Good Sleep Habits Tied to Lower Risk of Heart Failure

A combination of healthy sleep habits may help reduce the risk for heart failure, new research suggests.

Scientists studied 408,802 generally healthy people aged 27 to 73 between 2006 and 2010, collecting information on their sleep habits. Each person got a zero-to-five “healthy sleep score,” based on five healthy sleep practices: being a “morning person”; sleeping seven to eight hours a night; rarely or never snoring; rarely having insomnia; and rarely being excessively sleepy during the day.

Over an average follow-up of 10 years, there were 5,221 cases of heart failure. Compared with people who scored zero or one, those who scored two had a 15 percent reduced risk for heart failure; those who scored three had a 28 percent reduced risk; and those who scored four a 38 percent risk reduction. Those who scored a perfect five had a 42 percent lower risk of heart failure compared with those who scored zero or one.

The study, in the journal Circulation, controlled for smoking, alcohol intake, physical activity, diabetes, hypertension and other variables. It is an observational study, however, so it does not prove causality.

“We should consider all of these sleep behaviors together rather than treating them as separate phenomena,” said the senior author Dr. Lu Qi, a professor of epidemiology at Tulane University. “People regulate their sleep as a whole, not as separate events.”

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Social Isolation Tied to High Blood Pressure in Women

Women who are socially isolated have an increased risk for high blood pressure, researchers report. But men, not so much.

Scientists used data on 28,238 Canadian men and women aged 45 to 85 who are participating in a large continuing study on aging.

The researchers found that compared with married women, single women had a 28 percent higher risk of hypertension, divorced women a 21 percent higher risk, and widowed women a 33 percent higher risk.

Social connections were also significant. Compared with the one-quarter of women with the largest social networks — which ranged from 220 to 573 people — those in the lowest one-quarter, with fewer than 85 connections, were 15 percent more likely to have high blood pressure.

The associations were different, and generally weaker, in men. Men who lived alone had a lower risk of hypertension than men with partners, but the size of men’s social networks, or their participation in social activity, was not significantly associated with high blood pressure.

The study, in the Journal of Hypertension, controlled for many factors that affect blood pressure, including age, education, smoking, alcohol use and depression.

The senior author, Annalijn I. Conklin, an assistant professor at the University of British Columbia, said that the most important finding is that social ties seem to be more meaningful for women than for men. “Social ties matter for cardiovascular health,” she said, “and they matter more for women.”

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‘Cardio-obstetrics’ Tied to Better Outcome in Pregnancy With CVD

A multidisciplinary cardio-obstetrics team-based care model may help improve cardiovascular care for pregnant women with cardiovascular disease (CVD), according to a recent study.

“We sought to describe clinical characteristics, maternal and fetal outcomes, and cardiovascular readmissions in a cohort of pregnant women with underlying CVD followed by a cardio-obstetrics team,” wrote Ella Magun, MD, of Columbia University, New York, and coauthors. Their report is in the Journal of the American College of Cardiology.

The researchers reported the outcomes of a retrospective cohort analysis involving 306 pregnant women with CVD, who were treated at a quaternary care hospital in New York City.

They defined cardio-obstetrics as a team-based collaborative approach to maternal care that includes maternal fetal medicine, cardiology, anesthesiology, neonatology, nursing, social work, and pharmacy.

More than half of the women in the cohort (53%) were Hispanic and Latino, and 74% were receiving Medicaid, suggesting low socioeconomic status. Key outcomes of interest were cardiovascular readmissions at 30 days, 90 days, and 1 year. Secondary endpoints included maternal death, need for a left ventricular assist device or heart transplantation, and fetal demise.

The most frequently observed forms of CVD were arrhythmias (29%), cardiomyopathy (24%), congenital heart disease (24%), valvular disease (16%), and coronary artery disease (4%). The median Cardiac Disease in Pregnancy (CARPREG II) score was 3, and 43% of women had a CARPREG II score of 4 or higher.

After a median follow-up of 2.6 years, the 30-day and 90-day cardiovascular readmission rates were 1.9% and 4.6%, which was lower than the national 30-day postpartum rate of readmission (3.6%). One maternal death (0.3%) occurred within a year of delivery (woman with Eisenmenger syndrome).

“Despite high CARPREG II scores in this patient population, we found low rates of maternal and fetal complications with a low rate of 30- and 90-day readmissions following delivery,” the researchers wrote.

Experts Weigh In

“We’re seeing widely increasing interest in the implementation of cardio-obstetrics models for multidisciplinary collaborative care and initial studies suggest these team-based models improve pregnancy and postpartum outcomes for women with cardiac disease,” said Lisa M. Hollier, MD, past president of the American College of Obstetricians and Gynecologists and professor at Baylor College of Medicine in Houston.

Magun and colleagues acknowledged that a key limitation of the present study was the retrospective, single-center design.

“With program expansions over the next 2-3 years, I expect to see an increasing number of prospective studies with larger sample sizes evaluating the impact of cardio-obstetrics teams on maternal morbidity and mortality,” Hollier said.

“These findings suggest that our cardio-obstetrics program may help provide improved cardiovascular care to an otherwise underserved population,” the authors concluded.

In an editorial accompanying the reports, Pamela Ouyang, MBBS, and Garima Sharma, MD, wrote that, although this study wasn’t designed to assess the benefit of cardio-obstetric teams relative to standard of care, its implementation of a multidisciplinary team-based care model showed excellent long-term outcomes.

The importance of coordinated postpartum follow-up with both cardiologists and obstetricians is becoming increasingly recognized, especially for women with

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Higher Donor BMI Tied to Improved Lung Transplant Survival

Lung transplant patients who received a lung from obese donors had a 15-20% reduction in mortality at 1 year in one of the first studies to examine the impact of donor body mass index (BMI) and post-transplant survival.

Findings from the retrospective trial, which included data on patients and donors registered with the United Network for Organ Sharing Standard Transplant and Analysis database, suggest that donor obesity may confer a protective benefit for transplanted lungs.

The findings were presented this week in a poster session at the virtual CHEST conference, the annual meeting of the American College of Chest Physicians.

The BMI of lung transplant recipients has been shown to be an independent predictor of mortality, with studies showing an increased risk of death following transplant in patients who are either underweight or overweight, said Sung Choi, MD, of Rutgers New Jersey Medical School in Newark, who presented the findings.

For example, in a 2017 study involving over 17,000 lung transplants performed in the U.S. from 2005 to 2016, underweight and overweight lung recipients (i.e., BMI ≤20 and ≥28 at the time of listing) were found to be at increased risk for both short- and long-term mortality.

Recipient weight-loss prior to lung transplantation was also associated with a reduction in mortality and days on mechanical ventilation in a 2015 study, with greater reductions in BMI associated with greater survival benefit.

And, in a 2014 consensus statement, the International Society for Heart and Lung Transplantation recommended that a BMI of 30 or greater be considered a relative contraindication to lung transplantation.

Regarding donor BMI, however, Choi told MedPage Today that there hasn’t been prior research examining the impact on lung recipient outcomes and that the findings from his team’s study were a surprise: “We really weren’t expecting this result,” he said.

“We thought greater donor BMI might be associated with an increase in recipient mortality or maybe a null finding. What we found was striking to us. There appeared to be a dose-dependent relationship, with higher donor BMI associated with lower recipient mortality at 90 days and 1 year after the transplant,” Choi said.

Close to 16,000 adult patients who received single- or double-lung transplants from 2005 to 2018 were included in the analysis. Median age of the lung recipients was 59, and roughly 60% were male. Donors were categorized as underweight (BMI <18.5), normal weight (18.5 to <25), overweight (25 to <30), class I obesity (30 to <35), class II obesity (35 to <40), and class III obesity (≥40.0).

Average donor BMI was 25.9, and 45% were classified as normal weight.

A survival benefit at 1 year was observed among patients who received a lung transplant from donors in obesity class 1 (HR 0.867, 95% CI 0.772-0.975, P<0.01) and obesity classes II/III (HR 0.804, 95% CI 0.688-0.941, P<0.01) compared with lungs from normal-weight donors, the researchers reported.

In adjusted analyses, the team reported lower odds of survival with increased donor age, male sex, and presence of diabetes.

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Pandemic Fears Tied to Surge in Gun Sales in California | Health News

By Amy Norton
HealthDay Reporter

(HealthDay)

TUESDAY, Oct. 20, 2020 (HealthDay News) — Citing fears over violence and chaos, more than 100,000 Californians have bought guns in response to the COVID-19 pandemic, a new study estimates.

Researchers said the findings add to evidence that the U.S. pandemic has sparked firearm “panic-buying.” Early on, federal figures showed a spike in background checks, while some online firearm retailers reported soaring sales, according to Giffords, a gun violence prevention group.

The new study went beyond numbers, asking gun buyers about their motivations, said lead researcher Nicole Kravitz-Wirtz, an assistant professor with the University of California, Davis, Violence Prevention Research Program.

And it found that fear of violence and societal breakdown was the main driver.

The findings come from an ongoing California survey on firearm ownership and exposure to violence. Among 2,870 adults statewide, about 2.5% said they’d bought a firearm due to the pandemic.

That, according to Kravitz-Wirtz, translated to an estimated 110,000 gun purchases for the whole state. And it included 47,000 by first-time buyers.

Most buyers pointed to fears over “lawlessness” (76%), prison releases (56%), the government “going too far” (49%), or the government “collapsing” (38%).

The rise in firearm access is concerning, Kravitz-Wirtz said, because “extensive research” shows that having a gun in the home increases the risks of accidents, suicide and homicide — particularly where a woman is the victim.

Those risks could be further heightened now, at a time of widespread anxiety, unemployment and social isolation, according to Kravitz-Wirtz.

For mental health experts, the big concern is suicide, said Debbie Plotnick, vice president of state and federal advocacy for the nonprofit Mental Health America.

Two-thirds of gun deaths are suicides, she said. And access to a firearm greatly raises the odds that a suicide attempt will end in death.

With the pandemic taking a widespread mental health toll, experts fear it will all result in an increase in suicides, Plotnick said.

Since January, she noted, the Mental Health America website has seen a surge in traffic to its free screening tools for conditions like anxiety and depression. And many visitors are young people under age 24.

“We’re finding that young people are having a harder time than adults who’ve had the chance to live through trying times before,” Plotnick said.

So it’s particularly concerning, she noted, when guns are in the same home as teenagers and young adults — especially if the weapons are not stored properly.

And that may be a common scenario, the survey found. In response to pandemic fears, some gun owners had begun keeping firearms loaded and within easy reach.

An estimated 55,000 California gun owners had switched to that unsafe practice, according to Kravitz-Wirtz. About half of them lived with children or teenagers.

With many children home all day, that increases the chances of an accident, Kravitz-Wirtz noted.

Plotnick said, “If you bought a gun to make your family safer, the result may be the opposite.”

Both she and Kravitz-Wirtz stressed the importance

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Is it safe to go to the dentist? Very few infections tied to reopening, survey finds

Rates of Covid-19 among dentists were low in the late spring as dental practices reopened and patients returned, a report published Thursday by the American Dental Association suggests.

Researchers conducted a nationwide survey June 8 with responses from more than 2,000 dentists from across the country. Just 0.9 percent, they found, had either confirmed or probable cases of Covid-19.

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Early on in the coronavirus pandemic, it was widely believed that dentists would be at high risk of contracting Covid-19, as their work puts them in very close contact with patients and many of their procedures, which involve water and air spray, could generate virus-laden aerosol particles.

The survey also found that virtually all of the dentists — 99.7 percent — were using what was referred to as “enhanced infection control procedures.” They included screening protocols for patients and disinfection practices.

However, while nearly all dentists reported some use of personal protective equipment, only 73 percent of dentists reported wearing protective equipment in accordance with national guidance from the Centers for Disease Control and Prevention. That required the use of surgical masks, gowns, gloves and eye protection during procedures not expected to produce aerosols, as well as the use of N95 respirators for aerosol-generating procedures.

The lead author of the study, Cameron Estrich, a health data analyst at the American Dental Association, or ADA, said she was surprised by two things: the low rate of infection and the extremely high adoption of infection control measures.

“Pretty much all of the dentists that we surveyed had really stepped up their infection control and prevention procedures,” she said. “They had shut down their practices for a few months to get these all in place.”

Dr. Biana Roykh, an associate professor of dental medicine at Columbia University, said that while the findings are encouraging, it’s important to note that the survey was conducted in early June, when many practices may not have been fully operational and were limited to emergency visits only.

“It looks at a time when the pandemic was at its height and the experiences in the dental practices were probably more or less limited in terms of how much aerosols that we’re generating,” said Roykh, who wasn’t involved with the ADA report.

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In New York, for example, dentists weren’t allowed to fully reopen until May 31, just over a week before the survey was sent out.

Roykh said that while the findings are preliminary, they mirror what she has seen in her dental practice.

“Our experience with this specific pandemic shows that when we are compliant with good PPE measures, and health and safety controls are in place, that we are generally able to keep our workforce safe,” she said.

Renee Anthony, a professor of occupational and environmental health at the University of Iowa, said she is looking for data about infection rates of patients who have visited dental offices.

“While

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