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Gestational diabetes mellitus: Prevention, diagnosis and treatment. A fresh look to a busy corner.
Zito, G, Della Corte, L, Giampaolino, P, Terzic, M, Terzic, S, Di Guardo, F, Ricci, G, Della Pietà, I, Maso, G, Garzon, S
Journal of neonatal-perinatal medicine. 2020;(4):529-541
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a common pregnancy complication characterized by hyperglycaemia with onset or first recognition during pregnancy. Risk factors include family history of diabetes, previous GDM, genetic predisposition for GDM/type 2 diabetes, insulin resistance conditions such as overweight, obesity and ethnicity. Women with GDM are at high risk for fetal macrosomia, small for gestational age, neonatal hypoglycaemia, operative delivery and caesarean delivery. The aim of this narrative review is to summarize the most recent findings of diagnosis and treatment of GDM in order to underline the importance to promote adequate prevention of this disease, especially through lifestyle interventions such as diet and physical activity. METHODS The research was conducted using the following electronic databases, MEDLINE, EMBASE, Web of Science, Scopus, ClinicalTrial.gov, OVID and Cochrane Library, including all published randomized and non-randomized studies as well as narrative and systematic reviews. RESULTS The lack of universally accepted criteria makes the definition of diagnosis and prognosis of this condition difficult. Early diagnosis and glucose blood level control may improve maternal and fetal short and long-term outcomes. Treatment strategies include nutritional interventions and exercise. Medical treatment can be necessary if these strategies are not effective. Moreover, novel non-pharmacologic agents such as myo-inositol seem to be effective and safe both in the prevention and the treatment of GDM. CONCLUSIONS It is important to promote adequate prevention of GDM. Further studies are needed in order to better define the most appropriate strategies for the clinical management of women affected by GDM.
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Patient Use of Cardiovascular Devices and Apps: Are We Getting Our Money's Worth?
Aguillard, K, Garson, A
Methodist DeBakey cardiovascular journal. 2020;(4):291-295
Abstract
The evolution of technology makes it likely that a large number of people will invest in and use health-related mobile applications and wearable devices. Yet the question remains: Do these technology-based interventions modify health behavior and improve health…and are we getting our money's worth? The vast majority of studies concerning health-related apps and wearable devices have small sample sizes and short time spans of 6 months or less, so it is not clear if these durations were determined by lack of consistent use over time. Furthermore, many of the most popular applications have not been subjected to randomized trials. Overall, the small demonstrated improvements in outcomes are often associated with professional involvement from clinicians, coaches, or diabetes educators provided in conjunction with use of mobile health (mHealth) platforms. This paper explores the use of mHealth technologies that address cardiovascular disease/prevention (eg, diabetes, diet, physical activity, and associated weight loss) and discusses the lack of adequate evidence to support even minimal patient investment in mobile applications or wearable devices at this time.
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Curing breast cancer and killing the heart: A novel model to explain elevated cardiovascular disease and mortality risk among women with early stage breast cancer.
Kirkham, AA, Beaudry, RI, Paterson, DI, Mackey, JR, Haykowsky, MJ
Progress in cardiovascular diseases. 2019;(2):116-126
Abstract
Due to advances in prevention, early detection and treatment, early breast cancer mortality has decreased by nearly 40% during the last four decades. Yet, the risk of cardiovascular disease (CVD) mortality is significantly elevated following a breast cancer diagnosis, and it is a leading cause of death in this population. This review will discuss the most recent evidence for risks, pathology, mechanisms, and prevention of CVD morbidity and mortality in women with breast cancer. This evidence will be synthesized into a new model 'the compounding risk and protection model.' This model proposes that the balance between risk factors (i.e., older age, pre-existing traditional CVD risk factors and shared biologic pathways for CVD and cancer such as inflammation, as well as treatment-related and lifestyle toxicity) and potential protection factors (i.e., lifelong non-smoking, regular physical activity, a healthy diet rich in fruits and vegetables, and management of body weight and stress, heart failure therapy) determine the individual risk of CVD morbidity and mortality after diagnosis of early breast cancer.
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Prevention of osteoporosis in cystic fibrosis.
Chedevergne, F, Sermet-Gaudelus, I
Current opinion in pulmonary medicine. 2019;(6):660-665
Abstract
PURPOSE OF REVIEW The increased life span of patients with cystic fibrosis has lead to the detection of new complications. Osteopenia is present in up to 50% of adult patients with cystic fibrosis, and osteoporosis in 10-34% and can cause a difficult management problem. RECENT FINDINGS In children, defects in bone health become apparent generally at adolescence because of suboptimall bone peak mass achievement. Malnutrition, inflammation, vitamin D and vitamin K deficiency, altered sex hormone production, glucocorticoid therapy, and physical inactivity potentiate poor bone health. SUMMARY Monitoring bone mineral density and preventive care of osteoporosis are necessary from childhood to minimize cystic fibrosis-related bone disease in adult cystic fibrosis patients.
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Global physical activity levels - Need for intervention.
Ozemek, C, Lavie, CJ, Rognmo, Ø
Progress in cardiovascular diseases. 2019;(2):102-107
Abstract
Substantial evidence shows that physical inactivity (PI) and sedentary behavior (SB) increases the risk of many chronic diseases and shortens life expectancy. We describe evidence that certain domains of physical activity (PA) in the United States (US) population have declined substantially over 5 decades. The prevalence of PI is very high worldwide, which has contributed to 6%-10% of the burden of many chronic diseases and premature mortality. Reduction or elimination of PI would likely produce substantial increases in life expectancy of the world's population. Great efforts are needed to reduce PI and SB and increase levels of PA in the US and worldwide.
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Ten Secrets to a Long Life.
Frishman, WH
The American journal of medicine. 2019;(5):564-566
Abstract
For centuries there has been an ongoing search to identify the secrets of long life and healthy aging. Recently, multiple factors have been identified, including genetics, the introduction of antibiotics, vaccines, and public health, effective management of cardiovascular risk factors, advances in surgery, eliminating or modifying high-risk behaviors, family and social supports, eliminating wars and poverty, luck, exercise and nutrition, and psychological factors such as optimism and conscientiousness. To increase a maximum life span now estimated to be 115-120 years will involve manipulation of genes and the body's stem cells and the potential use of senolytic drugs (that kill old cells), which will need to be investigated. This is a worthy pursuit if these interventions will also maintain or enhance quality of life.
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7.
Greig Health Record for Young Adults: Preventive health care for young adults aged 18 to 24 years.
Greig, AA, Tellier, PP
Canadian family physician Medecin de famille canadien. 2019;(8):539-542
Abstract
OBJECTIVE To describe the Greig Health Record for Young Adults (GHRYA), an evidence-based, peer-reviewed, endorsed guide that can assist providers with age-appropriate screening and counseling. SOURCES OF INFORMATION A literature search was performed by the librarian from the Department of Family and Community Medicine at the University of Toronto in Ontario. PubMed, MEDLINE, the Cochrane Database of Systematic Reviews, and Google Scholar were searched using the terms young adults, emerging adults, preventive services, prevention, screening, and health promotion. Additional searches were performed using the terms mental health, substance use, addictions, sexual health, bullying, abuse, nutrition, sleep, injury prevention, and physical fitness. A total of 521 articles were identified. Articles retained for review were those relevant to young adults and were population studies, guidelines, and systematic reviews. MAIN MESSAGE Recently, there has been a recognition of the unique health care needs of the 18- to 24-year-old age group. Emerging adults have higher risks of health issues including mental illness, substance use, sexually transmitted infections, and risk-taking behaviour. Providing preventive care requires an age-specific approach, especially as contact with health care providers is often infrequent and episodic. Primary care providers who are less familiar with the preventive care needs of young adults can use the GHRYA to guide their interactions with these patients. This new tool is an easy-to-access guide to evidence-based recommendations to be used when patients present to the office or an urgent-care setting and a ready-to-hand place to record prevention strategies when delivered. The tool includes a checklist and 4 pages of resources and recommendations. CONCLUSION The GHRYA is a peer-reviewed, endorsed guide to the provision of prevention and screening for young adults, which provides an approach to patient care but also evidence-based resources.