Podcasts about us preventive services task force

Un nouvel épisode du Pharmascope est maintenant disponible! Dans de ce 113ème épisode, Sébastien, Nicolas et Isabelle débutent une série d'épisodes sur l'ostéoporose. Dans ce premier épisode, on aborde le dépistage, l'évaluation et le diagnostic de l'ostéoporose, une maladie qui n'en est peut-être pas vraiment une…   Les objectifs pour cet épisode sont les suivants: Définir l'ostéoporose Identifier les patients nécessitant un dépistage de l'ostéoporose Expliquer les avantages et les limites d'une ostéodensitométrie Évaluer le risque de fracture d'un patient   Ressources pertinentes en lien avec l'épisode National Institute for Health and Care Excellence (NICE). Osteoporosis: assessing the risk of fragility fracture. London; 2017. US Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319:2521-31. Viswanathan M et coll. Screening to Prevent Osteoporotic Fractures: An Evidence Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018. (Evidence Synthesis, No. 162. Papaioannou A et coll. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010;182:1864-73. Korownyk C, McCormack J, Allan GM. Who should receive bone mineral density testing? Can Fam Physician. 2015;61:612. Choisir avec soin. L'ostéodensitométrie. Canada. Management of Osteoporosis in Postmenopausal Women: The 2021 Position Statement of The North American Menopause Society'' Editorial Panel. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021;28:973-97. Calculateur FRAX Centre for Metabolic Bone Diseases. FRAX: Fracture Risk Assessment Tool. University of Sheffield, UK.

Broadcast from KSQD, Santa Cruz on 10-30-2025: Dr. Dawn opens with Halloween-themed scary medical stories, beginning with food toxins lurking in refrigerators and pantries. She explains how molds on grains and nuts, particularly Aspergillus species, produce aflatoxins that bind to DNA and cause liver cancer, making peanuts especially risky. Fusarium on wheat produces trichothecenes and fumonisins damaging cell membranes. Penicillium molds on fruits like apples produce patulin creating reactive oxygen species that harm organs. She advises discarding soft moldy foods entirely since fungal hyphae penetrate deeply, while hard cheeses can have moldy portions cut away. Meat spoilage involves bacteria producing cadaverine and putrescine, with E. coli, Campylobacter, Salmonella, and Clostridium causing severe illness through heat-stable toxins. A caller asks about yogurt-covered peanuts tasting rancid and confirms Botox contains botulinum toxin A in different salt forms, used medically for migraines, hyperhidrosis, and strabismus. The caller also describes paper-thin skin on sun-exposed forearms that bleeds easily. Dr. Dawn explains UV radiation damages collagen and elastin, making blood vessels vulnerable to shear forces. She recommends topical vitamin K products like Dermal K and protective lycra sleeves or gardening gauntlets to prevent injuries, emphasizing the need for annual dermatologic exams after extensive sun exposure. An emailer asks about RSV vaccine recommendations before overseas travel. Dr. Dawn disagreed with the couple's physician, citing US Preventive Services Task Force guidelines recommending RSV vaccination for all adults 60 and older, plus those 50+ with chronic conditions. She discusses FDA-approved home testing options including the PIXEL by LabCorp test for COVID, flu, and RSV, and iHealth rapid tests. She notes RSV point-of-care tests are available to medical practitioners and recommends thorough vaccination before international trips. Dr. Dawn presents a frightening investigation into private equity hospital bankruptcies, focusing on Steward Healthcare's 31 hospitals and Prospect's 16 facilities. Private equity firm Cerberus earned $700 million while Steward 650 documented incidents of deficient care including deaths. One woman died from hemorrhage after vendors repossessed equipment due to unpaid bills. She explains the shell game where companies sell hospital land to Medical Properties Trust, forcing new operators to pay rent while private equity extracts profits. The Brookings Institution study reveals systematic prioritization of investor returns over patient care, with courts failing to prevent these practices despite some states passing protective legislation. She discusses stillbirth rates being significantly underreported, with Harvard research showing actual rates of 1 in 147 pregnancies versus CDC's 1 in 175, worsening to 1 in 95 for black families. Over 70% involved known risks like obesity or diabetes, but 30% had no identifiable factors. Dr. Dawn emphasizes unconscious bias in medicine where women's complaints are dismissed, particularly affecting women of color and non-English speakers, noting both patient and provider biases require training to address. Dr. Dawn warns about HPV-related oral squamous cell carcinoma in young men, explaining that changing sexual practices over 30 years have created new transmission routes from genitals to mouth. Major risk factors include smokeless tobacco and hard alcohol which damage DNA. She mentions newly available saliva tests for persistent HPV detection, recommending risk factor reduction for positive cases. She concludes optimistically with a breakthrough Huntington's disease treatment using microRNA molecule AMT-130 delivered via virus to brain striatum. The treatment mirrors toxic Huntington protein's RNA, creating double-stranded structures cells destroy, preventing toxic protein accumulation. The three-year trial of 29 patients showed 75% slowing of disease progression with few side effects, offering hope for 100,000 Americans carrying the mutation, including 40,000 with current symptoms.

Send us a message with this link, we would love to hear from you. Standard message rates may apply.Colon cancer screening saves lives by catching cancer early and even preventing it, yet only 69% of eligible adults are up to date with their screenings. We explore who needs screening, what tests are available, and how to choose the right one for you.• Most adults should start colon cancer screening at age 45, even if healthy• Family history may mean you need to start screening earlier• Stool-based tests like FIT and Cologuard are convenient home options• Colonoscopy remains the gold standard, allowing doctors to remove polyps• One in 23 men and one in 25 women will develop colorectal cancer• The best screening test is the one you'll actually completePlease get screened! Check with your doctor about which test is right for you based on your risk factors and preferences.References1. Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians (Version 2). Qaseem A, Harrod CS, Crandall CJ, et al. Annals of Internal Medicine. 2023;176(8):1092-1100. doi:10.7326/M23-0779.2. AGA Clinical Practice Update on Risk Stratification for Colorectal Cancer Screening and Post-Polypectomy Surveillance: Expert Review. Issaka RB, Chan AT, Gupta S. Gastroenterology. 2023;165(5):1280-1291. doi:10.1053/j.gastro.2023.06.033.3. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. Davidson KW, Barry MJ, Mangione CM, et al. JAMA. 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238.4. Colorectal Cancer Screening and Prevention. Sur DKC, Brown PC. American Family Physician. 2025;112(3):278-283.5. Increasing Incidence of Early-Onset Colorectal Cancer. Sinicrope FA. The New England Journal of Medicine. 2022;386(16):1547-1558. doi:10.1056/NEJMra2200869.6. From Guideline to Practice: New Shared Decision-Making Tools for Colorectal Cancer Screening From the American Cancer Society. Volk RJ, Leal VB, Jacobs LE, et al. CA: A Cancer Journal for Clinicians. 2018;68(4):246-249. doi:10.3322/caac.21459.7. Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. Lin JS, Perdue LA, Henrikson NB, Bean SI, Blasi PR. JAMA. 2021;325(19):1978-1998. doi:10.1001/jama.2021.4417.8. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. Bibbins-Domingo K, Grossman DC, Curry SJ, et al. JAMA. 2016;315(23):2564-2575. doi:10.1001/jama.2016.5989.9. How Would You Screen This Patient for Colorectal Cancer? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Burns RB, Mangione CM, Weinberg DS, Kanjee Z. Annals of Internal Medicine. 2022;175(10):1452-1461. doi:10.7326/M22-1961.Support the showSubscribe to Our Newsletter! Production and Content: Edward Delesky, MD & Nicole Aruffo, RNArtwork: Olivia Pawlowski

The incidence of early onset colorectal cancer (EOCRC) has been rising prompting the change in change in screening guidelines to 45 years of age for average risk patients. Join us for an in-depth discussion with guest speakers Dr. Andrea Cercek and Dr. Nancy You, where we provide a comprehensive look at the growing challenge of EOCRC. Hosts: - Dr. Janet Alvarez - General Surgery Resident at New York Medical College/Metropolitan Hospital Center - Dr. Wini Zambare – General Surgery Resident at Weill Cornell Medical Center/New York Presbyterian - Dr. Phil Bauer, Graduating Colorectal Surgical Oncology Fellow at Memorial Sloan Kettering Cancer Center  - Dr. J. Joshua Smith MD, PhD, Chair, Department of Colon and Rectal Surgery at MD Anderson Cancer Center - Dr. Andrea Cercek - Gastrointestinal Medical Oncologist at Memorial Sloan Kettering Cancer Center - Dr. Y. Nancy You, MD MHSc - Professor, Department of Colon and Rectal Surgery at MD Anderson Cancer Center Learning objectives:  - Describe trends in incidence of colorectal cancer, with emphasis on the rise of EOCRC. - Identify age groups and demographics most affected by EOCRC. - Summarize USPSTF recommendations for colorectal cancer screening. - Distinguish between screening methods (e.g., colonoscopy, FIT-DNA) and their sensitivity. - Understand treatment approaches for colon and rectal cancer (CRC) - Understand the role of mismatch repair (MMR) status in guiding treatment. - Outline the importance of genetic counseling and testing in young patients. - Discuss racial, ethnic, and socioeconomic disparities in CRC incidence and outcomes. - Describe the impact of cancer treatment on fertility and sexual health. -  Review fertility preservation options. - Identify the value of integrated care teams for young CRC patients. References: 1.         Siegel, R. L. et al. Colorectal Cancer Incidence Patterns in the United States, 1974–2013. JNCI J. Natl. Cancer Inst. 109, djw322 (2017). https://pubmed.ncbi.nlm.nih.gov/28376186/ 2.         Abboud, Y. et al. Rising Incidence and Mortality of Early-Onset Colorectal Cancer in Young Cohorts Associated with Delayed Diagnosis. Cancers 17, 1500 (2025). https://pubmed.ncbi.nlm.nih.gov/40361427/ 3.         Phang, R. et al. Is the Incidence of Early-Onset Adenocarcinomas in Aotearoa New Zealand Increasing? Asia Pac. J. Clin. Oncol.https://pubmed.ncbi.nlm.nih.gov/40384533/ 4.         Vitaloni, M. et al. Clinical challenges and patient experiences in early-onset colorectal cancer: insights from seven European countries. BMC Gastroenterol. 25, 378 (2025). https://pubmed.ncbi.nlm.nih.gov/40375142/ 5.         Siegel, R. L. et al. Global patterns and trends in colorectal cancer incidence in young adults. (2019) doi:10.1136/gutjnl-2019-319511. https://pubmed.ncbi.nlm.nih.gov/31488504/ 6.         Cercek, A. et al. A Comprehensive Comparison of Early-Onset and Average-Onset Colorectal Cancers. J. Natl. Cancer Inst. 113, 1683–1692 (2021). https://pubmed.ncbi.nlm.nih.gov/34405229/ 7.         Zheng, X. et al. Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer. JNCI J. Natl. Cancer Inst. 113, 543–552 (2021). https://pubmed.ncbi.nlm.nih.gov/33136160/ 8.         Standl, E. & Schnell, O. Increased Risk of Cancer—An Integral Component of the Cardio–Renal–Metabolic Disease Cluster and Its Management. Cells 14, 564 (2025). https://pubmed.ncbi.nlm.nih.gov/40277890/ 9.         Muller, C., Ihionkhan, E., Stoffel, E. M. & Kupfer, S. S. Disparities in Early-Onset Colorectal Cancer. Cells 10, 1018 (2021). https://pubmed.ncbi.nlm.nih.gov/33925893/ 10.       US Preventive Services Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 325, 1965–1977 (2021). https://pubmed.ncbi.nlm.nih.gov/34003218/ 11.       Fwelo, P. et al. Differential Colorectal Cancer Mortality Across Racial and Ethnic Groups: Impact of Socioeconomic Status, Clinicopathology, and Treatment-Related Factors. Cancer Med. 14, e70612 (2025). https://pubmed.ncbi.nlm.nih.gov/40040375/ 12.       Lansdorp-Vogelaar, I. et al. Contribution of Screening and Survival Differences to Racial Disparities in Colorectal Cancer Rates. Cancer Epidemiol. Biomarkers Prev. 21, 728–736 (2012). https://pubmed.ncbi.nlm.nih.gov/22514249/ 13.       Ko, T. M. et al. Low neighborhood socioeconomic status is associated with poor outcomes in young adults with colorectal cancer. Surgery 176, 626–632 (2024). https://pubmed.ncbi.nlm.nih.gov/38972769/ 14.       Siegel, R. L., Wagle, N. S., Cercek, A., Smith, R. A. & Jemal, A. Colorectal cancer statistics, 2023. CA. Cancer J. Clin. 73, 233–254 (2023). https://pubmed.ncbi.nlm.nih.gov/36856579/ 15.       Jain, S., Maque, J., Galoosian, A., Osuna-Garcia, A. & May, F. P. Optimal Strategies for Colorectal Cancer Screening. Curr. Treat. Options Oncol. 23, 474–493 (2022). https://pubmed.ncbi.nlm.nih.gov/35316477/ 16.       Zauber, A. G. The Impact of Screening on Colorectal Cancer Mortality and Incidence: Has It Really Made a Difference? Dig. Dis. Sci. 60, 681–691 (2015). https://pubmed.ncbi.nlm.nih.gov/25740556/ 17.       Edwards, B. K. et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116, 544–573 (2010). https://pubmed.ncbi.nlm.nih.gov/19998273/ 18.       Cercek, A. et al. Nonoperative Management of Mismatch Repair–Deficient Tumors. New England Journal of Medicine 392, 2297–2308 (2025). https://pubmed.ncbi.nlm.nih.gov/40293177/ 19.       Monge, C., Waldrup, B., Carranza, F. G. & Velazquez-Villarreal, E. Molecular Heterogeneity in Early-Onset Colorectal Cancer: Pathway-Specific Insights in High-Risk Populations. Cancers 17, 1325 (2025). https://pubmed.ncbi.nlm.nih.gov/40282501/ 20.       Monge, C., Waldrup, B., Carranza, F. G. & Velazquez-Villarreal, E. Ethnicity-Specific Molecular Alterations in MAPK and JAK/STAT Pathways in Early-Onset Colorectal Cancer. Cancers 17, 1093 (2025). https://pubmed.ncbi.nlm.nih.gov/40227607/ 21.       Benson, A. B. et al. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Cancer Netw. JNCCN 19, 329–359 (2021). https://pubmed.ncbi.nlm.nih.gov/33724754/ 22.       Christenson, E. S. et al. Nivolumab and Relatlimab for the treatment of patients with unresectable or metastatic mismatch repair proficient colorectal cancer. https://pubmed.ncbi.nlm.nih.gov/40388545/ 23.       Dasari, A. et al. Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer (FRESCO-2): an international, multicentre, randomised, double-blind, phase 3 study. The Lancet 402, 41–53 (2023). https://pubmed.ncbi.nlm.nih.gov/37331369/ 24.       Strickler, J. H. et al. Tucatinib plus trastuzumab for chemotherapy-refractory, HER2-positive, RAS wild-type unresectable or metastatic colorectal cancer (MOUNTAINEER): a multicentre, open-label, phase 2 study. Lancet Oncol. 24, 496–508 (2023). https://pubmed.ncbi.nlm.nih.gov/37142372/ 25.       Sauer, R. et al. Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer. N. Engl. J. Med. 351, 1731–1740 (2004). https://pubmed.ncbi.nlm.nih.gov/15496622/ 26.       Cercek, A. et al. Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer. JAMA Oncol. 4, e180071 (2018). https://pubmed.ncbi.nlm.nih.gov/29566109/ 27.       Garcia-Aguilar, J. et al. Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy. J. Clin. Oncol. 40, 2546–2556 (2022). https://pubmed.ncbi.nlm.nih.gov/35483010/ 28.       Schrag, D. et al. Preoperative Treatment of Locally Advanced Rectal Cancer. N. Engl. J. Med. 389, 322–334 (2023). https://pubmed.ncbi.nlm.nih.gov/37272534/ 29.       Kunkler, I. H., Williams, L. J., Jack, W. J. L., Cameron, D. A. & Dixon, J. M. Breast-Conserving Surgery with or without Irradiation in Early Breast Cancer. N. Engl. J. Med. 388, 585–594 (2023). https://pubmed.ncbi.nlm.nih.gov/36791159/ 30.       Jacobsen, R. L., Macpherson, C. F., Pflugeisen, B. M. & Johnson, R. H. Care Experience, by Site of Care, for Adolescents and Young Adults With Cancer. JCO Oncol. Pract. (2021) doi:10.1200/OP.20.00840. https://pubmed.ncbi.nlm.nih.gov/33566700/ 31.       Ruddy, K. J. et al. Prospective Study of Fertility Concerns and Preservation Strategies in Young Women With Breast Cancer. J. Clin. Oncol. (2014) doi:10.1200/JCO.2013.52.8877. https://pubmed.ncbi.nlm.nih.gov/24567428/ 32.       Su, H. I. et al. Fertility Preservation in People With Cancer: ASCO Guideline Update. J. Clin. Oncol. 43, 1488–1515 (2025). https://pubmed.ncbi.nlm.nih.gov/40106739/ 33.       Smith, K. L., Gracia, C., Sokalska, A. & Moore, H. Advances in Fertility Preservation for Young Women With Cancer. Am. Soc. Clin. Oncol. Educ. Book 27–37 (2018) doi:10.1200/EDBK_208301. https://pubmed.ncbi.nlm.nih.gov/30231357/ 34.       Blumenfeld, Z. How to Preserve Fertility in Young Women Exposed to Chemotherapy? The Role of GnRH Agonist Cotreatment in Addition to Cryopreservation of Embrya, Oocytes, or Ovaries. The Oncologist 12, 1044–1054 (2007). 35.       Bhagavath, B. The current and future state of surgery in reproductive endocrinology. Curr. Opin. Obstet. Gynecol. 34, 164 (2022). 36.       Ribeiro, R. et al. Uterine transposition: technique and a case report. Fertil. Steril. 108, 320-324.e1 (2017). 37.       Yazdani, A., Sweterlitsch, K. M., Kim, H., Flyckt, R. L. & Christianson, M. S. Surgical Innovations to Protect Fertility from Oncologic Pelvic Radiation Therapy: Ovarian Transposition and Uterine Fixation. J. Clin. Med. 13, 5577 (2024). 38.       Holowatyj, A. N., Eng, C. & Lewis, M. A. Incorporating Reproductive Health in the Clinical Management of Early-Onset Colorectal Cancer. JCO Oncol. Pract. 18, 169–172 (2022). ***Behind the Knife Colorectal Surgery Oral Board Audio Review: https://app.behindtheknife.org/course-details/colorectal-surgery-oral-board-audio-review Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

The Department of Health and Human Services has canceled a planned meeting of the US Preventive Services Task Force. The number of measles cases hits a 30-year high after being eliminated in the United States. And, a Senate committee advanced President Trump's nominee to lead the Centers for Disease Control and Prevention. Those stories and more coming up on today's episode of the Gist Healthcare podcast. Hosted on Acast. See acast.com/privacy for more information.

In this episode of Diabetes Dialogue, co-hosts hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, discuss significant developments in diabetes care from May 2025, including Medtronic's restructured business model, Sequel Twiist's technological collaboration with Abbott, and Breakthrough T1D's efforts to advance early detection of type 1 diabetes (T1D) through national screening initiatives. The discussion opens with news of Medtronic's decision to spin off its diabetes division into a standalone entity, currently referred to as “New Diabetes Company.” While the final name is forthcoming, the move is intended to streamline operations and accelerate innovation within the diabetes space. The hosts highlight the company's promising technology pipeline, including the forthcoming 800 series insulin pump with full smartphone control and plans for a tubeless insulin delivery system. Both experts express optimism that the independence may foster greater agility in product development, enhance accessibility, and maintain a focus on user-centered design, including for populations with visual impairments. Next, Isaacs and Bellini examine the announcement of the Sequel Twiist partnership with Abbott to integrate continuous ketone monitoring (CKM) into a hybrid sensor, which is expected to function similarly to the FreeStyle Libre 3. This device, still in development, will provide real-time data on both glucose and ketone levels—a critical advance for people with type 1 diabetes using insulin pumps, who are at elevated risk for diabetic ketoacidosis (DKA). While excited about the potential for earlier DKA detection, Bellini emphasizes the importance of cost-effective implementation and integration with existing pump platforms. The episode concludes with coverage of Breakthrough T1D's advocacy before the US Preventive Services Task Force to support routine screening for T1D autoantibodies. The goal is to identify individuals in early stages of the disease to prevent DKA and misdiagnosis. The hosts note that despite advancements in understanding T1D progression, many patients remain undiagnosed until presenting with DKA or are mistakenly classified as having type 2 diabetes. References: Medtronic plc. Medtronic announces intent to separate Diabetes business. Medtronic News. Published May 21, 2025. Accessed June 2, 2025. https://news.medtronic.com/2025-05-21-Medtronic-announces-intent-to-separate-Diabetes-business Sequel Med Tech. Sequel Med Tech to Integrate twiist Automated Insulin Delivery (AID) System with Abbott's Future Dual Glucose-Ketone Sensor. GlobeNewswire News Room. Published May 22, 2025. Accessed June 2, 2025. https://www.globenewswire.com/news-release/2025/05/22/3086535/0/en/Sequel-Med-Tech-to-Integrate-twiist-Automated-Insulin-Delivery-AID-System-with-Abbott-s-Future-Dual-Glucose-Ketone-Sensor.html Breakthrough T1D. Breakthrough T1D Submits Application to Make Screening for Type 1 Diabetes Part of Recommended Preventive Services in the US - Breakthrough T1D. Breakthrough T1D. Published May 21, 2025. Accessed June 2, 2025. https://www.breakthrought1d.org/for-the-media/press-releases/breakthrough-t1d-submits-application-to-make-screening-for-type-1-diabetes-part-of-recommended-preventive-services-in-the-us/

Evidence-based recommendations from groups like the US Preventive Services Task Force are only as effective as the screening tools currently available.

Evidence-based recommendations from groups like the US Preventive Services Task Force are only as effective as the screening tools currently available.

Un nouvel épisode du Pharmascope est disponible et on s'attaque cette fois au trouble d'usage d'alcool. Dans cette première partie, Nicolas, Isabelle et une nouvelle invitée discutent du dépistage et de l'évaluation de cette maladie sous diagnostiquée, en plus de réviser la prise en charge du sevrage alcoolique. Les objectifs pour cet épisode sont: Procéder au dépistage du trouble d'usage d'alcool Diagnostiquer un trouble d'usage d'alcool Discuter des bénéfices et des désavantages associés aux principaux traitements pharmacologiques du sevrage alcoolique   Ressources pertinentes en lien avec l'épisode Lignes directrices canadiennes récentes en trouble d'usage d'alcool Wood E, Bright J, Hsu K, et coll. Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder. CMAJ. 2023 Oct 16;195(40):E1364-E1379. Repères canadiens sur l'alcool et la santé : rapport final. Centre canadien sur les dépendances et l'usage de substances. 2023 Guide canadien sur les risques associés à l'usage d'alcool Coalition canadienne pour la santé mentale des personnes pagées. Lignes directrices sur le trouble lié à l'utilisation de l'alcool chez les personnes âgées. 2023. Guide de l'INESSS sur la prise en charge du trouble d'utilisation d'alcool INESSS. Sevrage d'alcool et prévention des rechutes. 2021. US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, et coll. Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018 Nov 13;320(18):1899-1909. Mitchell AJ, Bird V, Rizzo M, et coll. Accuracy of one or two simple questions to identify alcohol-use disorder in primary care: a meta-analysis. Br J Gen Pract. 2014 Jul;64(624):e408-18. Bush K, Kivlahan DR, McDonell MB, et coll. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998 Sep 14;158(16):1789-95. Maldonado JR, Sher Y, Das S, et coll. Prospective Validation Study of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) in Medically Ill Inpatients: A New Scale for the Prediction of Complicated Alcohol Withdrawal Syndrome. Alcohol Alcohol. 2015 Sep;50(5):509-18. Kaner EF, Beyer FR, Muirhead C, et coll. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2018 Feb 24;2(2):CD004148. Amato L, Minozzi S, Vecchi S, Davoli M. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD005063. Daeppen JB, Gache P, Landry U, et coll. Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: a randomized treatment trial. Arch Intern Med. 2002 May 27;162(10):1117-21. Elholm B, Larsen K, Hornnes N, Zierau F, Becker U. Alcohol withdrawal syndrome: symptom-triggered versus fixed-schedule treatment in an outpatient setting. Alcohol Alcohol. 2011 May-Jun;46(3):318-23. Minozzi S, Amato L, Vecchi S, Davoli M. Anticonvulsants for alcohol withdrawal. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD005064. Airagnes G, Valter R, Ducoutumany G, Vansteene C, Trabut JB, Gorwood P, Dubertret C, Matta J, Charles-Nelson A, Limosin F. Magnesium in the treatment of alcohol withdrawal syndrome: a multicenter randomized controlled trial. Alcohol Alcohol. 2023 May 9;58(3):329-335.

Obamacare is back before the Supreme Court in a challenge to its no-cost coverage requirements for certain preventive health services. The justices will weigh the constitutionality of the US Preventive Services Task Force, which recommends the tests and treatments insurers should cover, when they return to the bench on Monday for the April sitting. If the lower court's decision is upheld, "it is possible, given the posture of the case, that over 150 million Americans lose free coverage of hundreds of benefits," said Sara Rosenbaum, an emerita professor of health law and policy at George Washington University. Rosenbaum joins Cases and Controversies hosts Greg Stohr and Lydia Wheeler to talk about why the case is more about power than it is public health and what's at stake if the court does away with the insurance coverage that's caught in its crosshairs. Do you have feedback on this episode of Cases & Controversies, Give us a call and leave a voicemail at 703-341-3690.

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-425 Overview: In this episode we discuss updates on the treatment and management of obstructive sleep apnea (OSA). This is a common health concern, but it is often underdiagnosed and can have significant health impacts. We review its prevalence and standard treatments, highlighting the recently used medication therapy that has been found to be effective in treating OSA, particularly in individuals with obesity.  Episode resource links: https://www.aafp.org/pubs/afp/issues/2023/0300/uspstf-obstructive-sleep-apnea.html https://emedicine.medscape.com/article/295807-overview Malhotra, A., Grunstein, R. R., Fietze, I., Weaver, T. E., Redline, S., Azarbarzin, A., ... & Bednarik, J. (2024). Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. New England Journal of Medicine. Mangione, C. M., Barry, M. J., Nicholson, W. K., Cabana, M., Chelmow, D., Coker, T. R., ... & US Preventive Services Task Force. (2022). Screening for obstructive sleep apnea in adults: US Preventive Services Task Force recommendation statement. Jama, 328(19), 1945-1950. https://aasm.org/rising-prevalence-of-sleep-apnea-in-u-s-threatens-public-health/ Guest: Mariyan L. Montaque, DNP, FNP-BC  Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-425 Overview: In this episode we discuss updates on the treatment and management of obstructive sleep apnea (OSA). This is a common health concern, but it is often underdiagnosed and can have significant health impacts. We review its prevalence and standard treatments, highlighting the recently used medication therapy that has been found to be effective in treating OSA, particularly in individuals with obesity.  Episode resource links: https://www.aafp.org/pubs/afp/issues/2023/0300/uspstf-obstructive-sleep-apnea.html https://emedicine.medscape.com/article/295807-overview Malhotra, A., Grunstein, R. R., Fietze, I., Weaver, T. E., Redline, S., Azarbarzin, A., ... & Bednarik, J. (2024). Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. New England Journal of Medicine. Mangione, C. M., Barry, M. J., Nicholson, W. K., Cabana, M., Chelmow, D., Coker, T. R., ... & US Preventive Services Task Force. (2022). Screening for obstructive sleep apnea in adults: US Preventive Services Task Force recommendation statement. Jama, 328(19), 1945-1950. https://aasm.org/rising-prevalence-of-sleep-apnea-in-u-s-threatens-public-health/ Guest: Mariyan L. Montaque, DNP, FNP-BC  Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  

Luigi Mangione is facing several charges – including a rare one – for the killing of UnitedHealthcare's CEO earlier this month. Incoming Senate Majority Leader John Thune has a plan to get the new Congress up and running next month. The suspect in the Gilgo Beach serial killings has been charged with the murder of a seventh victim. The US Preventive Services Task Force may have new recommendations for preventing falls and fractures in older adults. Plus, a 500-year-old British institution is in the process of being sold. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Un nouvel épisode du Pharmascope est disponible et on s'attaque cette fois au trouble d'usage d'alcool. Dans cette première partie, Nicolas, Isabelle et une nouvelle invitée discutent du dépistage et de l'évaluation de cette maladie sous diagnostiquée, en plus de réviser la prise en charge du sevrage alcoolique. Les objectifs pour cet épisode sont: Procéder au dépistage du trouble d'usage d'alcool Diagnostiquer un trouble d'usage d'alcool Discuter des bénéfices et des désavantages associés aux principaux traitements pharmacologiques du sevrage alcoolique Ressources pertinentes en lien avec l'épisode Lignes directrices canadiennes récentes en trouble d'usage d'alcoolWood E, Bright J, Hsu K, et coll. Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder. CMAJ. 2023 Oct 16;195(40):E1364-E1379. Repères canadiens sur l'alcool et la santé : rapport final. Centre canadien sur les dépendances et l'usage de substances. 2023 Guide canadien sur les risques associés à l'usage d'alcoolCoalition canadienne pour la santé mentale des personnes pagées. Lignes directrices sur le trouble lié à l'utilisation de l'alcool chez les personnes âgées. 2023. Guide de l'INESSS sur la prise en charge du trouble d'utilisation d'alcoolINESSS. Sevrage d'alcool et prévention des rechutes. 2021. US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, et coll. Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018 Nov 13;320(18):1899-1909. Mitchell AJ, Bird V, Rizzo M, et coll. Accuracy of one or two simple questions to identify alcohol-use disorder in primary care: a meta-analysis. Br J Gen Pract. 2014 Jul;64(624):e408-18. Bush K, Kivlahan DR, McDonell MB, et coll. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998 Sep 14;158(16):1789-95. Maldonado JR, Sher Y, Das S, et coll. Prospective Validation Study of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) in Medically Ill Inpatients: A New Scale for the Prediction of Complicated Alcohol Withdrawal Syndrome. Alcohol Alcohol. 2015 Sep;50(5):509-18. Kaner EF, Beyer FR, Muirhead C, et coll. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2018 Feb 24;2(2):CD004148. Amato L, Minozzi S, Vecchi S, Davoli M. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD005063. Daeppen JB, Gache P, Landry U, et coll. Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: a randomized treatment trial. Arch Intern Med. 2002 May 27;162(10):1117-21. Elholm B, Larsen K, Hornnes N, Zierau F, Becker U. Alcohol withdrawal syndrome: symptom-triggered versus fixed-schedule treatment in an outpatient setting. Alcohol Alcohol. 2011 May-Jun;46(3):318-23. Minozzi S, Amato L, Vecchi S, Davoli M. Anticonvulsants for alcohol withdrawal. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD005064. Airagnes G, Valter R, Ducoutumany G, Vansteene C, Trabut JB, Gorwood P, Dubertret C, Matta J, Charles-Nelson A, Limosin F. Magnesium in the treatment of alcohol withdrawal syndrome: a multicenter randomized controlled trial. Alcohol Alcohol. 2023 May 9;58(3):329-335.

Send us a Text Message.We're bombarded with advertisements for all sorts of tests these days: comprehensive blood panels for a few hundred dollars, total body MRI scans for cancer detection, heart calcium scans, and even tests to rule out multiple cancers. But are these tests worth it if you are asymptomatic and don't have an important family history? A few years ago, I experienced fainting episodes while running. After a series of tests, including seeing a cardiologist, I was told that my blood pressure dropped upon standing—a condition that required no treatment, just caution. During these tests, they found that my heart was larger than usual. This discovery led to a lot of anxiety over the years, despite it likely being a false positive. This case illustrates how even with legitimate symptoms, testing can sometimes lead to more questions than answers.  And, large panels of tests compound the problem.The Issues with TestingIt's tempting to think that more testing is better, but the reality is that tests are imperfect. They're often based on statistical averages, and results can be misleading. For example, if you undergo multiple tests, you're likely to get some abnormal results just by chance. This can lead to further testing, expense, time, potential medical complications, and unnecessary worry.Medical Expert RecommendationsOrganizations like the US Preventive Services Task Force and the American College of Radiology provide guidance on screening tests. They recommend specific tests like pap smears, mammograms, and colonoscopies, but not routine total body MRIs or large blood panels. Even well-regarded screening tests can result in false positives, as shown by studies and practices in countries like South Korea.Real-Life ExamplesI've seen friends go through the stress of false positives from MRIs or calcium scores, leading to further tests and anxiety. It's essential to weigh the potential impact of these findings on your life, including how they might affect insurance and your mental well-being.ConclusionTo sum up, while early detection of health issues sounds appealing, the reality is that many screening tests can lead to false positives and unnecessary complications. If you're asymptomatic and don't have a concerning family history, it's often best to save your money and avoid these tests. Always consult with your doctor to make informed decisions based on your specific health needs.

Significant variations in medical treatments, even within the same state, challenge the belief that medical care is primarily based on science. In this episode, Dr. Rita Redberg, a Professor of Medicine at UCSF Health, examines the belief that medical care is based primarily on science by discussing significant variations in treatment practices and advocating for evidence-based medicine. In her "Less is More" series in JAMA Internal Medicine, she aims to improve test readability and effectiveness. Throughout this interview, Dr. Redberg discusses the US Preventive Services Task Force's controversial mammography guidelines and the potential harms of over-testing, underscoring the importance of high-quality, unbiased evidence and rigorous FDA approval processes for new medical devices and drugs. She also addresses issues like unnecessary procedures motivated by fear of litigation or financial incentives and strongly calls for removing conflicts of interest from scientific trials and enhancing NIH funding to promote independent research.  Tune in and learn about the importance of evidence-based practices in health care and the steps needed to ensure safer, more effective patient care! Learn more about your ad choices. Visit megaphone.fm/adchoices

Today's Headlines: Following the Supreme Court's recent ruling against an executive ban on bump stocks, Senate Majority Leader Chuck Schumer attempted to introduce Congressional legislation for a similar ban. However, Senate Republicans blocked the proposal despite having over 20 cosponsors, with Susan Collins of Maine being the sole Republican supporter. Meanwhile, Vladimir Putin and Kim Jong Un have signed an agreement solidifying their alliance, pledging mutual aid in case of aggression and emphasizing trade, security, and cultural ties. On a different front, Iran-backed Houthi rebels attacked a carrier ship in the Red Sea, causing it to sink and killing one person, which has significantly disrupted maritime traffic in the region. Lastly, the US Preventive Services Task Force released new guidelines for healthy eating and exercise for children over six with high BMI, recommending 26 hours of behavior modification but not semaglutide medications, addressing the increasing issue of high BMI among US children. Resources/Articles mentioned in this episode: Axios: Bump stock ban blocked by Senate Republicans AP News: Russia and North Korea sign partnership deal that appears to be the strongest since the Cold War Politico: Ship attacked by Yemen's Houthi rebels in fatal assault sinks in Red Sea CNN: To help children with high BMI, expert panel recommends 26 hours of behavior coaching — but not weight-loss drugs Morning Announcements is produced by Sami Sage alongside Bridget Schwartz and edited by Grace Hernandez-Johnson Learn more about your ad choices. Visit megaphone.fm/adchoices

Amidst rising breast cancer rates among younger Americans, a new guideline about breast cancer screening emerges from the US Preventive Services Task Force. The USPSTF now recommends women beginning at 40 years old should receive a mammogram every other year. The previous recommendation was that women should begin receiving biannual screenings at age 50. Candy O'Terry, radio personality and breast cancer survivor, joined Dan to discuss the new guideline and share her story.Ask Alexa to play WBZ NewsRadio on #iHeartRadio

Episode 161: Depression FundamentalsFuture doctors Madeline Tena and Jane Park define depression and explain different methods to diagnose it. Non-pharmacologic and pharmacologic treatment is mentioned briefly at the end.  Written by Madeline Tena, MSIII, and Jane Park, MSIII. Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition. Per the language of Mental Health, depression can be defined as a mood, a symptom, a syndrome of associated disorders, or a specific mental disorder. As a state of mood, depression is associated with feelings of sadness, despair, emptiness, discouragement, and hopelessness. The sense of having no feelings or appearing tearful can also be a form of depressed mood. A depressed mood also can be a part of a collection of symptoms that explain a syndrome. Depression as a mental disorder can encompass depressive syndromes. Per the American Psychiatric Association DSM-5-TR, depressive disorders commonly include sad, empty, irritable mood, accompanied by changes in one's functional capacity. They can be classified by severity and recurrence, and associated with hypomania, mania, or psychosis. Depressive disorders include major depressive disorder (including major depressive episodes), persistent depressive disorder, premenstrual dysphoric disorder, substance-induced depressive disorder, depressive disorder due to medical condition, other specified depressive disorder, and unspecified depressive disorder.Today, we will cover unipolar depressive disorder, also known as major depressive disorder. MDD.Major depressive disorder is a mood disorder primarily characterized by at least one major depressive episode without manic or hypomanic episodes. Depressive episode is a period of at least 2 weeks of depressed mood or anhedonia in nearly all activities for most of the day nearly every day, with four or more associated symptoms in the same 2 weeks. We will discuss specific symptoms for diagnosis further on. Epidemiology of depression.Nationally or regionally representative surveys in 21 countries estimate that the 12-month prevalence of major depressive disorder across all countries is 5 percent. Furthermore, the prevalence of major depressive disorder plus persistent depressive disorder in developed countries (United States and Europe) is approximately 18 percent. Multiple studies consistently indicate that in the general population of the United States, the average age of onset for unipolar major depression and for persistent depressive disorder (dysthymia) is approximately 30 years old. During 2020, approximately ⅕ US adults have reported receiving a diagnosis by a healthcare provider, with the highest prevalence found among young adults age (18-24 year age… generation Z). Within the US there was considerable geographic variation in the prevalence of depression, with the highest state and county estimates of depression observed along the Appalachian and southern Mississippi Valley regions. Why do we care about depression?Because depression is associated with impaired life quality. It can impair a patient's social, physical, and psychological functioning. Also, depression is associated with mortality. A study done by UPenn Family Practice and Community Medicine in 2005 showed that among older, primary-care patients over a 2-year follow-up interval, depression contributed as much to mortality as did myocardial infarction or diabetes. A prospective study from 2005-2017 that followed 186 patients for up to 38 years further showed that patients with major depressive disorder had 27 times higher incidence rate of suicide than the general population. (1, 2). Also, patients dying by suicide visit primary care physicians more than twice as often as mental health clinicians. It is estimated that 45% of patients who died by suicide saw their primary care physician in the month before their death. Only 20% saw a mental health professional a month before their death. (3)Suicidality in depression.It seems that primary care physicians often do not ask about suicidal symptoms in depressive patients. A 2007 study by Mitchell Feldman at the University of California San Francisco showed that 152 family physicians and internists who participated in a standardized patient with antidepressants, suicide was explored in only 36% of the encounters. (4)Physicians, including primary care physicians, should ask patients with depression about suicidality with questions such as: Do you wish you were dead? In the past few weeks, have you been thinking about killing yourself? Do you have a plan to kill yourself? Have you ever tried to kill yourself? (5) Screening for depression.The USPSTF recommends screening for depression in all adults: 18 years old and over regardless of risk factors. Some factors increase the risk of positive screening, such as temperament (negative affectivity/neuroticism), general medical illness, and family history. First-degree family members of people with MDD have a 2-4 times higher risk of MDD than the general population. Furthermore, social history can increase risk as well: sexual abuse, racism, and other forms of discrimination.It is important to highlight the risk in women because they may also be at risk related to specific reproductive life stages (premenstrual period, postpartum, perimenopause). The USPSTF includes pregnant individuals and patients in the postpartum period to be screened for depression. Screening tools. The US Preventive Services Task Force recommends depression screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years (grade B). Similarly, the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) has also recommended annual screening for depression in children aged 12 and older. (6) Some tools used for screening in this age group are the Patient Health Questionnaire for Adolescents (PHQ-A) and the primary care version of the Beck Depression Inventory (BDI). For the general adult population, it is recommended that all patients not currently receiving treatment for depression be screened using the Patient Health Questionnaire-2 (PHQ-2) (7)PHQ 2 is a survey scored 0-6. The survey asks two questions: Over the last 2 weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing things.Feeling down, depressed, or hopeless.Answers should be given in a numerical rating. 0=Not at all; 1=Several days; 2=More than half the days; 3=Nearly every day. A score ≥ 3 is considered positive, and a follow-up full clinical assessment is recommended. The PHQ-2 has a sensitivity of 91% and a specificity of 67% when compared to a semi-structured interview. Keep in mind that the PHQ-2 may be slightly less sensitive to older individuals. Individuals who screen positive with PHQ-2 should have additional screening with the PHQ-9, which is a nine-item, self or clinician-administered, brief questionnaire that is specific to depression. (8) Its content maps directly to the DSM-5 criteria for major depression. (9)The PHQ-9 is a set of 9 questions. The answers are scored similarly to PHQ-2, with a numerical scoring between 0 and 3. (0=Not at all; 1=Several days; 2=More than half the days; 3=Nearly every day). Dr. Arreaza, you will be my patient today, are you ready? It's important that you think about the last 2 weeks.Over the last 2 weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing things. [Dr. Arreaza answers, “sometimes”. Jane asks, “is it several days or nearly every day?”. Dr. Arreaza answers, “nearly every day” 3]Feeling down, depressed or hopeless [Dr. Arreaza: every day 3]Trouble falling or staying asleep, or sleeping too much [Dr. Arreaza: not at all 0]Feeling tired or having little energy [Dr. Arreaza: not at all 0]Poor appetite or overeating [Dr. Arreaza: every day 3]Feeling bad about yourself- or that you are a failure or have let yourself or your family down [Dr. Arreaza: several days 1]Trouble concentrating on things, such as reading the newspaper or watching television [Dr. Arreaza: Several days 2]Moving or speaking so slowly that other people could have noticed. Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual. [Dr. Arreaza: Not at all 0]Thoughts that you would be better off dead, or of hurting yourself [Not at all 0]Jane: Your score is 12.Maddy: Regarding severity, a total score of 1-4 suggests minimal depression. 5-9 suggests mild, 10-14 moderate, 15-19 moderately severe, and 20-27 severe depression. PHQ-9 with patients' scores over 10 had a specificity of 88% and sensitivity of 88% for MDD. (10)But if there are at least 4 non-zero items, including question #1 or #2, consider a depressive disorder and add up the scores. If there are at least 5 non-zero items including questions #1 or #2, consider major depressive disorder specifically. The questionnaire is the starting point for a conversation about depression.A couple of things to note: 1. Physicians should make sure to verify patient responses given the questionnaire can be self-administered. Diagnosis also requires impairment in the patient's job, social, or other important areas of functioning. 2. Diagnosis requires a ruling-out of normal bereavement, histories of manic episodes, depressive episodes better explained by schizoaffective disorder, any superimposed schizophrenia, a physical disorder, medication, or other biological cause of depressive symptoms.Once a patient is newly diagnosed and/or started on treatment, a regular interval administration (e.g. 2 weeks or at every appointment) of PHQ-9 is recommended. The PHQ-9 has good reliability, validity, and high adaptability for MDD patients in psychiatric hospitals for screening and evaluation of depression severity. (12) Other than PHQ-9, there is also Geriatric Depression Scale-15 for older patients with mini mental status exam (MMSE) that scored over 10. (13)For postpartum depression, the preferred screening tool is the Edinburgh postnatal depression scale[Click here (stanford.edu)].Non-pharmacologic and pharmacologic treatment.Now that we have diagnosed the patient, we have to start management. Patients can consider non-pharmacologic treatment such as lifestyle modifications. This can include sleep hygiene, reduction in drug use, increased social support, regular aerobic exercise, finding time for relaxation, and improved nutrition. Furthermore, based on severity, patients can start psychotherapy alone or psychotherapy + pharmacotherapy. Admission is required for pts with complex/severe depression or suicidality. There should be an assessment of efficacy at 6 weeks.There is a warning about patients aged 18-24 who are at increased risk of suicide when taking SSRI within the first couple weeks of treatment. Mediations: SSRI, SNRI, tricyclic antidepressants, MAOIs, and Atypical antidepressants: including trazodone, mirtazapine (Remeron), bupropion (Wellbutrin SR). More research is being done on psychedelic drugs such as ketamine and psilocybin as possible treatments. There are therapies such as ECT available too.Potential Harm of Tx: Potential harms of pharmacotherapy: -SNRI:  initial increases in anxiety, insomnia, and restlessness, and possible sexual dysfunction and headaches as well. Compared with the SSRI class, the SNRI class tends to induce more nausea, insomnia, dry mouth, and in rare cases hypertension.-Tricyclic: Cause of numerous side effects, very infrequently prescribed unless the patient is not responding to other forms of treatment. Side effects that are included are: dry mouth. slight blurring of vision, constipation, problems passing urine, drowsiness, dizziness,  weight gain, excessive sweating (especially at night). Avoid TCAs in elderly patients.-MAOIS: MAO-IS can cause side effects too, including dizziness or lightheadedness, dry mouth, nausea, diarrhea or constipation, drowsiness, and insomnia. Furthermore, other less common side effects can include involuntary muscle jerks, hypotension, reduced sexual desire/ ability to orgasm, weight gain, difficulty starting urine flow, muscle cramps, and paresthesia.Remember to screen your patients. In case you establish a diagnosis, discuss treatments, including non-pharmacologic and pharmacologic options. Warn your patients about side effects and the timing to see the benefits of the medication, usually after 6 weeks. __________________Conclusion: Now we conclude episode number 161, “Depression Fundamentals.” Future doctors Park and Tena discussed depression and its risk factors, screening, and treatment. They went through the PHQ2 and PHQ9 as screening tools, as well as commonly used treatments and their side effects, such as SSRIs. Dr. Arreaza also highlighted the importance of asking about suicidality in your depressed patients, there is a lot of room for improvement in that aspect. This week we thank Hector Arreaza, Madeline Tena, and Jane Park. Audio editing by Adrianne Silva.Talk_OutroEven without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Angst F, Stassen HH, Clayton PJ, Angst J. Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord. 2002;68(2-3):167-181. doi:10.1016/s0165-0327(01)00377-9. https://pubmed.ncbi.nlm.nih.gov/12063145/Miron O, Yu KH, Wilf-Miron R, Kohane IS. Suicide Rates Among Adolescents and Young Adults in the United States, 2000-2017. JAMA. 2019;321(23):2362-2364. doi:10.1001/jama.2019.5054. https://pubmed.ncbi.nlm.nih.gov/31211337/ Feldman MD, Franks P, Duberstein PR, Vannoy S, Epstein R, Kravitz RL. Let's not talk about it: suicide inquiry in primary care. Ann Fam Med. 2007;5(5):412-418. doi:10.1370/afm.719. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2000302/.Brief Suicide Safety Assessment,National Institute of Mental Health (NIMH), July 11, 2020. https://www.nimh.nih.gov/sites/default/files/documents/research/research-conducted-at-nimh/asq-toolkit-materials/adult-outpatient/bssa_outpatient_adult_asq_nimh_toolkit.pdfBeck A, LeBlanc JC, Morissette K, et al. Screening for depression in children and adolescents: a protocol for a systematic review update. Syst Rev. 2021;10(1):24. Published 2021 Jan 12. doi:10.1186/s13643-020-01568-3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802305/Williams, John; Nieuwsma, Jason. Screening for depression in adults, UpToDate, updated on November 30, 2023. https://www.uptodate.com/contents/screening-for-depression-in-adults.Instrument: Patient Health Questionnaire-9 (PHQ-9), National Institute on Drug Abuse, https://cde.nida.nih.gov/instrument/f226b1a0-897c-de2a-e040-bb89ad4338b9.Lowe B, et al. Monitoring depression-treatment outcomes with the Patient Health Questionnaire-9 (PHQ-9). Med Care, 42, 1194-1201, 2004.Sun, Y., Fu, Z., Bo, Q. et al.The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC Psychiatry20, 474 (2020). https://doi.org/10.1186/s12888-020-02885-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701937/Conradsson M, Rosendahl E, Littbrand H, Gustafson Y, Olofsson B, Lövheim H. Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment. Aging Ment Health. 2013;17(5):638-645. doi:10.1080/13607863.2012.758231. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701937/.Royalty-free music used for this episode: Old Mexican Sunset by Videvo, downloaded on Nov 06, 2023 from https://www.videvo.net

The history of mammography begins with the discovery of X-rays in 1895. But it took a very long time for breast imaging to advance, in part because it wasn't prioritized.  Research: “The St George's Four: Meet the women that shaped St George's.” St. George's University of London. 3/8/2019. https://www.sgul.ac.uk/news/the-st-george-s-four-meet-the-women-that-shaped-st-george-s American Physical Society. “This Month in Physics History.” November 2001 (Volume 10, Number 10). https://www.aps.org/publications/apsnews/200111/history.cfm Bassett, Lawrence W. and Richard H. Gold. “The Evolution of Mammography.” AJR 150:493-498, March 1988. Bhidé, Amar et al. “Case Histories of Significant Medical Advances: Mammography.” Harvard Business School Working Paper 20-002. 2021. CROWTHER, J. Röntgen Centenary and Fifty Years of X-Rays. Nature 155, 351–353 (1945). https://doi.org/10.1038/155351a0 Davis, Devra. “The Secret History Of Mammography.” HuffPost. 11/17/2011. https://www.huffpost.com/entry/the-secret-history-of-mam_b_364733 Haus, Arthur G. “Historical Technical Developments in Mammography. Technology in Cancer Research & Treatment. ISSN 1533-0346. Volume 1, Number 2, April (2002) Kalaf, José Michael. “Mammography: a history of success and scientific enthusiasm.” Radiol Bras. 2014 Jul/Ago;47(4):VII–VIII. http://dx.doi.org/10.1590/0100-3984.2014.47.4e2 Lerner, Barron H. “'To See Today With the Eyes of Tomorrow: A History of Screening Mammography.'” CBMH/BCMH I Volume 20:2 2003 / p. 299-321. Lerner, Barron H. “Why Was the US Preventive Services Task Force's 2009 Breast Cancer Screening Recommendation So Objectionable? A Historical Analysis.” The Milbank Quarterly, September 2022, Vol. 100, No. 3 (September 2022). https://www.jstor.org/stable/10.2307/48713998 Lienhard, Dina A., "Mammography". Embryo Project Encyclopedia ( 2018-03-25 ). ISSN: 1940-5030 https://hdl.handle.net/10776/13056 Mao X, He W, Humphreys K, et al. Breast Cancer Incidence After a False-Positive Mammography Result. JAMA Oncol. Published online November 02, 2023. doi:10.1001/jamaoncol.2023.4519 Mekasut, Nitida. “Mammography: From Past to Present.” The Bangkok Medical Journal. February 2011. https://www.bangkokmedjournal.com/sites/default/files/fullpapers/2010-1-Mekasut.pdf Nicosia, Luca et al. “History of Mammography: Analysis of Breast Imaging Diagnostic Achievements over the Last Century.” Healthcare 2023, 11, 1596. https://doi.org/10.3390/healthcare11111596 Ritvo, Max. "The Role of Diagnostic Roentgenology in Medicine." New England Journal of Medicine 262, no. 24 (1960): 1201-09. Skloot, Rebecca. “Taboo Organ: How a Pitt Alum Refused to Let Mammography Be Ignored.” Pittmed. April 2001. https://www.pittmed.health.pitt.edu/apr_2001/taboo_organ.pdf Warren, Stafford L. “A Roentgenologic Study of the Breast.” The American Journal of Roentgenology and Radium Therapy 1930-08: Vol 24 Iss 2. Zenger, Ingo. “The history of mammography.” Siemens. https://www.medmuseum.siemens-healthineers.com/en/stories-from-the-museum/history-mammography  See omnystudio.com/listener for privacy information.

In this episode of the Black Health 365 podcast, Jackie and Britt are joined by Dr. Esa Davis, a U.S. Preventive Services Task Force member. Dr. Davis is a professor of medicine and family and community medicine and holds the positions of Associate Vice President for community health and senior dean of population and community medicine at the University of Maryland School of Medicine. During the podcast, Dr. Davis explains the importance of the US Preventive Services Task Force for hypertensive disorders of pregnancy. She shares how screenings can help diagnose hypertensive disorders like preeclampsia and hypertension. The nationwide initiative can assist expectant mothers and decrease the black maternal death rate in our community. Jackie and Britt hope this information will inspire our community to learn about the U.S. Preventative Services Task Force recommendations and seek medical attention sooner during pregnancy. Dr. Esa Davis is a Task Force member and a professor of medicine and family and community medicine, the associate vice president for community health, and the senior associate dean of population and community medicine at the University of Maryland School of Medicine. She is the lead health equity strategist for the University of Maryland Institute for Health Computing. Dr. Davis is also the director of the Transforming Biomedical Research and Academic Faculty Through Leadership Opportunities, Training, and Mentorship (TRANSFORM) program.See omnystudio.com/listener for privacy information.

The US Preventive Services Task Force has recently updated its guidelines for breast cancer screenings to help curb the 42,000yearly deaths. Our experts explain these changes, how to perform at-home exams, and why aggressive breast cancer may no longer be a death sentence. Learn More: https://radiohealthjournal.org/everyone-has-lumps-and-bumps-make-sure-yours-arent-deadly Learn more about your ad choices. Visit podcastchoices.com/adchoices

Brendan speaks with Dr. Joshua Thomas, CEO and Executive Director of the National Alliance on Mental Illness in Delaware and Lynett, who is living with lupus to discuss the connection between physical and mental health for people living with chronic conditions. TRIGGER WARNING: This episode contains mention of self-harm and suicide, which may be triggering to some individuals. If you are in crisis, or you know someone who may be, please contact the 988 Lifeline by dialing 988 or visit 988lifeline.org. Everyone's wellbeing matters.   The National Alliance on Mental Illness (NAMI) is the largest grassroots mental health organization in the US, dedicated to building better lives for the millions of Americans impacted by mental illness. It is an alliance of more than 600 local Affiliates and 49 State Organizations working in communities to raise awareness and provide support and education to those in need. For more information or to access the resources referenced in this episode, please visit NAMI.org. To learn which screenings are appropriate for you, we encourage you to visit the US Preventive Services Task Force. The US Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. It works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services and prolong life.

Brendan has a conversation with AstraZeneca's very own Dr. Rachele Berria and Dr. Carlos Doti to talk about the importance of routine preventive medical screenings and the variety of factors that impact the rates at which individuals receive screenings. To learn which screenings are appropriate for you, we encourage you to visit the US Preventive Services Task Force. The US Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. It works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services and prolong life.

Brendan speaks with AstraZeneca's very own Chief Sustainability Officer, Pam Cheng, and President of National Academy of Medicine, Dr. Victor Dzau, to discuss the health implications of the climate crisis on the next episode of That's Understandable. At AstraZeneca, we believe our future depends on the interconnection of healthy people, a healthy society and a healthy planet. Click here to learn more about sustainability at AstraZeneca.OR: To learn more about sustainability at AstraZeneca, visit: https://www.astrazeneca.com/sustainability.html. AstraZeneca, in collaboration with the National Academy of Medicine (NAM) and POLITICO Focus, convened a roundtable discussion in June 2023 to identify opportunities to scale public-private action to decarbonize the healthcare sector. Click here to learn more about the National Academy of Medicine's (NAM) Action Collaborative on Decarbonizing the U.S. Health Sector.To learn which screenings are appropriate for you, we encourage you to visit the US Preventive Services Task Force. The US Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. It works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services and prolong life.

In this episode of "That's Understandable," Liz Bodin, Vice President, US Respiratory & Immunology, and Mariam Koohdary, Deputy General Counsel, BioPharmaceuticals, join Brendan to shed light on the challenges and triumphs of women in leadership roles within the healthcare industry. They discuss the importance of diversity, the role of mentorship, the drive to innovate and how we can all agree – the struggle is real.To learn which screenings are appropriate for you, we encourage you to visit the US Preventive Services Task Force. The US Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. It works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services and prolong life.

In this episode, Brendan brings in Cindy Hoots from AstraZeneca and Deborah DiSanzo, President of Best Buy Health, to discuss how artificial intelligence is changing the face of healthcare. Hear what they have to say about AI-led diagnostics, patient privacy and how the Geek Squad has switched from installing TVs to at-home healthcare. (Yes, that Geek Squad). To learn which screenings are appropriate for you, we encourage you to visit the US Preventive Services Task Force. The US Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. It works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services and prolong life.

In a recent development, the US Preventive Services Task Force sounded the alarm about the increasing prevalence of hypertensive disorders among pregnant women. They have advised monitoring blood pressure throughout pregnancy since these disorders have doubled in the last three decades, impacting one in ten pregnancies. Unfortunately, the United States lags in maternal health, bearing a troublingly high maternal mortality rate compared to other countries. While the newly recommended guidelines are undeniably important, it is crucial to delve deeper into the root causes that contribute to this and the growing number of other chronic health problems showing up in pregnancy. On today's episode of On Health, I have the privilege of being joined once again by the remarkable Dr. Neel Shah, a forward-thinking OBGYN and the Chief Medical Officer of Maven Clinic. Together, we delve into the heart of the maternal health crisis, exploring its multifaceted origins, and discuss important new ways of thinking about critical problems. We examine the profound societal challenges that impact maternal health and emphasize the urgent need for and significance of personalized care and the promising role of emerging digital healthcare solutions in supporting pregnant individuals. Furthermore, we address the repercussions of the COVID-19 pandemic, including the impact of forced isolation on maternal health. It is of utmost importance that we continue to raise awareness about maternal health and strive for comprehensive changes that prioritize the well-being of both mothers and babies in this country. By tackling the underlying factors that contribute to these challenges and ensuring access to meaningful care, we can achieve healthier outcomes for all, including the most vulnerable members of society. Dr. Neel and I discuss: COVID-19, lack of labor support, isolation, and other unforeseen obstacles for pregnant people Systemic racism and the impact of weathering on maternal mortality rates Dr. Neel's firsthand experience as a practicing OBGYN during the pandemic The dangers of generalizing and the importance of working directly with pregnant people on their individual needs A breakdown of what pregnant or aspiring pregnant people deserve from the healthcare system The goal of the Maven Clinic app and the potential of digital maternal care options Dr. Neel's perspective on the centering pregnancy model Why Dr. Neel feels that competence, reliability, and affirmation are required to move the needle in creating systemic change in maternal care Thank you so much for taking the time to tune in to your body, yourself, and this podcast! Please share the love by sending this to someone in your life who could benefit from the kinds of things we talk about in this space. Make sure to follow your host on Instagram @dr.avivaromm and go to avivaromm.com to join the conversation. Follow Dr. Neel @neel_t_shah, check out the Maven Clinic App and more @mavenclinic

In this episode, Brendan sits down with Dr. Tonya Villafana, Vice President, Global Franchise Head of Infectious Disease at AstraZeneca, to talk about the impact science has on public health. Tonya speaks about the process, the ripple effect of science, the early stages of modern medicine, and the reason why “Talking Heads” is on her pre-meeting playlist. To learn which screenings are appropriate for you, we encourage you to visit the US Preventive Services Task Force. The US Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. It works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services and prolong life.

Today's Headlines: Former President Donald Trump has been found liable for sexual abuse and defamation in the New York state civil trial, and has been ordered to pay $5 million to E. Jean Carroll. New York Representative George Santos has been charged with a crime, but the charges are not yet known. Congress failed to reach a deal on the debt ceiling crisis, and President Biden has floated the idea of invoking the 14th Amendment. A bill to raise the age to buy an AR-15 style rifle from 18 to 21 has been advanced in Texas. The US Preventive Services Task Force now recommends women start getting mammograms to detect breast cancer at age 40. Resources/Articles mentioned in this episode: AP News: Jury finds Trump liable for sexual abuse, awards accuser $5M  Washington Post: Rep. George Santos charged by federal prosecutors, people familiar say  NBC News: Biden and McCarthy barely speak, dimming prospects for a debt ceiling deal Texas Standard: In surprise vote, Texas House committee advances bill to raise minimum age to buy assault rifles  Axios: Women should start getting mammograms at 40 not 50, major health panel says US Preventative Task Force: Breast Cancer: Screening  Morning Announcements is produced by Sami Sage alongside Amanda Duberman and Bridget Schwartz

Discovery leads to innovation. Innovation usually leads to changes in processes. But that doesn't always equate to better. Or not necessarily as a replacement.You may have seen a commercial or two for a commercial product where a walking and talking white box depicts the ease and comfort for checking for colorectal cancer at home. The insinuation is that anyone can simply send in a sample of their “#2” and find out if they have anything to worry about regarding cancer in the lower gastrointestinal tract.But at what cost is this substitute for the gold standard of colonoscopy screening actually to the patient? What are the accuracy comparisons? What to make of a positive or negative result?Ken & Eric dive in and discuss the commercial pitch for this method of using fecal DNA vs visual inspection of the colon and what actually might be overlooked for the unsuspecting patient who is trying to remain healthy.Join us on RUMBLE & LOCALS for RAW GCP! USE code GCPFREE for a month of FREE RAWHttps://kbmdhealth.com/rawHttps://kbmdhealth.com/rumbleBonus Notes covered in this episode:Does Cologuard detect polyps?Yes, Cologuard can detect polyps.  However, the detection of large polyps (the precursors to colon cancer) is less than half as accurate as a colonoscopy.Is the Cologuard test as effective as a colonoscopy?No, the Cologuard test is not as effective as a colonoscopy.  Detecting and removing polyps is critical to colon cancer prevention, and Cologuard only detects large precancerous polyps 42% of the time.  A colonoscopy detects the same polyps 95% of the time and they are removed during the same procedure.What does Cologuard detect?Cologuard can detect 92% of cancers and 42% of large precancerous polyps, the precursor to colon cancer.What does it mean if your Cologuard test is positive?If the Cologuard test is positive, it may mean that colon cancer or polyps are present. After a positive Cologuard test a colonoscopy is required for a definitive answer.  The Cologuard test has a 13% false-positive rate, which means 1 in 10 positive tests will incorrectly identify cancer or polyps.Does Cologuard detect cancer?Yes, the Cologuard test can detect cancer 92% of the time.  However, prevention of colon cancer is better than identifying it once you have it.  The best way to prevent colon cancer is by identifying and removing precancerous polyps that don't turn into cancer later.  Cologuard only finds 42% of large, dangerous polyps that can turn into colon cancer.Can patients use Cologuard instead of a colonoscopy?Cologuard is not designed to be a replacement for a colonoscopy, even though advertisements may suggest otherwise.  58% of the time, dangerous precancerous polyps are not detected with Cologuard, which is significantly less effective than a colonoscopy. However, Cologuard may be an option for some patients who insist on not getting a colonoscopy or those not healthy enough to have a colonoscopy.  Even a 42% chance of detection is better than no detection at all.References for this episode:Uptodate.com- colon cancer screening guidelinesItzkowitz SH, Ahlquist DA. The case for a multitarget stool DNA test: a closer look at the cost effectiveness model. Gastroenterology. 2017;152(6):1620–1621Johnson DH, Kisiel JB, Burger KN, et al. Multitarget stool DNA test: clinical performance and impact on yield and quality of colonoscopy for colorectal cancer screening. Gastrointest Endosc. 2017;85(3):657–665.e1.Zauber A, Knudsen A, Rutter CM, et al. Evaluating the Benefits and Harms of Colorectal Cancer Screening Strategies: A Collaborative Modeling Approach. AHRQ Publication No. 14-05203-EF-2. Rockville, MD: Agency for Healthcare Research and Quality; October 2015.Knudsen AB, Zauber AG, Rutter CM, et al. Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies: Modeling Study for the US Preventive Services Task Force. JAMA 2016; 315:2595.Cost-effectiveness of a multitarget stool DNA test for colorectal cancer screening of Medicare beneficiaries Steffie K. Naber  ,Amy B. Knudsen ,Ann G. Zauber,Carolyn M. Rutter,Sara E. Fischer,Chester J. Pabiniak,Brittany Soto,Karen M. Kuntz,Iris Lansdorp-VogelaarRex DK, Boland CR, et al. Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. GI Endosc. 2017; 86(1):18-33.

Brendan invites Brittany to tell her story to help the audience understand what it means to be immunocompromised. ​​Episode 3 will serve as a human-interest piece and dive into how Brittany coped with her diagnosis, how it changed her life and how the pandemic further complicated her daily living. ​To learn which screenings are appropriate for you, we encourage you to visit the US Preventive Services Task Force. The US Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. It works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services and prolong life.

https://302.buzz/PM-WhatAreYourThoughtsAggression in children is a complex issue that can leave parents feeling helpless and desperate for a solution. Many turn to medication as a quick fix, but according to Dr. Lia Gaggino's guest, Dr. Peter Jensen, multiple medications are not always the answer. It's important to assess the situation correctly and consider alternative approaches before turning to medication. In this episode, Doctors Gaggino and Jensen explore the various causes of aggression in children and provide tips on how to handle it effectively without resorting to excessive medication. Whether you're a parent, caregiver, or educator, the information provided in this episode can help you better understand aggression in children and how best to support them. Get your pad and pencils ready, you'll be taking notes on this one. [00:30 -27:46] Understanding the Different Types of Aggression in Children and How to Treat ThemThe Importance of Assessing and Diagnosing before Prescribing MedicationAggression in children can fall into different categories, such as chronically irritable and explosive or misinterpreting social cuesDiagnostic Skills Help in Identifying the Underlying Causes of Aggressive Behaviors in ChildrenBipolar disorder and schizophrenia are unlikely causes of aggressive behavior in children[27:47- 38:02] Understanding and Treating Aggressive Behaviors in Children Treatment for ADHD should be maximized before turning to other medicationsResperidone and Aripiprazole have been approved by the FDA to treat aggression in childrenPrimary care providers need to get comfortable with atypical medications Guidelines for treating maladaptive aggression in youth are available in the journal Pediatrics[38:03 -48:14] Evaluating Medication for Children with Mental Health DisordersTrauma should be considered when treating children with psychiatric medications.Avoid the "pharmacotherapy of desperation," which involves adding multiple medications without clear rationale. Deprescribing, or slowly decreasing medication use, can be helpful for children on multiple medications that may not be effective.A thorough evaluation of the underlying disorder, using rating scales and input from multiple sources, is essential for choosing the right medication.[48:15 - 57:06] Top Screening Tools for Child Mental HealthVanderbilt Rating Scale is essential for monitoring ADHD in kids on stimulantsPHQ-9 is a quick and free depression scale that is recommended by the US Preventive Services Task Force and Academy of PediatricsSCARED is an effective tool for tracking and screening anxiety in children and can be given to parents or youthPSC-17 is ideal for well-child visits as it has only 17 items and screens for inattention, ADHD, anxiety, and depressionSuicide specific tools like ASK Screening Questions and Columbia should be used alongside PHQ-9 for better screening of suicidal ideation and behavior; CRAFFT can be used to screen for substance use in teenagers. [57:07 - 1:04:54] Closing segment TakeawayYou can reach Dr. Peter JensenWebsite: https://thereachinstitute.org/LinkedIn:

Greed should not be a factor in patient care, and yet more and more it seems to be. Dr. Donald Berwick has a wonderful article titled Salve Lucrum in JAMA, and I highly recommend it. He touches on how his father inspired and inspires him, the importance of community and connection, and the small steps we can take to fight greed. Dr. Donald M. Berwick, MD, MPP, FRCP, is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement. He is former Administrator of the Centers for Medicare & Medicaid Services. Trained as a pediatrician by background, he has taught at Harvard Medical School and Harvard School of Public Health, and he has served on the staffs of Boston's Children's Hospital Medical Center, Massachusetts General Hospital, and the Brigham and Women's Hospital. He was Vice Chair of the US Preventive Services Task Force, the first "independent member" of the American Hospital Association Board of Trustees, and Chair of the National Advisory Council of the Agency for Healthcare Research and Quality, and the Institute of Medicine. Recognized as a leading authority on health care quality and improvement, Dr. Berwick has received numerous awards for his contributions, including from the British National Health Service in 2005, when he was appointed "Honorary Knight Commander of the British Empire" by Her Majesty, Queen Elizabeth II. Dr. Berwick is the author or co-author of over 160 scientific articles and six books. He currently serves as lecturer in the Department of Health Care Policy at Harvard Medical School.  He has a new podcast in spring, 2023 called Turn on the Lights.

In this episode, Brendan is joined by AstraZeneca's VP of US Corporate and Government Affairs, Christie Bloomquist, and Tulane University's Dr. Thomas LaVeist to discuss health equity. The trio chat about navigating the healthcare system, the roots of health disparity, how organizations can help, Star Trek, romance novels, and Brendan's sweet dreams.  To learn which screenings are appropriate for you, we encourage you to visit the US Preventive Services Task Force. The US Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. It works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services and prolong life.

Our healthcare system is always evolving and changing—which means that doctor's recommendations are too. It's important to stay on top of these to keep our body in tip top shape, particularly as we get older.Dr. Michael Berry is the Vice Chair of the US Preventative Services Task Force and a leading authority on health and aging. He is a board-certified family and preventive medicine physician, with training in integrative medicine, and specializes in primary care. Dr. Berry has dedicated his career to helping people understand how to improve their health and wellbeing through preventive measures. He has been a guest lecturer at medical conferences, a featured speaker on podcasts, and a contributing author to medical publications. Dr. Berry has an extensive background in preventive services, with a particular focus on the latest health recommendations for aging. He has been a part of the US Preventive Services Task Force since 2008, and currently serves as its Vice Chair. He is passionate about helping people practice preventive medicine and live longer, healthier lives. On today's episode, Dr. Berry explains the importance of aspirin for people between the ages of 40 and 59 (and why those over the age of 60 should not start taking it), he explains the importance of lung cancer screening, colon cancer screening and much more.What's Next?What are your views, comments or questions on changing medical recommendations?  Share them with us at info@seniorityauthority.org!  Stay ConnectedGet in touch with our host Cathleen Toomey on LinkedInYou can also find Seniority Authority on Facebook, on Instagram, or you can connect with us on our website!Subscribe to our show on Apple Podcasts, Spotify, or anywhere you get your podcasts.

To learn which screenings are appropriate for you, we encourage you to visit the US Preventive Services Task Force. The US Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. It works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services and prolong life.

To learn which screenings are appropriate for you, we encourage you to visit the US Preventive Services Task Force. The US Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. It works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services and prolong life.

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!The American Academy of Pediatrics has put out a new Clinical Guideline for the care of higher-weight children. This document is 100 pages long including references and there are so many things that are concerning and dangerous in it that I had trouble deciding how to divide it up to write about it. I began on Thursday with a piece about the undisclosed conflicts of interest. Ultimately for today, I decided to focus on what I think will do the most harm in the guidelines, which is the recommendations for body size manipulation of toddlers, children, and adolescents through intensive behavioral interventions, drugs, and surgeries.A few things before we dive in. First, this piece is long. Really long. I thought about breaking it up to make it easier to parse, but I also know that people are (rightly) very concerned about these guidelines and I didn't want to trickle information/commentary out over days and weeks in case it might be helpful to someone now. Also, know that this may be emotionally difficult to read, in particular for those who have been harmed by weight loss interventions foisted on them as children. That will likely be exacerbated by the gaslighting these guidelines do to erase the lived experience of harm and trauma from the “interventions” they are recommending, and from their co-option of anti-weight-stigma language to promote weight loss. So please take care of yourself, you can always take a break and come back. Per my usual policy I will not link to studies that are based in weight bias and the weight loss paradigm, but will provide enough information for you to Google if you want to read them. I'll also use an asterisk in “ob*sity” for the reasons I explain in the post footer. Ok, big breath and let's get into this.In later newsletters, I'll address other issues in depth, but for now here are some quick thoughts and links about overarching issues before I dig into the actual recommendation:The claim that “ob*sity is a chronic disease—similar to asthma and diabetes”No, it's really not. And it's this faulty premise (that having a body of a certain size is the same thing as having a health condition with actual identifiable symptomology) that underlies everything in these guidelines. The diagnosis of asthma requires documentation of signs or symptoms of airflow obstruction, reversibility of obstruction (improvement in these signs or symptoms with asthma therapy) and no clinical suspicion of an alternative diagnosis. The diagnosis of diabetes requires a glycated hemoglobin (A1C) level of 6.5% or higher. But to diagnose “ob*sity” you just need a scale and a measuring tape. A group of people with this “diagnosis” don't have to share any symptoms at all, they simply have to exist in their bodies. That is not the same as asthma or diabetes, though the weight loss industry (in particular pharmaceutical companies and weight loss surgery interests) have absolutely poured money into campaigns to try to convince us that it is. (Note that the argument that ob*sity is correlated with other health conditions and thus is a disease actually proves the fallacy since some kids/people who are “diagnosed” with “ob*sity” don't have any of those health conditions and some kids/people who are thin do have them. It's especially disingenuous as it ignores the confounding variables of weight stigma and, in particular, weight cycling both of which these guidelines, if adopted, are very likely to increase.)The myth of “non-stigmatizing ob*sity care” Like so much of these guidelines, this idea and much of the verbiage around it mirrors that of the weight loss industry. In this case, it's attempt to co-opt the language of anti-weight-stigma in order to promote (and profit from) weight loss (there's a guide to telling the difference between true anti-stigma work and diet industry propaganda here!) In truth, there is no such thing as non-stigmatizing care for ob*sity, because the concept of ob*sity is rooted in size and the treatment is changing size (the word was made up to pathologize larger bodies, based on a latin root that literally means to eat until fat so…less science than stereotype there.) There is no shame in having a disease, it's just that existing while fat isn't one. The concept of “ob*sity” as a “disease” pathologizes someone's body size. The concept of ob*sity says that your body itself is wrong, and requires intensive therapy and/or risky drugs and surgeries so that it can be/look right. There is no way to say that without engaging in weight stigma.If someone claims that the treatment is actually about health and not size, then it's not “ob*sity” treatment since both the criteria for the “disease” and the measure of successful “treatment” of ob*sity are based on body size. If the treatment is about health and not size, then the treatment and measures of success should be about actual metabolic health, not body size (which would be ethical, evidence-based, weight-neutral care.)The idea that “It is important to recognize that treatment of ob*sity is integral to the treatment of its comorbidities and overw*ight or ob*sity and comorbidities should be treated concurrently”Again, I think this is demonstrably untrue. Any health issues that are considered “comorbidities” of being higher-weight are also health issues that thin people get, which means that they have independent treatments. We could skip body size manipulation attempts entirely and still treat any health issues that a higher-weight child/adolescent has.The dubious claim that “ob*sity treatment” is compatible with eating disorders preventionI wrote a specific piece about this here. Weight loss as a “solution” to weight stigmaThis is unconscionable. Regardless of what someone believes about weight and health, the message that children (as young as 2!) should solve stigma by undertaking intensive and dangerous interventions that risk quality of life moves beyond inappropriate to disgusting, especially when one is perpetuating weight stigma, as these guidelines (and the weight loss industry talking points that are repeated herein) do.There is so much more to unpack here, but I want to move into a discussion of the recommendations themselves.For this, I will start where I left off on the conflict of interest piece. Which is to say, almost all of the authors of these guidelines are firmly entrenched in the body-size-as-disease paradigm. They have pinned their careers to it. None of the authors are coming from a weight-neutral paradigm.  In fact, in the research evaluation methodology section, they explain that they excluded studies that looked at impacting health, rather than weight. In their own words:The primary aim of the intervention studies had to be examination of an ob*sity prevention (intended for children of any weight status) or treatment (intended for children with overw*ight or ob*sity) intervention. The primary intended outcome had to be ob*sity, broadly defined, and not an ob*sity comorbidity.Note that by “ob*sity comorbidity” they mean a health condition that happens to children of all sizes.I don't know if it was intentional, or just a myopic focus on body size manipulation as a supposed healthcare intervention, but the option to focus on health rather than size was specifically excluded by a group of authors whose careers on based on focusing on size.There are three main areas of their recommendation that I'll talk about today - Intensive Health Behavior and Lifestyle Treatment, Weight Loss Drugs, and Weight Loss Surgeries.RECOMMENDATION:  Intensive Health Behavior and Lifestyle Treatment (IHBLT)This is recommended starting as young as age two. That's right, they are recommending intensive interventions to kids in diapers (and they think that they should look into how to “diagnose” kids who are even younger, yikes!) What these guidelines subtly admit is that these interventions don't actually work. They include this (long-time weight loss industry) talking point “a life course approach to identification and treatment should begin as early as possible and continue longitudinally through childhood, adolescence, and young adulthood, with transition into adult care.”The translation to this is that they have absolutely no idea how to make higher-weight people of any age thin long-term. They are aware (and if not they are negligent) that a century of data shows that the vast majority of people will lose weight short-term and gain it back long-term. What they seem to be trying to do here is rebrand yo-yo dieting (aka weight-cycling) as a successful intervention. If there is a prize for moving the goalpost and declaring victory, they are in the running.Don't just take my word for it, they created a graphic as part of Figure 1 to show it:Pro tip: When they say “relapsing remitting” they mean “yo-yo dieting". I know why the weight loss industry loves this idea - it's how they've built a business that creates exponential growth with a product that doesn't work. What I don't understand is how this group of authors can possibly justify this ethically. The health risks of weight cycling are documented (and very consistent with the health risks that get blamed on higher-weight bodies) so setting people up for weight cycling starting as toddlers does not, to me, have the ring of sound science or ethical, evidence-based medicine.Let's dig into the evidence they are using to support this:The guidelines claim that “IHBLT is the foundational approach to achieve body mass reduction or the attenuation of excessive weight gain in children. It involves visits of sufficient frequency and intensity to facilitate sustained healthier eating and physical activity habits.” The study they cite to back this up (Grossman et al; 2017, Screening for ob*sity in children and adolescents: US Preventive Services Task Force recommendation statement) says “Comprehensive, intensive behavioral interventions (≥26 contact hours) in children and adolescents 6 years and older who have ob*sity can result in improvements in weight status for up to 12 months.”They also include a chart of seven randomized controlled trials (RCTs) from 2005-2017. The combined study population of all seven studies was just 1,153 kids. The largest study (with 549 participants) and the only study to include children from ages 2 to 5 had a duration of 12 months and showed a BMI change of 0.42 that year, and was only “effective” (if you consider a .42 change in a year “effective”) in kids ages 4-8 years old. There was only one study that followed up for more than 12 months, and from 12 months to 24 months, the BMI change decreased (from 3.3 to 2.8,) consistent with the weight regain pattern that we would expect.This will be a running theme in these guidelines - short-term studies will be used to justify life-long recommendations, and weight regain is ignored. In general, sometimes this is based on the idea that if a weight loss intervention works short-term, then it will continue to work forever, other times it's based on the idea that weight cycling is an ethical, evidence-based healthcare intervention. Again, the data on both the long-term failure of weight loss and the danger of weight cycling does not support this.They make a point to mention that IHBLT “involves interaction with pediatricians and other PHCPs who are trained in lifestyle-related fields and requires significantly more time and resources than are typically allocated to routine well-child care.” At this point I'll note that many of the authors of the guidelines run clinics or have practices that provide exactly this type of care.Their criteria for the studies was, I'll just call it lax: “Over a 3-12 month period: The criteria for the evidence review required a weight-specific outcome at least 3 months after the intervention started.” Obviously, this is a very short-term requirement and, again, excludes studies that looked at actual health instead of just body size.Here again they tell on themselvesTreatments with duration longer than 12 months are likely to have additional and sustained treatment benefit. There is limited evidence, however, to evaluate the durability of effectiveness and the ability of long-term treatments to retain family engagement.Note that the idea that longer duration treatment is “likely” to have additional and sustained treatment benefit is not remotely an evidence-based statement, and I would argue that it is biased and should not be included here. Also, they seem to be setting the stage for blaming families for the entirely predictable and almost always inevitable weight regain.Under “referral strategies” they get real about how little weight loss we're actually talking about:Pediatricians and other Primary Healthcare Providers (PHCP's) are encouraged to help to set reasonable expectations for these [BMI-based] outcomes among families, as there is a significant heterogeneity to treatment response and there is currently no evidence to predict how individual children will respond. Many children will not experience BMI improvement, particularly if their participation falls below the treatment threshold.”As described in the Health Behavior and Lifestyle Treatment section, those who do experience BMI improvement will likely note a modest improvement of 1% to 3% BMI percentile decline.So they are recommending an “intensive,” time-consuming, expensive intervention to kids starting as young as age 2 with no prognostics as to which kids might be “successful,” the stated result of which is that “many” (their word) of them won't experience any change in the primary outcome, those who do will see a very small change.They do mention the supposed actual health benefits of these interventions, but fail to mention that the health benefits may have nothing to do with the very small change in size. That's because often when health changes and weight changes (at least temporarily) follow behavior change, those who are invested in the weight loss paradigm (financially, clinically, or both) are quick to credit the weight change, rather than the behavior change, for the health change. Here again, the evidence does not support this. It's very possible that these same health improvements could be achieved with absolutely no focus or attention paid to weight, which would provide more benefits and less risks (including the risks associated with both weight stigma and weight cycling.) It could also allow the children (some, remember, still in diapers) to create healthy relationships with food and movement, rather than seeing choices around food and movement as punishment for their size or a way to manipulate it.As they move into specific recommendations, they start with:Despite the lack of evidence for specific strategies on weight outcomes many of these strategies have clear health benefits and were components in RCTs of intensive behavioral intervention. Many strategies are endorsed by major professional or public health organizations. Therefore, pediatricians and other PHCPs can appropriately encourage families to adopt these strategies. To me this sounds a lot like throwing the concept of “evidence-based” right out the window. None of this means “these strategies are likely to lead to long-term weight loss,” but I'll bet that won't be what is conveyed to the patients and families upon whom these “strategies” are foisted. Before we move on to their recommendations around diet drugs, here is some research to contextualize these recommendations:Neumark-Sztainer et. al, 2012, Dieting and unhealthy weight control behaviors during adolescence: Associations with 10-year changes in body mass indexNone of the behaviors being used by adolescents for weight-control purposes predicted weight lossOf greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors…including eating disorders and weight gain [Note: This is not to say that there is anything wrong with higher-weight, but that there is something wrong with a supposed healthcare intervention that has significant risks, almost never works, and has the opposite of the intended effect up to 66% of the time.] Raffoul and Williams, 2021, Integrating Health at Every Size principles into adolescent careCurrent weight-focused interventions have not demonstrated any lasting impact on overall adolescent healthBEAT UK, 2020 Eating Disorders Association, Changes Needed to Government Anti-ob*sity StrategiesGovernment-sanctioned anti-ob*sity campaigns* increase the vulnerability of those at risk of developing an eating disorder* exacerbate eating disorder symptoms in those already diagnosed with an eating disorder* show little success at reducing ob*sityStrategies including changes to menus and food labels, information around ‘healthy/unhealthy' foods, and school-based weight management programs all pose a risk.Pinhas et. al. 2013, Trading health for a healthy weight: the uncharted side of healthy weights initiativesOb*sity-prevention programs that push “healthy eating” are triggering disordered eating in some children, creating sudden neuroses around food in children who never before worried about their weightThey were all affected by the idea of trying to adopt a more healthy lifestyle, in the absence of significant pre-existing notions, beliefs or concerns regarding their own weight, shape or eating habits prior to the interventionFiona Willer, Phd, AdvAPD, FHEA, MAICD, Non-Executive Board Director at Dietitians AustraliaQuoted from: health.usnews.com/health-news/blogs/eat-run/articles/for-healthy-kids-skip-the-kurbo-app“Dieting to a weight goal was found to be related to poorer dietary quality, poorer mental health and poorer quality of life when compared with people who were health conscious but not weight conscious”Ok. Moving on.RECOMMENDATION: Use of Pharmacotherapy (aka Weight Loss Drugs)Their consensus recommendation is that pediatricians and other PCHPs “may offer children ages 8 through 11 years of age with ob*sity weight loss pharmacotherapy, according to medication indications, risks, and benefits as an adjunct to health behavior and lifestyle treatment.”They admit that “For children younger than 12 years, there is insufficient evidence to provide a Key Action Statement (KAS) for use of pharmacotherapy for the sole indication of ob*sity,” but then go on to suggest that if kids 8-11 also have other health conditions, somehow weight loss drugs (which are not indicated for the treatment of the actual health conditions they have) “may be indicated.”Their KAS is that “pediatricians and other PHCPs should offer adolescents 12 y and older with ob*sity weight loss pharmacotherapy, according to medication indications, risks and benefits as and adjunct  to health behavior and lifestyle treatment.”The studies that were actually included in the evidence review predominantly studied metformin (alone and in combination with other drugs,) which is not approved for weight loss, orlistat, exenatide, and one study that looked at phentermine, mixed carotenoids, topiramate, ephedrine, and recombinant human growth hormone.Even though the studies for other drugs did not exist at the time of the evidence review, they made the choice to include them anyway. (This includes Wegovy, the drug that Novo Nordisk, a donor to the AAP, has promised their shareholders will be a blockbuster and that announced its approval in children as young as 12 just days prior to the publication of the guidelines.) Let's look at the efficacy of the drugs they are recommending:MetforminAdverse effects include bloating, nausea, flatulence, and diarrhea and lactic acidosis which they characterize as “serious but very rare.” The guidelines describe the evidence of metformin for weight loss in pediatric populations as “conflicting” They evaluated 16 studies, about two-thirds of which showed a “modest BMI reduction” and one-third showed “no benefit.” Also, this drug is not approved for weight loss. They recommend that due to the “modest and inconsistent effectiveness, metformin may be considered as an adjunct to intensive health behavior and lifestyle treatment (IHBLT) and when other indications for use of metformin are present.”Orlistat:This drug is currently approved for ages 12 and up. Orlistat is sold under the name alli by GlaxoSmithKline and as Xenical by Genentech (both GlaxoSmithKline and Genentech are donors to the AAP.) The guidelines point out that the side effects (including fecal urgency, flatulence and oily stool) “greatly limit tolerability” but do say that “Orlistat is FDA approved for long-term treatment of ob*sity in children 12 years and older.” They cite two studies from 2005. One (Behzat et al., Addition of orlistat to conventional treatment in adolescents with severe ob*sity) started with 22 adolescents, 7 of whom dropped out within the first month due to drug side effects. The remaining 15 subjects were followed for 5-15 months with an average of 11.7 months of follow up. Those 15 patients lost 6.27 +/- 5.4 kg within the study time.The other (Chanoine JP et al, 2005, Effect of orlistat on weight and body composition in ob*se adolescents) was a one-year study with 357 adolescents (age 12-15) in the Orlistat group. They lost weight initially but the weight loss stopped at week 12 and by the end of the study the weight of those in the Orlistat group had increased by .53kg.Glucagon-like peptide-1 receptor agonistsThese are drugs that are type 2 diabetes medications that were found to have a side effect of weight loss. In some cases they have been rebranded specifically for weight loss and, in others, are prescribed off-label.ExenatideThis drug is currently approved in kids ages 10 to 17 years of age. The guidelines point out that a small weight loss was shown in two small studies but with “significant adverse effects.”LiraglutideThe study they cite for liraglutide (Kelly et al, Trial Investigators. A randomized, controlled trial of liraglutide for adolescents with ob*sity.) was a 56 week study with a 26-week follow-up period. Participants lost weight initially, but after 42 weeks began to regain weight (though they were still on the drug) at 56 weeks weight gain became more rapid and at the end of the 26-week follow up they were nearing baseline. The guidelines characterize this as “A recent randomized controlled trial found liraglutide (daily injection) more effective than placebo in weight loss at 1 year among patients 12 years and older with ob*sity who did not respond to lifestyle treatment.” They do not make it clear that participants experienced near total weight regain (see graphic below.) In addition to the near total lack of weight loss (and remember that it's pretty likely that subjects continued to regain weight after the tracking stopped at 82 weeks,) side effects included nausea and vomiting, and among patients with a family history of multiple endocrine neoplasia, a slightly increased risk of medullary thyroid cancer. Liraglutide is sold as Victoza and Saxenda by Novo Nordisk. This study was a clinical trial funded by Novo Nordisk, multiple study authors work for, are employees of, take payments from and/or own stock in Novo Nordisk (see disclosures below) and Novo Nordisk provides funding directly to the American Academy of Pediatrics, and has paid thousands of dollars to authors of these guidelines.Just for funsies I checked the disclosures: Dr. Kelly reports receiving donated drugs from AstraZeneca and travel support from Novo Nordisk and serving as an unpaid consultant for Novo Nordisk, Orexigen Therapeutics, VIVUS, and WW (formerly Weight Watchers); Dr. Auerbach, being employed by and owning stock in Novo Nordisk; Dr. Barrientos-Perez, receiving advisory-board fees from Novo Nordisk; Dr. Gies, receiving advisory-board fees from Novo Nordisk; Dr. Hale, being employed by and owning stock in Novo Nordisk; Dr. Marcus, receiving consulting fees from Itrim and owning stock in Health Support Sweden; Dr. Mastrandrea, receiving grant support from AstraZeneca and Sanofi US and grant support and fees for serving on a writing group from Novo Nordisk; Ms. Prabhu, being employed by and owning stock in Novo Nordisk; and Dr. Arslanian, receiving fees for serving on a data monitoring committee from AstraZeneca, fees for serving on a data and safety monitoring board from Boehringer Ingelheim, grant support, paid to University of Pittsburgh, and advisory-board fees from Eli Lilly and Novo Nordisk, and consulting fees from Rhythm Pharmaceuticals. Melanocortin 4 receptor (MC4R) agonistsThese are specialty drugs that are only FDA approved for patients 6 years and older with proopiomelanocortin deficiency, proprotein subtilisin or kexin type 1 deficiency and leptin receptor deficiency confirmed by genetic testing. They site a small, uncontrolled study in which patients experience weight loss of 12-25% over 1 year. PhenterminePhentermine is a controlled substance chemically similar to amphetamine which carries a risk of dependence as well as side effects including elevated blood pressure, dizziness, and tremor. These are FDA approved for a 3-month course of therapy for adolescents 16 or older. I'm not clear what good could come out of giving a teenager a drug with these kinds of risk for 3 months?TopiramateThis is a drug that is used to treat seizures and migraines that happens to have a side effect of making people not want to eat through what the guidelines admit are “largely unknown mechanisms.” These drugs cause cognitive slowing and can cause embryo malformation. It's approved for children 2 years and older with epilepsy and 6 and older for headaches and I cannot for the life of me imagine how it could possibly be ethical to cause cognitive slowing in a child (who is going to school!) in order to disrupt their bodies hunger signals.Phentermine/TopiramateYou read that right, those last two drugs with the dangerous, quality-of-life impacting side effects? The guidelines discuss the option of prescribing them together. To children. This is based on a 56-week study (Kelly et al, 2022, Phentermine/topiramate for the treatment of adolescent ob*sity.) In the study, 54 subjects were given a mild dose, 15 of them dropped out. 113 were given the “top dose” 44 of them dropped out. As we've seen in other studies, weight loss had leveled off and begun to rise slightly by week 56 and there is no reason to believe it wouldn't go back up, but we'll never know because they didn't do any more follow-up. By the way, like most of the other studies, these subjects were also undergoing a “lifestyle modification program.” Also, like the other drugs, I think it's important to note that this was FDA-approved for “chronic treatment” based on the results of a study that only lasted 56 weeks. That is a common situation with weight loss drugs.Finally, the guidelines don't mention that side effects of this drug include increased heart rate, suicidal behavior and ideation, slowing of linear growth, acute myopia, secondary angle closure glaucoma, visual problems; mood and sleep disorders; cognitive impairment; metabolic acidosis; and decrease in renal function.  As I was looking this up, I noticed that the lead author of this study is the same lead author of the liraglutide study. Phentermine/Topiramate is sold under the brand name Qysmia by Vivus. I had to do some digging to get to the disclosures on this one and what do you know, Dr. Kelly has received grant consideration and consults for Vivus. In fact, with the exception of Megan Oberle, every author of this study either receives funding from/consults for Vivus, or is an employee of Vivus. Megan Oberle lists no conflicts of interest in this 2022 study but, interestingly, in a 2019 study (It is Time to Consider Glucagon-Like Peptide-1 Receptor Agonists for the Treatment of Type 2 Diabetes in Youth) the disclosure states “MO serves as site PI [principal investigator] for study through Vivus Pharmaceuticals” so we know they're not strangers. LisdexamfetamineThis is a stimulant that is approved for kids 6 and older who have ADHD, in those 18 and up for Binge Eating Disorder, and while it is sometimes prescribed off-label for higher-weight kids, the guidelines note that “no evidence available at the time of this review to demonstrate safety or efficacy for the indication of ob*sity in children.”Summing up, there are significant risks of side effects (some life threatending) and not a drug among them has shown anything approaching long-term efficacy. Let's look at the last of the recommendations.RECOMMENDATION: Weight Loss SurgeryThis is the last bit I'll write about today. This section beginsIt is widely accepted that the most severe forms of pediatric ob*sity (ie, class 2 ob*sity; BMI ≥ 35 kg/m2, or 120% of the 95th percentile for age and sex, whichever is lower) represent an “epidemic within an epidemic.”Remember, for a moment, that this phrasing is from authors who swear up and down that they are working to end weight stigma. One wonders what they would have written if they were trying to stigmatize higher-weight children. (Just fyi, if anyone is confused, you can't usefear-mongering language, describing a group of people simply existing in the world at a higher-weight as an “epidemic” without stigmatizing them.)The KAS here (for me the most horrifying of those offered,) isPediatricians and other PHCPs should offer referral for adolescents 13y and older with severe ob*sity (BMI ≥ 120% of the 95th percentile for age and sex) for evaluation for metabolic and bariatric surgery to local or regional comprehensive multidisciplinary pediatric metabolic and bariatric surgery centers. [I'll note here that at least one of the authors of these guidelines runs just such a facility.]Before we get too far into this, let's be clear about what these surgeries do. They take a child's perfectly functioning digestive system, and put it into a (typically irreversible) disease state forcing, restriction and/or malabsorption (for an explanation of the various surgeries, check out this post.) If this state happens to a child because of disease or accident, it is considered a tragedy. If the child is higher-weight, it is considered, at least by the authors of these guidelines, healthcare.They make the claim “Large contemporary and well-designed prospective observational studies have compared adolescent cohorts undergoing bariatric surgical treatment versus intensive ob*sity treatment or nonsurgical controls. These studies suggest that weight loss surgery is safe and effective for pediatric patients in comprehensive metabolic and bariatric surgery settings that have experience working with youth and their families”To support this, they cite a single study. The study (Laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity (AMOS): a prospective, 5-year, Swedish nationwide study) included 81 subjects who underwent Roux-en-Y gastric bypass.The average weight loss was 36·8 kg over five years, but 11% of those who had the surgery lost less than 10% of their body weight.A full 25%  had to have additional abdominal surgery for complications from the original surgery or rapid weight loss and 72% showed some type of nutritional deficiency. And that's just in five years. Remember that the damage done to the digestive system is permanent. They are recommending this as young as 13, so a five year follow-up only gets these kids to 18. Then what?By the look of their own graph, what comes next may well be more weight gain, since the surgery survivors' weight loss leveled off after year one and started to steadily climb after year two. There's also the impact of those nutrient deficiencies. They also claim that these surgeries lead to a “durable reduction of BMI.” Let's take a look at the studies they cite to prove that.Inge et al., 2018 Comparison of Surgical and Medical Therapy for Type 2 Diabetes in Severely Ob*se AdolescentsThis study lasted two years. It looked at data from 30 adolescents who had weight loss surgery. They averaged 29% weight loss over 2 years and 23% of the subjects had to have a second surgery during those two years.Göthberg et al., 2014, Laparoscopic Roux-en-Y gastric bypass in adolescents with morbid ob*sity--surgical aspects and clinical outcomeThis study just rehashes information from the Olbers study above.O'Brien et al. Laparoscopic adjustable gastric banding in severely ob*se adolescents: a randomized trialThis study is about gastric banding and I'm not sure why they included it because in the paragraph above it they point out that these surgeries are “approved by the FDA only for patients 18 years and older, have declined in use in both adults and youth because of worse long-term effects as well as higher-than expected complication rates” (they cite 18 studies to back up this particular claim.)Olbers et al., 2012 Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity: results from a Swedish Nationwide Study (AMOS)These are just the two-year outcomes from the five-year Olbers study aboveOlbers et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity (AMOS): a prospective, 5-year, Swedish nationwide study.This is the exact same 5-year Olbers study from above, just given a different citation number.Ryder et al., 2018 Factors associated with long-term weight-loss maintenance following bariatric surgery in adolescents with severe ob*sityThis study included 50 subjects who had Roux-en-Y gastric bypass and had a follow-up at year one and another follow-up sometime between years 5 and 12. They were then divided into “regainers” and “maintainers” though by their criteria, “maintainer” subjects could regain, they just couldn't regain more than 20% of the weight they lost prior to their follow-up. Though the study is called “Factors associated with long-term weight-loss maintenance” they were not able to identify any factors that were predictors of “regaining” or “maintaining.” You'll note in the graph below that weight was still trending upward when they stopped following up.So let's recap: They cite 7 studies to back up their recommendation of referrals for these surgeries for kids ages 13 and up. Four of the seven are the same study. One is a study for a surgery that they themselves have said is declining in use, so I'm excluding it. Combined, the rest of the studies followed a grand total of 161 people. The longest follow-up is “5+ years” and the studies consistently showed weight regain that was trending up when follow-up ended, as well as high rates of additional surgery and nutrient deficiencies. This, to me, doesn't come close to justifying a blanket recommendation that every kid 13 and older whose BMI ≥ 120% of the 95th percentile for age and sex be referred for evaluation for weight loss surgery.And when it comes to their criteria for these surgeries, they predicate risk on size. Those with “class 2 ob*sity” are required to have “clinically significant disease” which doesn't make the surgery ethical but, in comparison; children with “class 3 ob*sity” simply have to exist in the world to meet the criteria to have their digestive system put into a permanent disease state. One thing they do point out is that recent data showing multiple micronutrient deficiencies following metabolic and bariatric surgery serve to highlight the need for routine and long-term monitoring. Here we see a serious issue with giving this surgery to adolescents. First of all, they are rarely in control of their access to food. If their parents don't buy them what they need, if a parent loses their job and can no longer afford the supplements they require, if they experience hunger and/or homelessness… there are so many things that could impact a 13-year-old's ability to eat in the very specific ways they need to after the surgery for the rest of their life. Also, these surgeries are going to change the ways that these kids eat - at every school lunch, birthday party, family holiday. Anytime food is served, it is going to become clear that they are different, and if they aren't in charge of preparing the food, there is no guarantee that they will be able to get what they need. And that's if they want to do that. Let's not forget, these are humans who are/will be exploring their independence, including through rebellion, they are humans whose prefrontal cortex is not fully developed, meaning that they can literally lack the ability to fully recognize the consequences of their choices. (Of course, given that we only have five years of follow-up data, I would argue that their doctors and surgical teams also lack the ability to fully recognize the consequences of their choices.)The authors end the section with a fairly shameless plug for insurance coverage of these surgeries. This is another long-time goal of the weight loss industry that has made its way into these guidelines.I think this is a good time for a reminder that thin kids get the same health issues for which higher-weight kids are referred to these surgeries and thin kids are NOT asked to take the risks of these surgeries or to have their digestive systems permanently altered. They just get the ethical, evidence-based treatment for the health issue they actually have. Also, remember that the authors' research methodology specifically excluded research about weight-neutral intervention to see if any health benefits that the surgeries might create could be achieved without the significant (and, from a long-term perspective, largely unknown) risks of these surgeries, and perhaps be more lasting?But there is more to this in terms of informed consent. There are many of the same issues that we see with adults (which I wrote about here). With kids, there is another layer. In the state of California, for example, it is illegal to give a tattoo to someone under the age of 18, even with parental permission. But an eighth grader can make the decision to have their digestive system permanently altered, impacting their life and quality of life in myriad ways, many of which are unknown, and with no prognostics? Given all of this, is informed consent even possible for these kids? I would argue that it is not.Even worse, how many kids' parents, in some combination of weight stigma, concern for their child, and acquiescence to a doctor who may be pressuring them, will make this decision for their child?While I'm sure that there are adolescents who had the surgery and are happy with their outcome, I'm equally sure that there are adolescents who had terrible outcomes and would give anything to not have had the surgery (I know because I hear from them). And I know that the research can't tell us why anyone has the outcome they have. When you combine that with the total lack of long-term follow-up (I'm completely unwilling to consider 5 years “long term” for a lifelong intervention,) I think what we have here are, at best, experimental procedures, not procedures that should receive the kind of blanket recommendations that these guidelines provide for kids as young as 13.Ok, there's a lot more to discuss in these guidelines but I will save that for another newsletter. I hope that the outcry against these guidelines is loud, sustained, and successful in getting them rescinded. Kids deserve far better than this.Finally, I just want to give a quick shout-out to my paid subscribers (I know not everyone can/wants to have a paid subscription and that's totally fine - absolutely no shame at all if you are reading this for free as a subscriber or randomly!) those who are able to pay are allowed me to spend HOURS this week going through these guidelines and creating Thursday's post and this post, I'm just super grateful for the support.I'll be posting additional deep-dives into the research they cite and I'll keep a list here:“New insights about how to make an intervention in children and adolescents with metabolic syndrome” Pérez et al.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 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

Amidst the battle of the mental health crisis, major depressive disorder stands out as an all-too-common reality for many children and adolescents, but the forces of science and medicine can stand against this foe. Dr. Christopher Drescher, a clinical child psychologist, joins pediatric resident Dr. Daniel Allen and medical student Vuk Lacmanovic to remove the cape from this increasingly common condition and discuss its symptoms, diagnosis, and treatment. Specifically, they will: Define major depressive disorder (MDD) and recognize the common symptoms in both children and adolescents. Formulate a differential diagnosis for patients presenting with depressive symptoms. Recognize validated screening tools for depression in both children and adolescents. Review cognitive behavioral therapy and pharmacotherapy as treatment options. Review appropriate referral to a mental health specialist. Free CME Credit (requires sign-in): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=12493  References: Bhatia SK, Bhatia SC. Childhood and adolescent depression. Am Fam Physician. 2007 Jan 1;75(1):73-80. PMID: 17225707. Brent DA, Maalouf F. Depressive Disorders (in Childhood and Adolescence). In: Ebert MH, Leckman JF, Petrakis IL. eds. Current Diagnosis & Treatment: Psychiatry, 3e. McGraw-Hill; Accessed November 17, 2020. https://accessmedicine.mhmedical.com/content.aspx?bookid=2509§ionid=200807606 Clark MS, Jansen KL, Cloy JA. Treatment of childhood and adolescent depression. Am Fam Physician. 2012 Sep 1;86(5):442-8. PMID: 22963063. Fendrich M, Weissman MM, Warner V. Screening for depressive disorder in children and adolescents: validating the Center for Epidemiologic Studies Depression Scale for Children. Am J Epidemiol. 1990 Mar;131(3):538-51. doi: 10.1093/oxfordjournals.aje.a115529. PMID: 2301363. (PDF of CES-DC here) Forman-Hoffman V, McClure E, McKeeman J, Wood CT, Middleton JC, Skinner AC, Perrin EM, Viswanathan M. Screening for Major Depressive Disorder in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016 Mar 1;164(5):342-9. doi: 10.7326/M15-2259. Epub 2016 Feb 9. PMID: 26857836. Hathaway EE, Walkup JT, Strawn JR. Antidepressant Treatment Duration in Pediatric Depressive and Anxiety Disorders: How Long is Long Enough? Curr Probl Pediatr Adolesc Health Care. 2018 Feb;48(2):31-39. doi: 10.1016/j.cppeds.2017.12.002. Epub 2018 Jan 12. PMID: 29337001; PMCID: PMC5828899. March JS, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J. The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. Arch Gen Psychiatry. 2007 Oct;64(10):1132-43. doi: 10.1001/archpsyc.64.10.1132. Erratum in: Arch Gen Psychiatry. 2008 Jan;65(1):101. PMID: 17909125. Meister R, Abbas M, Antel J, Peters T, Pan Y, Bingel U, Nestoriuc Y, Hebebrand J. Placebo response rates and potential modifiers in double-blind randomized controlled trials of second and newer generation antidepressants for major depressive disorder in children and adolescents: a systematic review and meta-regression analysis. Eur Child Adolesc Psychiatry. 2020 Mar;29(3):253-273. doi: 10.1007/s00787-018-1244-7. Epub 2018 Dec 8. PMID: 30535589; PMCID: PMC7056684. Rachel A. Zuckerbrot, Amy Cheung, Peter S. Jensen, Ruth E.K. Stein, Danielle Laraque and GLAD-PC STEERING GROUP. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics March 2018, 141 (3) e20174081; DOI: https://doi.org/10.1542/peds.2017-4081 Scott K, Lewis CC, Marti CN. Trajectories of Symptom Change in the Treatment for Adolescents With Depression Study. J Am Acad Child Adolesc Psychiatry. 2019 Mar;58(3):319-328. doi: 10.1016/j.jaac.2018.07.908. Epub 2019 Jan 8. PMID: 30768414; PMCID: PMC6557284. Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ. 2016 Jan 27;352:i65. doi: 10.1136/bmj.i65. PMID: 26819231; PMCID: PMC4729837. Siu AL; US Preventive Services Task Force. Screening for Depression in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. Pediatrics. 2016 Mar;137(3):e20154467. doi: 10.1542/peds.2015-4467. Epub 2016 Feb 8. PMID: 26908686. Weersing VR, Brent DA, Rozenman MS, Gonzalez A, Jeffreys M, Dickerson JF, Lynch FL, Porta G, Iyengar S. Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Randomized Clinical Trial. JAMA Psychiatry. 2017 Jun 1;74(6):571-578. doi: 10.1001/jamapsychiatry.2017.0429. PMID: 28423145; PMCID: PMC5539834. Weersing VR, Shamseddeen W, Garber J, Hollon SD, Clarke GN, Beardslee WR, Gladstone TR, Lynch FL, Porta G, Iyengar S, Brent DA. Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects. J Am Acad Child Adolesc Psychiatry. 2016 Mar;55(3):219-26. doi: 10.1016/j.jaac.2015.12.015. Epub 2016 Jan 18. PMID: 26903255; PMCID: PMC4783159. Xu Y, Bai SJ, Lan XH, Qin B, Huang T, Xie P. Randomized controlled trials of serotonin-norepinephrine reuptake inhibitor in treating major depressive disorder in children and adolescents: a meta-analysis of efficacy and acceptability. Braz J Med Biol Res. 2016 May 24;49(6):e4806. doi: 10.1590/1414-431X20164806. PMID: 27240293; PMCID: PMC4897997. Zhou X, Cipriani A, Zhang Y, Cuijpers P, Hetrick SE, Weisz JR, Pu J, Giovane CD, Furukawa TA, Barth J, Coghill D, Leucht S, Yang L, Ravindran AV, Xie P. Comparative efficacy and acceptability of antidepressants, psychological interventions, and their combination for depressive disorder in children and adolescents: protocol for a network meta-analysis. BMJ Open. 2017 Aug 11;7(8):e016608. doi: 10.1136/bmjopen-2017-016608. PMID: 28801423; PMCID: PMC5629731. Zhou X, Teng T, Zhang Y, Del Giovane C, Furukawa TA, Weisz JR, Li X, Cuijpers P, Coghill D, Xiang Y, Hetrick SE, Leucht S, Qin M, Barth J, Ravindran AV, Yang L, Curry J, Fan L, Silva SG, Cipriani A, Xie P. Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. Lancet Psychiatry. 2020 Jul;7(7):581-601. doi: 10.1016/S2215-0366(20)30137-1. PMID: 32563306; PMCID: PMC7303954.

What does the body of evidence say on the topic of osteoporosis? Plus: we look at a genuinely breakthrough therapy for metastatic melanoma, and Chris lets you in on a troubling “secret” when it comes to travel health insurance! You will also learn what a “dowager's hump” is and hear Chris sing, and for that we formally apologize.   Block 1: (2:01) Osteoporosis: what it is; bone cells and how they are assessed   Block 2: (9:02) Osteoporosis: bone mineral density, T-score and Z-score; can doctors see signs of osteoporosis in the clinic; causes of osteoporosis; treating it: lifestyle changes, supplements, bisphosphonates, and Prolia; screening guidelines   Block 3: (32:04) Breakthrough therapy for metastatic melanoma: TILs (vs. ipilimumab)   Block 4: (47:53) Travel insurance caveat     * Theme music: “Fall of the Ocean Queen“ by Joseph Hackl. * Assistant researcher: Nicholas Koziris   To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/.   To make a one-time donation to our show, you can now use PayPal! https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE   Patrons get a bonus show on Patreon called “Digressions”! Check it out!     References:   1) Estrogen does reduce the risk of hip fracture from osteoporosis: https://doi.org/10.1001/jama.288.3.321   2) Exercise increases bone mineral density in post-menopausal women: https://doi.org/10.7326/0003-4819-108-6-824 & https://doi.org/10.1001/jama.288.18.2300   3) Calcium and vitamin D supplementation and the risk of fractures: https://doi.org/10.1001/jama.2017.19344   4) Medications can reduce the risk of osteoporotic fractures: https://jamanetwork.com/journals/jama/fullarticle/2685995   5) Screening guidelines from the US Preventive Services Task Force: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening   6) Results from the phase III clinical trial comparing TILs to ipilumumab in advanced melanoma: https://www.nejm.org/doi/full/10.1056/NEJMoa2210233     It's Not Twitter, But It'll Do:   1) Jonathan on the Martial Culture Podcast: https://www.stitcher.com/show/the-martial-culture-podcast/episode/combating-pseudoscience-unscientific-thinkings-in-martial-arts-w-jonathan-jarry-209989826   2) Jonathan's article on the Healy: https://www.mcgill.ca/oss/article/critical-thinking-pseudoscience/healy-old-woo-new-clothes   3) The Hard Fork Podcast: https://www.nytimes.com/2022/10/04/podcasts/hard-fork-technology.html   4) The CTV Montreal News website: https://montreal.ctvnews.ca/video?binId=1.1332485   5) The CBC Player: https://www.cbc.ca/player/news   6) The CJAD website: https://www.iheartradio.ca/cjad   7) Odyssey TV: http://odysseytv.ca/   8) Chris on the CBC, interviewed about mpox: https://www.cbc.ca/news/politics/mpox-outbreak-canada-plateau-1.6696842     Time Machine:   1) Our episode on childbirth: https://bodyofevidence.ca/042-childbirth-and-crowdfunding-quackery   2) Our interview on conspirituality: https://bodyofevidence.ca/interview-matthew-remski-on-conspirituality     Music Credits:   The following music was used for this media project: Music: 3am Glowsticks by Tim Kulig Free download: https://filmmusic.io/song/9166-3am-glowsticks License (CC BY 4.0): https://filmmusic.io/standard-license    

At the end of September, the US Preventive Services Task Force made the recommendation that all adults under the age of 65 years be screened for anxiety by their healthcare provider. Why is this newsworthy? It includes screening all adults including those who do not have a diagnosed mental health disorder and are not showing any signs or symptoms of anxiety.  This same recommendation was made for kids ages 8-18 earlier in April.  In this episode, we're diving into why these recommendations were made, access to treatment, and our thoughts on if this will have an impact when it comes to helping friends and family with anxiety issues.  Show Notes:  References mentioned include: Screening for Depression, Anxiety, and Suicide Risk in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force   Thank you for listening to The Happy Eating Podcast. Tune in weekly on Thursdays for new episodes! For even more Happy Eating, head to our website!  https://www.happyeatingpodcast.com Learn More About Our Hosts:  Carolyn Williams PhD, RD: Instagram: https://www.instagram.com/realfoodreallife_rd/ Website: https://www.carolynwilliamsrd.com Facebook: https://www.facebook.com/RealFoodRealLifeRD/ Brierley Horton, MS, RD Instagram: https://www.instagram.com/brierleyhorton/ Got a question or comment for the pod? Please shoot us a message!  happyeating@gmail.com Produced by Lester Nuby OE Productions 

The United States Preventative Services Task Force issued new recommendations for the use of vitamins, minerals, and multivitamins for the prevention of cardiovascular disease and cancer. This is a revision from the 2014 recommendations and is based on recent data. Host Geoff Wall will provide a review of the recommendations – and evidence on these over-the-counter products. The GameChanger Based on the new USPSTF recommendations, most vitamins and supplements have insufficient data to determine their benefits versus harm. However, the USPSTF recommends against the use of beta carotene or vitamin E supplementation for the prevention of cancer or cardiovascular disease.  Show Segments 00:00 – Introductions 01:15 – Vitamins, Minerals, and Supplements Regulations and Controversies 06:11 – USPSTF Recommendations 10:07 – Beta Carotene in Cancer and Cardiovascular Disease 11:49 – Vitamin A Supplementation 12:14 – Vitamin E Supplementation 12:52 – Multivitamin Use 15:16 – Vitamin D & Calcium Supplementation  17:40 – Folic Acid Supplementation  18:50 – Vitamin C Supplementation  19:05 – The GameChanger 22:58 – Connecting to Practice 23:40 – Closing Remarks  Host Geoff Wall, PharmD, BCPS, FCCP, CGP Professor of Pharmacy Practice, Drake University Internal Medicine/Critical Care, UnityPoint Health References and resources:US Preventive Services Task Force. Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer: US Preventive Services Task Force Recommendation Statement.Redeem your CPE or CME creditCPE (Pharmacist)CME (Physician)Get a membership & earn CE for GameChangers Podcast episodes (30 mins/episode) Pharmacists: Get a Membership Prescribers: Get a Membership   Continuing Education Information:Learning Objectives:1. Discuss the use of vitamin E for cardiovascular disease prevention2. Describe the USPSTF recommendations for vitamins, minerals, and multivitamins0.05 CEU | 0.5 HrsACPE UAN: 0107-0000-22-281-H01-PInitial release date: 08/08/22Expiration date: 08/08/2023Additional CPE & CME details can be found here

Dental's pharmacology expert, Tom Viola, RPh, returns to the show to share some interesting words recently published in the Journal of the American Medical Association about beta carotene and vitamin E and what the US Preventive Services Task Force is saying about them. This is a must-listen for dental professionals not only for themselves but their patients as well.

O retorno do bolus com Joanne e Marcela falando sobre AAS na profilaxia primária para doença cardiovascular (DCV)! Elas abordam 3 tópicos: - História de AAS na prevenção de DCV - Recomendação atual e os principais estudos que motivaram a mudança de recomendação (ASPREE, ARRIVE E ASCEND) - O que fazer com quem já usa? Tá imperdível! Referências: 1. Aimo A, De Caterina R. Aspirin for primary prevention of cardiovascular disease: Advice for a decisional strategy based on risk stratification. Anatol J Cardiol. 2020;23(2):70-78. 2. Berger JS. Aspirin for Primary Prevention—Time to Rethink Our Approach. JAMA Netw Open.2022;5(4):e2210144. 3. Bowman L, et al. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med 2018; 379:1529-1539 4. Chiang KF, Shah SJ, Stafford RS. A Practical Approach to Low-Dose Aspirin for Primary Prevention. JAMA. 2019;322(4):301-302 5. Gaziano JM, et al. Aspirin to Reduce Risk of Initial Vascular Events - ARRIVE. Lancet 2018; 392: 1036–46 6. McNeil JJ, et al. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med 2018; 379:1519-1528 7. Précoma DB, Oliveira GMM, Simão AF, Dutra OP, Coelho OR, Izar MCO, Póvoa RMS, et al. Atualização da Diretriz de Prevenção Cardiovascular da Sociedade Brasileira de Cardiologia – 2019. Arq. Bras. Cardiol. 2019;113(4):787-891 8. Raber I, et al. The rise and fall of aspirin in the primary prevention of cardiovascular disease. Lancet 2019; 393: 2155–67 9. US Preventive Services Task Force. Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement. JAMA.2022;327(16):1577–1584.

Donald M. Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement, is also former Administrator of the Centers for Medicare & Medicaid Services. A pediatrician by background, Dr. Berwick has served on the faculty of the Harvard Medical School and Harvard School of Public Health, and on the staffs of Boston's Children's Hospital Medical Center, Massachusetts General Hospital, and the Brigham and Women's Hospital. He has also served as Vice Chair of the US Preventive Services Task Force, the first "Independent Member" of the American Hospital Association Board of Trustees, and Chair of the National Advisory Council of the Agency for Healthcare Research and Quality. He served two terms on the Institute of Medicine's (IOM's) Governing Council, was a member of the IOM's Global Health Board, and served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry. Recognized as a leading authority on health care quality and improvement, Dr. Berwick has received numerous awards for his contributions. In 2005, he was appointed "Honorary Knight Commander of the British Empire" by Her Majesty, Queen Elizabeth II in recognition of his work with the British National Health Service. Dr. Berwick is the author or co-author of over 160 scientific articles and six books. He currently serves as Lecturer in the Department of Health Care Policy at Harvard Medical School. Follow Don on Twitter Nana Twum-Danso, MD, MPH, FACPM, ​Senior Vice President, Global, Institute for Healthcare Improvement (IHI), leads all global strategy and client development, with top-line revenue responsibility. Previously she was Managing Director for Health at The Rockefeller Foundation, overseeing a strategy designed to transform the practice of public health through data science. She is a public health and preventive medicine physician with 20 years of experience in health policy, practice, strategy, monitoring, learning, evaluation, research, and philanthropy at local, national, and international levels. Dr. Twum-Danso is also an Adjunct Assistant Professor in the Department of Maternal and Child Health at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill. She worked at the Task Force for Global Health in Atlanta, Georgia; was Director of IHI's nationwide CQI initiative in Ghana; Senior Program Officer in the MNCH Department at the Bill & Melinda Gates Foundation; independent consultant; and Founder and CEO of MAZA, a social enterprise that provided on-demand health care transportation for pregnant women and sick infants in remote areas of Ghana. She also served on technical advisory committees for the World Health Organization, the US National Academy of Sciences, Engineering and Medicine, and the Canadian International Development Research Centre. Dr. Twum-Danso received her undergraduate and medical education from Harvard University and her public health and preventive medicine residency training from Emory University.  Follow Nana on Twitter.

In this limited series of episodes, we have conversations with a variety of experts and community leaders in the field of maternal and child health to discuss how to advance maternal health equity. In this episode we spoke with CHET Director/Founder -- Dr. Melissa Simon. Melissa A. Simon, MD, MPH is the George H. Gardner Professor of Clinical Gynecology, Vice Chair of Research in the Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine. She is also the Founder and Director of the Center for Health Equity Transformation and the Chicago Cancer Health Equity Collaborative. She serves as the Robert H. Lurie Comprehensive Cancer Center's Associate Director for Community Outreach and Engagement. She is an expert in implementation science, women's health across the lifespan, minority health, community engagement and health equity. She has been recognized with numerous awards for her substantial contribution to excellence in health equity scholarship, women's health and mentorship, including her recent election to the National Academy of Medicine and the Association of American Physicians. She has received the Presidential Award in Excellence in Science Mathematics and Engineering Mentorship and is a Presidential Leadership Scholar. She is a former member of the US Preventive Services Task Force and serves on the NIH Office of Research in Women's Health Advisory Committee. For more information on maternal health projects, please visit: - https://www.feinberg.northwestern.edu/sites/chet/ - https://well-mama.org/

The US Preventive Services Task Force is considering making several changes to its guidance on taking a daily aspirin to prevent heart disease and stroke. On Tuesday, the task force posted a draft statement recommending that adults ages 40 to 59 who are at a higher risk for cardiovascular disease -- but do not have a history of the disease -- decide with their clinician whether to start taking aspirin, based on their individual circumstances. This is the first time the task force has recommended that adults in their 40s talk to their doctors about whether to take aspirin for heart health. The draft also says that adults 60 and older should not start taking aspirin to prevent heart disease and stroke because new evidence shows that potential harms cancel out the benefits, according to the task force.To learn more about how CNN protects listener privacy, visit cnn.com/privacy

Hoje, no Check-up Semanal, nosso programa de podcast que traz as principais atualizações da última semana, o editor-chefe médico do Portal PEBMED, Ronaldo Gismondi, comenta: os guidelines atualizados da Surviving Sepsis Campaign; recomendações da US Preventive Services Task Force para uso de aspirina para prevenir pré-eclâmpsia; e um estudo que avaliou o melhor momento de iniciar a anticoagulação pós-AVC em paciente com fibirlação atrial.

The US Preventive Services Task Force on Tuesday lowered the recommended age to start screening for colon and rectal cancers from 50 to 45. The task force, which is the leading panel for medical guidance in the US, released a draft of the recommendation in October. The final recommendation statement, published Tuesday in the journal JAMA, says all adults ages 45 to 75 years should be screened for colorectal cancer. This recommendation is for asymptomatic people of average risk, with no prior diagnosis of colorectal cancer, history of colon or rectal polyps or personal or family history of genetic disorders that put them at higher risk. The task force also recommended selective screening among adults ages 76 to 85 years based on a patient's overall health, prior screening history and preferences.To learn more about how CNN protects listener privacy, visit cnn.com/privacy