Archive for month: November, 2024

USA: Recent research published in The Laryngoscope journal has shed light on venous thromboembolism (VTE) risk in patients undergoing otolaryngology surgeries. It reveals that this patient population generally faces a low risk of postoperative complications related to blood clots.

A recent study found that syringe pump induction of propofol
significantly reduced the wastage compared to manual induction across patient
groups. The study results were published in the British Journal of Anesthesia.

A new study published in the New England Journal of Medicine showed that once-weekly injectable semaglutide led to considerably higher reductions in body weight and knee osteoarthritis pain among patients with obesity and moderate-to-severe pain. It has been shown that losing weight can reduce the discomfort associated with osteoarthritis of the knee. Not much research has been done on how glucagon-like peptide-1 receptor agonists affect the course of osteoarthritis in the knees of obese individuals. Thereby, Henning Bliddal and associates conducted this research to rule out the efficacy of semaglutide in individuals with osteoarthritis and obesity.

A 68-week, double-blind, randomized, placebo-controlled study was carried out at 61 locations throughout 11 nations. In addition to counseling on physical activity and a lower-calorie diet, participants with obesity (defined as a body-mass index [BMI] of ≥30] and a clinical and radiologic diagnosis of moderate knee osteoarthritis with at least moderate pain were randomized, in a 2:1 ratio, to receive once-weekly subcutaneous semaglutide (2.4 mg) or a placebo. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score (which ranges from 0 to 100, with higher scores indicating worse results) and the percentage change in body weight were the main endpoints. The 36-item Short Form Health Survey (SF-36), version 2’s physical-function was a crucial confirmatory secondary end objective, where higher scores denoted more well-being.

There were a total of 407 competitors in all, where the average WOMAC pain score was 70.9, the average age was 56, and the average BMI was 40.3. Women made up 81.6% of the participants overall. Semaglutide caused a mean decrease in body weight of 13.7% from baseline to week 68, while a placebo caused a decrease of 3.2% (P<0.001). At week 68, the average change in the WOMAC pain score was -27.5 points with a placebo and -41.7 points with semaglutide (P<0.001).

The SF-36 physical-function score improved more in the semaglutide group than in the placebo group (mean change, 12.0 points vs. 6.5 points; P<0.001). In both groups, the frequency of severe adverse events was comparable. 3.0% of participants in the placebo group and 6.7% of those in the semaglutide group experienced adverse events that resulted in the permanent cessation of the trial regimen. Whereas, the most frequent cause of termination was gastrointestinal issues. Overall, the findings of this study clearly indicates the positive effects of once-weekly dose of semaglutide in obesity and osteoarthritis based knee pain.

Source:

Bliddal, H., Bays, H., Czernichow, S., Uddén Hemmingsson, J., Hjelmesæth, J., Hoffmann Morville, T., Koroleva, A., Skov Neergaard, J., Vélez Sánchez, P., Wharton, S., Wizert, A., & Kristensen, L. E. (2024). Once-Weekly Semaglutide in Persons with Obesity and Knee Osteoarthritis. In New England Journal of Medicine (Vol. 391, Issue 17, pp. 1573–1583). Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2403664

A study co-led by a Johns Hopkins Children’s Center clinician-researcher shows that adding text messaging and other electronic feedback to traditional in-clinic health counseling for parents about feeding habits, playtime and exercise prevents very young children from developing obesity and potentially lifelong obesity-related problems.

Findings from the study, which was co-led by Eliana Perrin, M.D., M.P.H., Bloomberg Distinguished Professor of Primary Care at the Johns Hopkins University Schools of Medicine, Nursing and Public Health, will be published in JAMA and presented at the Obesity Society’s “Obesity Week” in San Antonio, both on Nov. 3. The work stems from decades of research showing that having obesity in early childhood significantly increases the risk of lifetime obesity, cardiovascular disease, diabetes and other serious diseases, particularly in low-income and minority populations.

About 1 in 5 school-aged children were affected by obesity in 2017–18, according to the U.S. Centers for Disease Control and Prevention-rates that have only increased during and since the COVID-19 pandemic. Efforts to reduce the rate have relied heavily on in-person interventions by pediatric providers, with limited success.

In an earlier study, also co-led by Perrin, investigators demonstrated that a “health literacy-informed” primary care-based intervention called the Greenlight Program, which Perrin and colleagues at other medical centers developed for parents, improved healthy growth in newborns until 18 months of age, but found that improvements were not sustained at age 2 years.

In an effort to extend the improvements through 2 years of age, when pediatrics office visits become less frequent, the new study focused on using digital technology to reinforce elements of the Greenlight Program, which previously only consisted of written materials and health counseling during primary care visits.

“We found that parents are eager for more information to help their children grow up healthy, and the vast majority of parents own smartphones,” says Perrin, who is also a general pediatrician at the Harriet Lane Clinic at the Children’s Center.

Building on that knowledge, to conduct the new study, which was co-led by Vanderbilt University and five other academic medical institutions, the researchers recruited nearly 900 parent-infant pairs between October 2019 and January 2022 from newborn nurseries or pediatric primary care clinics at Duke University, University of Miami, New York University/Bellevue Hospital Center, University of North Carolina, Stanford University and Vanderbilt University Medical Center.

At the start of the trial, all babies were 21 days old or younger, born after 34 weeks gestation, at a healthy weight, and with no chronic medical conditions that might affect weight gain.

The participants were about 45% Hispanic, 20% white and nearly 16% Black. More than 55% were considered to have limited health literacy based on the Newest Vital Sign, a widely used health literacy screening tool developed by researchers at the University of Arizona, and nearly 16% reported household food insecurity, meaning limited access to healthy food choices.

The infant-parent pairs were randomly sorted into two groups. Both groups received Greenlight Program education, with counseling on healthy nutrition and behaviors from their primary care providers, along with eight educational booklets matching the child’s age at regular well visits, with guidance and goal-setting tips in English or Spanish on feeding, physical activity, sleep and screen time.

Next, half (449) of the infant-parent pairs received personalized, interactive text messages from a fully automated system to support health behavior goals and also access to a web-based “dashboard” designed to help parents keep track of healthy goals.

Goals (such as fewer sugar-sweetened beverages or less screen time) were texted in English or Spanish every two weeks until 2 years of age. Those texts were followed by five automated check-in messages throughout the two weeks. Parents were asked to self-rate their goal progress.

Based on parents’ responses, the automated digital intervention system then provided immediate feedback, tips for addressing challenges and encouragement based on progress.

The researchers found that children of parents who received the digital intervention as well as personal counseling had healthier weight-for-length growth curves over the first two years of life than children of parents who had counseling only, which resulted in an estimated reduction of 0.33 kg/m at the 24-month time point. Researchers say while this doesn’t sound like a lot, it’s consistent with the U.S. Preventive Services Task Force target for effective obesity trials. Also, obesity prevention for the digital group was significant. Some 7% of the digital intervention group had obesity, compared with nearly 13% of the clinic-only group, which is a nearly 45% adjusted relative reduction.

The researchers conclude that their digital intervention led to healthier weight-for-length paths and reduced the incidence of obesity at 2 years of age when added to in-person health counseling.

The investigators say the digital services were effective in populations that traditionally experience the highest risk of obesity, and “could have significant impact” if implemented on a broader scale.

Moreover, they concluded “the intervention effect” occurred as early as 4 months and sustained throughout the two years. The researchers say this study may be one of the first ever to prevent early childhood obesity, particularly in a large group of diverse participants.

Perrin indicated that research shows most young children with obesity do not outgrow it. “What is kind of exciting from our study is we prevented those children who would have had an unhealthy weight in the first place and helped them have a healthier weight, which sets them up better for health throughout their lives,” she says.

Finally, the researchers say the digital intervention had a greater effect on children from households with food insecurity, on Hispanic and non-Hispanic Black children, and those with lower health literacy. “If we can prevent obesity in these children at greatest risk, we can also create better health equity in the future,” Perrin says.

Reference:

Heerman WJ, Rothman RL, Sanders LM, et al. A Digital Health Behavior Intervention to Prevent Childhood Obesity: The Greenlight Plus Randomized Clinical Trial. JAMA. Published online November 03, 2024. doi:10.1001/jama.2024.22362

Compared to surgical removal of mandibular third molars, Coronectomy significantly impacted postoperative oral health-related QoL suggests a study published in the Journal of Oral and Maxillofacial Surgery.