Medical Bulletin 24/ October/ 2024 - Video

Expanding access to new, highly effective weight-loss medications could prevent more than 40,000 deaths a year in the United States, according to a new study led by researchers at Yale School of Public Health and the University of Florida. The findings highlight the critical need to remove existing barriers that are hindering people’s access to effective weight loss treatments and impeding public health efforts to address the national obesity crisis, the researchers said

Medications like glucagon-like peptide-1 (GLP-1) receptor agonists, such as Ozempic and dual gastric inhibitory polypeptide and GLP-1 (GIP/GLP-1) receptor agonists, such as tirzepatide, have shown promise in clinical trials and are increasingly being used for weight management.

In conducting their study, the researchers aimed to quantify the potential mortality impact of increased access to these weight-loss drugs. They integrated data on mortality risk associated with different body mass index (BMI) categories, obesity prevalence, and the current limitations on drug access due to high costs and insurance restrictions.

The study highlights a critical disparity in drug access. Currently, the high cost of these medications, limits their availability.

Reference: Pandey A, Ye Y, Wells CR, Singer BH, Galvani AP. Estimating the lives that could be saved by expanded access to weight-loss drugs. Proceedings of the National Academy of Sciences. 2024 Oct 22;121(43):e2412872121.

Having happy intimate partners might not only lift our moods, but it also helps us manage stress, especially as we age, according to new University of California, Davis, research.

When comparing individuals’ self-reported emotional states and relationship satisfaction with their levels of cortisol, researchers observed that older couples have lower levels of the stress hormone when their partners feel positive emotions. This effect was even stronger for people who reported higher satisfaction in their relationships. The study was published in the journal Psychoneuroendocrinology.

“Having positive emotions with your relationship partner can act as like a social resource,” said Tomiko Yoneda, an assistant professor of psychology in the College of Letters and Science and the study’s lead author.

In old age, the links between our emotions and cortisol may be even stronger. Older adults also tend to have stronger physiological responses to stress, but their bodies are less able to slow down their cortisol production. For older couples, intimate relationships might play a role in managing their cortisol levels, researchers said.

Yoneda and her research team analyzed data from 321 adults from 56 to 87 years of age across three intensive studies in Canada and Germany between 2012 and 2018. The analysis compared people’s self-reported emotional states and their relationship satisfaction with levels of cortisol measured by saliva samples. In all three studies, people’s emotional states and cortisol were measured multiple times each day for a full week.

The study found that a person’s body produced less cortisol in moments when their partner reported higher positive emotions than usual. This effect was even stronger than when people reported their own positive emotions. It was also stronger among those who were older and people who reported being happier in their relationship.

Reference: Tomiko Yoneda, Theresa Pauly, Nilam Ram, Karolina Kolodziejczak-Krupp, Maureen C. Ashe, Kenneth Madden, Johanna Drewelies, Denis Gerstorf, Christiane A. Hoppmann, “What’s yours is mine”: Partners’ everyday emotional experiences and cortisol in older adult couples, Psychoneuroendocrinology, Volume 167, 2024, 107118, ISSN 0306-4530,

https://doi.org/10.1016/j.psyneuen.2024.107118.

Magnetic resonance imaging (MRI) can spare many patients with rectal cancer from invasive surgery that can carry lifelong side effects, new research indicates.

The findings, from UVA Cancer Center’s Arun Krishnaraj, MD, MPH, and collaborators, indicate that MRI can predict patient outcomes and the risk of the tumor reccurring or spreading for patients who have undergone chemotherapy and radiation.

That information could be extremely useful in determining the best course of treatment and deciding whether a patient can avoid surgery in favor of a “watch and wait” approach, the researchers say. In watch-and-wait, doctors continue to monitor patients for cancer reccurrence or spread, holding off on surgery but potentially leaving them uncertain and anxious about the future.

The information MRI can provide would be both useful for doctors and comforting for patients, the new findings suggest.

Rectal cancer is typically treated at first with radiation and chemotherapy, but some patients require what is known as “total mesorectal excision” – the removal of a substantial portion of their bowel. This can be lifesaving but it can also be life-changing: Side effects can include the need for a permanent colostomy bag and sexual dysfunction.

To help patients make the best choices and get the best outcomes, Krishnaraj a radiologist and imaging expert who is director of UVA Health’s Division of Body Imaging, and his collaborators wanted to see if MRI could serve as a crystal ball for the effects of watch-and-wait. To do this, they analyzed the results of the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial to see how MRI results aligned with patient outcomes. In total, they reviewed outcomes from 277 patients, with an average age of 58, who had the stage of their rectal cancer determined by MRI. The average length of the follow-up period was slightly more than 4 years.

After crunching the numbers, the researchers determined MRI was an effective tool for predicting the patients’ overall survival, the risk of their cancer returning and their chances for keeping their bowel intact.

The promising MRI crystal ball can likely be made even more effective by combining it with data from endoscopies (visual inspections) after treatment, the OPRA Consortium researchers say. They are urging additional research on the potential of the combination, which they believe could offer doctors and patients a powerful new tool.

Reference: Williams, H., Omer, D. M., Thompson, H. M., Lin, S. T., Verheij, F. S., Miranda, J., ... & OPRA Consortium. (2024). MRI Predicts Residual Disease and Outcomes in Watch-and-Wait Patients with Rectal Cancer. Radiology, 312(3), e232748.

The lifetime risk of an unexpected and sudden death from a cardiovascular cause in the absence of pre-existing heart disease—known as sudden cardiac death—is more than 4 times higher for people with schizophrenia than it is for the general population, indicates Danish research published online in the journal Heart.

The risk is still around twice as high for those with other types of mental ill health, such as depression, whatever their age, indicate the findings, which suggest that an 18 year old can expect to live around 10 fewer years than someone of the same age without mental health issues.

The research to date indicates that young people with a psychiatric illness are at heightened risk of sudden cardiac death, but it’s not clear if that risk extends across the lifespan or if particular mental health disorders are associated with greater risk. To find out, the researchers systematically reviewed all deaths occurring in 18 to 90 year old Danish residents over the course of 2010, drawing on information from death certificates and post mortem reports.

Mental health disorders within the previous 10 years were defined according to International Classification of Diseases criteria or by prescriptions for psychotropic drugs filled within the preceding year. During the course of 2010, 45,703 people between the ages of 18 and 90 died. In all, 6002 of these deaths were classified as sudden cardiac deaths: 3683 in the general population and 2319 among those with a mental illness.

Overall, the number of cases of sudden cardiac death was up to 6.5 times higher among those with mental health disorders than it was in the general population. The risk was twice as high in people with depression, 3-fold higher among those with bipolar disorder, and 4.5 times higher risk among those with schizophrenia. Mental health disorders were also significantly associated with death from other causes–almost 3 times the risk–and with a shortened lifespan.

Based on the findings, the researchers estimated that an 18 year-old with any type of psychiatric disorder might expect to live around 10 fewer years than someone of the same age without any of these conditions—68 instead of 78.

Reference: Mujkanovic J, Warming PE, Kessing LV, et al Nationwide burden of sudden cardiac death among patients with a psychiatric disorder Heart Published Online First: 22 October 2024. doi: 10.1136/heartjnl-2024-324092