Aporte a la rutina de la trinchera asistencial donde los conocimientos se funden con las demandas de los pacientes, sus necesidades y las esperanzas de permanecer en la gracia de la SALUD.
Hypertension Prevalence Among Adults Aged 18 and Over: United States, 2017–2018
Key findings Data from the National Health and Nutrition Examination Survey
In survey period 2017–2018, the prevalence of age-adjusted hypertension was 45.4% among adults and was higher among men (51.0%) than women (39.7%).
Hypertension increased with age: 22.4% (aged 18–39), 54.5% (40–59), and 74.5% (60 and over).
Hypertension prevalence was higher among non-Hispanic black (57.1%) than non-Hispanic white (43.6%) or Hispanic (43.7%) adults.
Hypertension was lowest among college graduates compared with those having a high school education or less, and those with more than high school or some college. This trend was similar among both men and women.
Overall hypertension prevalence decreased from 47.0% in 1999–2000 to 41.7% in 2013–2014 and then increased to 45.4% in 2017–2018.
Keywords
high blood pressure, National Health and Nutrition Examination Survey (NHANES)
The FDA is working to address the coronavirus disease (COVID-19) outbreak and keep you and your family informed on the latest developments. Here are answers to some frequently asked questions from consumers about possible treatments and Emergency Use Authorizations (EUAs):
Q. Can disinfectant sprays or wipes be used on my skin, injected, inhaled, or ingested, to prevent or treat COVID-19?
A: No. Always follow the instructions on household cleaners. Disinfectant sprays or wipes are intended for use on hard, non-porous surfaces. Disinfectant sprays or wipes are not intended for use on humans or animals. Do not use disinfectant sprays or wipes on your skin because they may cause skin and eye irritation. Do not inject, inhale, or ingest disinfectant sprays or household cleaners. Doing so is dangerous and may cause serious harm or death. If ingested, call poison control or a medical professional immediately.
Q: Are there data showing that chloroquine phosphate or hydroxychloroquine sulfate might benefit patients with COVID-19?
A: Hydroxychloroquine and chloroquine have not been shown to be safe and effective for treating or preventing COVID-19. They are being studied in clinical trials for COVID-19, and the FDA authorized their temporary use during the COVID-19 pandemic for treatment of the virus in hospitalized patients when clinical trials are not available, or participation is not feasible, through an Emergency Use Authorization (EUA) issued March 28, 2020.
In the lab, these drugs have been shown to prevent the growth of the virus that causes COVID-19. There are a few reports of patients with COVID-19 who received these drugs and improved. Some are reports of groups of patients, all of whom received the drug. It is not known whether it was the drug that led to the improvement or whether there were other factors involved. We do not know if the treated patients’ condition would have improved without the drug. To know this, there would have to be a group of similar patients who did not receive the drug (control).
Under the EUA, health care providers and patients are provided with information about the risks of these drugs. However, more data from clinical trials are necessary for us to determine whether chloroquine phosphate or hydroxychloroquine sulfate are safe and effective in treating or preventing COVID-19. In a Drug Safety Communication, the FDA cautions against the use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to the risk of heart rhythm problems.
Q: What does it mean when the FDA issues an “Emergency Use Authorization” for drugs, diagnostic tests, and/or other critical medical products?
Emergency use authorizations (EUAs) are one of several tools the FDA is using to help make important medical products available quickly during the COVID-19 pandemic. Learn more about EUAs by watching this video.
Blocking enzyme inhibits arthritis progression in mice
At a Glance
Loss of an enzyme called TET1 protected mice against the development of osteoarthritis.
Blocking TET1 in cells taken from people with osteoarthritis also prevented gene changes that help drive the disease.
The findings suggest a potential strategy for arthritis drug development.
Bone spurs and other arthritic damage appeared in normal mice after knee surgery (left); in contrast, mice lacking the enzyme TET1 were protected from arthritis progression (right).
Osteoarthritis occurs when cartilage, the tissue that cushions the ends of bones within joints, breaks down and wears away. It most often affects the fingers, knees, and hips. It typically develops after injury or surgery to a joint, or as part of the aging process. The resulting pain can prevent some people from working or doing daily living tasks.
Many people with osteoarthritis will eventually need surgery to repair or replace damaged joints. Currently, no drugs exist to prevent the progression of osteoarthritis. This is partially due to its complexity. Osteoarthritis is thought to be driven by changes in many different cellular pathways that the body uses to maintain cartilage health.
Researchers led by Dr. Nidhi Bhutani from Stanford University previously showed that a type of epigenetic change called cytosine hydroxymethylation (5hmC) builds up in the cartilage of people with osteoarthritis. Epigenetic changes are chemical changes that don’t alter the DNA sequence but modify the way genes are expressed—switched on or off. The changes found by the researchers affected the expression of many genes, including ones that have been linked with osteoarthritis development.
In a new study, they more closely examined 5hmC in a mouse model of osteoarthritis. The research was funded in part by NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Results were published on April 15, 2020, in Science Translational Medicine.
The researchers first performed knee surgery on male mice and tracked them for the development of post-traumatic osteoarthritis. Mice that developed the condition showed substantial increases in 5hmC. This corresponded to changes in expression for many genes associated with osteoarthritis.
To test whether TET1, an enzyme known to help drive 5hmC, was required for these changes, the researchers used mice that had been engineered to lack the enzyme. Unlike normal mice, mice lacking TET1 did not show deterioration of their knee cartilage after surgery, either immediately after surgery or in later stages of healing.
Mice lacking TET1 also showed few of the epigenetic changes driven by the enzyme—or corresponding changes in gene expression that can lead to damaged cartilage. While mice lacking TET1 seemed to have normal inflammation responses overall, their cartilage appeared protected from the effects of chronic inflammation that accompany osteoarthritis.
The researchers next blocked TET1 in cells taken from people with osteoarthritis. Whether done genetically or with a drug, inhibiting TET1 decreased 5hmC and corresponding harmful changes in gene expression.
Normal mice that received injections of the same drug into their knees after surgery had a reduction in 5hmC. They also had less degradation of their cartilage, similar to that seen in mice engineered to lack TET1.
“These results show that inhibiting multiple cellular pathways associated with osteoarthritis through a single target may be a feasible strategy for drug development,” Bhutani says. “Further studies should test whether blocking TET1 can prevent the progression of osteoarthritis in larger animals that have joints more representative of human joints and the loads they bear.”
Researchers reprogrammed skin cells into light-sensing eye cells that restored sight in mice.
The technique may lead to new approaches for modeling and treating eye diseases.
Three months after transplantation, immunofluorescence studies confirmed the survival of the chemically induced photoreceptor-like cells (green) and integration into the layers of the mouse retina. Sai Chavala, M.D., CIRC Therapeutics
The retina is a light-sensitive layer of tissue at the back of the eye. When light hits the retina, special cells called photoreceptors turn the light into electrical signals. Some eye diseases like macular degeneration can lead to damage and ultimately loss of the retina’s photoreceptors, causing permanent vision loss.
Stem cell therapy is a promising technique to replace dying photoreceptors. Researchers can create stem cells from skin or blood—called induced pluripotent stem cells—and then program them to become photoreceptors in the eye. These lab-made cells may then be transplanted into the retina to potentially restore sight. However, this process is difficult and time-consuming.
Researchers led by Dr. Sai Chavala at CIRC Therapeutics, Inc., Texas Christian University, and the University of North Texas Health Science Center set out to directly reprogram skin cells into photoreceptors, eliminating the need for stem cells. The study was funded in part by NIH’s National Eye Institute (NEI) and also involved NEI investigators. Findings were published in Nature on April 15, 2020.
The team began by testing a combination of four small compounds known to convert skin cells into neurons. By modifying this mixture and then adding another compound reported to reprogram cells into photoreceptors, they were able to chemically transform the skin cells into ones similar to rod photoreceptors. Rods work at low levels of light and are important for night vision.
The lab-made rod-like cells looked and functioned similarly to rods found naturally in the eye. The genes expressed by the new cells were also similar to those in real rod photoreceptors.
The researchers next transplanted the cells into mice with retinal degeneration. They tested their pupillary reflex, which controls the diameter of the pupil in response to light. In low light, pupil constriction depends on functioning rods. Within a month of transplanting the cells, six of 14 mice showed strong pupil constriction under low light, compared to none of the untreated controls.
Mice tend to seek out safe, dark locations, which requires vision in low light. The treated mice with restored pupil reflexes were significantly more likely to seek out and spend time in dark spaces than either untreated controls or treated mice without pupil constriction.
Three months after transplantation, the lab-made photoreceptors were still alive and integrated into the mouse retina.
The new technique is considerably more efficient than current approaches using induced pluripotent stem cells. Those can take six months before cells or tissues are ready for transplantation. In comparison, the reprogramming used in this study turned skin cells into functional rods ready for transplant in only 10 days.
“This is the first study to show that direct, chemical reprogramming can produce retinal-like cells, which gives us a new and faster strategy for developing therapies for age-related macular degeneration and other retinal disorders caused by the loss of photoreceptors,” says senior NEI investigator Anand Swaroop.
References: Pharmacologic fibroblast reprogramming into photoreceptors restores vision. Mahato B, Kaya KD, Fan Y, Sumien N, Shetty RA, Zhang W, Davis D, Mock T, Batabyal S, Ni A, Mohanty S, Han Z, Farjo R, Forster M, Swaroop A, Chavala SH. Nature. 15 April 2020, http://dx.doi.org/10.1038/s41586-020-2201-4(link is external).
Funding: NIH’s National Eye Institute (NEI); Nancy Lee and Perry R. Bass Endowment; Foundation Fighting Blindness.
Infant temperament predicts introversion in adulthood
At a Glance
Researchers found that an inhibited temperament in infancy predicts a reserved, introverted personality as an adult.
The study highlights the enduring nature of early temperament and suggests ways to identify those most at risk for developing anxiety and depression later in life.
The researchers studied how behavioral inhibition in infancy affected outcomes in young adulthood. NiDerLander / iStock / Getty Images Plus
We each have different temperaments that are fairly stable over time. Temperament is the biologically based way a person tends to emotionally and behaviorally respond to the world. Temperament during infancy can serve as the foundation for personality over time.
One type of temperament, called behavioral inhibition, is characterized by cautious, fearful behavior toward unfamiliar people, objects, and situations. Behavioral inhibition is relatively stable across toddlerhood and childhood. Children with behavioral inhibition are at elevated risk for developing so-called internalizing conditions such as social withdrawal and anxiety disorders.
The brain’s error monitoring system is thought to play a role in such conditions. This can be seen on EEG brain recordings. Negative dips show up when a person makes an error on a computerized task. This is called error-related negativity, or ERN. ERN reflects how sensitive a person is to their errors. A larger ERN has been associated with behavioral inhibition, while a smaller ERN has been linked with conditions such as impulsivity and substance use.
To investigate whether behavioral inhibition in infancy can predict personality traits in adulthood, a research team led by Drs. Daniel Pine at NIH’s National Institute of Mental Health (NIMH) and Nathan Fox at the University of Maryland recruited 165 infants at 4 months of age and assessed them for behavioral inhibition based on observation at 14 months.
When the infants were 15 years of age, the researchers recorded ERN on EEGs. The participants then returned at age 26 for assessments of psychopathology, personality, social functioning, and education and employment outcomes. Results appeared on April 20, 2020, in Proceedings of the National Academy of Sciences.
The team found that behavioral inhibition at 14 months of age predicted, by age 26, a more reserved personality, fewer romantic relationships, and lower social functioning with friends and family. It also predicted higher levels of internalizing behaviors in adulthood, particularly among those who also displayed larger ERN signals at age 15. Behavioral inhibition was not associated with education and employment outcomes.
“We have studied the biology of behavioral inhibition over time, and it is clear that it has a profound effect influencing developmental outcome,” Fox says.
More research is needed to see whether these findings apply more broadly to diverse populations. Most of the participants in the study were Caucasian and grew up in the middle to upper-middle classes.
Helping Cancer Survivors Cope with Cancer-Related Anxiety and Distress
, by NCI Staff
Studies have shown that anxiety and stress are common among long-term cancer survivors.
Credit: National Cancer Institute
Being diagnosed with cancer and going through intensive treatment is stressful. So, when treatment ends, family and friends are eager to celebrate. But many cancer survivors don’t feel like celebrating or don’t feel ready to move on with their lives.
One reason for this apparent disconnect is that “it can be scary to go from seeing [health care] providers and a medical team on a regular basis to not being seen as frequently,” said Suzanne Danhauer, Ph.D., a clinical psychologist at Wake Forest School of Medicine. As a result, Dr. Danhauer said, survivors’ distress levels often go up, often unexpectedly.
Fear that the cancer will come back, or recur, is another source of distress for many survivors. People often feel especially anxious when they’re due for a scan or other follow-up medical visit—a feeling that some cancer survivors have dubbed “scanxiety.”
“Scans are like revolving doors, emotional roulette wheels that spin us around for a few days and spit us out the other side,” wrote cancer survivor Bruce Feiler, in a June 2011 Time magazine article. “Land on red, we're in for another trip to Cancerland; land on black, we have a few more months of freedom.”
“Fear of recurrence is the most common emotional difficulty that people tell us they have after they’ve completed [cancer] treatment,” said Karen Syrjala, Ph.D., a clinical psychologist at the Fred Hutchinson Cancer Research Center in Seattle. And while a certain amount of anxiety is normal, for some survivors it can become debilitating, she said.
Research shows that anxiety and distress are more common in long-term cancer survivors than in their healthy peers with no history of cancer. In addition to the fear of recurrence, other sources of cancer-related distress for survivors include concerns about family and finances, changes in body image and sexuality, and the challenges of managing their long-term health needs.
These cancer-specific types of distress “may not fall into the classic description of anxiety or depression but are still disruptive to [a person’s] quality of life,” Dr. Syrjala said.
Numerous approaches have been shown to help cancer patients and survivors cope with cancer-related anxiety and distress. However, many studies of these methods have been done in large cancer centers, and one challenge that remains is how to implement existing approaches in real-world settings, such as community oncology or primary care practices, said Deborah Mayer, Ph.D., R.N., interim director of NCI’s Office of Cancer Survivorship.
Another limitation, Dr. Mayer said, is that many studies of approaches to help survivors cope with anxiety and distress, as well as with depression, have focused only on women who are breast cancer survivors. “We need to study people with other types of cancers as well,” she said.
Studies supported by NCI and others, however, are exploring new ways to support the psychological and emotional health needs of a diverse range of cancer survivors and how to tailor existing approaches to meet the needs of specific individuals or groups.
As the number of long-term cancer survivors continues to grow, oncologists and other providers who care for survivors have become more aware that their patients are at increased risk of anxiety and distress.
“Cancer survivors need the expertise of someone who knows cancer and understands what is ‘normal’ for a cancer survivor,” Dr. Syrjala said. It’s important to reassure survivors that some degree of anxiety and distress is very much normal and won’t increase their risk of dying or cause the cancer to come back, she added.
“And that’s a starting point for being able to say, ‘How do we then move on to help you manage [those feelings]?’”
Approaches that have been shown to be helpful for managing anxiety and distress in cancer survivors include a type of psychotherapy called cognitive behavioral therapy, mindfulness-based stress reduction, self-management, exercise, and—in some cases—antianxiety or antidepressant medications.
Support groups can also be helpful, but the logistics of organizing them can be challenging, Dr. Syrjala said. The growth of online support groups for survivors of diverse cancer types and treatments has made these resources accessible to far more people, she noted.
For adolescent and young adult cancer survivors, peer support through programs like First Descents, an outdoor adventure therapy program that has been shown to reduce symptoms of psychological distress, can be helpful, said Bradley Zebrack, Ph.D., M.S.W., M.P.H., of the University of Michigan School of Social Work.
Some approaches that help adult cancer survivors cope with distress, including cognitive behavioral therapy and mindfulness-based stress management, can also help adolescents and young adults.
But these younger survivors have unique needs because “their lives are interrupted at a time when there is a lot of rapid emotional and psychological growth,” Dr. Zebrack said. “Re-engagement in work, school, and relationships with friends will be much more challenging for them than for people diagnosed with cancer when they are older and in later stages of life.”
Acceptance and Commitment Therapy for Fear of Recurrence
One approach that could help cancer survivors cope with distress is a newer form of cognitive behavioral therapy called acceptance and commitment therapy, or ACT.
“ACT supports survivors in figuring out what they can change by taking specific actions consistent with their values, yet recognizing the parts of their experience they can’t change,” explained clinical psychologist Shelley Johns, Psy.D., of the Regenstrief Institute and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center.
For instance, she said, cancer survivors may always have concerns that the cancer will come back, but ACT can teach skills that help them “live with greater ease with those unchangeable realities.”
In a recent pilot study, Dr. Johns and her colleagues tested whether ACT could help breast cancer survivors better manage their fears of recurrence. Women in the study were randomly assigned to receive either 6 weeks of group-based ACT, a six-session survivorship education workshop, or a 30-minute group coaching session with a booklet on life after cancer treatment.
Six months after the intervention, participants in the ACT group reported greater reductions in the severity of their fear of recurrence than women in the other two groups. ACT also reduced anxiety and symptoms of depression at the 6-month follow-up point and improved survivors’ quality of life more than the other interventions, Dr. Johns said.
With ACT, she continued, “we offer coping skills so that fear is no longer ‘driving the car’ in survivors’ lives. The fear may still be in the car, yet it can ride in the back seat, while survivors keep their hands on the wheel and drive in their preferred direction.” These skills include pursuing meaningful activities, focusing on the present moment (mindfulness), and being kinder to yourself.
Storytelling to Help Survivors and Caregivers Cope with Distress
Addressing the needs of caregivers is another important area of research, Dr. Mayer said, as studies show that spouses and partners of cancer survivors are also more prone to anxiety than other people and may have their own health issues.
Health communication and behavioral scientist Wonsun (Sunny) Kim, Ph.D., of Arizona State University Edson College of Nursing and Health Innovation, is studying the effectiveness of a 4-week web-based digital storytelling approach to help both patients with cancer undergoing hematopoietic stem cell transplantation (HSCT) and their caregivers.
In an ongoing clinical trial, her team is investigating whether viewing personal, emotionally engaging “digital stories” told by other HSCT survivors and their caregivers during a 3-day digital storytelling workshop can help them cope with psychosocial distress, such as depression, anxiety, and social isolation.
“We encourage patients and caregivers to watch the digital stories together and discuss not just the story itself but also the emotions they felt” while watching, Dr. Kim said. Study participants are being followed for 3 months to learn whether the series of stories helps them talk with loved ones about how they are feeling, and thereby improve their emotional well-being. Patients and caregivers may not talk to each other about feelings such as anxiety “because they don’t want to worry the other person,” Dr. Kim noted.
If the approach is successful, she hopes to do a longer follow-up study to examine the effectiveness of the narrative-based digital storytelling approach for optimizing patient and caregiver psychosocial well-being during and after a transplant.
Additionally, she said, “The storytelling approach has broad applicability to other cancer types and other points in the cancer journey, depending on how we design the storytelling workshop” where the videos are made.
Exercising Together for Better Mental Health
At Oregon Health and Science University’s Knight Cancer Institute, exercise scientist Kerri Winters-Stone, Ph.D., is studying the effects of partnered exercise training on the physical and mental health and relationship quality of couples (survivors and their partners) coping with cancer.
“Cancer affects each partner’s physical and mental health and puts a strain on their relationship. It’s like a triple threat,” Dr. Winters-Stone said in a video being used to recruit study participants.
The Exercising Together trial is designed to learn whether and how exercise can benefit prostate, breast, or colorectal cancer survivors and their partners. Participants will be randomly assigned to exercise twice a week for 6 months in one of three groups: partnered exercise classes in a group setting, separate survivor and partner exercise classes in a group setting, or home-based, unsupervised, separate exercise for survivors and their partners.
The study will examine whether exercising together helps to reduce participating couples' anxiety, depression, and fear of recurrence and improve their physical health and the quality of their relationship.
“If couples train together as a team during exercise, we hope this can transfer outside of the gym and help them function better as a team in all facets of their life,” Dr. Winters-Stone said.
Her long-term goal is to make a compelling case that exercise should be included as a standard of care for every person with cancer. “We want partners to be included, too, because we know they’re also affected by cancer,” she said. “And that by keeping couples healthy, we achieve the best outcomes for everyone.”
Telehealth for Cancer Survivors in Rural Areas
Helping cancer survivors who live in rural areas cope with cancer-related anxiety and distress can be especially challenging. Survivors in these areas live far from large cancer centers, and “there often aren’t health providers in rural areas, especially mental health providers, who have oncology experience,” Dr. Danhauer said.
That’s where researchers hope that “telehealth” approaches such as therapy and other psychosocial support delivered by phone, mobile apps, and websites may be useful.
Dr. Danhauer and another clinical psychologist at Wake Forest, Gretchen Brenes, Ph.D., are conducting a pilot study that uses a cognitive behavioral therapy workbook as part of a stepped-care approach (based on the severity of symptoms) to help adult cancer survivors in rural areas who have clinically significant symptoms of anxiety or depression.
If randomly assigned to the stepped-care group, “people with more severe depression or anxiety will receive the workbook and work through it with a therapist on the telephone,” Dr. Danhauer said. Survivors with lower levels of depression or anxiety will go through the workbook on their own and check in with a research team member by phone every couple of weeks. Participants in the control group will receive information about resources, including local mental health providers.
If the pilot study results are promising, “we want to do a larger study looking at a telephone-based cognitive behavioral therapy intervention for distress in cancer survivors,” Dr. Danhauer continued.
She and Dr. Brenes also have a pilot research grant from Wake Forest Baptist Comprehensive Cancer Center to adapt the workbook and the telehealth approach linguistically and culturally for Hispanic cancer survivors.
Providing Resources When and Where People Need Them
The studies described here are just a sample of ongoing research to help cancer survivors cope with anxiety and distress, according to Ashley Wilder Smith, Ph.D., M.P.H., chief of NCI’s Outcomes Research Branch. “Cancer is many diseases and has many different trajectories, and researchers are exploring lots of ways to support cancer patients and survivors as they go through this experience,” Dr. Smith said.
One challenge that remains, Dr. Syrjala said, is that “we need to have the systems in place to make resources available when and where people need them, especially after patients finish treatment.”
To help address this challenge, NCI’s IMPACT Consortium, an initiative funded through the Cancer MoonshotSM, is looking at ways to incorporate the management of symptoms, including psychological symptoms, into electronic health records. This will allow such symptoms to be addressed in a more routine and comprehensive fashion in people with cancer and cancer survivors, Dr. Smith noted.
Finding the Silver Lining
Left unaddressed, serious anxiety, depression, or other types of psychological distress may leave cancer survivors unable to tend to their health care needs, Dr. Syrjala and other experts said. People may stop following treatment recommendations or avoid going to recommended follow-up appointments.
But surviving cancer can also lead to positive changes in a person’s life.
The flip side of psychological distress in survivors is “post-traumatic growth,” Dr. Syrjala said. The cancer experience may help survivors develop new strategies to manage emotional challenges, deepen their relationships with family or friends, and help them realize they have the strength to get through difficult situations. Surviving cancer may also lead people to re-evaluate their priorities and appreciate life more fully.
In addition, Dr. Smith said, “Cancer survivors may choose more healthy behaviors, such as exercising more or quitting smoking, because they are interested in a healthier life overall.”
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