Posts by Julie Corliss
Websites that rate doctors and their practices can offer valuable information, but it’s often incomplete. Narrative reviews, in which patients describe in their own words their experiences with clinicians, are usually the most helpful — but could be even more so if they were collected in a standardized format. What’s more, only 40% of doctor-rating sites list information on how well a provider performs in terms of offering timely appointments and following guidelines for preventive screening tests. If you’re looking for a new clinician, it may be most helpful to ask trusted friends and family members for recommendations.
The latest guidelines used to determine who should take a cholesterol-lowering statin to prevent heart disease appear to be more accurate and cost-efficient than the previous guidelines. That’s according to two studies led by Harvard researchers, both published in this week’s Journal of the American Medical Association. The new guidelines, published in 2013 by the American College of Cardiology and the American Heart Association, recommend a statin for men and women between the ages of 40 and 75 who have a 7.5% or higher risk of having a heart attack or stroke over the next 10 years. The JAMA studies show that the new guidelines provide a more accurate assessment of who would benefit from a statin and who wouldn’t, and are more cost-effective than the older guidelines. Statins aren’t a cure-all. Eating a healthier diet, exercising often, and not smoking will go a long way to preventing heart attack and stroke.
Many people with insomnia turn to sleeping pills, which often have unwanted side effects. Few of them know about an equally effective therapy that targets the root cause of insomnia without medications. Called cognitive behavioral therapy for insomnia, or CBT-i, this short-term talk therapy teaches people to change the unproductive thinking patterns and habits that get in the way of a good night’s sleep. While this therapy can’t “cure” insomnia, it does provide tools to better manage it. In a review article in this week’s Annals of Internal Medicine, researchers found that people treated with CBT-i fell asleep almost 20 minutes faster and spent 30 fewer minutes awake during the night compared with people who didn’t undergo CBT-i. These improvements are as good as, or better than, those seen in people who take prescription sleep medications such as zolpidem (Ambien) and eszopiclone (Lunesta). And unlike medications, the effects of CBT-i last even after the therapy ends.
Can a Mediterranean-type diet with extra servings of nuts and extra-virgin olive oil help protect memory and thinking skills with age? A study in this week’s JAMA Internal Medicine suggests that it might. The findings come from a small substudy done as part of the PREDIMED trial, which showed that a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced heart attacks, strokes, and other cardiovascular problems among people at high risk for them. Although the results of the new PREDIMED study are promising, its small size and the fact that it wasn’t designed to look at connections between diet and brain health mean the results need to be taken with a grain of salt. That said, since there’s no downside to following a Mediterranean diet, an added bonus beyond great taste could be protecting memory and thinking skills.
Yoga is good for the muscles and the mind. New research suggests that it may also be good for the heart. A review of yoga and cardiovascular disease published in the European Journal of Preventive Cardiology indicates that yoga may help lower heart disease risk as much as conventional exercise, such as brisk walking. It can help people lose weight, lower blood pressure and cholesterol, and ease stress. Each of those changes works to prevent heart disease, and can help people who already have cardiovascular problems.
If you’re among the one in three American adults with high blood pressure, be sure you’re getting plenty of the B vitamin known as folate. Doing so may lower your odds of having a stroke, an often disabling or deadly event linked to high blood pressure. That’s the conclusion of a large trial conducted in China, where many people don’t get enough folate. Most Americans get plenty of folate or its synthetic version, folic acid. That’s largely because grain folic acid is added to most grain products, including wheat flour, cornmeal, pasta, and rice. It’s a good idea for everyone to do a diet check to make sure it delivers enough folate. Good sources include green leafy vegetables, beans, and citrus fruits.
Worrying about a problem or a long to-do list at bedtime can be a recipe for insomnia. Mindfulness meditation — a mind-calming practice that focuses on breathing and awareness of the present moment — can help, according to a report in JAMA Internal Medicine. Mindfulness meditation involves focusing on your breathing and then bringing your mind’s attention to the present without drifting into concerns about the past or future. It helps you break the train of your everyday thoughts and relax. In addition to calling on mindfulness meditation at night to fight insomnia, it’s a good idea to practice it during the day, too, so it’s easier to evoke the relaxation response at night when you can’t sleep.
More than half of the average person’s waking hours are spent sitting: watching television, working at a computer, commuting, or doing other physically inactive pursuits. But all that sitting could be sending some to an early grave. That’s the conclusion of a Canadian study published in this week’s Annals of Internal Medicine. People in the study who sat for prolonged periods of time had a higher risk of dying from all causes — even those who exercised regularly. The negative effects were even more pronounced in people who did little or no exercise. In addition to premature death, the study documented higher rates of type 2 diabetes, cancer, and cancer-related deaths in very sedentary people. If you sit for work, try standing or moving around for one to three minutes every half hour. Better yet, think about working at a standing desk. At home, stand when watching TV or talking on the phone.
Over the past decade, a barrage of reports linking low vitamin D levels to cancer, heart disease, diabetes, and a host of other ills led many doctors to routinely test vitamin D levels in their healthy patients. But there is no good reason to do that, according to a new recommendation from the U.S. Preventive Services Task Force (USPSTF) published in this week’s Annals of Internal Medicine. The task force concluded that it isn’t helpful for most people to know their vitamin D level, and that even if you have a “low” vitamin D level there’s little evidence that taking a vitamin D supplement will do most people any good.
Getting a flu shot can help ward off the flu. It also works to prevent pneumonia, a leading cause of hospitalization (about one million a year) and death (about 50,000) in the United States. Pneumonia can be especially dangerous in young children and older people. For these groups, as well as others who face a high risk of pneumonia, two different vaccines can help prevent pneumonia caused by the bacterium known as Streptococcus pneumoniae. One, called PPSV23 or Pneumovax, is derived from 23 different types of pneumococcal bacteria. A newer vaccine, called PCV13, features parts of 13 different pneumococcal bacteria linked to a protein that helps the vaccine work better. PCV13 is recommended for all children younger than 5 years old, all adults 65 years or older, and anyone age 6 or older with risk factors for pneumonia. PPSV23 is recommended for all adults 65 years or older and anyone age 2 years through 64 years are at high risk of pneumonia.