Medical Bulletin 05/ November/ 2024
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Here are the top medical news for the day:
1 in 3 Cancer Patients Visit Emergency Department 90 Days Before Diagnosis
About 1 in 3 patients diagnosed with cancer in Ontario visited an emergency department in the 90 days before diagnosis, found a new study published in Canadian Medical Association Journal.
In a study that included more than 650 000 patients diagnosed with cancer between 2014 and 2021 in Ontario, 35% had visited an emergency department in the 90 days before diagnosis. Among patients with emergency department visits before their cancer diagnosis, 64% had visited once, 23% had visited twice and 13% had 3 or more visits. More than half of patients with an emergency department visit before diagnosis were admitted to hospital.
Most emergency department visits were related to symptoms of the type of cancer diagnosed. Patients later diagnosed with colorectal cancer had emergency department visits related to bowel obstruction and abdominal pain, and those with gastroesophageal cancer had emergency department visits related to gastrointestinal bleeding, difficulty swallowing, and abdominal pain. Patients with brain cancers had high odds of visiting the emergency department before diagnosis for weakness, confusion, or seizures.
Several patient groups were more likely to use the emergency department prior to a cancer diagnosis, including older adults, people from rural or northern areas, those living in marginalized neighbourhoods, people with multiple illnesses, and those diagnosed during the COVID-19 pandemic. Patients who had immigrated within the previous 5 years were less likely to use the emergency department before diagnosis.
Reference: Grewal, K., Calzavara, A., McLeod, S. L., Eskander, A., Savage, D. W., Thompson, C., Borgundvaag, B., Ovens, H., Cheskes, S., de Wit, K., Irish, J., Krzyzanowska, M. K., Walsh, R., Mohindra, R., Thiruganasambandamoorthy, V., & Sutradhar, R. (2024). Emergency department use before cancer diagnosis in Ontario, Canada: A population-based study. CMAJ, 196(37), E1252–E1261. https://doi.org/10.1503/cmaj.240952
Preventing Childhood Obesity? Digital Technology May Help Parents
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. The findings were published in JAMA.
The current 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.
The researchers recruited nearly 900 parent-infant. 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 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. 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. Moreover, they concluded “the intervention effect” occurred as early as 4 months and sustained throughout the two years.
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
Poor People Have Poor Cognitive Status?
Socioeconomic factors such as education, occupation, and wealth influence the likelihood of developing cognitive impairment or dementia in later life and whether a person is likely to recover, finds a new study led by UCL researchers.
The research, published in Scientific Reports, followed 8,442 adults aged 50 and above in England over 10 years from 2009 to 2019, to examine how socioeconomic factors at the start of the study were associated with changes in cognitive status.
The researchers tracked how these people moved between various states: healthy, mild cognitive impairment, and dementia. They also considered the possibility of reversals, where individuals improved from a mild cognitive impairment state to a healthy one.
Information on socioeconomic factors was collected through a self-completion questionnaire. Cognitive impairment was determined using a mix of sources, including participants’ reports of a doctor’s diagnosis, cognitive test results, and their own reports of symptoms and complaints, providing a full picture of each participant’s cognitive health. In addition to these aspects, the study also accounted for demographic factors, such as age, sex, and marital status.
The team found that people from more socioeconomically advantaged backgrounds – particularly those with post-secondary school education, managerial or professional-level occupations, and those in the wealthiest third of the population – were less likely to move from a healthy cognitive state to mild cognitive impairment, or from mild cognitive impairment to dementia compared to those with primary education, working in manual or routine occupations, and in the most socioeconomically disadvantaged third of the population. For instance, being in the wealthiest third of the population was linked with a 26% lower chance of shifting from mild cognitive impairment to dementia.
Reference: Gireesh, A., Sacker, A., McMunn, A., Bhatt, R., & Cadar, D. (2024). Socioeconomic inequalities linked to the transitioning to neurocognitive disorders and mortality. Scientific Reports, 14(1), 24690.
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