,Sodium, hypertension
Random Research Thoughts
Wed/Jul/07 07:48 PM
I have been reviewing some recent British Medical Journal (BMJ) articles that deal with common questions in primary care. I will outline a few below.
1. What is the best method to encourage exercise in children or adults? This is interesting. A systemic review by Ogilivie et al of a total of 48 studies on the subject showed that almost all interventions resulted in change in exercise patterns in the most sedentary AND the most motivated patients. This is similar to research in the past that showed approximately 33% of smokers will make an effort to stop after their doctor merely suggesting that they need to do so. Obviously these initial changes fade with time but it is encouraging to know that by working with our sedentary patients we can have an impact.
2. Does low dose aspirin improve women's cognitive function? Again interesting results. J. Kang et al reviewed data from the Women's Health Study from 1998 to 2004 where nearly 6400 woment aged 65 or more were using placebo or low dose aspirin for a mean of 9.6 years. OVERALL the cognitive function in the study group was not improved by aspirin use. There have been some prior observational studies that have shown possible benefit and I believe we still do not know enough about certain subsets (smokers for instance). Future studies may tease these out.
3. Would a tonsillectomy be better than watchful waiting for recurrent strep throat in adults? This comes up every week. Some patients get strep again and again and the risk for more severe disease, although not as common in this day of easy access to meds, does exist. The study by ). Alho et al looked at 70 adults who had recurrent strep. Thirty-six had "instant" tonsilecltomy and 34 had watchful waiting. The intervention group was less likely to have further strep throat infection or throat infection or days with throat pain than those without the surgery. At 90 days strep had recurrent in 24 % of the patients without surgery and only 3% of those who had the surgery. Insurance companies take note. Waiting to do the surgery will result in more infections and more cost, more days of work and/or school lost.
4. What are the long term effects of restriction of sodium? N. Cook et al reviewed date from the TOHP (trials of hypertension prevention) study that was done in multiple sites on adults aged 30-54 years with pre-hypertension. They found that in addition to have a slight effect on blood pressure, there was a significant reduction in cardiovascular events during the followup. I am a fan of using sea salts as better mixes of mineral and salts. Using them generally causes a reduction in sodium salt reduction. This may not only help blood pressure but may result in fewer cardiovascular events such as heart attacks.
1. What is the best method to encourage exercise in children or adults? This is interesting. A systemic review by Ogilivie et al of a total of 48 studies on the subject showed that almost all interventions resulted in change in exercise patterns in the most sedentary AND the most motivated patients. This is similar to research in the past that showed approximately 33% of smokers will make an effort to stop after their doctor merely suggesting that they need to do so. Obviously these initial changes fade with time but it is encouraging to know that by working with our sedentary patients we can have an impact.
2. Does low dose aspirin improve women's cognitive function? Again interesting results. J. Kang et al reviewed data from the Women's Health Study from 1998 to 2004 where nearly 6400 woment aged 65 or more were using placebo or low dose aspirin for a mean of 9.6 years. OVERALL the cognitive function in the study group was not improved by aspirin use. There have been some prior observational studies that have shown possible benefit and I believe we still do not know enough about certain subsets (smokers for instance). Future studies may tease these out.
3. Would a tonsillectomy be better than watchful waiting for recurrent strep throat in adults? This comes up every week. Some patients get strep again and again and the risk for more severe disease, although not as common in this day of easy access to meds, does exist. The study by ). Alho et al looked at 70 adults who had recurrent strep. Thirty-six had "instant" tonsilecltomy and 34 had watchful waiting. The intervention group was less likely to have further strep throat infection or throat infection or days with throat pain than those without the surgery. At 90 days strep had recurrent in 24 % of the patients without surgery and only 3% of those who had the surgery. Insurance companies take note. Waiting to do the surgery will result in more infections and more cost, more days of work and/or school lost.
4. What are the long term effects of restriction of sodium? N. Cook et al reviewed date from the TOHP (trials of hypertension prevention) study that was done in multiple sites on adults aged 30-54 years with pre-hypertension. They found that in addition to have a slight effect on blood pressure, there was a significant reduction in cardiovascular events during the followup. I am a fan of using sea salts as better mixes of mineral and salts. Using them generally causes a reduction in sodium salt reduction. This may not only help blood pressure but may result in fewer cardiovascular events such as heart attacks.
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