Medical Oncology at the Peter MacCallum Cancer Centre in Melbourne, Margarita Majem from the Department of Medical Oncology at the Hospital de la Santa Creu i Sant Pau in Barcelona, Diane Legg, founder of LUNGSTRONG, and Jonathan Goldman from the David Geffen School of Medicine at the University of California in Los Angeles discuss health-related quality of life in resectable EGFR-mutant non-small cell lung cancer. This podcast is published open access in Targeted Oncology and is fully citeable. You can access the original published podcast article through the Targeted Oncology website and by using this link: https://link.springer.com/article/10.1007/s11523-022-00927-5. All conflicts of interest can be found online. Open Access This podcast is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The material in this podcast is included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
Editor-in-Chief Dr. Sue Yom hosts Dr. Shankar Siva, Associate Professor and Radiation Oncologist from the Peter MacCallum Cancer Centre, Australia and the supervising author of "Cost-Effectiveness of Single- versus Multi-Fraction SABR for Pulmonary Oligometastases - The SAFRON II Trial"; Dr. David Sher, Professor at the University of Texas Southwestern Medical Center and the Red Journal's Methodology Section Editor who first-authored this month's OncoScan "The Cost-Effectiveness of Consolidative Radiation Therapy in Oligometastatic Disease: High-Value Proposition or Wishful Thinking?"; and Dr. Aisling Barry, Professor and Chair of Radiation Oncology at University College Cork and Cork University Hospital, Ireland, who first-authored "The Impact of Disease Progression on Health-Related Quality of Life Outcomes in Patients with Oligo-Metastatic Disease at 12-Months post Stereotactic Body Radiotherapy."
Multiple Sclerosis News Today's multimedia associate, Price Wooldridge, discusses how researchers have identified early factors that may affect the trajectory of an MS patient's long-term quality of life following diagnosis. He also reads “My MS Makes Getting Sick With a Viral Infection 10 Times Worse”, a column by Benjamin Hofmeister. =================================== Are you interested in learning more about multiple sclerosis? If so, please visit: https://multiplesclerosisnewstoday.com/ ===================================== To join in on conversations regarding multiple sclerosis, please visit: https://multiplesclerosisnewstoday.com/forums/
Drs Sumanta Pal and Brian Rini discuss front-line treatment of renal cell carcinoma. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/968736). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals. Resources Bevacizumab Plus Interferon-alpha Versus Interferon-alpha Monotherapy in Patients With Metastatic Renal Cell Carcinoma: Results of Overall Survival for CALGB 90206 https://ascopubs.org/doi/10.1200/jco.2009.27.18_suppl.lba5019 An updated table of the front-line IO combination RCC studies that have shown an OS advantage https://twitter.com/brian_rini/status/1309609380585844736/photo/1 Targeting PD-1 or PD-L1 in Metastatic Kidney Cancer: Combination Therapy in the First-Line Setting https://aacrjournals.org/clincancerres/article/26/9/2087/83102/Targeting-PD-1-or-PD-L1-in-Metastatic-Kidney Conditional Survival and Long-term Efficacy With Nivolumab Plus Ipilimumab Versus Sunitinib in Patients With Advanced Renal Cell Carcinoma https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.34180 International Metastatic Renal Cell Carcinoma Database Consortium Criteria https://www.uptodate.com/contents/image?imageKey=ONC%2F116130&topicKey=ONC%2F2984&source=see_link Molecular Correlates Differentiate Response to Atezolizumab (atezo) + Bevacizumab (bev) vs Sunitinib (sun): Results From a Phase III Study (IMmotion151) in Untreated Metastatic Renal Cell Carcinoma (mRCC) https://cslide.ctimeetingtech.com/esmo2018/attendee/confcal/presentation/list?q=LBA31 Nivolumab Versus Everolimus in Patients With Advanced Renal Cell Carcinoma: Updated Results With Long-term Follow-up of the Randomized, Open-Label, Phase 3 CheckMate 025 Trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415096/pdf/nihms-1732721.pdf Lenvatinib Plus Pembrolizumab or Everolimus for Advanced Renal Cell Carcinoma https://www.nejm.org/doi/10.1056/NEJMoa2035716 The Uromigos Debate: Treatment of Favorable Risk Renal Cancer https://anchor.fm/the-uromigos/episodes/Episode-67-The-Third-Uromigos-Debate---fPD1VEGF-vs-PD1CTLA4-for-front-line-renal-cancer-emjpji Health-Related Quality-of-Life Outcomes in Patients With Advanced Renal Cell Carcinoma Treated With Lenvatinib Plus Pembrolizumab or Everolimus Versus Sunitinib (CLEAR): A Randomised, Phase 3 Study https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(22)00212-1/fulltext Study of Cabozantinib in Combination With Nivolumab and Ipilimumab in Patients With Previously Untreated Advanced or Metastatic Renal Cell Carcinoma (COSMIC-313) https://clinicaltrials.gov/ct2/show/NCT03937219 A Study of Pembrolizumab (MK-3475) in Combination With Belzutifan (MK-6482) and Lenvatinib (MK-7902), or Pembrolizumab/Quavonlimab (MK-1308A) in Combination With Lenvatinib, Versus Pembrolizumab and Lenvatinib, for Treatment of Advanced Clear Cell Renal Cell Carcinoma (MK-6482-012) https://clinicaltrials.gov/ct2/show/NCT04736706 Twitter poll questions: What magnitude of benefit is required to adopt triplets? OS https://mobile.twitter.com/brian_rini/status/1508450496104783877 What magnitude of absolute PFS benefit vs doublets is required to adopt triplets? https://mobile.twitter.com/brian_rini/status/1508450910506295305 What would be the most convincing endpoint to adopt triplets? https://mobile.twitter.com/brian_rini/status/1508451622564909057 Molecular Subsets in Renal Cancer Determine Outcome to Checkpoint and Angiogenesis Blockade https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436590/ OPtimal Treatment by Invoking biologic Clusters in Renal Cell Carcinoma (OPTIC RCC) https://www.kcameetings.org/wp-content/uploads/2021/12/IKCSNA21_TIP8_Chen.pdf
In this episode, Antonia and Andrew discuss a selection of articles from the August 3, 2022 issue of JBJS, along with an added dose of entertainment and pop culture. Listen at the gym, on your commute, or whenever your case is on hold! Articles Discussed: Current Concepts Review. Current State of Platelet-Rich Plasma and Cell-Based Therapies for the Treatment of Osteoarthritis and Tendon and Ligament Injuries, by Su et al. What's Important: The Individualism Excuse and the Myth of Meritocracy in Orthopaedics, by Baird et al. Orthopaedic Forum: The Pioneering Women of Orthopaedic Surgery. A Historical Review, by Dib et al. Outcomes After Anatomic and Reverse Shoulder Arthroplasty for the Treatment of Glenohumeral Osteoarthritis. A Propensity Score-Matched Analysis, by Kirsch et al. The Influence of Surgeon Sex on Adverse Events Following Primary Total Hip Arthroplasty. A Register-Based Study of 11,993 Procedures and 200 Surgeons in Swedish Public Hospitals, by Jolbäck et al. A Prospective, Longitudinal Study of the Influence of Obesity on Total Knee Arthroplasty Revision Rate. Results from the Australian Orthopaedic Association National Joint Replacement Registry, by Wall et al. Total Hip Arthroplasty Leads to Better Results After Low-Energy Displaced Femoral Neck Fracture in Patients Aged 55 to 70 Years. A Randomized Controlled Multicenter Trial Comparing Internal Fixation and Total Hip Arthroplasty, by Bartels et al. Development and Validation of Health-Related Quality of Life Measure in Older Children and Adolescents with Early Onset Scoliosis. Early Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF), by Matsumoto et al. Exposure-Related Anxiety and Improving Patient Sat
FRONTAL FIBROSING ALOPECIA : ISOTRETINOIN VS FINASTERIDE Rakowska A, et al (starts at 9:15). Efficacy of Isotretinoin and Acitretin in Treatment of Frontal Fibrosing Alopecia: Retrospective Analysis of 54 Cases. J Drugs Dermatol. 2017. Rokni GR et al (starts at 10:43). Evaluating the combined efficacy of oral isotretinoin and topical tacrolimus versus oral finasteride and topical tacrolimus in frontal fibrosing alopecia - A randomized controlled trial. J Cosmet Dermatol. 2022 Jul 11. FRONTAL FIBROSING ALOPECIA : EYELASH INVOLVEMENT Salas-Callo C et al (starts at 16:14). Eyelash involvement in frontal fibrosing alopecia: A prospective study. J Am Acad Dermatol 2022 Jul;87(1):232-234. FRONTAL FIBROSING ALOPECIA : QUALITY OF LIFE David Saceda-Corralo et al (starts at 22:52). Health-Related Quality of Life in Patients With Frontal Fibrosing Alopecia. JAMA Dermatol. 2018 Apr 1;154(4):479-480. Varghae A et al (starts at 24:43). Assessment of health-related quality of life in patients with frontal fibrosing alopecia. J Cosmet Dermatol. 2022 Jun 27. FRONTAL FIBROSING ALOPECIA : MALE FFA STUDIES OF ORAL MINOXIDIL AND FINASTERIDE/DUTASTERIDE Moussa A et al (starts at 30:00). Clinical features and treatment outcomes of frontal fibrosing alopecia in men. Int J Dermatol. 2022 Jun 21 LPP PREVALENCE STUDIES Trager MH et al (starts at 40:50). Prevalence estimates for lichen planopilaris and frontal fibrosing alopecia in a New York City health care system. J Am Acad Dermatol 2021 Apr;84(4):1166-1169 Lavian J et al (starts at 41:37). Incidence estimates for lichen planopilaris and frontal fibrosing alopecia in a New York City health care system.Dermatol Online J. 2021 Aug 15;27(8). Lim S H et al (starts at 42:29). Rapidly increasing incidence and prevalence of lichen planopilaris in an Asian population: A Korean nationwide population-based study. J Dermatol. 2022 Jun 21. Joshi TP et al (starts at 49:10). Prevalence of lichen planopilaris in the United States: A cross-sectional study of the All of Us research program. JAAD Int. 2022 Jun 13;8:69-70 CENTRAL CENTRIFUGAL CICATRICIAL ALOPECIA: QUALITY OF LIFE Akintilo et al (starts at 54:48). Health care barriers and quality of life in central centrifugal cicatricial alopecia patients. Cutis. 2018 Dec;102(6):427-432. Maranga et al (starts at 56:49). Quality of life in patients with central centrifugal cicatricial alopecia: a preliminary study. Br J Dermatol. 2022 Jun 15. CONCLUSION AND SUMMARY - starts at 58:46
In this episode of the Award-winning PRS Journal Club Podcast, 2022 Resident Ambassadors to the PRS Editorial Board – Saïd Azoury, Emily Long, and Ronnie Shammas- and special guest Vu T. Nguyen, MD, discuss the following articles from the April 2022 issue: “Prepectoral and Subpectoral Tissue Expander– Based Breast Reconstruction: A Propensity- Matched Analysis of 90-Day Clinical and Health-Related Quality-of-Life Outcomes” by Nelson, Shamsunder, Vorstenbosch, et al. Read the article for FREE: https://bit.ly/TissueExpanderOutcomes Special guest Vu T. Nguyen, MD is an Associate Professor of Plastic Surgery at the University of Pittsburgh and Program Director of the Pittsburgh Plastic Surgery Residency. Dr. Nguyen completed his residency training at the University of Pittsburgh followed by a Microsurgery Fellowship at the University of Pennsylvania. READ the articles discussed in this podcast as well as free related content from the archives: https://bit.ly/PRSApril22Collection
Dr. Abbatemarco discusses the Neurology article, "Costs and Health-Related Quality of Life in Patients With NMO Spectrum Disorders and MOG-Antibody–Associated Disease". Show references: https://n.neurology.org/content/98/11/e1184
Musculoskeletal diseases consume a large amount of health and social resources and are a major cause of disability in both low- and high-income countries. In addition, patients frequently present with co-morbid chronic diseases of lifestyle. The area of musculoskeletal disease is restricted by a lack of epidemiological knowledge, particularly in low- and middleincome countries.
Bailey & Ashley discuss what it's like to miscarry in other countries. They review blogs, statistics, and superstitions that follow women around the world as they face pregnancy loss. They discovered that women suffer as one from this universal hurt. All information mentioned is linked below. New Zealand Approves Paid Leave After A Miscarriage : NPR https://resolve.org/infertility-101/what-is-infertility/fast-facts/ Reproductiveaccess.com Miscarriage - NHS (www.nhs.uk) How Culture Shapes Perceptions of Miscarriage - SAPIENS Caring for women experiencing pregnancy loss: a free e-learning resource - The Miscarriage Association How Culture Shapes Perceptions of Miscarriage - SAPIENS New Zealand becomes one of the first countries to legalize paid leave for miscarriages - The Washington Post Miscarriage - Expectant, Medical and Surgical Management (adhb.govt.nz) The Country Where Having a Miscarriage Can Land You in Prison (thewire.in) New Zealand not the first to provide paid miscarriage leave; India has a law since 1960s (republicworld.com) Estimation of pregnancy losses attributable to exposure to ambient fine particles in south Asia: an epidemiological case-control study - The Lancet Planetary Health Having a Miscarriage in China - WWAM Bam! Traditional Chinese Pregnancy Restrictions, Health-Related Quality of Life and Perceived Stress among Pregnant Women in Macao, China - Asian Nursing Research (asian-nursingresearch.com) Rising number of Swedish women suffer recurrent miscarriages (sciencenordic.com) Here In Africa, The Stigma Surrounding Baby Loss Meant My Miscarriages Were Seen As Punishment From God | HuffPost UK Parents (huffingtonpost.co.uk)
Dr. Donovan summarizes Prior Injury, Health-Related Quality of Life, Disablement, and Physical Activity in Former Women's Soccer Players by Shannon J. Cross, EdD; Diane L. Gill, PhD; Pam Kocher Brown, EdD; Erin J. Reifsteck, PhD which is featured in the January issue of the Journal of Athletic Training. Article Link: https://bit.ly/3fVZP6l
Tem gente que desperta e dá bom dia para o sol.Mas tem muita gente que acorda mal humorada e demora até mesmo para conseguir socializar.Por que isso acontece?Confira no papo entre o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.> OUÇA (57min 43s)*Naruhodo! é o podcast pra quem tem fome de aprender. Ciência, senso comum, curiosidades, desafios e muito mais. Com o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.Edição: Reginaldo Cursino.http://naruhodo.b9.com.br*PARCERIA: ALURAA Alura tem mais de 1.000 cursos de diversas áreas e é a maior plataforma de cursos online do Brasil -- e você tem acesso a todos com uma única assinatura.Aproveite o desconto de R$100 para ouvintes Naruhodo no link:https://www.alura.com.br/promocao/naruhodo *PARCERIA: ACTConheça a campanha "Viva melhor, beba menos", realizada pela OPAS, Organização Pan-Americana da Saúde, com apoio da ACT Promoção da Saúde. O podcast Naruhodo apoia essa iniciativa.Acesse: twitter.com/OPASOMSBrasil*REFERÊNCIASA marker for the end of adolescencehttps://www.sciencedirect.com/science/article/pii/S0960982204009285Morningness and eveningness personality: A survey in literature from 1995 up till 2006https://www.sciencedirect.com/science/article/abs/pii/S0191886907002516GWAS of 89,283 individuals identifies genetic variants associated with self-reporting of being a morning personhttps://www.nature.com/articles/ncomms10448Distribution and heritability of diurnal preference (chronotype) in a rural Brazilian family-based cohort, the Baependi studyhttps://www.nature.com/articles/srep09214DIURNAL PREFERENCE AND SLEEP QUALITY: SAME GENES? A STUDY OF YOUNG ADULT TWINShttps://www.tandfonline.com/doi/abs/10.3109/07420521003663801The Physiological Period Length of the Human Circadian Clock In Vivo Is Directly Proportional to Period in Human Fibroblastshttps://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0013376Molecular interrogation of hypothalamic organization reveals distinct dopamine neuronal subtypeshttps://www.nature.com/articles/nn.4462A Cryptochrome 2 mutation yields advanced sleep phase in humanshttps://elifesciences.org/articles/16695Phenotyping of PER3 variants reveals widespread effects on circadian preference, sleep regulation, and healthhttps://www.sciencedirect.com/science/article/abs/pii/S1087079217301387?casa_token=FwV3rbinBKIAAAAA:aDnC_DtGS5fX3ywDD02sahy2DHaVizxLxo9u3CsUEJFNnh9-QOG5ywZwaWnCsQzquqvAZ3Cx0frpTime for Bed: Genetic Mechanisms Mediating the Circadian Regulation of Sleephttps://www.sciencedirect.com/science/article/abs/pii/S0168952518300015?casa_token=8Uw_zcyy8dQAAAAA:KZVL7DFZq7YoX101uSgWs6frxgMa5LxezgGInYOOeoDNoqIHzAyUSfEDHJ4OlW9HA1ggaKhZ4n-kExtreme morning chronotypes are often familial and not exceedingly rare: the estimated prevalence of advanced sleep phase, familial advanced sleep phase, and advanced sleep–wake phase disorder in a sleep clinic population.https://academic.oup.com/sleep/article/42/10/zsz148/5542813?login=trueChronotype Genetic Variant in PER2 is Associated with Intrinsic Circadian Period in Humanshttps://www.nature.com/articles/s41598-019-41712-1A PERIOD3 variant causes a circadian phenotype and is associated with a seasonal mood traithttps://www.pnas.org/content/113/11/E1536.abstract?sid=9d1fba25-6642-4bb6-8048-756dbb5e2f13Sleep and Mood: Chicken or Egg?https://escholarship.org/content/qt1zj3s69s/qt1zj3s69s.pdfExposure to jet lag aggravates depression-like behaviors and age-related phenotypes in rats subject to chronic corticosteronehttps://academic.oup.com/abbs/article/51/8/834/5533128?login=trueCircadian preference and academic achievement in school-aged students: a systematic review and a longitudinal investigation of reciprocal relationshttps://www.tandfonline.com/doi/full/10.1080/07420528.2021.1926473?casa_token=8CHiH2ACoMUAAAAA%3A-kvhljaeiSNlZi7SA58yc1OzZiauLTPG1pwvk7ExalVaSPSTRD3IP95xudyvpraYH4bxSjC440KkL3IAge, the Big Five, and time-of-day preference: A mediational modelhttps://www.sciencedirect.com/science/article/abs/pii/S0191886913012592?via%3DihubLarks, owls, swifts, and woodcocks among fruit flies: differential responses of four heritable chronotypes to long and hot summer dayshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016586/Suprachiasmatic Nucleus: Cell Autonomy and Network Propertieshttps://www.annualreviews.org/doi/abs/10.1146/annurev-physiol-021909-135919Morningness–eveningness, sleep–wake variables and big five personality factorshttps://www.sciencedirect.com/science/article/abs/pii/S0191886907002516Night eating patterns and chronotypes: A correlation with binge eating behaviorshttps://www.sciencedirect.com/science/article/abs/pii/S0191886908000974Chronotype Differences in Health Behaviors and Health-Related Quality of Life: A Population-Based Study Among Aged and Older AdultsAutoMEQ - https://chronotype-self-test.info/index.php?sid=61524&newtest=YNaruhodo #5 - É possivel recuperar uma noite mal dormida dormindo mais na noite seguinte?https://www.youtube.com/watch?v=E-JN2qagigY&ab_channel=Cient%C3%ADstica%26PodcastNaruhodoNaruhodo #129 - Sono polifásico funciona segundo a ciência?https://www.youtube.com/watch?v=h6AfuI46VhQ&t=3s&ab_channel=Cient%C3%ADstica%26PodcastNaruhodoNaruhodo #245 - Por que sempre tem espaço pro doce?https://www.youtube.com/watch?v=mMRAGpdXEp8&ab_channel=Cient%C3%ADstica%26PodcastNaruhodoNaruhodo #256 - Porque roncamos?https://www.b9.com.br/shows/naruhodo/naruhodo-256-por-que-roncamos/Naruhodo #188 - Contar carneirinhos faz a gente dormir mais rápido?https://www.youtube.com/watch?v=Txu8-QTZB7IPodcasts das #Minas: PERGUNTA DE QUINTA - É PAU É PEDRA#MulheresPodcastershttps://open.spotify.com/show/7wpw0VXhWurAofD2zeJgsm*APOIE O NARUHODO!Você sabia que pode ajudar a manter o Naruhodo no ar?Ao contribuir, você pode ter acesso ao grupo fechado no Telegram, receber conteúdos exclusivos e ter vantagens especiais.Assine o apoio mensal pelo PicPay (https://picpay.me/naruhodopodcast), pelo Apoia-se (https://apoia.se/naruhodopodcast) ou ainda, para pessoas que moram fora do Brasil, pelo Patreon (https://www.patreon.com/naruhodopodcast).
Quality of life can be negatively impacted by chronic illnesses like POTS. Please join us for an honest discussion of quality of life based on the scientific literature and personal experience. Trigger warning: this episode gets heavy at times, and discusses suicide as related to poor quality of life in POTS patients. Please click the "subscribe" button so that you don't miss an episode of The POTScast. Subscribing also helps us reach other people just like you! Links referenced in this episode: Health-Related Quality of Life and Suicide Risk in Postural Tachycardia Syndrome CDC Healthy Days Questionnaire Standing Up to POTS page on Suicide Prevention You can read the transcript for this episode here: https://tinyurl.com/3ps5jzws Please click the "subscribe" button so that you don't miss an episode of The POTScast. Subscribing also helps us reach other people just like you! If you liked this episode, we hope you will help to support our production costs by donating to Standing Up to POTS at https://www.standinguptopots.org/donate Find out more about Standing Up to POTS! Check us out on our Website: www.standinguptopots.org Facebook: https://www.facebook.com/standinguptopots/ Instagram: https://www.instagram.com/standinguptopots/ Twitter: https://twitter.com/POTSActivist Pintrest: https://www.pinterest.com/TheStandingUpToPOTS/ Medical Disclaimer: The information provided here is not intended to serve as professional medical advice, diagnosis, or treatment. If you have health related issues, please contact a qualified health professional to get the personalized assessment, advice, and treatment that you need. Standing Up to POTS will not be liable for any direct, indirect, or other damages arising from the use of this podcast.
Quality of life can be negatively impacted by chronic illnesses like POTS. Please join us for an honest discussion of quality of life based on the scientific literature and personal experience. Trigger warning: this episode gets heavy at times, and discusses suicide as related to poor quality of life in POTS patients. Please click the "subscribe" button so that you don't miss an episode of The POTScast. Subscribing also helps us reach other people just like you! Links referenced in this episode: Health-Related Quality of Life and Suicide Risk in Postural Tachycardia Syndrome CDC Healthy Days Questionnaire Standing Up to POTS page on Suicide Prevention You can read the transcript for this episode here: https://tinyurl.com/3ps5jzws Please click the "subscribe" button so that you don't miss an episode of The POTScast. Subscribing also helps us reach other people just like you! If you liked this episode, we hope you will help to support our production costs by donating to Standing Up to POTS at https://www.standinguptopots.org/donate Find out more about Standing Up to POTS! Check us out on our Website: www.standinguptopots.org Facebook: https://www.facebook.com/standinguptopots/ Instagram: https://www.instagram.com/standinguptopots/ Twitter: https://twitter.com/POTSActivist Pintrest: https://www.pinterest.com/TheStandingUpToPOTS/ Medical Disclaimer: The information provided here is not intended to serve as professional medical advice, diagnosis, or treatment. If you have health related issues, please contact a qualified health professional to get the personalized assessment, advice, and treatment that you need. Standing Up to POTS will not be liable for any direct, indirect, or other damages arising from the use of this podcast.
Quality of life can be negatively impacted by chronic illnesses like POTS. Please join us for an honest discussion of quality of life based on the scientific literature and personal experience. Trigger warning: this episode gets heavy at times, and discusses suicide as related to poor quality of life in POTS patients. Please click the "subscribe" button so that you don't miss an episode of The POTScast. Subscribing also helps us reach other people just like you! Links referenced in this episode: Health-Related Quality of Life and Suicide Risk in Postural Tachycardia Syndrome CDC Healthy Days Questionnaire Standing Up to POTS page on Suicide Prevention You can read the transcript for this episode here: https://tinyurl.com/3ps5jzws Please click the "subscribe" button so that you don't miss an episode of The POTScast. Subscribing also helps us reach other people just like you! If you liked this episode, we hope you will help to support our production costs by donating to Standing Up to POTS at https://www.standinguptopots.org/donate Find out more about Standing Up to POTS! Check us out on our Website: www.standinguptopots.org Facebook: https://www.facebook.com/standinguptopots/ Instagram: https://www.instagram.com/standinguptopots/ Twitter: https://twitter.com/POTSActivist Pintrest: https://www.pinterest.com/TheStandingUpToPOTS/ Medical Disclaimer: The information provided here is not intended to serve as professional medical advice, diagnosis, or treatment. If you have health related issues, please contact a qualified health professional to get the personalized assessment, advice, and treatment that you need. Standing Up to POTS will not be liable for any direct, indirect, or other damages arising from the use of this podcast.
Dr Marwan Bukhari asks Dr Ioannis Parodis (Karolinska Institutet, Sweden) about his recent paper, which examined the impact of high BMI on health-related quality of life in patients with systemic lupus erythematosus. They discuss the main findings from the study, clinical implications, and possible future research. This paper is the Editor's Choice for March 2021.
Dr Marwan Bukhari asks Dr Ioannis Parodis (Karolinska Institutet, Sweden) about his recent paper, which examined the impact of high BMI on health-related quality of life in patients with systemic lupus erythematosus. They discuss the main findings from the study, clinical implications, and possible future research. This paper is the Editor's Choice for March 2021.
Multiple Sclerosis News Today's columnist, Jenn Powell, discusses health-related quality of life in people with multiple sclerosis Plus, Multiple Sclerosis News Today's columnist and forums moderator, Ed Tobias, reports on differences between how physicians in the U.S. and Britain are treating patients during the COVID-19 pandemic. ===================================== Treatment for Relapsing MS Progression | MAYZENT® (siponimod) Read about MAYZENT, a once daily pill that can significantly slow down disability progression in people with relapsing MS. See full prescribing & safety info. http://ChangesInRMS.com ===================================== Are you interested in learning more about multiple sclerosis? If so, please visit: https://multiplesclerosisnewstoday.com/ ===================================== To join in on conversations regarding multiple sclerosis, please visit: https://multiplesclerosisnewstoday.com/forums/
What is Heart Rate Variability (HRV)? -Chantea Goetz Heart rate variability is the change in the time intervals between consecutive heartbeats. Variations can be due to age, gender, athletic ability, circadian rhythms, core body temperature, and metabolism. 24-hour recordings are the gold standard. To measure the autonomic, cardiovascular, & respiratory systems a short-term reading of 5 minutes a day is sufficient. HRV is a critical indicator of health, resilience, well-being, and performance. Several research studies indicate that lowered HRV values lead to increased reports of diabetes, coronary disease, anxiety, depression, asthma, and poor performance. These aliments are due to autonomic dysregulation. HRV biofeedback positively effects the cardiovascular system, respiratory system, gastrointestinal system, performance, and behavior. The benefits of using HRV biofeedback has the ability for people to become aware of their proper breathing rate, also known as resonant frequency. Proper breathing patterns can improve professional and athletic performance, improve focus and concentration, reduce anxiety and depression symptoms, improve overall health and mental well-being, while reducing risk factors for disease. HRV biofeedback training involves slowing the breathing rate to achieve the RF breathe. For most people the respiratory sinus arrhythmia (RSA) is maximized when breathing at a rate of 6 breaths per minute. In order to obtain an ideal HRV there needs to be a balance between the parasympathetic and sympathetic nervous systems. When a person is over-stressed and under-recovered there will be a decline in performance. Some ways in which to separate emotional responses from physical actions are to practice mindfulness and meditation. My Journey in BioHacking Functional Fitness -Jim Goetz I work with people daily in order to help them achieve their goals and improve their way of life. What good is life if it's a life that's not worth living? Everyone deserves a happy and healthy life but many lack any clue on how to achieve this. Goals are an essential part of health and happiness. Without setting objective goals, having a plan and being accountable to this plan, success will not happen. What biohacking is and some thoughts on this were discussed in a recent interview I gave with The Vitamin Shoppe in their publication, What is Good. My journey is not unlike any other. However the plan I use to achieve my goals is highly researched. As goals may be and should be in different aspects of life, this article focuses on health and fitness goals. I began working out in the fourth grade. My grammar school teacher was not the best and as a result I became very unhappy. I found enjoyment through running, push ups, and sit ups. There was a burning sensation in either my legs, chest and arms or abs that was perplexing. The more I did, the more it burned. As an eight year old, this confusing sensation led to greater experimentation, which essentially meant to do more exercises. I would do these exercises daily, timing myself to see how long I could do them until the burn began and then how long I could push through the burn until I literally could not move that body part any longer. I was utilizing the most unscientific manner to increase lactic threshold and muscular endurance and function but for an eight year old, it made sense. My life was always filled with sports. Grammar school through high school it was cross country, basketball and baseball. In college it was baseball. Like most, I only did what the coach had me do. Like most I did not realize the coach had no clue himself in how to make better athletes. It was in undergrad when I changed majors to exercise science that I began to learn new techniques in how to improve athletic ability. Some ideas worked for me, some did not. For instance, increasing carbohydrate intake before and after working out caused a dissipation of the visual appearance of muscle. In other words, carbs for energy and replenishment caused me to gain body fat. I also noticed that by consuming high carb meals the nigh before an event, I would wake up in the morning lethargic and with stomach pangs. I would also find that during a distance event, I would eventually feel depleted of all energy and not flow through the event as planned. Training for my first Tough Mudder was also an experiment. Though I ran long distances all my life, I loathed running at this point in my life. Instead of running, I did a spin class each morning and then later on would complete two circuits of six exercises with extremely heavy weight, being able to complete no more than 1-3 reps. I would move through this as fast yet efficient as possible. In the three months leading up to the Tough Mudder, I inadvertently lost 16 lbs and gained an incredible amount of strength. For example, before I began training I could do six pull ups. By the time three months passed, I was doing twenty pull ups at a time with ease. Through these two experiences and examples, I had self discovered methods that indeed were topics of research yet had no idea about it at the time. My journey to biohacking was well on the way before I had even heard of the idea of biohacking. I went through an arduous two year period without access to a gym. I became weak to the point of no longer being able to do a pull up or a full range of motion dip. I lost forty pounds and was emaciated. Refusing to be beat, I adapted and learned I needed to make some changes and utilize every ounce of exercise science, physiology and neurology that I knew. I found rocks, concrete, steel pipes and built some awkward equipment that I could use and train in a functional manner. Each day I would apply the lessons I knew from the text books and research journals to my personal physical development. Some say nutrition is 80% of the solution when it comes to lean muscle gain and body fat loss. I personally believe it is closer to 90% of the solution. During the two year period without access to a gym, my access to nutritious food of any sort, even food in any quantity was limited at best. I was able to find access to large amounts of peanut butter, to which I hoarded and lived off of. In January of 2017, I weighed 160 lbs. I began to hone eating a ketogenic diet that I plan on keeping a lifestyle for the rest of my life. The science appears to be there for my Genotype that my physiology thrives on this manner of eating. I combined daily undulating periodization with cross fit workout of the days, power lifting for the lower extremity, Pilates, Olympic lifting and moderate distance running. On certain days, I utilize KAATSU and ensure I train all muscles every day in some manner yet ensure I do not go past no return so that I may properly recover. There is no one size fits all formula for success. Each individual has goals. Each individuals goals are unique and important to that person. Yet 95% of people will fail in their workout routine. This is due to a lack of setting a proper goal, lack of a plan towards that goal, and most importantly accountability to execute this plan on a daily basis. The book BioHacking Your Brain for Success: Becoming a True Champion in All Aspects of Life written by myself and Chantea Goetz discusses this in great detail. There's a reason some people are successful in all they do. Others make excuses for their failure, which really is a result of never actually putting in any effort. The most important aspect of success is passion!!! People tell me all the time they want to lose weight. I often tell them that there's no chance they will lose the weight and keep it off. They should save their money and do something enjoyable with it. Yes, these individuals are shocked at what I say but it is true. When one gets out of bed in the morning, they need to have a true passion and meaning in why they put their feet on the ground. If there's no passion for getting up, then the odds of success at an idea are futile at best. Does anyone really have a true passion for losing 20 lbs? They have the best intentions in the world but will assuredly fail. Take that same person who is 20 lbs overweight and sign them up for a competition and they may find that passion in training. The 20 lb weight loss will occur as a result. As Yogi Berra once said, "half of the game is ninety percent mental". I can write the greatest program in the universe for someone to succeed. If there's no passion behind it then success is not happening. One has to show up to the field to play the game. Exercise is a lot more than simply opening up a magazine and doing chest and tri's on Monday, back and bi's on Tuesday, shoulders on Wednesday, skipping legs on Thursday because let's face it, doing legs suck and with all good intention of doing something Friday, it just does not happen. Most do "abs" every day, without ever being able to see a true six pack. So many aspects of this model are flawed from the get go. First and foremost, muscles only stay anabolic for around 48 hours. This means that after a tough "chest" day, by Wednesday this muscle ceases growth. Unfortunately, the overzealous weight lifter has damaged their muscle fibers too great to be able to work it again and is left with a muscle that is catabolic. Bodybuilders can get away with this because they are taking anabolic steroids. This keeps them anabolic all day and every day. For those of us not on performance enhancing drugs, we need to stay a few steps ahead of the game and can use science (BioHack) our way to our goals. Einstein defined insanity as doing the same thing over and over again and expecting different results. So why do the majority of individuals do this single or double body part split day week after week, month after month, and think they are making progress? If someone goes to the gym with no plan, how can they see if they are progressing and progressing in the right manner? That would be like a strength and conditioning coach having a professional football team "just go lift" as opposed to having a highly specialized and detailed season long program. Perhaps progress can be optimized if they followed the rules of human physiology. Yet people do this day after day, week after week, month after month until they realize they "will never" reach their goals and eventually give up. Daily undulated periodization (DUP) has a key, which is getting in maximum workout volume, without impacting recovery, which is why the undulating and periodization aspects are critical. One trains the entire body multiple times per week and utilizes different repetition ranges, thus focusing in on more specific muscle fiber types. Training in this manner has been shown to be more effective than linear exercise programming in terms of muscular hypertrophy, strength and endurance. Combine DUP with KAATSU (vascular occlusion moderation training) and you get extreme muscle strength and growth in a far shorter time frame than would be believed. It is believed that the restricted blood flow recruits a greater number of fast twitch muscle fibers and even converts fibers to fast twitch. This combined with the increase in chemical mediators to repair tissues has been shown to have phenomenal results. High Intensity Interval Training (HIIT) has it's place for fat burning and strength training. Some utilize it to save time in a day. Others can utilize it to have amazing physical performance results. Pilates is utilized for dexterity, flexibility, and fine tuning a strong core. This can be done literally by anyone. Never let a fat person on statins tell you how to eat. Never let a skinny person tell you how to lift. And never get accurate information from the media. Open up recent text books. Read peer reviewed journals and do critical appraisals on each article you consider utilizing. In the end, set your goals to mirror your passions. Set a realistic plan to achieve them and stay accountable each day towards it. Do this and welcome into your life the success you very much deserve. My goal...pull a 500 lb deadlift and on the same day run and complete an Iron Man triathalon. What's yours? Let's get to BioHacking our way there!!!! References: Jennifer T. Fine, Graham A. Colditz, Eugenie H. Coakley, George Moseley, JoAnn E. Manson, Walter C. Willett, and Ichiro Kawachi. A Prospective Study of Weight Change and Health-Related Quality of Life in Women . JAMA 1999 282: 2136-2142. Alfred Wirth and Jutta Krause. Long-term Weight Loss With Sibutramine: A Randomized Controlled Trial. JAMA 2001 286: 1331-1339 Shinichi Amano, Arimi Fitri Mat Ludin, Rachel Clift, et al. Effectiveness of blood flow restricted exercise compared with standard exercise in patients with recurrent low back pain: study protocol for a randomized controlled trial. Trials201617:81 Zourdos, Michael C.; Jo, Edward; Khamoui, Andy V. et al. Modified Daily Undulating Periodization Model Produces Greater Performance Than a Traditional Configuration in Powerlifters. Journal of Strength & Conditioning Research: March 2016 - Volume 30 - Issue 3 - p 784–791 Nicholas J Krilanovich. Benefits of ketogenic diets. Am J Clin Nutr January 2007 vol. 85 no. 1 238-239 BioHacking the Myths of Water -Dr. Michael Brandon, DC We all know that as long as we drink 8 cups of water a day our skin will be softer and glisten, we'll have a faster metabolism, better kidney function, we'll clear out toxins from our body, perform better, and lose weight. Well, now it's time to state that you have been lied to. In fact, only about half of that appears to hold any truth. The other half has either never been proven, or worse, been proven incorrect but is yet repeated to everybody as health advice. So what is false tales vs true benefits? Lets do what biohackers do best and get to the science of the life requiring, ultimate biohack of H2O! Let's begin with hacking the untruths, and target the big one. There is NO proof or reason to have 8 cups of water each day. Yep, I said it. In fact, there has been multiple studies done proving this is illegitimate! In reality, there are too many variables that effect hydration requirements such as weight, gender, activity levels, what/how much you have eaten, heat, and heart or kidney pathologies just to name a few, so no one amount will work for even half of the population. The Committee at the Institute of Medicine even states that “While it might appear useful to estimate an average requirement (an EAR) for water, an EAR based on data is not possible” There are 2 easy guidelines to account for this and the first is quite simple. If you are thirsty or active, you should drink some water. You can over do it, but it takes a lot to do so. Again, everyone is different, but typically after a gallon or so within 2-3 hours is too much for almost everybody and can cause some acute health issues. At that point you almost literally have to force water down your throat which brings us to guideline number 2; if you're drinking and it becomes physically difficult to drink water, you've probably had enough. We have a reflex that slows down our swallowing strength when we are over full of food and fluids, so as always, listen to your body, it knows best. Also, our bodies can only absorb about a quart an hour, so even if you are in heavy exercise, any more than that is going in and straight out without any benefit anyway other then depleting your body of more salt and electrolytes. The next myth to bust is that caffeine dehydrates you, so here you go, it doesn't. Well not if you're used to drinking it, and it only minimally does if you are a caffeine novice. Moderate amounts of caffeine usage (4 cups of coffee or 100mg of caffeine) showed no significant diuretic effects leading to lower hydration levels. This is not to be confused with saying that coffee and water are equal, as caffeine does lower our bodies' salt levels and does not give all the same effects as water which will be covered down the page. Based on the most current research, increasing water intake alone also DOES NOT provide the following benefits as many have proclaimed; healthier and shinier skin, better kidney functions, clearing out toxins, and giving more energy. These were all thought up by one industry or another to help promotions and as far as could be found, held no scientific support. So what does drinking water help with? Still quite a bit, I mean it is necessary for a reason! Staying hydrated is great for both physical and mental performance. Muscle is 80% water, so staying fully hydrated helps prevent early muscle fatigue, cramping, and may allow for an extra rep or 2 in the gym. Also when dehydrated, our bodies release less anabolic hormones and more catabolic hormones including cortisol, so having sufficient water levels may help with exercise gains. Though these effects of dehydration effect all activities, it appears that it hampers high intensity and endurance activities like long distance running significantly more than anaerobic ones like weight lifting. Being dehydrated, also can effect short term memory, focus, visual perception, and other cognitive factors. Both these and the physical decreases can occur once someone has lost as little as 2% of weight from water such as sweating. This would be about 3lbs for someone weighing initially 150lbs, and it's not uncommon for many athletes to lose 6-8% in any given workout. Drinking water can also help with weight loss, and this is 2 fold. First the simple mechanism; drinking 500ml of water (around 16 oz) before a meal helps with satiety and forces us to eat less. However, there is more to it then that. The same amount also is shown to increase metabolic rate by roughly 30%. This increase in metabolism begins in only 10 minutes and peaks after about 30-40 minutes and can last up to 3 hours. So you can burn a few extra calories a day just by staying hydrated; sounds worth-while to me. Even if water doesn't hold up to all the “facts” that many of us have heard time and time again, it is still the item which should be consumed the most by everybody on any given day. With all the benefits mentioned, let alone the thousands of physiological reactions it helps with in the body, I say bottoms up with the bottle to good health! References: Boschmann, Michael, et al. “Water Drinking Induces Thermogenesis through Osmosensitive Mechanisms | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic.”OUP Academic, Oxford University Press, 1 Aug. 2007, academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2006-1438. Killer, Sophie C., et al. “No Evidence of Dehydration with Moderate Daily Coffee Intake: A Counterbalanced Cross-Over Study in a Free-Living Population.” PLOS ONE, Public Library of Science, journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0084154. Popkin, Barry M., et al. “Water, Hydration and Health.” Nutrition Reviews, U.S. National Library of Medicine, Aug. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2908954/. University of Michigan. Myth of 8 Glasses of Water a Day. 24 Aug. 2015, www.med.umich.edu/1libr/Gyn/ObgynClinic/8GlassesWaterMyth.pdf. “What Is Hyponatremia?” WebMD, WebMD, www.webmd.com/a-to-z-guides/what-is-hyponatremia#1. biohackhumans.com Find us: Instagram (@biohackhumans) Facebook (@biohackhumans) Twitter (@biohackhumans) Tumblr (@biohackhumans) Contact Us: support@biohackhumans.com
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