Unfiltered traffic-related air associated with immediate, significant blood pressure increase

Effects of exposure persisted more than 24 hours

2023-11-27

(Press-News.org) Embargoed for release until 5:00 p.m. ET on Monday 27 November 2023
Annals of Internal Medicine Tip Sheet
@Annalsofim
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
----------------------------
1. Unfiltered traffic-related air associated with immediate, significant blood pressure increase

Effects of exposure persisted more than 24 hours

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1309
URL goes live when the embargo lifts  
A randomized crossover trial found that the inhalation of traffic-related air pollution while in a car with unfiltered air was associated with a 4.5 mm Hg increase in blood pressure. This change in blood pressure occurred rapidly, peaked within 60 minutes of exposure, and persisted over 24 hours. The findings are published in Annals of Internal Medicine.

Traffic-related air pollution (TRAP) exposure is recognized as a risk factor for cardiovascular disease and other health effects. Work commute times in the U.S. are longer, averaging 27 minutes in 2019. Exposure to TRAP has been associated with increased cardiovascular risk in observational studies. TRAP may include ultrafine particles; black carbon; oxides of nitrogen; carbon monoxide (CO); carbon dioxide (CO2); and other particulate matter.

In this study from the University of Washington, 16 persons aged 22 to 45 years of age were driven through traffic in Seattle, Washington for 3 days between 2014 and 2016 to determine—by using particle filtration or sham filters—the effect of on-roadway pollutant exposure on blood pressure. For 2 days, on-road air was entrained into the vehicle. On another day, the vehicle was equipped with high efficiency particulate air (HEPA) filtration. Blood pressure was monitored up to 24 hours before, during, and after the drive. The authors found that—in the participants with complete data—drives in vehicles with unfiltered TRAP resulted in significant net increases in blood pressure compared with drives with in-vehicle filtration. According to the authors, these findings suggest that not only does TRAP raise blood pressure, but also that the effects of air pollution on blood pressure may be reduced with effective cabin air filtration.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Joel D. Kaufman, MD, MPH, please email joelk@uw.edu.

----------------------------
2. Two-week prophylaxis may mitigate HCV infection in uninfected kidney transplant recipients

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2682

URL goes live when the embargo lifts  
A research report evaluating the transplantation of kidneys from donors with hepatitis C virus (HCV) viremia for recipients without HCV found that the use of direct-acting antiviral (DAA) prophylaxis for 2 weeks may prevent HCV transmission . The report is published in Annals of Internal Medicine.

The use of organs from donors with HCV viremia for recipients without HCV with DAA prophylaxis can increase access to kidney transplant (KT). Giving DAA prophylaxis immediately before transplant to recipients without HCV is an alternative to the transmit-and-treat approach where DAAs are given after transplant, once the recipient is already infected. Transmit-and-treat cures HCV, however, some recipients treated with this approach develop donor-specific antibodies, rejection, BK and cytomegalovirus viremia, and severe fibrosing cholestatic HCV. These complications may be avoided with prophylaxis, which is also less costly than a full treatment course. However, the optimal duration of prophylaxis is unknown.

Researchers from Johns Hopkins University and New York University conducted a small, uncontrolled trial of 10 persons eligible for kidney transplant without HCV. Eligible deceased donors were r HCV viremic. Participants received a dose of glecaprevir (300 mg)–pibrentasvir (120 mg) prophylaxis before the KT, then once daily for 13 additional doses after the KT. The authors report that all 10 participants remained HCV-negative after 2-week DAA prophylaxis; only one participant had transient laboratory abnormalities in liver function. According to the authors, this study provides proof of concept for 2-week DAA prophylaxis as the optimal duration.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding authors, please contact Christine M. Durand, MD at christinedurand@jhmi.edu, or Niraj M. Desai, MD, at ndesai13@jhmi.edu.

----------------------------

3. Thyroidectomy may improve symptoms in some patients with Hashimoto disease

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1593

URL goes live when the embargo lifts  
A research report evaluating health outcomes for patients with Hashimoto thyroiditis and persistent symptoms despite taking thyroid medications found that a thyroidectomy intervention relieved symptoms for patients 5 years later. However, 14 percent of these patients experienced complications after surgery. The report is published in Annals of Internal Medicine.

Even when thyroxine is adequately replaced for hypothyroidism, patients with Hashimoto disease may report persistent extrathyroidal symptoms, including chronic fatigue, muscle and joint tenderness, dry mouth and eyes, and poor sleep quality. It has been hypothesized that these persistent symptoms may be related to extrathyroidal autoimmune reactions, and that complete removal of thyroid tissues may relieve symptoms.

Researchers from Telemark Hospital, Norway conducted a randomized, open-label clinical trial of 150 persons with Hashimoto disease who reported persistent symptoms despite interventions with thyroid hormone medication. The authors evaluated self-reported quality-of-life changes in patients who received thyroidectomy and patients who received only medical treatment over 18 months. They found that patients who received thyroidectomy reported quality-of-life improvements at both 18 months and 5 years after surgical intervention compared with patients receiving medication-only treatment. However, the authors caution that 10 of the 73 participants who received thyroidectomy experienced health complications in terms of recurrent laryngeal nerve paralysis and hypoparathyroidism.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Geir Hoff, MD, PhD, please telephone +47 91866762 or e-mail hofg@kreftregisteret.no.

----------------------------

4. Commentary: Communicating value of flu vaccines to patients is critical

Authors highlight the benefits of influenza vaccination and tools, including the ‘SHARE’ method, to make physician/patient communication easier

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2802

URL goes live when the embargo lifts

Influenza vaccinations have been regularly recommended to all Americans starting from 6 months of age for over a decade, but vaccinations among children and younger adults have usually remained low. During the COVID-19 pandemic, annual influenza vaccination coverage rates remained low overall and declined in some groups. The United States experienced high levels of influenza virus, SARS-CoV-2, and respiratory syncytial virus co-circulation during the 2022 to 2023 influenza season, putting a strain on health care resources. As the 2023 to 2024 season begins, internal medicine physicians and other health care professionals play an important role in communicating the benefits of vaccinations against influenza and other respiratory viruses, say members of the Influenza Division of the Centers for Disease Control and Prevention (CDC).

In their commentary, the authors highlight the importance of physicians communicating the benefit of annual influenza vaccination and offer the SHARE (Share why an influenza vaccine is right for the patient, Highlight positive experiences with influenza vaccines, Address patient questions and any concerns, Remind patients that vaccines help protect them and their loved ones, and Explain the potential costs of getting influenza) method to help healthcare professionals clearly communicate with patients.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Mark W. Tenforde, MD, PhD, MPH, DTM&H, please contact media@cdc.gov.

END

ELSE PRESS RELEASES FROM THIS DATE:

Practice facilitation programs can help primary care clinics adopt best practices for providing COVID-19 vaccinations

2023-11-27

In Ontario, Canada, most COVID-19 vaccinations were administered by public health organizations and pharmacies rather than by family physicians. Researchers devised a practice facilitation intervention program to help family physicians proactively engage with their patients who were not yet vaccinated for COVID‐19. Six trained practice facilitators helped 90 family physicians identify unvaccinated patients and offered resources to address COVID‐19 vaccine hesitancy, scripts and email templates for patient outreach, and connections to trained medical student volunteers to work as physician‐delegates by conducting patient telephone outreach and motivational interviewing. ...

Breathing highway air increases blood pressure, UW research finds

2023-11-27

For more than a century, American cities have been sliced and diced by high-traffic roadways. Interstate highways and wide arterials are now a defining feature of most metropolitan areas, their constant flow of cars spewing pollution into nearby neighborhoods. Researchers have only just begun to understand the health risks posed by all that pollution. Long-term exposure to traffic-related air pollution — a complex mixture of exhaust from tailpipes, brake and tire wear, and road dust — has been linked to increased rates ...

Doctors whose psychological needs are met is associated with greater well-being in the new digital era

2023-11-27

Canadian researchers examined how the rapid shift to using virtual care during the COVID-19 pandemic has impacted primary care doctors’ well-being at work. They utilized a self-determination theory (SDT) lens to examine how autonomous (vs. controlled) motivation among family physicians impacted their well-being when shifting to virtual care, and whether satisfaction (vs. frustration) of their basic psychological needs at work mediated that relationship. The researchers gathered qualitative data by surveying 156 family physicians ...

Dutch researchers explore patient profiles of those who choose to stop eating and drinking to hasten death

2023-11-27

Some patients choose to voluntarily stop eating and drinking (VSED) as a way of hastening death. Researchers from the Amsterdam University Medical Centre conducted a study to describe patients’ motives for doing so, how they decide to voluntarily stop eating and drinking, and the way in which they prepare to do so, along with how they involve others. The researchers conducted qualitative interviews with 29 patients living in the Netherlands. Among 29 cases, 24 started VSED and 19 died. Thirteen cases were included before and ...

Almost two-thirds of residents in US family medicine programs are training in states that have abortion restrictions

2023-11-27

Researchers performed an analysis to assess the proportion of accredited U.S. family medicine residency programs and trainees in states with abortion restrictions. Of 693 accredited family medicine residency programs in the U.S., 201 programs (29%) were in states where abortion was banned or heavily restricted as of August 2, 2023. Fourteen of the 17 states in this category had complete abortion bans. While most (63.8%) family medicine residency programs were in states with at least some abortion restrictions, 251 ...

International group of research experts establish checklist detailing key consensus reporting items for primary care studies

2023-11-27

In an effort to fill the need for primary care–focused guidelines, an international group of top researchers has developed the Consensus Reporting Items for Studies in Primary Care (CRISP) Checklist, which outlines 24 items that describe the research team, patients, study participants, health conditions, clinical encounters, care teams, interventions, study measures, settings of care, and implementation of findings and results in primary care. The CRISP Working Group conducted a scoping review of literature on the state of primary care research reporting as well as several rounds of online surveys to assess ...

Researchers find neurons work as a team to process social interactions

2023-11-27

Researchers have discovered that a part of the brain associated with working memory and multisensory integration may also play an important role in how the brain processes social cues. Previous research has shown that neurons in the ventrolateral prefrontal cortex (VLPFC) integrate faces and voices—but new research, in the Journal of Neuroscience, shows that neurons in the VLPFC play a role in processing both the identity of the “speaker” and the expression conveyed by facial gestures and vocalizations. “We still don’t fully understand how facial and vocal information is combined and what information is processed by different ...

Not only is virtual care safe, patients and providers use it effectively, new research finds

2023-11-27

New research from McMaster University has found that not only is virtual care a safe way to hold medical appointments, but that patients and physicians were able to use it appropriately and effectively with minimal guidance. The study, published in Healthcare Quarterly on Nov. 27, was led by Shawn Mondoux, an emergency physician and associate professor in the Department of Medicine at McMaster. Mondoux and his team wanted to find out just how safe virtual care is when compared to an in-person assessment. To do this, researchers keyed in specifically on virtual ...

Child care centers aren’t a likely source of COVID-19 spread, study says

2023-11-27

Parents who send their children to child care can breathe a little easier – research published in JAMA Network Open from experts at Michigan Medicine, the University of Pittsburgh School of Medicine, and UPMC Children’s Hospital of Pittsburgh shows that children in daycare were not significant spreaders of COVID-19. The study found that transmission rates of SARS-CoV-2 within child care centers was only about 2% to 3%, suggesting that children and caregivers were not spreading COVID at significant rates to others ...

Next generation semiconductors: Diamond device shows highest breakdown voltage

2023-11-27

To reach the world’s goal of carbon neutrality by 2050, there must be a fundamental change in electronic materials to create a more reliable and resilient electricity grid. A diamond might be a girl’s best friend, but it might also be the solution needed to sustain the electrification of society needed to reach carbon neutrality in the next 30 years. Researchers at the University of Illinois Urbana-Champaign have developed a semiconductor device made using diamond, that has the highest breakdown voltage and lowest leakage current compared to previously reported diamond devices. Such a device will enable more efficient technologies needed as the world transitions to renewable energies. It ...

LAST 30 PRESS RELEASES:

Study shows psychedelic drug psilocybin gives comparable long-term antidepressant effects to standard antidepressants, but may offer additional benefits

Study finds symptoms of depression during pregnancy linked to specific brain activity: scientists hope to develop test for “baby blues” risk

UK study shows there is less stigma against LGBTQ people than you might think, but people with mental health problems continue to experience higher levels of stigma