Guns and health

Guns and health - People choose to possess weapons for several reasons: hunting, shooting, picking ... The number one reason is for protection now. 

As physicians, we also care about your protection. Our mission is to treat the disease, promote quality of life and prevent injury and death. Health and safety issues are discussed confidentially, without prejudice. We asked to depression, domestic violence, and drugs.

We make recommendations on the practice of safe sex and the use of seat belts. But some believe that doctors should not talk about guns. In fact, Florida has passed legislation restricting such discussion. But weapons will affect health and safety.

In the US, the number of deaths by firearms continues to increase (currently at about 33,000 per year, far more than any other developed country per capita) and is expected to exceed the death of motor vehicles in 2015. It is the second cause of death among children.

Death by association 

Weapons have been successfully used in self-defense. But the reality is that owning a gun is associated with an increased risk of injury or death family. Manslaughter and suicide attempts or completed are far superior to the use of firearms in self-defense. 

In fact, more households have guns in a particular state, most firearm deaths there - even after adjusting for crime, unemployment, urbanization, alcohol and poverty. 

And which is intended to be protected can be a threat. In an unauthorized entrance examination in homes, 1.5% of reported cases with a gun to defend himself, but twice that of the loss of his gun the intruder.

Moreover, most homicides (54%) are committed by someone known to the victim and another 25% were for the family, especially with firearms. When you have access to firearms in the house, the risk of dying from domestic violence of women quintupled.

Suicides 

As the possession of weapons has increased, so has the number of suicides. Two-thirds of gun deaths are suicides. However, firearms owners have more mental health problems, depression or suicidal thoughts than those without weapons. The problem is more easily accessible. Nobody thinks it could happen to them or their families, but many suicide attempts are unexpected and done on impulse.

Damage to children

Children also use weapons to commit suicide; 82% of suicides involving firearms in the house, most of the time stored unlocked. When suicide attempt, 90% of children do when firearms are used, compared to 5% by other means. It is difficult to prevent because young people often act impulsively and may have signs such as suicidal thoughts. 

Children often accidentally thrown by a friend or a brother. We think we know our children - but do not underestimate the secrets they keep. One study found that parents often mistakenly believe that their children had never handled their weapons. One third of children said otherwise.

Choose wisely

Weapons are your good choice. But know that even weapons can protect, chances are higher that they will hurt those who intend to keep. Education and commitment can help us work toward acceptable means to stem the rising tide of deaths related to firearms. That's why I'm going to talk to my patients the security of firearms.

What can you do?

       * If you plan to bring a weapon, consider the real risks for you and your family. If there is a history of domestic violence, or if someone in your family suffers from depression, consider removing any weapon.

       * If you choose to have a gun, keep it locked. Although this will not eliminate all risks, arms locked away will probably be less prone to theft and curious children. The Bureau of Justice estimated that firearms were stolen 1.4 million between 2005 and 2010, mainly domestic burglaries. 

       * If you decide to have a gun, store it with the button and ammunition separately. Explore the latest features and new technologies unlocked scanning and storage of fingerprints gun safety locks.

       * Before your child goes to a playdate, consider asking parents if they have a weapon, and if they are stored safely. This may be difficult at first. One day it might come as easy as asking about food allergies and safety seats for carpooling.

       * Talk to your children about what to do if they find a gun, or if your friend wants to show a weapon. Advise them, "Do not touch the gun, immediately leave the area and tell an adult."

       * Research on Firearms Support injuries so we can better understand the problem and find solutions. Research on the prevention of firearm injuries CDC stopped after funding was excluded for nothing interpreted as promoting stricter laws on weapons.
By: Wynne Armand,MD

 

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New treatment for hepatitis C - but affordable?

New treatment for hepatitis C - but affordable?- The burden of hepatitis C public health is enormous. 

This viral infection causes severe liver cirrhosis, terminal liver cancer and liver failure, often require a liver transplant. Over 3 million people in the United States and 150 million worldwide, are infected with hepatitis C, resulting in 700,000 deaths annually.

People who are infected with hepatitis C often have no symptoms. The virus persists in the liver damage liver tissue slowly over a long period of time. For this reason, it is essential that the progression of liver damage before stopping advanced liver disease or liver cancer occurs.

But there is good news: in recent years we have witnessed remarkable progress in the development of new drug treatments for hepatitis C. sofosbuvir (Sovaldi) and combined with ledipasvir sofosbuvir (Harvoni) are two well known examples these new drug treatments.

Another new drug combination, and sofosbuvir velpatasvir, which was recently described in a report published in the New England Journal of Medicine, is extremely effective against most forms of hepatitis C will become the standard treatment when this combination FDA approved. 

But although the new drugs can cure hepatitis C in many cases they are not accessible to all who need it. New drugs for hepatitis C cost between $ 80,000 and $ 150,000 per year.

People with excellent insurance coverage see low-pocket costs for these drugs. But because of the cost, many insurance companies have set up systems that require high switching costs quotas of people with less robust plans make these medicines out of reach of many people.

In the US, drug hepatitis C are just one example of "specialty drugs." These new drugs for many chronic diseases - such as cancer and arthritis - that were issued to levels that are unaffordable to many people in need.

Up to medicines for hepatitis C, and other drugs are sold at affordable levels, some people without sufficient funds being left behind and can not benefit from modern advances in drug therapy. 

As a society, we must find ways to make these drugs available to all who need it and at the same time compensate pharmaceutical companies for its fresh research and high development. It is a difficult balance, but in a society based on justice and equity, is that we must achieve. For those who have hepatitis C should go without treatment.
By: Gregory Curfman, MD

  

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4 new recommendations for adolescent health

4 new recommendations for adolescent health - The annual "check-up" is (perhaps only) perfect for not only how children develop and provide the necessary vaccines, but to see how they are generally time - and help ensure they turn into happy, healthy adults. After all, prevention is really what is pediatrics.

That's why the American Academy of Pediatrics (AAP) has a checklist for pediatricians called "Recommendations for pediatric preventive health care." These recommendations, which are updated every few years, based on the update on child health research now - and in the future.

 

While the latest version which includes new recommendations for younger children, like putting fluoride varnish on the teeth of children under 5 years and make a simple test of heart defects in newborns, most changes this occasion relate to teenagers. Here is what the AAP thinks pediatricians should do with their pre-teen and adolescent patients:

 

Detection of the lipids. Sometimes high cholesterol runs in families - but parents and other family members can not have checked your own, or may not be aware of the results of other family members tests.

 

Because high cholesterol can cause real damage to blood vessels over time and lead to heart disease and stroke, it is recommended that all young people have their cholesterol between the ages of 9 and 11. Doctors can before or again it is based on risk, but the AAP wants to be sure that everyone is checked at least once.

The detection of drugs and alcohol. As we all know, teenagers usually experience with drugs and alcohol. For some young people, this may be difficult or even fatal consequences.

 

The AAP recommended six simple questions (called the CRAFFT screen) that the really important information became apparent - and allow important discussions.

 

Depression screening (eg, a questionnaire). Suicide is the leading cause of death among teenagers - and depression is a treatable illness. But to treat it, we know it's there.

 
HIV testing between the ages of 16 and 18. This is important because one in four new HIV infections occur among young people aged 13-24, and 60% of all young people living with HIV do not know that they are infected. 

 

If you do not know, they not only can not help, but they can pass the infection to others. 

 

I guess some parents say, "My son did not need these. - Our family is healthy and my son is a good boy, happy to know stay out of trouble" But the truth is that we never can Learn everything about the history of our family or our children - and when it comes to health and well-being of our children is always better to be safe than sorry.

If you have questions about these recommendations or whatever you do - or not - happening at the check-up of your child, talk to your doctor.

By: Claire McCharty,MD. 

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Do statins interfere with the vaccine against the flu?

Do statins interfere with the vaccine against the flu? - Statins are powerful, unusual, and as He Niño and Tom Cruise, it is not well understood. Statins have enormous potential. Improve survival after a heart attack and reduce the risk of recurrent stroke.  

They are also the only drugs to lower cholesterol that has been clearly shown to reduce heart attacks and death in high-risk patients without heart disease. In addition to lowering cholesterol, statins also lower levels of inflammation in the body.  

Reduce inflammation, statins help probably prevent heart attacks and strokes. However, evidence is emerging that these effects statins may also have a downside, hampering the ability of the immune system to fight infections.

Tease the relationship between statins and immune response 

Two recent studies have examined the relationship between statins and immune response to the vaccine against influenza. For the first study, Emory University researchers analyzed a large database of patients in a managed care organization to see if there was a link between the use of statins, vaccination against influenza, and frequency of visits to doctors for influenza-like illness.  

They found that patients who received the vaccine against influenza were more likely to seek treatment for a respiratory illness during flu season if they were also taking a statin, compared with patients who received the vaccine against influenza but they not take statins.  

This suggests that patients treated with statins may not have responded so well to the vaccine against influenza than those not taking the drug to lower cholesterol.

The other study provides concrete evidence of the lowest immunization against influenza in people taking statins immune response. For this study, researchers analyzed data from over 5000 patients in a clinical trial of a new vaccine against influenza. They found that levels of antibodies against the flu virus were lower in patients taking statins compared to patients not taking statins.

Both studies were a major constraint. Patients taking statins were more likely to have serious underlying diseases such as diabetes, heart disease, COPD, neurological disorders, or kidney disease, compared with patients not taking statins.  

Thus, the poor response to the vaccine against influenza and the apparent increased risk of influenza statins in patients with the disease could have been the result of its high burden of chronic disease, and no treatment with statins. It should be noted that a randomized trial in young healthy volunteers showed no statin treatment effect in antibody responses to the vaccine against hepatitis A. 

There is also a bewildering variety of other research on statins and their effects on the human immune response. At various times, statins were associated with each of the following: a lower risk of dying from the flu; a lower risk of dying from the flu in some years but not others; a slightly increased risk of shingles (herpes zoster); a lower risk of pneumonia; neutral effect on the risk of pneumonia; and a lower risk of dying from pneumonia.

But do not leave your statin ...

According to current data, I do not think we need to change how we prescribe statins, which are extremely beneficial medications, but I need more information on how statins influence the risk of infection. Patients taking statins may consider getting a flu vaccine against high doses, resulting in higher levels of antibodies and increased protection against the flu, compared with standard-dose vaccine.  
By: John Ross MD,FIDSA

 

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Can withstand dela actually worsen the pain of arthritis?

Can withstand dela actually worsen the pain of arthritis? - If you have arthritis, you may have noticed that the weather affects your symptoms. What I hear from my patients all the time. 

While the weather can aggravate arthritis pain, how it works? Is there scientific evidence to explain? People have asked these questions for many years without finding good answers. But that keep researchers are trying to understand it better.

What (we) know 

Previous studies that examined the effects of rain, moisture and other factors related to weather conditions in arthritis symptoms were conclusive and in some cases contradictory. Some suggest that the key variable increases barometric pressure.  

Other studies have found the opposite - that the pressure drop can cause pain or stiffness. There have even been attempts to artificially vary the environmental conditions to simulate climate change, such as placement with arthritis in barometric pressure chambers and varying from top to bottom. 

Despite this, I still do not know if this is a particular feature of the weather or a combination of features that count. There are many potential factors - humidity, temperature, precipitation and barometric pressure between them.  

Even if we could identify precisely what is happening with the weather affects pain and stiffness of arthritis, which is always why - biologically speaking - time should have no impact on joint symptoms.

Having received the studies, I'm not sure how to respond to my patients who ask me why their symptoms worsen reliable when the weather is wet or rain comes, or when another weather event happens. Usually I say, first, I think there is a link between time and joint symptoms, and on the other hand, researchers have not been able to find exactly what you're looking for weather and symptoms or arthritis it must be a connection.
 
The most recent studies
 
Only in the last year, two new studies have intervened in the question of whether the climate has an impact on the symptoms of arthritis. And both found that yes, indeed, climate issues! 

In the first study, researchers enrolled 222 Dutch people with the hip - the most common type, the "wear and tear" arthritis - and its symptoms reported with a variety of weather variables are compared.  

They found that over a period of two years, the pain and stiffness were slightly worse with increase in barometric pressure and humidity, although the overall impact was small. The second study involved more than 800 adults living in one of the six European countries and had osteoarthritis of the hip, knee or hands.  

While changes in the weather does not seem to affect symptoms, higher humidity was associated with increased pain and stiffness, especially in cold weather. So while these studies varied in the details, we now have a little more evidence linking long joint symptoms.

So what? 

It is a good question. After all, even if we were able to demonstrate a clear and powerful impact of time on the symptoms of arthritis, how is it useful to know? It's not like doctors tend to suggest that a patient's movement to a friendly climate of arthritis.  

It is even less likely that patients follow this recommendation. So we can not control the weather or precisely our internal environments, these new studies will probably have little impact on the individual victim of arthritis. 

However, identifying a relationship between a particular type of weather and joint symptoms may help to understand the causes and mechanisms of arthritis symptoms. And that could lead to better treatments and even prevention strategies.  

Also, find out why some people seem to feel worse in some circumstances, while others see no change (or even feel better) in these environments could help us understand the subtle differences between types of arthritis or of ways in which people respond.

"Everyone keeps talking about the weather ...

... But nobody does anything about it. "That's an old line, but of course there is no truth. But even if the weather affects the symptoms of arthritis and there's nothing you can do about the weather, it not mean that there is nothing!. to about arthritis, there are more treatment options than ever before, with and without the use of medication If you have a large and persistent pain , stiffness or swelling, see your doctor - rain or shine.
By: Robert Shmerling,MD

 

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Update on the trial of SPRINT: preliminary results pan out

Update on the trial of SPRINT: preliminary results pan out - In a previous blog, she presented the preliminary results of SPRINT, a clinical trial that examined whether a target systolic blood pressure of 120 mm Hg or less would be better than a target of 140 mm Hg in patients with hypertension (high blood pressure).

The National Heart, Lung and Blood Institute of the National Institutes of Health issued a press release with exciting results. Now, all the work was published in the New England Journal of Medicine, and the results seem so practical that changes the first appeared, demonstrating a stricter target blood pressure can reduce the likelihood of death. In the world of medicine, which is really great news.

The SPRINT researchers randomly assigned 9361 patients with increased cardiovascular risk (but not diabetes) with a systolic blood pressure of 130 mm Hg or higher than any standard or intensive therapy treatments. Standard treatment meant a lower target to 140 mm Hg for systolic blood pressure (the top number) and the intensive treatment meant a target of less than 120 mm Hg. 

On average, patients in the trial were followed for 3 , 26, by which time the trial was stopped earlier than expected because the researchers examined the results were too compelling to allow the study to continue. There was a 25% reduction in the rate of cardiovascular events, including events such as myocardial infarction, heart failure and stroke. There was a 27% reduction in risk of death.

It is important to note that very few medical interventions effectively reduce the risk of death. Among the doctors who performed clinical trials, this would be considered a home run. 

To achieve the highest degree of reduction in blood pressure, an average of three drugs are needed instead of two. Not surprisingly (for all physicians), which resulted in more side effects such as low blood pressure, fainting, kidney failure and electrolyte abnormalities in blood tests.

In practical terms, this means that to achieve the impressive results seen in this study, patients will have to take more drugs and should be carefully monitored by their doctors. Otherwise, the benefits shown in this research context can not be fully reproducible in practice in the real world, and the risk of serious side effects may be even higher.

Moreover, the results do not apply to everyone at increased cardiovascular risk have high blood pressure. For example, patients with diabetes, heart failure, previous stroke, or under 50 and not included in the study.

People with high blood pressure (systolic 180 mm Hg or more) were also excluded. There were many 75 years or more patients in the trial, which is great because many studies exclude older people, but none of these elderly volunteers studies living in nursing homes or assisted living facilities.

What patients with high blood pressure should do? Make an appointment to see your primary care physician to determine if you need a more aggressive management of blood pressure senses. No urgency to do this, since the adverse effects of high blood pressure in the range studied in this test usually take time to manifest.  

But I do not pretend to wait until your annual health check, or - the beneficial results seen in the SPRINT trial began to be evident in about a year. And it may take a few visits to get a drug plan to reduce blood pressure without causing too many side effects.

The good news is that there are many generic drugs for high blood pressure, so with a bit of trial and error, many patients can achieve the degree of control of blood pressure observed in this study.

The reality, however, is that the United States and around the world, many patients have uncontrolled blood pressure, even above the recommended targets. Therefore, the challenge remains is how we ensure that similar to the proof of this important advance in our understanding of the treatment of patients with hypertension.  

According to current estimates, in a study recently published in the Journal of the American College of Cardiology suggest that Article in the United States, the results of Sprint directly apply to about 8% of adults and treatment about half do not receive for high blood pressure, which corresponds to more than 8 million people!

The identification of these persons, some of which may even have a blood pressure of 130, will not be easy because they can not get regular medical care.

Therefore, the SPRINT study also implies that even if you do not have a diagnosis of high blood pressure, you should know what their blood pressure is and talk to your doctor about how to assess the risks and benefits of treatment to meet you what is the goal of optimal blood pressure for you. 
By: Deepak Bhatt, MD, MPH  

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