All Work and No Play Leads To…

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All Work and No Play Leads To…

…Stroke? …Heart disease?

Show of hands—did any Morning Report readers work 55 hours or more this week? That is the definition of “working long hours,” according to the World Health Organization (WHO) and the International Labour Organization (ILO). Working long hours is common, upward trending, and more harmful than many of us assumed.

From 2000 to 2016, the WHO and ILO conducted a global meta-analysis of working long hours. Here are some findings that could make you drop your stethoscope mid-exam:

  • In 2016, 745,000 worldwide deaths from stroke and ischemic heart disease were attributed to working long hours
  • Working long hours increased 29% from 2000 to 2016, with deaths rising in tandem
  • Working ≥55 hours, compared with 35 to 40 hours, was associated with a 35% relative increase in risk of stroke and a 17% relative increase in risk of dying from ischemic heart disease
  • Currently, about 9% of the global population works long hours

Not to alarm you further, but we’d hate to see what that data looked like for clinicians during the COVID-19 pandemic.

You’ll have to excuse us while we close our laptops here at Pri-Med. We hope you are able to do the same!

“Who Needs Clinical Trial Data?”, Asks Dr. Fauci

Well, let’s put this into context. Our lionhearted COVID-19 leader, Dr. Anthony Fauci, stated at the recent American Thoracic Society virtual meeting that real-world evidence is continuing to show that the COVID-19 vaccines are extremely effective against concerning COVID-19 variants, including the UK variant and South African variant, and most likely against the P.1 and B.1.617 variants.

Real-world data show that the Pfizer/BioNTech vaccine, in particular, is 97.4% effective against severe and fatal COVID-19 across all variants.

“As many of you know, effectiveness in the real world is usually not as good as efficacy in the pristine conditions of a clinical trial,” said Dr. Fauci. “We have found just the opposite with the COVID-19 vaccine, where the effectiveness is easily as good, if not better, in real-world settings.”

mRNA COVID-19 Vaccines in Pregnancy—Any Safety Signals?

Have your pregnant patients been asking about the safety of the COVID-19 vaccines? We know a lot about the vaccines, but we haven’t known how they affect pregnant women, a vulnerable population given their higher risk of COVID-19 complications. Looking at two databases spanning 14 months of the pandemic, researchers uncovered the following data on pregnant women who received one of the mRNA vaccines:

  • More than 90% experienced injection site pain
  • More than half experienced fatigue, headache, and myalgia after dose No. 2
  • More than a third experienced chills and subjective fever

But how does this compare with nonpregnant women? Injection site reactions were slightly more common with pregnant women, but systemic reactions were more frequent in nonpregnant women.

Although not directly comparable, the proportions of adverse pregnancy and neonatal outcomes (e.g., fetal loss, preterm birth, small size for gestational age, congenital anomalies, and neonatal death) among participants with completed pregnancies from the v-safe pregnancy registry used in the study appear to be similar to the published incidences in pregnant populations studied before the COVID-19 pandemic.

Clearly, more research is needed—specifically a longer follow-up period and a larger number of pregnant women vaccinated in the first trimester—but this preliminary study showed no obvious safety signals for COVID-19 mRNA vaccination in the third trimester. Your pregnant patients can breathe a little easier after hearing this—well, except those in their ninth month when deep breaths are hard to come by.

Ovarian Cancer Screening—Does It Work?

A nearly two-decade long trial of 200,000-plus women aimed to determine the value of annual screening for ovarian cancer via multimodal screening or transvaginal ultrasound.

First, the good news: Screening DID detect early-stage disease.

Now, the bad news: That early detection did NOT save lives.

Coinvestigator Ian Jacobs, MD stated, “This is deeply disappointing and frustrating given the hope of all involved that we would save the lives of thousands of women who are affected by ovarian cancer each year.”

Based on these unfortunate findings, screening for ovarian cancer in the general population cannot be recommended. Back to the drawing board for fighting this devastating disease.

Official USPSTF CRC Screening Guidelines

The training wheels are off! The US Preventive Services Task Force (USPSTF) officially published its updated colorectal cancer (CRC) screening recommendations, finalizing draft recommendations released in October 2020.

Following the example of other organizations, the USPSTF determined that the intersection of risk and benefit is screening for CRC at age 45 for average-risk individuals. This bumps up its 2016 recommendation by 5 years, a move aimed to earlier detect and treat the 10.5% of new CRC cases that occur in people under age 50. Given that CRC is the third leading cause of cancer death for men and women, this recommendation is a major win for patient care.

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Did You Know?

Sildenafil citrate (Viagra) can make cut flowers stand up straighter for longer.
Yes, this was actually studied in 1999 by Australian researchers, who found that 1 mg of sildenafil citrate helped cut flowers stand up straight for up to a week beyond their natural life.

Could Modest BP Lowering Do the Trick?

Much like when using glitter or listening to “Baby Shark,” sometimes a small reduction can have an important effect. The same can be said for blood pressure (BP) lowering for primary and secondary prevention of cardiovascular (CV) events. At least that is what a new meta-analysis suggests.

An observational study of 48 randomized trials with a total of 340,000 plus individuals sought to understand whether a fixed reduction in BP provided the same CV risk reduction across varying systolic levels among those with and without CV disease.

After a median follow-up of 4.15 years, 12.3% of participants developed at least 1 major CV event. The key finding was that a reduction of systolic BP by only 5 mm Hg lowered the relative risk of major CV events by approximately 10%. This held true regardless of baseline BP or previous diagnosis of CV disease.

This study suggests that everyone can benefit from relaxed arterioles—they don’t discriminate. For those on antihypertensive agents, even a small decrease in BP is meaningful—hooray! And it also suggests that those without CV disease can also benefit. Now, we don’t necessarily recommend immediately prescribing antihypertensives for all your patients without CV disease or elevated BP. For those without hypertension, we do support a 5-mm Hg reduction. However, we want to remind you of all the other ways someone can reduce their BP by 5 mm Hg. For example, may we suggest a 4-minute walk per day, reducing salt intake, taking a spa day, and limiting sweetened and commercially prepared drinks.

Healthcare Humor

Patient: I told my physician I didn’t want to undergo brain surgery.

But he changed my mind.

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

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Not your typical medical newsletter… We get it, you see a lot of medical newsletters, so hear us out. This newsletter is intended to be fun, refreshing, and informative!

Every other week, we’ll highlight important medical news, sprinkled with some witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.