The Vitals - October 2015

October 2015, Vol 3, No 10 - The Vitals

In This Article

Children’s IQ Not Linked to Breastfeeding

As the benefits of breastfeeding continue to be part of ongoing debate, recent data published in PLoS ONE indicate that it has little benefit for early life intelligence and cognitive growth from toddlerhood through adolescence.

Using data from the Twins Early Development Study, a prospective cohort study of twins born in the United Kingdom between 1994 and 1996, twins were excluded from the study if they had severe medical problems during pregnancy, at birth, or at the time of the study; their first language was not English; and their intelligence was tested <3 times between 2 and 16 years. Overall, 11,582 children were included in the analysis.

Breastfeeding was associated with a significantly higher IQ in girls aged 2 years; this association was not seen in boys. However, breastfeeding was not associated with other IQ growth factors in girls and boys.

“One might understand these findings to support the notion that breastfeeding has nutritional benefits for intelligence in the first few years of life given that breastfeeding was slightly associated with early life intelligence but not with later cognitive growth,” study authors Sophie von Stumm, Department of Psychology, Goldsmiths University of London, United Kingdom, and Robert Plomin, King’s College London, United Kingdom, concluded. “However because the observed effects were weak and at best modest, we interpret the findings as evidence for the lack of any benefits of breastfeeding on cognitive development from early life through adolescence.”

These data may be of interest to community pharmacists and healthcare providers who care for women seeking more information about the benefits of breastfeeding.

  1. von Stumm S, Plomin R. Breastfeeding and IQ growth from toddlerhood through adolescence. PLoS ONE. 2015 Sep 25. Epub ahead of print.

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Bed-Time BP Novel Therapeutic Target for New-Onset Diabetes

Data from a prospective study of 2656 people suggest that sleep-time blood pressure (BP) is a highly significant, independent prognostic marker for new-onset diabetes.

The study, which was published in Diabetologia, included 1292 men and 1364 women (age, 50.6 ± 14.3 years) without diabetes. BP was measured at baseline and annually thereafter, for a median follow-up period of 5.9 years. Altogether, 190 study participants were diagnosed with type 2 diabetes. Asleep systolic ambulatory BP was the most significant predictor of new-onset diabetes, the authors found, after adjusting for age, waist circumference, glucose, chronic kidney disease, and hypertension treatment. Daytime BP, as well as awake and mean 48-hour ambulatory BP, did not have predictive value. “Most important, lowering asleep BP, a novel therapeutic target requiring [ambulatory] BP evaluation, could be a significant method for reducing new-onset diabetes risk,” Ramón C. Hermida, University of Vigo, Pontevedra, Spain, and colleagues concluded.

In another study, also published in Diabetologia, Hermida and colleagues conducted a prospective, open-label, blinded end-point trial of 2012 patients without diabetes who were randomized to take all of their prescribed hypertension medication upon waking, or the entire daily dose of ≥1 prescriptions at bedtime. The patients were also followed for a median of 5.9 years, and 171 patients developed type 2 diabetes. Overall, bedtime ingestion of hypertension medications reduces the risk of new-onset type 2 diabetes.

Pharmacists and other healthcare providers should council patients to follow the instructions of their primary care physician about their BP medication and raise awareness about the potential risk for new-onset diabetes.

  1. Hermida RC, Ayala DE, Mojón A, Fernández JR. Sleep-time BP: prognostic marker of type 2 diabetes and therapeutic target for prevention. Diabetologia. 2015 Sep 23. Epub ahead of print.
  2. Hermida RC, Ayala DE, Mojón A, Fernández JR. Bedtime ingestion of hypertension medications reduces the risk of new-onset type 2 diabetes: a randomised controlled trial. Diabetologia. 2015 Sep 23. Epub ahead of print.

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Older Patients with Multimorbidities at Higher Risk for Cognitive Impairment

Chronic disease prevention and management in elderly patients is key to delaying or preventing mild cognitive impairment in this patient population, according to results published in the Journal of the American Geriatrics Society.

“With the growing number of individuals aged ≥65 in the United States and worldwide, the implications of the effect of multimorbidity on risk of age-related conditions such as mild cognitive impairment and dementia are highly relevant for public health planning, allocation of resources, and development of strategies to reduce risk of these conditions,” the study authors explained.

As part of a prospective cohort study, Maria Vassilaki, MD, MPH, PhD, Department of Neurology, and Department of Health Sciences Research, Mayo Clinic, Rochester, MN, and colleagues evaluated 2176 cognitively normal patients enrolled in the Mayo Clinic Study of Aging; participants were randomly selected from the community, evaluated by physicians, and underwent neuropsychometric testing at baseline and at 15-month intervals to assess diagnoses for mild cognitive impairment and dementia. Multimorbidity was defined as having ≥2 chronic conditions.

Among the study participants, 86.6% had multimorbidity. The risk for mild cognitive impairment or dementia was higher among patients with multimorbidity (hazard ratio [HR], 1.38) compared with patients with 1 or no chronic conditions. The risk was higher among patients with ≥4 conditions (HR, 1.61) compared with patients with 2 or 3 conditions (HR, 1.03), and higher in men with multimorbidity (HR, 1.20) than women with multimorbidity (HR, 1.20).

Multiple chronic conditions were associated with greater risk for mild cognitive impairment and dementia. Pharmacists and healthcare providers may use these data to educate patients about chronic diseases and raise awareness regarding multimorbidities and the risk for mild cognitive impairment and dementia.

Pharmacists and other healthcare providers in the community should be conscious of these data when caring for elderly patients with comorbidities as well as raise awareness about the potential risks for cognitive impairment.

  1. Vassilaki M, Aakre JA, Cha RH, et al. Multimorbidity and risk of mild cognitive impairment. J Am Geriatr Soc. 2015;63:1783-1790.

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Diagnostic Errors Persist in the United States

Approximately 5% of US adults seeking outpatient care experience a diagnostic error each year, according to a recent report by The National Academies of Sciences, Engineering, and Medicine.

“The delivery of health care has proceeded for decades with a blind spot: Diagnostic errors—inaccurate or delayed diagnoses—persist throughout all settings of care and continue to harm an unacceptable number of patients,” Erin P. Balogh and colleagues stated in the report.

In addition, the authors reported that, according to postmortem examination research, diagnostic errors contribute to approximately 10% of patient deaths; diagnostic errors account for 6% to 17% of hospital adverse events; and diagnostic errors are the leading type of paid medical malpractice claims.

Factors associated with diagnostic errors range from inadequate collaboration and communication among healthcare providers, patients, and their families; to a healthcare work system not well-designed to support the diagnostic process; limited feedback to clinicians about diagnostic performance; and a culture that discourages transparency and disclosure of diagnostic errors.

The researchers came to the conclusion that most people will experience ≥1 diagnostic errors in their lifetime, and without a concerted effort to improve diagnosis, these errors will likely worsen. They recommend that healthcare professionals and organizations, as well as patients, families, researchers, and policy-makers re-envision the diagnostic process and make a commitment to change.

  1. The National Academies of Sciences, Engineering, and Medicine. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press; 2015.

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CDC Reports on Vancomycin-Resistant Staphylococcus Aureus Strain

In a new report published by the Centers for Disease Control and Prevention (CDC), Maroya S. Walters, PhD, from the National Center for Emerging and Zoonotic Infectious Diseases at the CDC, provides notes from the field where a strain of vancomycin-resistant Staphylococcus aureus (VRSA) was identified in the chronic toe wound of a Delaware-based patient with diabetes mellitus and end-stage renal disease.

Patients at increased risk for VRSA were healthcare providers at the wound clinic and the dialysis clinic, as well as dialysis patients sharing the same shift as the patient. No methicillin-resistant S. aureus, VRSA, or vancomycin-resistant enterococci were cultured from the healthcare workers or dialysis patients who consented to be screened; this indicates that close contacts did not share precursor organisms or VRSA with the patient, according to the report.

Guidelines for VRSA investigation were revised in 2015, and are available online. Isolation of suspected or confirmed VRSA should be reported immediately through state and local health departments to the CDC’s Division of Healthcare Quality Promotion (This email address is being protected from spambots. You need JavaScript enabled to view it.).

Community pharmacists and healthcare providers should be aware of the risks associated with VRSA and take precautionary measures to avoid transmission of the disease.

  1. Walters MS, Eggers P, Albrecht V, et al. Vancomycin-resistant Staphylococcus aureus—Delaware, 2015. MMWR Morb Mortal Wkly Rep. 2015;64:1056.

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Last modified: October 29, 2015
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