Medical Bulletin 29/ November/ 2024 - Video

Certain hormone replacement therapy (HRT) tablets containing both oestrogen and progestogen are associated with a higher risk of heart disease and rare but serious blood clots known as venous thromboembolism (VTE) in women around the age of menopause, finds a study from Sweden published by The BMJ.

Another HRT tablet called tibolone was associated with an increased risk of heart disease, heart attack and stroke, but not blood clots, “highlighting the diverse effects of different hormone combinations and administration methods on the risk of cardiovascular disease,” say the researchers.

Researchers set out to assess the effect of contemporary menopausal hormone therapy on the risk of cardiovascular disease according to the route of administration and combination of hormones.

Their findings are based on data from 138 emulated trials, involving 919,614 healthy women in Sweden aged 50-58 between 2007 and 2020 who had not used hormone therapy in the previous two years. They excluded women with a history of heart disease, stroke, narrowed arteries, or cancer, and who had undergone surgery to remove their ovaries, a hysterectomy, or sterilisation.

Using monthly prescription records, the women were assigned to one of eight menopausal hormone treatment groups: oral combined continuous, oral combined sequential, oral unopposed oestrogen, oral oestrogen with local progestin, tibolone, transdermal combined, transdermal unopposed oestrogen, or no menopausal hormone therapy.

Hospital records were then used to track cardiovascular events over two years, and other potentially influential factors such as age, education level, region of residence, high blood pressure and diabetes were taken into account. During this monitoring period, 24,089 cardiovascular events were recorded among the 919,614 women in the study.

Compared with not starting menopausal hormone therapy, starting oral combined continuous therapy or tibolone was associated with an increased risk of ischemic heart disease. This translates to approximately 11 new cases of ischaemic heart disease per 1,000 women who start treatment with oral combined continuous therapy or tibolone over one year. No increased risk of cardiovascular disease was found for transdermal treatments, which include skin patches, gels and creams.

An increased risk of blood clots was also found for oral combined continuous, oral combined sequential, oral unopposed oestrogen, and transdermal combined therapy. “If 1,000 women started each of these treatments and were observed for a year, we would expect to see seven new cases of venous thromboembolism across all groups,” say the authors.

Man Made sounds such as vehicle traffic can mask the positive impact of nature soundscapes on people’s stress and anxiety, according to a new study published in the open-access journal PLOS ONE.

In the new study, 68 student volunteers listened to three 3-minute soundscapes: a nature soundscape recorded at sunrise in West Sussex, U.K., the same soundscape combined with 20 mile per hour road traffic sounds, and the same soundscape with 40 mile per hour traffic sounds. General mood and anxiety were assessed before and after the soundscapes using self-reported scales.

The study found that listening to a natural soundscape reduced self-reported stress and anxiety levels, and also enhanced mood recovery after a stressor. However, the benefits of improved mood associated with the natural soundscape was limited when traffic sounds were included. The natural soundscape alone was associated with the lowest levels of stress and anxiety, with the highest levels reported after the soundscape that included 40 miles per hour traffic.

The authors conclude that reducing traffic speed in urban areas might influence human health and wellbeing not only through its safety impacts, but also through its effect on natural soundscapes.

The authors add: “Our study shows that listening to natural soundscapes can reduce stress and anxiety, and that anthropogenic sounds such as traffic noise can mask potential positive impacts. Reducing traffic speeds in cities is therefore an important step towards more people experiencing the positive effects of nature on their health and wellbeing.”

Reference: Gilmour LRV, Bray I, Alford C, Lintott PR (2024) Natural soundscapes enhance mood recovery amid anthropogenic noise pollution. PLoS ONE 19(11): e0311487. https://doi.org/10.1371/journal.pone.0311487

As artificial intelligence (AI) becomes more prevalent in health care, organizations and clinicians must take steps to ensure its safe implementation and use in real-world clinical settings, according to an article co-written by Dean Sittig, PhD, professor with McWilliams School of Biomedical Informatics at UTHealth Houston and Hardeep Singh, MD, MPH, professor at Baylor College of Medicine.

The guidance was published in the Journal of the American Medical Association.

Drawing from expert opinion, literature reviews, and experiences with health IT use and safety assessment, Sittig and Singh developed a pragmatic approach for health care organizations and clinicians to monitor and manage AI systems.

Some of the recommended actions for health care organizations are listed below:

· Review guidance published in high-quality, peer-reviewed journals and conduct rigorous real-world testing to confirm AI’s safety and effectiveness.

· Establish dedicated committees with multidisciplinary experts to oversee AI system deployment and ensure adherence to safety protocols. Committee members should meet regularly to review requests for new AI applications, consider their safety and effectiveness before implementing them, and develop processes to monitor their performance.

· Formally train clinicians on AI usage and risk, but also be transparent with patients when AI is part of their care decisions. This transparency is key to building trust and confidence in AI’s role in health care.

· Maintain a detailed inventory of AI systems and regularly evaluate them to identify and mitigate any risks.

· Develop procedures to turn off AI systems should they malfunction, ensuring smooth transitions back to manual processes.

“Implementing AI into clinical settings should be a shared responsibility among health care providers, AI developers, and electronic health record vendors to protect patients,” Sittig said. “By working together, we can build trust and promote the safe adoption of AI in health care.”

Reference: Sittig DF, Singh H. Recommendations to Ensure Safety of AI in Real-World Clinical Care. JAMA. Published online November 27, 2024. doi:10.1001/jama.2024.24598

New research from the University of Zurich, based on data from more than 28,000 caregivers in the Netherlands, Germany, and Australia, shows that the longer individuals spend caring for loved ones, the more their well-being suffers, regardless of the caregiving context. These findings underscore the need for policy discussions to alleviate the burden of informal care.

The results of the new study show a consistent drop in life satisfaction and emotional health, with an increase in loneliness and anxiety – particularly for women.

“The results of our analyses showed a decline in well-being in the years following the start of caregiving,” explains co-author Michael Krämer from the Department of Psychology at UZH. “These declines were consistent across different aspects of well-being – life satisfaction, emotional experiences, depression/anxiety, and loneliness – and were more pronounced and longer lasting for women than for men.”

The researchers also explored how time spent caregiving affected well-being. They found that the more time people spent on caregiving tasks, the more their well-being suffered, regardless of gender.

The study further examined factors like caregiving intensity, the relationship between caregivers and recipients, and full-time employment. Surprisingly, these factors had little influence on the overall decline in well-being, suggesting that caregivers face similar challenges across different contexts.

“While these findings highlight the stress caregiving can bring, individual experiences may differ,” says Krämer. “There are other aspects of psychological well-being, such as finding a sense of purpose, that we couldn’t assess with these data.” Some caregivers may even find meaning in their role.

Reference: Krämer, M. D., & Bleidorn, W. (2024). The Well-Being Costs of Informal Caregiving. Psychological Science, 0(0). https://doi.org/10.1177/09567976241279203