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Common heartburn meds linked to higher diabetes risk

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Often-used drugs called proton pump inhibitors, or PPIs, ease heartburn symptoms, but a new study suggests they might also increase the risk of type 2 diabetes.

Chinese researchers drew on information from studies of more than 200,000 U.S. health care professionals and found that regular use of PPIs — such as Aciphex, Nexium, Prilosec, Prevacid, Protonix — was associated with a 24% higher risk of developing type 2 diabetes.

The researchers also found that the longer people used the drugs, the higher their odds of diabetes.

“Regular PPI use was likely to be associated with an increased risk of type 2 diabetes, particularly for those with prolonged use,” the authors wrote in the report published online this week in the journal Gut.

Jinqiu Yuan, a researcher from the Sun Yat-Sen University, Shenzhen, Guangdong, China, led the study.

PPIs are available by prescription or over-the-counter to treat acid reflux, peptic ulcers and other digestive conditions. They are among the top 10 drugs used worldwide. Long-term use has previously been linked to a greater risk of bone fractures, kidney disease, digestive tract infections and stomach cancer.

Based on the new findings, the researchers suggested that people taking PPIs for a long time should have their blood sugar monitored for changes that might indicate developing diabetes.

It’s important to note, however, that this study was not designed to prove a cause-and-effect relationship between PPIs and type 2 diabetes. It can only show a link between the two.

The researchers relied on data from three long-term studies of U.S. health professionals that began in the 1970s and 1980s. They included more than 176,000 women and nearly 29,000 men.

Participants provided information on their health and behaviors every two years. In the early 2000s, the questions expanded to include whether they had used a PPI two or more times a week.

The investigators tried to control for factors that might affect type 2 diabetes risk, including high blood pressure, weight and physical inactivity.

Besides linking regular use of PPIs to an increased risk of type 2 diabetes, the researchers found that long-term use increased the odds, too. Study participants who used PPIs for up to two years had a 5% increased risk, and the risk rose 26% for those who took the drugs more than two years.

The study authors also noted that when people stopped taking these drugs, the risk of diabetes fell, and it continued to do so even more over time.

Surprisingly, the risk of diabetes associated with PPI use appeared to be highest in people with normal blood pressure and lower weight. Typically, higher weight is a risk factor for type 2 diabetes.

The study also found a 14% higher risk of type 2 diabetes in people taking another type of heartburn medication called H2 receptor blockers — such as Pepcid, Tagamet, Zantac.

It’s unclear exactly how taking acid-reducing medications might increase diabetes risk, the researchers said. One possible way might be through altering the body’s natural balance of bacteria, or microbiome, they suggested. Another possibility: PPI use may lead to weight gain that can increase the odds of diabetes. More research is needed.

Dr. David Bernstein, a digestive disease specialist from Northwell Health in Manhasset, N.Y., reviewed the findings.

“PPIs are the most effective therapies for the treatment of acid reflux, gastritis and peptic ulcers,” Bernstein said. “When first introduced, they were considered ‘miracle’ drugs as they alleviated previously refractory abdominal pains.”

Unfortunately, as the study authors noted, these drugs have been linked to some serious long-term side effects.

“This report, despite its weaknesses, adds yet another potential consequence to an already growing list of medical conditions associated with long-term PPI use,” Bernstein said. Weaknesses included the observational nature of the study and lack of randomized comparison groups, he noted.

Still, based upon the findings, it seems reasonable to check patients who have been taking PPIs for more than two years for development of diabetes at regular intervals, he said. “Further studies are required to determine what that interval should be,” Bernstein explained.

Another digestive disease specialist, Dr. Arun Swaminath, from Lenox Hill Hospital in New York City, agreed that the study had limitations.

“The main limitation of the study is that the true estimation of PPI exposure is based on memory and recall bias,” he said.

But, due to this study’s findings and other associated risks of long-term PPI use, Swaminath said, “it’s reasonable to always see if a patient still needs their PPI” or if their dose could be lowered.

For those who need to stay on PPIs, doctors and patients need to discuss the drugs’ risks and benefits, he advised. Because PPIs are available over-the-counter, “it will not be a simple process to identify all at-risk patients,” Swaminath pointed out.

More information

Learn more about proton pump inhibitors from the International Foundation for Gastrointestinal Disorders.

Copyright 2020 HealthDay. All rights reserved.



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‘Green prescriptions’ could cancel mental health benefits for some

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So-called “green prescriptions” may end up being counterproductive for people with mental health conditions, researchers say.

Spending time in nature is believed to benefit mental health, so some doctors are beginning to “prescribe” outdoor time for their patients.

That led researchers to investigate whether being in nature helps actually does help people with issues such as anxiety and depression. They collected data from more than 18,000 people in 18 countries.

The takeaway: Time in nature does provide several benefits for people with mental health conditions, but only if they choose on their own to visit green spaces.

While being advised to spend time outdoors can encourage such activity, it can also undermine the potential emotional benefits, according to the authors of the study published this month in the journal Scientific Reports.

The researchers said they were surprised to find that people with depression were spending time in nature as often as folks with no mental health issues, and that people with anxiety were doing so much more often.

While in nature, those with depression and anxiety tended to feel happy and reported low anxiety. But those benefits appeared to be undermined when the visits were done at others’ urging, the investigators found.

The more external pressure people with depression and anxiety felt to visit nature, the less motivated they were to do so and the more anxious they felt.

“These findings are consistent with wider research that suggests that urban natural environments provide spaces for people to relax and recover from stress,” said study leader Michelle Tester-Jones, a postdoctoral research associate at the University of Exeter in the United Kingdom.

But the findings also show that health care practitioners and loved ones should be sensitive about recommending time in nature for people who have mental health issues.

“It could be helpful to encourage them to spend more time in places that people already enjoy visiting, so they feel comfortable and can make the most of the experience,” Tester-Jones said in a university news release.

More information

For more on the benefits of green spaces, go to the National Recreation and Park Association.

Copyright 2020 HealthDay. All rights reserved.



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Study: Nearly half of ‘essential workers’ in U.S. at risk for severe COVID-19

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Nov. 9 (UPI) — Nearly half of those classified as “essential workers” in the United States are at increased risk for severe COVID-19, according to an analysis published Monday by JAMA Internal Medicine.

This means that more than 74 million workers and those with whom they live could be at risk for serious illness, based on disease risk guidelines developed by the U.S. Centers for Disease Control and Prevention, the researchers said.

“Many parts of the country face high and rising infection rates, [and] we should not think about work exposure and health risks in isolation, given that workers and persons at increased risk often live in the same households,” study co-author Thomas M. Selden told UPI.

“Insofar as we can reduce the prevalence of COVID-19 in our communities, we can reduce the extent to which policymakers have to choose between the economy and keeping the population safe,” said Selden, an economist with the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.

Since the COVID-19 pandemic spread to the United States in March, states and cities across the country have instituted lockdown measures designed to limit the spread of the disease.

Many of these measures entailed closing schools and non-essential businesses, with only banks, grocery stores, pharmacies and other businesses deemed to provide vital services allowed to stay open.

For this study, Selden and his colleagues analyzed data on the U.S. workforce to examine how many people were in essential jobs, how often they were able to work at home, their risk for severe COVID-19 and the potential health risks for their household members.

Of the more than 157 million workers across the country, 72% are in jobs deemed essential — based on U.S. Department of Homeland Security criteria — and more than three-fourths of all essential workers are unable to work at home, Selden said.

Essential workers include those in the medical and healthcare, telecommunications, information technology systems, defense, food and agriculture, transportation and logistics and energy, water and wastewater industries, as well as those in law enforcement and public works, the DHS criteria stipulates.

The study notes that up to 60% of these workers have underlying health issues, placing them at increased risk for severe COVID-19 if they get infected, as defined by U.S. Centers for Disease Control and Prevention guidelines.

Those with diabetes, heart disease, high blood pressure and chronic respiratory conditions like asthma are considered to be at high risk for serious illness, the CDC says.

Based on these findings, between roughly 57 million and 74 million adults working in on-site essential jobs — and their families — are at increased risk for serious illness, Selden and his colleagues estimated.

“Policymakers face important decisions about how to balance the economic benefits of keeping workers employed and the public health benefits of protecting those with increased risk of severe COVID-19,” Selden said.

“These issues arise in the context of decisions to close segments of the economy and decisions about how to distribute vaccines, which will initially be available only with limited supply, [and] become all the more difficult when the prevalence of infection rises in parts of the country,” he said.



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Study: Hydroxychloroquine no better than placebo for hospitalized COVID-19 patients

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Nov. 9 (UPI) — COVID-19 patients treated with hydroxychloroquine showed no signs of significant improvement in “clinical status” compared with those given a placebo, a study published Monday by JAMA found.

Patients given a five-day course of the drug were scored as “category six” based on the World Health Organization’s seven-category COVID Ordinal Outcomes Scale, the same as those given a placebo, the researchers said.

Also, 28 days after they started treatment, 10.4% of those treated with hydroxychloroquine died, just slightly lower than the 10.6% fatality rate in the placebo group.

“The results show that hydroxychloroquine did not help patients recover from COVID-19,” study co-author Dr. Wesley H. Self told UPI.

“In the study, patients treated with hydroxychloroquine and those treated with a placebo had nearly identical outcomes, [so] I do not foresee any role for hydroxychloroquine in acutely ill patients hospitalized with COVID-19,” said Self, an infectious disease specialist at Vanderbilt University Medical Center.

Hydroxychloroquine is an immunosuppressive and anti-parasitic drug that is used to treat malaria.

Early in the COVID-19 pandemic, it was touted by President Donald Trump and others as a potential treatment for the virus, despite the lack of any scientific data supporting its use.

Given its effectiveness helping those sickened with malaria — a mosquito-borne infection — to recover, “there was a strong rationale for why hydroxychloroquine may have been beneficial for patients with COVID-19,” according to Self.

However, in July, the U.S. Food and Drug Administration warned against the drug’s use in the treatment of those infected with the new coronavirus, due to potentially serious heart-related side effects.

For this study, Self and his colleagues treated 433 COVID-19 patients at 34 hospitals across the United States with either the drug or a placebo for a period of five days.

Patients assigned to the hydroxychloroquine group received 400 milligrams of the drug in pill form twice a day for the first two doses and then 200 mg. in pill form twice a day for the next eight doses, for a total of 10 doses over the five days.

All of the patients were then assessed based on the WHO’s COVID Ordinal Outcomes Scale, which categorizes those infected according to disease severity.

Most of the patients in both the hydroxycholorquine group and the placebo group were in “category six,” meaning they were hospitalized and receiving extracorporeal membrane oxygenation or invasive mechanical ventilation to maintain their breathing, the researchers said.

“Our results, especially when combined from other studies conducted in the United Kingdom and Brazil, are good evidence that hydroxychloroquine does not provide benefit for patients hospitalized with COVID-19,” Self said.



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