#JAMANetworkOpen

[mariebenz]

Yale Study Finds Pharmaceutical Companies Focus Advertising On Expensive Brand-Name Drugs

MedicalResearch.com Interview with: Neeraj Patel Medical Student (MS-2), Yale School of Medicine New Haven, CT MedicalResearch.com: What is the background for this study? Response: Direct-to-consumer pharmaceutical advertising has been increasing in popularity for the past two decades or so, particularly via television. But it’s highly controversial. Only two high-income countries (the U.S. and New Zealand) widely permit this type of advertising for prescription drugs. Critics have pointed to a growing body of literature that suggests that direct-to-consumer advertising for prescription drugs can be misleading, lead to inappropriate prescribing, and inflate healthcare costs. Proponents have argued that it improves public health by promoting clinically beneficial prescribing. MedicalResearch.com: What are the main findings? Response:  Our study assessed the most-commonly marketed drugs in these television advertisements and we had two main findings: First, we found that less than one-third of drugs commonly marketed from 2015 to 2021 were rated as having high therapeutic value, defined as providing at least moderate improvement in clinical outcomes compared to existing therapies according to at least one of three independent health technology assessment agencies. Second, we found that drugs categorized as “low benefit” accounted for $15.9 billion of the $22.3 billion (71.3%) in television advertising spending associated with our 73-drug sample over 6 years. MedicalResearch.com: What should readers take away from your report? Response: Taken together with other research, our findings suggest that pharmaceutical companies focus their advertising campaigns on expensive, brand-name drugs that have little or no comparative benefit versus existing alternatives. In general, I think our findings raise questions about the public health value that these advertisements are offering to society, especially when considering the body of research on the misleading nature and negative downstream effects of such advertisements on prescribing patterns and healthcare costs. From a public health standpoint, it’s concerning to me that the healthcare system allocates billions of dollars annually towards drug advertisements, as opposed to higher-quality forms of medical communication. In general, I hope that our research findings will encourage and help enable policymakers to create more rigorous, evidence-based regulations on prescription drug advertising. MedicalResearch.com: What recommendations do you have for future research as a results of this study? Response: Policymakers and regulators should consider requiring disclaimers on direct-to-consumer pharmaceutical advertisements regarding the comparative effectiveness of the products in such advertisements. Another concern about prescription drug advertisements is that they tend to have very low informational quality (as shown in a number of recent studies like this one). I think we should have more rigorous standards for weeding out misleading advertising and fund the FDA to apply current standards more proactively. Finally, given recent research on the harms and limited benefit of direct-to-consumer advertising of prescription drugs, I think policymakers should reconsider in which circumstances, if any, this type of advertising should be permitted. I have no conflicts of interest or other disclosures to report. Citation: Patel NG, Hwang TJ, Woloshin S, Kesselheim AS. Therapeutic Value of Drugs Frequently Marketed Using Direct-to-Consumer Television Advertising, 2015 to 2021. JAMA Netw Open. 2023;6(1):e2250991. doi:10.1001/jamanetworkopen.2022.50991 The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.     Read the full article

[covid-safer-hotties]

Also preserved on our archive

By Mary Van Beusekom, MS

Today in JAMA Network Open, a Mass General Brigham-led research team reports that US all-cause excess mortality during the COVID-19 pandemic disproportionately affected several minoritized populations, with the largest relative increase in adults aged 25 to 64 years—which the authors said implies lasting downstream consequences.

The researchers characterized overall and age-specific excess mortality by race by analyzing all US all-cause deaths related to the COVID-19 public health emergency (March 2020 to May 2023). They also evaluated whether measured differences reflected changes from racial disparities before the pandemic.

Excess deaths number more than 1.38 million More than 1.38 million all-cause excess deaths (observed-to-expected ratio, 1.15) occurred, corresponding to about 23 million years of potential life lost (YPLL) during the pandemic. Excess deaths included roughly 9,000 Black (542,000 YPLL), 6,000 Hispanic (395,000 YPLL), 400 American Indian or Alaska Native (AIAN; 24,000 YPLL), and 100 Native Hawaiian and other Pacific Islander people (7,500 YPLL).

The highest observed-to-expected mortality ratios occurred among AIAN (1.31) and Hispanic populations (1.31). But the ratios were highest in people aged 25 to 64 years (1.20), particularly AIANs (1.45), Hispanics (1.40), and Native Hawaiians or other Pacific Islanders (1.39) in this age-group.

The proportion of excess mortality exceeded the share of the population among AIAN, Black, and Native Hawaiian or other Pacific Islander populations. For example, among adults aged 25 years and older, Black people made up 51.1% of excess deaths, despite representing only 13.8% of the population.

Greater YPLL per-capita and per-excess deaths among AIAN, Black, Hispanic, and Native Hawaiian or other Pacific Islander populations were seen, reflecting their younger average and median ages of decedents compared with Asian and White people. More than 454,000 (32.9%) excess deaths occurred in people 0 to 64 years old, accounting for about 14.2 million (61.2%) of the overall YPLL.

Pandemic worsened historical mortality disparities If the rate of excess mortality seen among White people had been observed among the total population, more than 252,000 (18.3%) fewer excess deaths and more than 5.2 million (22.3%) fewer YPLL would have occurred.

While adults aged 65 years and older made up 67% of excess mortality in the US population, in the AIAN and Native Hawaiian or other Pacific Islander populations only, people younger than 65 accounted for most excess deaths (60.5% and 70.3%, respectively).

The magnitude of excess mortality both overall and within age-groups was greater before than after the development of COVID-19 vaccines. Established and largely stable pre-COVID disparities in all-cause death by race changed at the pandemic onset, with the studied racial groups at higher relative risk of death after March 2020.

By the third year of the pandemic, relative risks for death had returned to prepandemic levels except for AIANs and Native Hawaiians or other Pacific Islanders.

"Importantly, we demonstrate that the pandemic appears to have exacerbated historical mortality disparities that have long been understood to reflect strata in social determinants of health, structural inequality, and racism, and which have persisted," the study authors wrote.

The racial disparities can't be explained by genetics alone, the researchers said. "While pandemics are inevitable, disparities are not," they wrote. "The need to address the conditions that create health disparities—before the next public health crisis—is evident."

Study Link: jamanetwork.com/journals/jamanetworkopen/fullarticle/2824690

[spooniestrong]

Make your voice heard and ask the CDC to:

Recommend updated 2024-2025 COVID vaccines for all ages AND

Strengthen our vaccine drive by recommending more frequent boosting (at least every six months) and more frequent updates to the vaccines, adjusted for the latest variants.

Submit a public comment using our sample language below.

You can also register to give Oral Public Comment at the upcoming June 26-28 online CDC ACIP Meeting at: https://www2.cdc.gov/vaccines/acip/acip_publiccomment.asp 

Submit written comments and/or register to make oral comments at the meeting by Monday, June 17 at 11:59pm Eastern Standard Time.

It’s important to submit a personalized comment, which can be brief. Ideas for a personalized comment:

How you, your family, or your community would be impacted by fall vaccine eligibility being restricted to only high risk groups (such as older age or immunocompromised status)

Barriers to vaccination your have faced, particularly if your eligibility was questioned or misinterpreted by a vaccine provider

How out-of-pocket costs are a barrier to getting the latest vaccines

Also feel free to take inspiration from or borrow the language in our sample public comment below.

Docket No. CDC–2024–0043

Updated 2024-2025 COVID vaccines must be recommended for people of all ages, regardless of health status. A restrictive approach to eligibility would create undue barriers for vulnerable people and discourage high risk people from getting needed vaccine boosters.

The vaccine schedule should address waning efficacy in the months following vaccination [1-3] as well as emergence of new SARS-CoV-2 strains by recommending updated vaccination for all ages, at least every six months. Recent vaccination is also associated with a lower risk of developing Long COVID following a COVID infection [4] as well as a lower risk of Multisystem Inflammatory Syndrome in children (MIS-C) [5]. 

The CDC’s clear and unequivocal recommendation of updated COVID vaccination for all ages will influence what healthcare providers recommend, and what health insurances cover. Moreover, it will improve public awareness regarding the need for updated vaccination.

The CDC must ensure equitable and affordable access to updated vaccines and prevent limited access because of financial constraints or demographics. The CDC’s Bridge vaccine access program is slated to end August 2024 and must be extended to ensure uninsured and underinsured people have access to the updated vaccines this fall [6].

References:

1. Link-Gelles R. Effectiveness of COVID-19 (2023-2024 Formula) vaccines. Presented at: FDA VRBPAC Meeting; June 5, 2024. Accessed June 12, 2024. https://www.fda.gov/media/179140/download

2. Wu N, Joyal-Desmarais K, Vieira AM, et al. COVID-19 boosters versus primary series: update to a living review. The Lancet Respiratory Medicine. 2023;11(10):e87-e88. doi:10.1016/S2213-2600(23)00265-5

3. Menegale F, Manica M, Zardini A, et al. Evaluation of Waning of SARS-CoV-2 Vaccine–Induced Immunity: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023;6(5):e2310650. doi:10.1001/jamanetworkopen.2023.10650

4. Fang Z, Ahrnsbrak R, Rekito A. Evidence Mounts That About 7% of US Adults Have Had Long COVID. JAMA. Published online June 7, 2024. doi:10.1001/jama.2024.11370

5.  Yousaf AR. Notes from the Field: Surveillance for Multisystem Inflammatory Syndrome in Children — United States, 2023. MMWR Morb Mortal Wkly Rep. 2024;73. doi:10.15585/mmwr.mm7310a2

6. https://www.cdc.gov/vaccines/programs/bridge/index.html 

Full instructions for written and oral comment and meeting information can be found at: https://www.cdc.gov/vaccines/acip/meetings/index.html

You can also register to give Oral Public Comment at the upcoming June 26-28 online CDC ACIP Meeting at: https://www2.cdc.gov/vaccines/acip/acip_publiccomment.asp 

You must register by June 17 at 11:59pm Eastern Standard Time

CDC’s ACIP meeting information on the Federal Register: https://www.federalregister.gov/documents/2024/05/24/2024-11439/meeting-of-the-advisory-committee-on-immunization-practices 

Vaccination with the latest updated vaccines continues to be foundational to a multilayered approach to COVID, providing protection against both acute disease and Long COVID. Far too few Americans have received the latest vaccines. Only approximately 22.6% of adults and 14.8% of children have received the latest 2023-2024 vaccines (as of June 1, 2024), which have been available since Fall 2023. COVID vaccination rates in both groups lags far behind influenza vaccination rates. Only 7.1% of adults aged 65 and older received the recommended two doses of the 2023-2024 vaccine (as of April 27, 2024).

Vaccine efficacy wanes significantly four to six months following vaccination, making updated vaccination important for all people as COVID continues to spread in our communities. Vaccine approaches that restrict access based on age or risk status put all of us at risk and leave those at high risk of severe consequences of COVID infection confused about whether they qualify to receive additional doses. A more frequent vaccination approach providing vaccination at least every six months as well as frequent updates to match current variants is needed to better protect all of us amid year-round COVID spread.

The CDC’s Bridge Access Program, which provides COVID vaccines to uninsured and underinsured adults free of charge, is due to end August 2024. The end of this program will unnecessarily put vulnerable people at risk, and public health officials must advocate for continuation and expansion of this program.

Submitted written comments or registration to make oral comments at the meeting must be received by the CDC no later than June 17 at 11:59pm Eastern Standard Time

[hackernewsrobot]

Microplastics in the Olfactory Bulb of the Human Brain

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2823787

[gumjrop]

The FDA, between now and May 8, is accepting public comments for their upcoming vaccine committee meeting. Let them know that all of us need access to COVID vaccines at least twice a year.

Make your voice heard and ask the FDA Vaccines and Related Biological Products Advisory Committee Meeting to:

Ensure vaccine manufacturers anticipate the upcoming dominant strain of SARS-CoV-2.

Recommend updated COVID vaccines for all ages AND

Strengthen our vaccine drive by recommending more frequent boosting (at least every six months) and more frequent updates to the vaccines, adjusted for the latest variants.

Submit a public comment. Feel free to use our sample language below.

You can also register to give Oral Public Comment at the upcoming May 16 online FDA Vaccines and Related Biological Products Advisory Committee Meeting at: CBERVRBPAC@fda.hhs.gov on May 1, 2024. THAT’S TONIGHT!

Submitted written comments for the meeting must be received by the FDA via the Federal Register no later than May 8, 2024 at 11:59 Eastern Daylight Time. 

It’s important to submit a personalized comment, which could include the importance of anticipating the next dominant viral strain, the lack of vaccine access that has impacted or would impact you, or how out-of-pocket costs are a barrier in your family or community. Feel free to take inspiration from or borrow the language in our sample public comment below.

Docket No. FDA–2024–N–0970 Scientific evidence indicates updated vaccines are needed to address the ongoing changes in COVID variants, and they should ideally be allowed, available, and fully covered by public funds and/or insurance, for people of all ages at least every six months. The vaccine schedule should address waning efficacy in the months following vaccination [1-3] as well as emergence of new SARS-CoV-2 strains. The FDA’s decision will affect the current and future vaccine approach including what healthcare providers recommend, what health insurance covers, and level of public engagement. It is of utmost importance that the FDA anticipates the newest viral variants and provides recommendations that anticipates the next dominant strain in the next six months. This requires that the FDA ensure that manufacturers anticipate the newest variants. Restricting vaccinations to only annual updates misses an opportunity, given that there is the potential to update the vaccines to better match perpetually emerging variants. Updates to all vaccine types are needed, and mRNA vaccines are particularly suited to frequent updates. The recommendation for only annual vaccination also creates barriers for vulnerable people and discourages high risk people from getting needed vaccine boosters. The FDA must ensure support equitable and affordable access to updated vaccines and prevent limited access because of financial constraints or demographics by advocating for programs such as the CDC’s bridge program that ensures no cost access. [4] References:

Link-Gelles R. COVID-19 vaccine effectiveness updates. Presented at: FDA VRBPAC Meeting; June 15, 2023. Accessed February 9, 2024. https://www.fda.gov/media/169536/download

Wu N, Joyal-Desmarais K, Vieira AM, et al. COVID-19 boosters versus primary series: update to a living review. The Lancet Respiratory Medicine. 2023;11(10):e87-e88. doi:10.1016/S2213-2600(23)00265-5

Menegale F, Manica M, Zardini A, et al. Evaluation of Waning of SARS-CoV-2 Vaccine–Induced Immunity: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023;6(5):e2310650. doi:10.1001/jamanetworkopen.2023.10650

https://www.cdc.gov/vaccines/programs/bridge/index.html 

Full instructions for written and oral comment and meeting information can be found at: https://www.fda.gov/advisory-committees/advisory-committee-calendar/vaccines-and-related-biological-products-advisory-committee-may-16-2024-meeting-announcement

FDA Vaccines and Related Biological Products Advisory Committee Meeting on the Federal Register: https://www.federalregister.gov/documents/2024/03/04/2024-04523/vaccines-and-related-biological-products-advisory-committee-notice-of-meeting-establishment-of-a

[pgasiorek]

Alkohol zabija

Trafiłem gdzieś na dość świeże badania* dotyczące procentowej ilości zgonów spowodowanych przez alkohol. Realizowano je w latach 2015 – 2019 na terenie całych Stanów Zjednoczonych i średniorocznie obejmowały około 695 tysięcy śmierci kobiet i mężczyzn. Okazało się, że nadmierne spożycie alkoholu stanowiło blisko 13% (12,9%) wszystkich zgonów dorosłych między 20 a 64 rokiem życia i ponad 20% (20,3%) zgonów w węższej – od 20 do 49 lat – grupie wiekowej.

Nie wiem, czy są to dane zatrważające. Wydaje mi się, że tak, a już z pewnością powinny dać do myślenia każdemu. Oznacza to bowiem ni mniej ni więcej, że „tylko” jeden na osiem zgonów osoby dorosłej przed sześćdziesiątym piątym i aż jeden na pięć zgonów osoby dorosłej przed pięćdziesiątką jest wynikiem nadużywania alkoholu.

Nie będę teraz tutaj całościowo rozwodził się nad tym badaniem, gdyż zwyczajnie nie chce mi się tłumaczyć wcale nie takiego krótkiego, mocno specjalistycznego tekstu. Może jeszcze tylko dodam, że z analizowanych danych wynika, iż w Stanach Zjednoczonych alkohol jest główną przyczyną zgonów, której dałoby się zapobiec. I to zapobiec w sposób prosty: ograniczając ilości wypijanego alkoholu.

Pytanie, czy sytuacja ma się podobnie w Polsce wydaje się oczywiście ciekawe i niestety nie znam na nie odpowiedzi, ale sądzę, że śmiało można założyć, że wziąwszy pod uwagę powszechną dostępność do alkoholu w naszym kraju, raczej nie wypadamy lepiej na tym polu. Może więc czas uświadomić sobie, że ta lubiana i ceniona substancja psychoaktywna nie jest wcale takim niewinnym, w gruncie rzeczy niegroźnym reduktorem stresu i katalizatorem beztroskiej zabawy, ale dość niebezpieczną trucizna, której spożywanie w nadmiarze wiąże się z ryzykiem nie mniejszym niż to, przed którym ostrzegają nas napisy na pudełkach z papierosami.

*https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2798004

[reportsofawartime]

Cognetti氏の論文では、Ogata氏の論文の10万倍のスパイク蛋白が血中から検出されている。Ogata氏の感染時論文と比べるのなら100〜1000倍。 https://mdpi.com/1424-8220/21/17/5857… 『これは最大濃度 14.6 μg/mL に相当します。最近発表された Ogata らの研究では、Quanterix アッセイを使用して、同様の時間スケールで 50 pg/mL 未満の濃度の血中スパイクタンパク質を測定しました [ 10 ]。私たちの光子アッセイと Ogata の研究との大きな食い違いは興味深く、この分野における知識が初期段階にあることを反映している可能性があります(this corresponds to a maximum concentration of 14.6 μg/mL. Recently published work by Ogata et al. used a Quanterix assay measured spike protein in the blood at concentrations less than 50 pg/mL on a similar timescale [10]. The large discrepancy between our photonic assay and the Ogata work was intriguing and may reflect the early stage of knowledge in this area. )』 そもそも感染時よりスパイク蛋白が少ないのなら、何故、接種時の方が抗体価が高くなるのが説明つかない。 https://sciencedaily.com/releases/2022/11/221109124340.htm…https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2798223

[awfullyqueerwriter]

I stumbled across this article (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800814) read, it, the results are fascinating. However, if you’re a bit busy…

[havegaysex]

Comment period Ends June 17th 2024 Copied directly from the People's CDC website https://peoplescdc.org/2024/06/13/acip/ Also feel free to take inspiration from or borrow the language in our sample public comment below. Docket No. CDC–2024–0043 Updated 2024-2025 COVID vaccines must be recommended for people of all ages, regardless of health status. A restrictive approach to eligibility would create undue barriers for vulnerable people and discourage high risk people from getting needed vaccine boosters. The vaccine schedule should address waning efficacy in the months following vaccination [1-3] as well as emergence of new SARS-CoV-2 strains by recommending updated vaccination for all ages, at least every six months. Recent vaccination is also associated with a lower risk of developing Long COVID following a COVID infection [4] as well as a lower risk of Multisystem Inflammatory Syndrome in children (MIS-C) [5]. The CDC’s clear and unequivocal recommendation of updated COVID vaccination for all ages will influence what healthcare providers recommend, and what health insurances cover. Moreover, it will improve public awareness regarding the need for updated vaccination. The CDC must ensure equitable and affordable access to updated vaccines and prevent limited access because of financial constraints or demographics. The CDC’s Bridge vaccine access program is slated to end August 2024 and must be extended to ensure uninsured and underinsured people have access to the updated vaccines this fall [6]. References: 1. Link-Gelles R. Effectiveness of COVID-19 (2023-2024 Formula) vaccines. Presented at: FDA VRBPAC Meeting; June 5, 2024. Accessed June 12, 2024. https://www.fda.gov/media/179140/download Wu N, Joyal-Desmarais K, Vieira AM, et al. COVID-19 boosters versus primary series: update to a living review. The Lancet Respiratory Medicine. 2023;11(10):e87-e88. doi:10.1016/S2213-2600(23)00265-5 Menegale F, Manica M, Zardini A, et al. Evaluation of Waning of SARS-CoV-2 Vaccine–Induced Immunity: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023;6(5):e2310650. doi:10.1001/jamanetworkopen.2023.10650 Fang Z, Ahrnsbrak R, Rekito A. Evidence Mounts That About 7% of US Adults Have Had Long COVID. JAMA. Published online June 7, 2024. doi:10.1001/jama.2024.11370 Yousaf AR. Notes from the Field: Surveillance for Multisystem Inflammatory Syndrome in Children — United States, 2023. MMWR Morb Mortal Wkly Rep. 2024;73. doi:10.15585/mmwr.mm7310a2 https://www.cdc.gov/vaccines/programs/bridge/index.html Full instructions for written and oral comment and meeting information can be found at: https://www.cdc.gov/vaccines/acip/meetings/index.html You can also register to give Oral Public Comment at the upcoming June 26-28 online CDC ACIP Meeting at: https://www2.cdc.gov/vaccines/acip/acip_publiccomment.asp You must register by June 17 at 11:59pm Eastern Standard Time CDC’s ACIP meeting information on the Federal Register: https://www.federalregister.gov/documents/2024/05/24/2024-11439/meeting-of-the-advisory-committee-on-immunization-practices

Why? WHY??

U.S. CDC taking comments on potentially limiting COVID vaccine availbility by age or health status. Never mind that the vaccine is crucial to limiting long-term effects that could lead to immunocomprimisation. 🤬🤬🤬

You can comment here.

[darkmaga-returns]

If vaccines caused autism, then you would expect at least two things to occur:

— rising prevalence after the 1970s

—peak prevalence near age 6

Back in the 1970s, only 3 vaccines — covering 7 total diseases — were recommended:

But then the childhood vaccine schedule grew and grew, so that by just age 1 (12 months old), infants get at least 24 total shots:

If vaccines caused autism, then you would expect for the incidence of autism diagnoses to rise along with this remarkable rise in vaccine administration.

Also, after getting hit hard for the first year of life (up to 18 months, actually), later on — during ages 4 to 6 — kids get dosed again with final doses of 4 types of prior vaccines:

For this reason, not only would it be expected that autism rates would rise, but also that kids around age 6 would show up with the highest prevalence — having had the highest and final doses of four of the types of vaccines.

CDC reports a rising prevalence, from 1-child-in-150 back in 2000, to 1-child-in-36 today:

The situation is even worse when just looking at boys, who have an autism prevalence now of 1-boy-in-23 (4.3% of boys):

And a new report in JAMA shows that kids in the age group of around 6 years old (kids who have had that final round of childhood vaccines) have the most autism:

The evidence, though circumstantial, does suggest that vaccines cause autism.

Reference

[the “three-vaccine” schedule from the 1970s] — https://www.marinhealthcare.org/upload/public-meetings/2018-06-19-600-pm-mhd-community-health-seminar-vaccination/BRANCO_06192018_MGH%20Vaccine%20Presentation.pdf

[recent childhood vaccine schedule] — https://my.clevelandclinic.org/health/articles/11288-childhood-immunization-schedule?sf263367950=1

[CDC reports of autism prevalence] — https://www.cdc.gov/autism/data-research/index.html

[National Institute of Mental Health report on autism by sex] — https://www.nimh.nih.gov/health/statistics/autism-spectrum-disorder-asd

[new JAMA report on autism, showing kids 5-8 had the highest rate] — Grosvenor LP, Croen LA, Lynch FL, Marafino BJ, Maye M, Penfold RB, Simon GE, Ames JL. Autism Diagnosis Among US Children and Adults, 2011-2022. JAMA Netw Open. 2024 Oct 1;7(10):e2442218. doi: 10.1001/jamanetworkopen.2024.42218. PMID: 39476234. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825472

[ocombatente]

Saúde e nutrição com Clayton Camargos: álcool não é saudável

  Clayton Camargos Saúde e nutrição com Clayton Camargos: álcool não é saudável No Brasil, de acordo com dados do Instituto Brasileiro de Geografia e Estatística (IBGE), em 2022, o mercado de bebidas alcoólicas registrou um aumento de 5,2%, indicando que os brasileiros estão consumindo mais álcool. Um editorial da Organização Mundial da Saúde (OMS) publicado em janeiro de 2023 na revista científica The Lancet Public Health afirma que não há níveis seguros de consumo de álcool para a saúde. https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health O editorial enfatiza que o consumo de álcool é um fator significativo para mais de 200 tipos de prejuízos sanitários, incluindo câncer, doenças cardiovasculares e hepáticas, depressão, bem como comportamentos violentos, acidentes incapacitantes e fatais. A OMS defende que as nações adotem políticas públicas de saúde que promovam a diminuição do consumo apoiadas por medidas como a elevação de impostos, a limitação da venda para menores de idade e a proibição da publicidade de bebidas alcoólicas. De outra parte, a afirmação de que baixos níveis de ingestão de álcool podem trazer benefícios à saúde e proteção contra todas as causas de mortalidade é altamente controversa. Embora estudos observacionais e metanálises relatem que indivíduos que consomem quantidades moderadas de álcool tendem a viver mais e têm menor probabilidade de desenvolver doenças cardíacas em comparação com abstêmios, há evidências de que esses resultados são influenciados por vieses sistemáticos, como o uso de indicadores de saúde não relacionados ao consumo de álcool, incluindo dieta, higiene bucal, renda individual e peso corporal. Outros vieses incluem a falha em distinguir entre abstêmios completos, ex-bebedores e a possibilidade de que os abstêmios possam ter problemas de saúde por outras causas. O que temos de novo? No início de 2023, pesquisadores canadenses da University of Victoria veicularam no Journal of American Medical Association uma revisão sistemática e metanálise abrangendo 107 estudos publicados até julho de 2021, envolvendo mais de 4,8 milhões de participantes. O título do artigo: Association Between Daily Alcohol Intake and Risk of All-Cause Mortality – A Systematic Review and Meta-analyses, em livre tradução, “Associação entre a ingestão diária de álcool e o risco de mortalidade por todas as causas – uma revisão sistemática e metanálise”. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802963 O que o estudo mostrou? A revisão sistemática detectou que os erros em outras investigações envolvendo a classificação incorreta de bebedores ocasionais como abstêmios eram frequentes, com 86 das 107 pesquisas apresentando tais discrepâncias. Após considerar possíveis vieses e efeitos de confusão associados à amostragem e classificação incorreta de ex-bebedores, foi constatado que a ingestão de baixa quantidade de álcool, menos de 25 g/dia ou 02 drinques/dia, não ofereceu nenhum benefício protetor contra o risco de mortalidade por todas as causas em nenhum dos sexos frente aos abstêmios. No entanto, o risco de mortalidade por todas as causas foi significativamente maior para mulheres que consumiram mais de 25 g de álcool/dia e homens que beberam mais de 45 g de álcool/dia. Além disso, pessoas com alcoolismo tiveram um risco 19% maior de morte. Cabe destacar, idosos que bebem pouco tendem a ser mais saudáveis não por uma proteção brindada pelo álcool, mas porque aqueles que adoecem precisam parar de beber por orientação médica. Por fim, é importante lembrar que correlação não é causalidade. Beber uma taça de vinho por dia faz bem à saúde? Durante muito tempo, foi difundida a hipótese sedutora de que o consumo equilibrado de álcool poderia estar associado a um estilo de vida saudável e sofisticado. No entanto, a ingestão limitada de bebidas alcoólicas não traz benefícios à saúde, enquanto o consumo excessivo pode trazer graves prejuízos. É importante lembrar que os efeitos da sua ingestão variam de pessoa para pessoa e dependem de uma série de fatores, incluindo idade, sexo, histórico de saúde e genética. Idealmente, para promover a saúde de forma efetiva, o consumo de álcool deveria ser completamente evitado, mesmo em quantidades moderadas. Informação é prevenção. Você tem alguma dúvida sobre saúde, alimentação e nutrição? Envie um e-mail para e poderei responder sua pergunta futuramente. Nenhum conteúdo desta coluna, independentemente da data, deve ser usado como substituto de uma consulta com um profissional de saúde qualificado e devidamente registrado no seu Conselho de Categoria correspondente. Clayton Camargos é sanitarista pós graduado pela Escola Nacional de Saúde Pública – ENSP/Fiocruz. Desde 2002, ex gerente da Central Nacional de Regulação de Alta Complexidade (CNRAC) do Ministério da Saúde. Subsecretário de Planejamento em Saúde (SUPLAN) da Secretaria de Estado de Saúde do Distrito Federal (SES-DF). Consultor técnico para Coordenação-Geral de Fomento à Pesquisa Em Saúde da Secretaria de Ciência, Tecnologia e Insumos Estratégicos (SCTIE) do Ministério da Saúde. Coordenador Nacional de Promoção da Saúde (COPROM) da Diretoria de Serviços (DISER) da Fundação de Seguridade Social. Docente das graduações de Medicina, Nutrição e Educação Física, e coordenador dos estágios supervisionados em nutrição clínica e em nutrição esportiva do Departamento de Nutrição, e diretor do curso sequencial de Vigilância Sanitária da Universidade Católica de Brasília (UCB). Atualmente é proprietário da clínica Metafísicos. CRN-1 2970.   Fonte: Nacional Read the full article

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2024年08月02日 23時00分サイエンス 砂糖の多いお菓子やドリンクをたくさん摂取する人は生物学的老化が加速する可能性 長生きするには健康的な食事が重要だということは広く知られていますが、どうしても砂糖たっぷりの甘いお菓子や炭酸飲料をやめられないという人も多いはず。新たに、カリフォルニア大学の研究チームが、「他が健康的な食生活であっても砂糖の摂取量が多い人は生物学的老化が早い」という研究結果を報告しました。 Essential Nutrients, Added Sugar Intake, and Epigenetic Age in Midlife Black and White Women: NIMHD Social Epigenomics Program | Genetics and Genomics | JAMA Network Open | JAMA Network https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2821611 Healthy Diet with Less Sugar Is Linked to Younger Biological Age | UC San Francisco https://www.ucsf.edu/news/2024/07/428121/healthy-diet-less-sugar-linked-younger-biological-age Added Sugar in Your Diet May Speed Up Your Body's Biological Aging : ScienceAlert https://www.sciencealert.com/added-sugar-in-your-diet-may-speed-up-your-bodys-biological-aging 人間はたとえ生まれてからの時間に差がなくても、生物学的な老化の程度がライフスタイルや環境などの要因で異なることがあります。そんな生物学的老化の尺度のひとつとして、DNAメチル化と呼ばれるDNA中の化学反応を利用した「Epigenetic clock(エピジェネティック・クロック)」が用いられています。 研究チームは必須栄養素や砂糖の摂取量といった要因が、生物学的老化とどのよう��関連しているのかを調べるため、中年の白人および黒人女性342人を対象に調査を行いました。調査では連続しない3日間にわたる食事の記録を収集すると共に、だ液中サンプル中のDNAからエピジェネティック・クロックを用いて生物学的年齢を測定しました。 食生活の評価において、研究チームは抗炎症食品や抗酸化食品が豊富な地中海式ダイエットや慢性疾患のリスクを下げる食事と、女性の食事を比較しました。また、抗炎症および抗酸化プロセス、そしてDNAの維持と修復に関わる栄養素である「ビタミンA・ビタミンC・ビタミンB12・ビタミンE・葉酸・セレン・マグネシウム・食物繊維・イソフラボン」の摂取量も評価したとのことです。 分析の結果、健康的で栄養素の豊富な食生活はいずれも生物学的年齢の低下と有意に関連していることが判明。中でも地中海式ダイエットは、特に生物学的年齢の低下と強い関連性を持っていることがわかりました。 その一方で、被験者らは平均して1日あたり平均61.5gの砂糖を摂取していることが確認されました。ただし、1日2.7gの摂取にとどめている人もいれば、1日300g以上の砂糖を摂取している人もいたとのこと。なお、アメリカ医薬品局(FDA)が推奨する砂糖摂取量は成人で1日あたり50g以下となっています。 そして、たとえその他の食生活が健康的であっても、砂糖の摂取量が多ければ多いほど被験者の生物学的老化が進んでいたこともわかりました。これは教育レベルやライフスタイル、現在の健康状態といった要因を考慮に入れた場合でも当てはまったとのことです。 論文の共著者であるカリフォルニア大学バークレー校のバーバラ・ラライア教授は、「エピジェネティックなパターンは可逆的であると考えられるため、砂糖摂取量を1日あたり10g減らすのを継続することは、エピジェネティック・クロックを2.4カ月巻き戻すことに相当するかもしれません。重要な栄養素を多く含み、砂糖の添加量が少ない食品に注目することは、長寿のために良い食事をしたい人々の意欲を高める新しい方法かもしれません」とコメントしました。

砂糖の多いお菓子やドリンクをたくさん摂取する人は生物学的老化が加速する可能性 - GIGAZINE

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Results from a randomized control trial published yesterday in JAMA Network Open show that participants who received mRNA COVID-19 and inactivated influenza vaccines simultaneously had no more adverse effects than those who received the two shots sequentially, 1 or 2 weeks apart.

The study included 335 people who were vaccinated from October 2021 to June 2023 at one of three US study sites. All participants were ages 5 years and older and intended to receive both flu and mRNA COVID-19 vaccines. The average age of participants was 33.4 years, and 63% were female.

In total, 169 received the vaccines simultaneously, while 166 received them sequentially.

The authors said the main outcomes of the study were reactogenicity, including fever, chills, muscle aches, and/or joint pain of moderate or greater severity within 7 days after vaccination. Serious adverse events and adverse events of special interest were assessed for 121 days.

Over half of participants (57.0%) reported a history of SARS-CoV-2 infection or had detectible antibodies to the virus at the time of study enrollment.

Good safety data The authors found that the proportion of study participants with the primary composite reactogenicity outcome in the simultaneous group (25.6%) was noninferior to the proportion in the sequential group (31.3%).

"Fewer than 13% of participants in either group (simultaneous, 14 [8.3%]; sequential, 21 [12.6%]) had a severe reaction for any of the solicited reactions, and no participants sought medical attention for a solicited reaction," the authors wrote.

Similarly, there was no difference between the two groups in health-related quality of life indexes.

"This trial lends support to the option of simultaneous administration of these vaccines, which is a strategy to achieve high levels of vaccination coverage during anticipated periods of increased influenza and SARS-CoV-2 virus transmission," the authors concluded.

Study Link:

 jamanetwork.com/journals/jamanetworkopen/fullarticle/2825813

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Vacation Days Taken, Work During Vacation, and Burnout Among US Physicians

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2813914

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Effect of repeated low-level red light on myopia prevention

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2804215

[teachingrounds]

A 2020 article found that facilitating the transition from pediatric to adult medical care is one of the four most difficult skills pediatrics residents learn. (The others were managing behavioral and mental health conditions, resuscitating an unstable patient, and doing quality improvement.) An average of 70% of graduates (range 64-75%) could be entrusted to do so without supervision, according to a national study of ~2,000 residents across 23 programs.

Daniel Schumacher. et al. Longitudinal Assessment of Resident Performance Using Entrustable Professional Activities. JAMA Netw Open (2020), doi:10.1001/jamanetworkopen.2019.19316