Treatment by naturopathic doctors shows reduction in cardiovascular risk factors

Contact: Kim Barnhardt kim.barnhardt@cmaj.ca 800-663-7336 x2224 Canadian Medical Association Journal

Randomized controlled trial

Counselling and treatment with naturopathic care as well as enhanced usual care reduced the prevalence of metabolic syndrome, a risk factor for heart disease, by 17% over a year for participants in a randomized controlled trial published in CMAJ.

Researchers enrolled 246 members of the Canadian Union of Postal Workers at 3 study sites (Toronto, Vancouver and Edmonton) for a year-long clinical trial to determine whether naturopathic lifestyle counselling helped to reduce the risk of cardiovascular disease. Of the total sample, 207 people completed the study. The control group received enhanced usual care (EUC) and the intervention group received naturopathic care (NC)+EUC at 7 times during the study. Naturopathic doctors provided diet and lifestyle advice for patients to lose between 2.3 and 4.2 kg through a combination of caloric restriction and regular physical exercise, and dispensed natural health products such as omega-3 fatty acids, soluble fibre, coenzyme Q10 and other therapies.

Outcome measures were defined as change in prevalence of metabolic syndrome and a reduction in the Framingham 10-year cardiovascular risk score, a score used to estimate a person’s risk of heart disease.

“Compared with baseline, at one year the treatment group improved and the control group deteriorated across both primary outcomes,” writes Dugald Seely, Canadian College of Naturopathic Medicine, Toronto, Ont., and the Ottawa Integrative Cancer Centre, Ottawa, with coauthors.

The researchers found the prevalence of metabolic syndrome, a risk factor for heart disease, was reduced by 17% over a year compared with the control group. “This implies that 1 of 6 individuals receiving additional naturopathic care benefit, in comparison to those who do not, by not developing metabolic syndrome over the course of 1 year,” they write. The 10-year risk for cardiovascular disease on the Framingham score decreased by 3 percentage points, “[translating] into about 3 fewer people out of 100 with intermediate risk for cardiovascular disease who are treated with NC+EUC experiencing a serious cardiovascular event such as stroke, heart attack or death during the next 10 years compared with EUC alone,” state the authors.

“Primary health care that provides in-depth counselling around diet and lifestyle is uniquely poised to help comanage metabolic risk factors,” write the authors. “We have shown that naturopathic care is a feasible and potentially effective adjunct to usual medical care in reducing the incidence of metabolic syndrome and cardiovascular risk.”

In a related editorial, Dr. Matthew Stanbrook, Deputy Editor, CMAJ, writes that while the design of the study may not specifically prove that the naturopathic intervention was responsible for the effects of the trial, “the results of Seely and colleagues provide proof of principle that some aspects of cardiovascular prevention could feasibly and effectively be delegated to naturopaths.”

He cautions that “some might be tempted to use this trial to justify a conclusion that the nutritional supplements that formed part of naturopaths’ recommendations have now been validated as effective for reducing cardiovascular risk, but that would be inappropriate and potentially misleading. We can learn nothing new from this trial about supplements or any other individual component of care, because the trial was not designed to allow evaluation their evaluation.”

“The core components of the naturopathic intervention included several recommendations about diet and exercise that individually have been well validated scientifically,” writes Dr. Stanbrook. “To the extent that these may have driven the observed cardiovascular risk reductions, one might say that the intervention worked because the naturopaths were, in effect, practising medicine.”

He notes that it is important for medical journals to publish studies like this because they demonstrate an evidence-based approach to naturopathic medicine.

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The adult generations of today are less healthy than their counterparts of previous generations

Contact: Jacqueline Partarrieu press@escardio.org 33-492-947-756 European Society of Cardiology

Results from a large cohort study suggest that exposure to metabolic risks of cardiovascular disease is increasing

Sophia Antipolis, 10 April 2013. Despite their greater life expectancy, the adults of today are less “metabolically” healthy than their counterparts of previous generations. That’s the conclusion of a large cohort study from the Netherlands which compared generational shifts in a range of well established metabolic risk factors for cardiovascular disease. Assessing the trends, the investigators concluded that “the more recently born generations are doing worse”, and warn “that the prevalence of metabolic risk factors and the lifelong exposure to them have increased and probably will continue to increase”.

The study, reported today in the European Journal of Preventive Cardiology, analysed data on more than 6,000 individuals in the Doetinchem Cohort Study, which began in 1987 with follow-up examinations after six, 11, and 16 years.(1,2) The principal risk factors measured were body weight, blood pressure, total cholesterol levels (for hypercholesterolaemia) and levels of high-density lipoprotein (HDL) cholesterol, which is considered “protective”.

The subjects were stratified by sex and generation at baseline into ten-year age groups (20, 30, 40, and 50 years); the follow-up analyses aimed to determine whether one generation had a different risk profile from a generation born ten years earlier – what the investigators called a “generation shift”.

Results showed that the prevalence of overweight, obesity, and hypertension increased with age in all generations, but in general the more recently born generations had a higher prevalence of these risk factors than generations born ten years earlier. For example, 40% of the males who were in their 30s at baseline were classified as overweight; 11 years later the prevalence of overweight among the second generation of men in their 30s had increased to 52% (a statistically significant generational shift). In women these unfavourable changes in weight were only evident between the most recently born generations, in which the prevalence of obesity doubled in just 10 years.

Other findings from the study included:

  • Unfavourable (and statistically significant) generation shifts in hypertension in both sexes between every consecutive generation (except for the two most recently born generations of men).
  • Unfavourable generation shifts in diabetes between three of the four generations of men, but not of women.
  • No generation shifts for hypercholesterolaemia, although favourable shifts in HDL cholesterol were only observed between the oldest two generations.

 

As for the overall picture, and based on the evidence of a “clear” shift in the prevalence of overweight and hypertension, the investigators emphasise that “the more recently born adult generations are doing worse than their predecessors”. Evidence to explain the changes is not clear, they add, but note studies reporting an increase in physical inactivity.

What do the findings mean for public health? First author Gerben Hulsegge from the Dutch National Institute for Public Health and the Environment emphasises the impact of obesity at a younger age. “For example,” he explains, “the prevalence of obesity in our youngest generation of men and women at the mean age of 40 is similar to that of our oldest generation at the mean age of 55. This means that this younger generation is ’15 years ahead’ of the older generation and will be exposed to their obesity for a longer time. So our study firstly highlights the need for a healthy body weight – by encouraging increased physical activity and balanced diet, particularly among the younger generations.

“The findings also mean that, because the prevalence of smoking in high-income countries is decreasing, we are likely to see a shift in non-communicable disease from smoking-related diseases such as lung cancer to obesity-related diseases such as diabetes. This decrease in smoking prevalence and improved quality of health care are now important driving forces behind the greater life expectancy of younger generations, and it’s likely that in the near future life expectancy will continue to rise – but it’s also possible that in the more distant future, as a result of our current trends in obesity, the rate of increase in life expectancy may well slow down, although it’s difficult to speculate about that.”

Trial results ‘do not support the use of general health checks’ warn experts

Contact: Stephanie Burns
sburns@bmjgroup.com
44-020-738-36920
BMJ-British Medical Journal

Checks have not reduced number of deaths from cardiovascular disease or cancer

Research: General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis

Editorial: The value of conducting periodic health checks

Researchers have found that routine general health checks, which have become common practice in some countries, do not reduce the number of deaths from cardiovascular disease or cancer. They do, however, increase the number of new diagnoses.

Health checks were defined as screening for more than one disease or risk factor in more than one organ system offered to a general population unselected for disease or risk factors.

Health checks were introduced with the intention of reducing morbidity and prolonging life and there are many potential benefits, including: detection of both increased risk factors and precursors to disease (thus preventing cancer from developing); counselling on diet, weight and smoking; reassuring healthy people thus reducing worry about potential disease.

However, screening healthy people can be harmful and can lead to overdiagnosis and overtreatment, a topic which was featured in the BMJ in October. The researchers also point out that invasive diagnostic tests may cause harm. Being labelled as having a disease may also negatively impact healthy people’s views of themselves and their health behaviour.

Few of the individual tests commonly used in health checks have been adequately studied in trials and it is not clear whether they do more harm than good. When tests have been studied in trials, the results have been varied. Authors from the Nordic Cochrane Centre in Denmark therefore carried out a review of a total of 14 trials that looked at systematic health checks. The studies had between 1 and 22 years of follow-up.

Nine of the 14 trials had data on mortality and included 182,880 participants, 11,940 of whom died during the study period. 76,403 were invited to health checks and the remainder were not. All participants were over 18 years old and the study excluded trials specifically targeting older people or trials that only enrolled people aged 65 or over.

Despite some variation regarding the risk of death from cardiovascular disease and cancer, no evidence was found for a reduction of either total mortality, cardiovascular mortality, or cancer mortality. Unsurprisingly, the researchers found that health checks led to more diagnoses and more medical treatment for hypertension, although this was infrequently studied.

The lack of beneficial effects indicates that the interventions did not work as intended in the included trials. Health checks are likely to increase the number of diagnoses, but in the absence of benefits, this suggests over-diagnosis and overtreatment.

The researchers also note that people who accept a health check invitation are often different from those who do not, so the checks might not reach those who need prevention the most. Plus, many physicians already carry out testing for cardiovascular risk factors or diseases in patients that they judge to be at risk when they see them for other reasons.

In conclusion, the results do not support the use of general health checks aimed at the general population. The researchers say that further research should “be directed at the individual components of health checks e.g. screening for cardiovascular risk factors, chronic obstructive pulmonary disease, diabetes, or kidney disease”.

In an accompanying editorial, Professor Macauley, Primary Care Editor at the BMJ, agrees that although health checks are “seductive” and “seem sensible” there is little evidence to show that they reduce morbidity and mortality. As well questioning whether they do more harm than good, Dr Macauley says that Krogsbøll and colleagues’ study finds that “regular health checks are ineffective” and show “evidence of little effect” and adds that policy should be based on “wellbeing rather than […] well meant good intentions”.

How having an operation can send you delirious: Terrifying post-surgery hallucinations strike up to half of the over-65s: “can also leave people in a permanent state of confusion and suffering from dementia”

By Roger Dobson

PUBLISHED:18:46 EST, 10  September 2012| UPDATED:18:46 EST, 10 September 2012

When Gordon Sturmey came around after  surgery, he was convinced people were trying to kill him.

He believed a nurse was trying to poison him,  and he soon started to think his relatives were also involved.

Gordon, 65, of Thatcham, Berkshire, had been  admitted to the Royal Berkshire Hospital in Reading, where he underwent surgery  for a perforation in his large intestine triggered by a severe bout of food  poisoning.

Older patients can suffer from hallucinations, which can be benign, such as flying pigs and alien spaceships, but some report more sinister experiencesOlder patients can suffer from hallucinations, which can  be benign, such as flying pigs and alien spaceships, but some report more  sinister experiences

‘Afterwards, I was convinced the nurses and  my family were trying to kill me — and it was very, very real,’ he  recalls.

‘When my family came to see me, I asked for  them to be taken away from my bedside.

‘I remember one nurse spending 30 minutes  trying to explain what was happening to me, but I didn’t believe  her.’

Gordon, a retired accountant, had suffered  post-surgery delirium — a side-effect that leaves patients confused,  disorientated, aggressive and prone to hallucinations.

The condition is alarmingly common,  especially in older age groups.

Up to half of men and women aged over 65  experience post-surgery delirium.

Experts say a number of factors place this  age group at risk.

One reason they are particularly vulnerable  is because they are more likely to have underlying health conditions (such as  diabetes or high blood pressure) or be taking multiple medications — both of  which raise the risk.

Recently, however, scientists have suggested  another key factor may be that older brains are more susceptible to  inflammation.

Experts believe that inflammatory molecules  are released when we undergo surgery and can leak into brain tissue, triggering  confusion.

In younger people the protective barrier  around our brains prevents this from happening, but the barrier becomes less  effective as we age.

As a result, patients can suffer from  hallucinations.

These can be benign, such as flying pigs and  alien spaceships, but some patients report more sinister experiences — as Gordon  did.

Worryingly, experts warn that not only does  delirium slow recovery, it can also leave people in a permanent state of  confusion and suffering from dementia.

With record numbers of older people  undergoing surgery, there is growing concern that this condition could be  contributing significantly to the numbers of people with  dementia.

Professor John Young, a researcher at the  Academic Unit of Elderly Care and Rehabilitation at Bradford Royal Infirmary,  explains: ‘We have only recently recognised that delirium can persist long after  the time of surgery.

‘In 25 per cent of cases it is permanent, and  can become dementia. It usually appears within the first three days of surgery.

‘In some it can be fleeting, lasting just  hours. But in others it can last for days or weeks, or even become  permanent.

‘It can double the risk of premature death,  although the death is usually linked to an underlying health  problem.’

Wards tend to be very bright, busy and noisy, and are disorientating environments for people who are ill and vulnerableWards tend to be very bright, busy and noisy, and are  disorientating environments for people who are ill and vulnerable

Even when patients recover, many have partial  or full recollection of their terrifying visions, which can continue to haunt  patients for years.

This was certainly true for Gordon.

‘The hallucinations only lasted for about  half a day,’ he says.

‘But the experiences are as real to me now as  they were then. I recently attended a meeting and met the nurse who I thought  was trying to  poison me, and I still felt  very  uncomfortable.’

But why are so many  patients falling  prey to this terrifying condition?

‘Many things are going on in the onset of  delirium,’ says Professor Young.

‘Surgery is the trigger, but people at high  risk of delirium will have a background of fragile health.

‘They are likely to have a chronic illness or  be taking a combination of drugs.

‘We don’t fully understand the processes, but  some brain chemicals are implicated, particularly choline and dopamine.

‘Many medications can have deleterious  effects on these chemicals, including some anti-histamines, steroids and  pain-relieving opioids.

‘It was at first linked with heart surgery,  but it can occur with any procedure.’

Yet Professor Young says  the condition  is very simple  to prevent.

‘We need a cultural change that regards  delirium as a potentially preventable complication,’ he explains.

‘The reduction in delirium can be done with a  relatively simple strategy that identifies the risk factors and does something  about those that can be modified.’

Along with colleagues in Leeds, he is about  to start a major clinical trial at hospitals in Britain, testing a new strategy  for preventing the condition on 500 patients.

Results from pilot studies suggest that  targeting ten risk factors can lead to vast improvement: disorientation,  dehydration, constipation, an existing mental impairment, sleep problems,  infection, immobility, breathing difficulties, pain and multiple drug  use.

‘We decided to do this work because it has  been neglected in research,’ he says.

‘I was astounded by the sheer number of cases  and the distress it caused.’

A small pilot study showed a 50 per cent  reduction in the incidence of dementia.

‘The modern hospital is in many ways the  opposite of a traditional caring environment,’ says Professor Young.

Wards tend to be very bright, busy and noisy,  and are disorientating environments for people who are ill and  vulnerable.

‘We also now realise it is crucial that  patients are adequately hydrated around the clock, and that they are able to  sleep, as both dehydration and lack of sleep contribute to  delirium.

‘It is also important to orientate and  reassure the patient with clocks, a calendar, and frequent staff contact, and to  ensure they have their glasses and hearing aid if they need them.

‘This preventive approach is extremely cost  effective. If a patient develops delirium, they tend to stay longer in  hospital.

‘And at £300 a day per patient, that soon  mounts up.

‘Unfortunately, health services have been  slow to recognise that the modern general hospital should increasingly be  regarded as an older person’s facility.

‘We have largely designed a system to cater  for people who have only one thing wrong with them at once — but this has  changed, and it’s now mainly used by elderly people who have many things  wrong.’

Gordon now assists in running a support group  for patients who have suffered from the condition and believes greater awareness  is vital.

‘Although people have different  hallucinations, they never forget their experience,’ he says.

To  contact the support group, email icusupportnetworkreading  @royalberkshire.nhs.uk

Read more: http://www.dailymail.co.uk/health/article-2201278/How-having-operation-send-delirious-Terrifying-post-surgery-hallucinations-strike-half-65s.html#ixzz267zmp3Sl