2 Minute Medicine Rewind July 13 – July 19, 2015

Community Acquired Pneumonia Requiring Hospitalization among US Adults

Community acquired pneumonia is one of the leading infectious causes of hospitalization amongst adults in the United States.  In this active population based surveillance study, investigators identified 2,488 eligible study participants in five different hospitals throughout Chicago, Illinois and Nashville, Tennessee between January, 2010 and June, 2012.  Investigators calculated the population-based incidence rates of community-acquired pneumonia requiring hospitalization according to patient age and infectious pathogen.    The median age of participants hospitalized for community-acquired pneumonia was 57 years (interquartile range, 46 to 71).  The annual incidence of community-acquired pneumonia was found to be 24.8 cases per 10,000 adults (95% CI: 23.5 to 26.1 cases per 10,000 adults); this incidence increased with age and individuals over the age of 65 were found to be at a much higher risk of developing community-acquired pneumonia (incidence rate of 63.0 cases per 10,000 adults aged 65-79; incidence rate of 164.3 cases per 10,000 adults over the age of 80).  The investigators also looked at the different types of pathogens contributing to community-acquired pneumonia and found that the most common isolated pathogens were rhinovirus (9%), influenza virus (6 %), and Streptococcus pneumonia (5%).  These findings contribute to a growing body of research highlighting the need for the development of effective vaccines against respiratory viruses.  Seeing as adults over the age of 65 are at an increased risk of developing community-acquired pneumonia, improved access to existing vaccines against common respiratory pathogens, should be a priority for this population.

Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventative Services Task Force

With the increasing incidence of type-2 diabetes as well as the chronic nature of the disease progression, it is becoming more and more important to identify at-risk individuals early on in the course of the disease.  Early identification of at-risk individuals would allow for the implementation of interventions that may decrease an individual’s risk of developing clinically significant diabetes.  In this systematic review, researchers reviewed and analyzed 53 articles looking at single-group or comparative studies of combined diet and physical activity promotion programs.  The purpose of this study was to evaluate the effectiveness of diet and physical activity promotion programs for individuals at increased risk for type-2 diabetes. Diet and physical activity programs were found to reduce the overall incidence of type-2 diabetes (RR, 0.59; 95% CI, 0.51 to 0.66).  Unfortunately the majority of the studies included in this review did not look at the long-term effects of diet and physical activity programs and so future research should focus on identifying whether or not these interventions are effective at reducing the long-term risk of developing diabetes in individuals with identifiable risk factors.     

An Assessment of Community Health Workers’ Ability to Screen for Cardiovascular Disease Risk with a Simple, Non-invasive Risk Assessment Instrument in Bangladesh, Guatemala, Mexico, and South Africa: an Observational Study

Community health workers are in a unique position to provide healthcare to hard to reach populations in low-income countries.  Community health workers often live in the communities with which they work allowing them to provide individuals within their respective communities with improved access to an informed healthcare provider.  In this observational study, 42 trained community health workers in Bangladesh, Guatemala, Mexico, and South Africa used a standardized screening tool to screen 4049 community members for risk of cardiovascular disease. Each community member was then screened by a health professional.  The primary outcome of the study was the comparison of risk scores assigned by community health workers to those assigned by health professionals in order to assess whether or not community health workers could effectively identify cardiovascular risk with a risk assessment tool.  The mean level of agreement between the two sets of risk scores was found to be 96.8% (95% CI: 93.6% to 96.1%), which shows that community health workers can effectively identify individuals at high risk for cardiovascular disease.  Providing community health workers with the tools needed to screen individuals for cardiovascular disease will take some of the pressure off of an already stressed health care system in low-income countries.        

Risk of Intracranial Hemorrhage in Antidepressant Users with Concurrent use of Non-Steroidal Anti-Inflammatory Drugs: Nationwide Propensity Score Matched Study

Research has raised the concern of increased risk of bleeding in individuals taking both, antidepressants and non-steroidal anti-inflammatories (NSAIDs).  Given the large prevalence of depression amongst older adults as well as the high percentage of this same population using NSAIDs on a daily basis, it is important to ascertain whether or not using these medications together poses a true risk for bleeding.  In this retrospective propensity score matched cohort study, researchers analyzed data from 4, 145, 226 Korean patient cases in order to determine whether or not the risk of intracranial hemorrhage within 30 days of beginning antidepressants was higher amongst individuals also taking NSAIDs.  Researchers found that the 30-day risk of intracranial hemorrhage was indeed higher in the group of patients taking both, antidepressants and NSAIDs compared to those taking only antidepressants (HR 1.6, 95% CI 1.32 to 1.85).  Men taking antidepressants and NSAIDs seemed to be at higher risk of intracranial bleeding than female patients taking antidepressants and NSAIDs (Men: HR 2.6, 95% CI 1.93 to 3.42 vs. Women: HR 1.2, 95% CI 0.89 to 1.57).  No statistically significant difference was found with respect to risk of intracranial hemorrhage and class of antidepressant.  This study used information from a national database containing information on drugs prescribed to Koreans, therefore, despite a large sample size, generalizability is not possible.  Future research should focus on a more diverse patient population.     

Vaginal Misoprostol Compared With Buccal Misoprostol for Termination of Second Trimester Pregnancy: A Randomized Controlled Trial

Unfortunately, there are several potential fetal and maternal complications that may arise throughout a pregnancy necessitating termination during the second-trimester (13-24 weeks).  Surgical invention through dilation and evacuation as well as medications such as, mifepristone and misoprostol, can be used for second-trimester termination. These agents induce preterm labor allowing for natural expulsion of the fetus with very little complications or side effects.  In this randomized controlled trial, researchers assigned 172 women seeking termination of a viable second-trimester pregnancy to either the vaginal misoprostol group (n=65) or the buccal misoprostol group (n=65).  The primary outcome of the study was the comparison of the efficacy of vaginal misoprostol with that of buccal misoprostol for termination of pregnancy in the second-trimester.  It was found that women who had received vaginal misprostol had shorter induction-to-termination intervals (25+17 hours vs. 40+29 hours, p = 0.001) and higher complete termination rates within both, 24 hours (63% vs. 42%, p = 0.014) and 48 hours (91% vs. 68%, p = 0.001).  Complete abortion rates and incidence of side effects were similar for both groups.  Future research in this area may take into account patient preference regarding route of administration as well as a more detailed assessment of side effects.

Image: PD

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