A Systematic Review of Online Resources for the Dietary Management of Hyperphosphatemia in People With Chronic Kidney Disease.

OBJECTIVE: Internet search engines and social media websites are prominent and growing sources of dietary information for people with chronic kidney disease (CKD) and their healthcare providers. However, nutrition therapy for CKD is undergoing a paradigm shift, which may lead to inconsistent advice for managing hyperphosphatemia. The aim of this study was to summarize and evaluate online resources for phosphorus-specific nutrition therapy. DESIGN AND METHODS: Patient-facing resources were collected from Google, Yahoo, and Facebook in June-July 2021. Using nine independent search terms, the first 100 hits were reviewed. Dietary advice for food types, food groups, food subgroups, and individual food items was categorized as "restricted," "recommended," "mixed," and "not mentioned." Information on publication date, source, and author(s), phosphorus bioavailability, and demineralization were also collected. RESULTS: After removing duplicates, 199 resources from Google and Yahoo and 33 from Facebook were reviewed. Resources ranged from 2005 to 2021 and were primarily authored by registered dietitians and medical doctors (65% and 31%, respectively). Dietary advice mostly focuses on restricting high-phosphorus foods and phosphorus additive-based processed foods. Dietary restrictions were generally consistent with the traditional low-phosphorus diet, which targets whole grains, dairy, and plant-based protein foods, although major inconsistencies were noted. Phosphorus bioavailability and demineralization were rarely mentioned (16% and 8%, respectively). Similar findings were found on Facebook, but the limited number of resources limited meaningful comparisons. CONCLUSION: Results showed that online resources for phosphorus-specific nutrition therapy are highly restrictive of heart-healthy food items and contain significant inconsistencies. Given the widespread and increasing use of online resources by people with CKD and health care professionals to inform dietary choices, efforts are urgently needed to establish consensus for phosphorus-specific nutrition therapy. Until then, the findings of this study provide a basis for increasing awareness of the potential for confusion arising from online resources.

Age and racial and ethnic disparities in filled buprenorphine prescriptions post-emergency department visit in Nevada.

Objectives: We described age, gender, race, and ethnicity associations with filling buprenorphine prescriptions post-emergency department (post-ED) visits. Methods: We analyzed 1.5 years (July 1, 2020-December 31, 2021) of encounter-level Medicaid ED and retail pharmacy claims data obtained from the Nevada Department of Health and Human Services. We studied ED patients with an opioid use disorder (OUD) diagnosis who did not fill a prescription for OUD medications within 6 months before the ED encounter. Using logistic regression, we modeled the associations between the patient's demographic characteristics and the outcome, filling a buprenorphine prescription at a community pharmacy within 14 or 30 days of the ED encounter. Results: Among 2781 ED visits, representing 2094 patients, the median age was 39 years, 54% were male, 18.5% were Black, 11.7% were Hispanic, and 62.3% were White. Only 4% of the ED visits were followed by a filled buprenorphine prescription. Increasing age (14-day window: adjusted odds ratio (aOR) = 0.965, 95% confidence interval [CI]: 0.948-0.983) and being a Black patient (14-day window: aOR: 0.114, 95% CI 0.036-0.361) were both associated with lower odds of filled buprenorphine prescriptions. These results were similar within 30 days of an ED visit. Conclusions: Initiation of buprenorphine following an ED visit remains low among Nevadan Medicaid patients and is less likely with increasing age and among Black patients, despite strong evidence supporting its use. Overburdened EDs, lack of attention from managers, and substance use stigma are among possible explanations. When ED clinicians do write buprenorphine prescriptions, peer recovery support could increase the fill rates.

Vehicle-mounted high-power microwave systems and health risk communication in a deployed environment.

Vehicle-mounted high-power microwave systems have been developed to counter the improvised explosive device threat in southwest Asia. Many service members only vaguely comprehend the nature of these devices and the nonionizing radio frequency (RF) radiation they emit. Misconceptions about the health effects of RF radiation have the potential to produce unnecessary anxiety. We report an incident in which concern for exposure to radiation from a high-power microwave device thought to be malfunctioning led to an extensive field investigation, multiple evaluations by clinicians in theater, and subsequent referrals to an Occupational Health clinic upon return from deployment. When acute exposure to RF does occur, the effects are thermally mediated and immediately perceptible--limiting the possibility of injury. Unlike ionizing radiation, RF radiation is not known to cause cancer and the adverse health effects are not cumulative. Medical officers counseling service members concerned about potential RF radiation exposure should apply established principles of risk communication, attend to real and perceived risks, and enlist the assistance of technical experts to properly characterize an exposure when appropriate.

Electronic Nicotine Delivery Systems or E-cigarettes: American College of Preventive Medicine's Practice Statement.

INTRODUCTION: E-cigarettes or or electronic nicotine delivery systems (ENDS) have rapidly gained popularity in the U.S. Controversy exists about the safety and efficacy of ENDS. The American College of Preventive Medicine's Prevention Practice Committee undertook a consensus-based evidence review process to develop a practice statement for the American College of Preventive Medicine. METHODS: A rapid review of the literature was performed through June 2017 to identify efficacy, patient-oriented harms, and the impact on population health. RESULTS: On an individual level, limited evidence suggests that ENDS may be effective at reducing cigarette use among adult smokers intending to quit. There is insufficient evidence addressing potential long-term harms of ENDS, and limited evidence is available about short-term harms of ENDS and the impact of secondhand exposure. Although ENDS appear safer than combustible cigarettes, they are not without risk. Among youth there is no known benefit and significant concern for harm. On a population level, there may be significant harms associated with ENDS, particularly among youth nonsmokers. The long-term balance of potential benefits versus harms from the individual and population perspectives are unclear. CONCLUSIONS: The American College of Preventive Medicine developed practice recommendations that include encouraging screening for ENDS use, strategies to prevent the initiation of ENDS use in nonsmokers, particularly in youth, adoption of a harm reduction model for smokers intending to quit in those who refuse or fail to quit with evidence-based smoking-cessation methods, recommendations on policy and regulatory strategies to decrease public use of ENDS and regulation of their components, and future research needs.

West Nile virus.

West Nile virus infection has quickly become a feared cause of neurologic disability and death, particularly when it presents with encephalitis. Recent epidemics in endemic regions of Eurasia and Africa, as well as its recent spread to North America, have highlighted the need for all physicians to be aware of its clinical presentation and course. In particular, because of the increased susceptibility of West Nile virus infection during outdoor activities, as well as during travel to the Middle East and Southeastern Europe, military physicians should be informed about case recognition, management, and prevention to maintain the health of soldiers and their families.

Effects of experience and commercialisation on survival in Himalayan mountaineering: retrospective cohort study.

OBJECTIVES: To determine whether previous Himalayan experience is associated with a decreased risk of climbing death, and whether mountaineers participating in commercial expeditions differ in their risk of death relative to those participating in traditional climbs. DESIGN: Retrospective cohort study. SETTING: Expeditions in the Nepalese Himalayan peaks, from 1 January 1970 to the spring climbing season in 2010. PARTICIPANTS: 23,995 non-porters venturing above base camp on 39,038 climbs, 23,295 on 8000 m peaks. OUTCOME: Death. RESULTS: After controlling for use of standard route, peak, age, season, sex, summit success, and year of expedition, increased Himalayan experience was not associated with a change in the odds of death (odds ratio 1.00, 95% confidence interval 0.96 to 1.05, P = 0.904). Participation in a commercial climb was associated with a 37% lower odds of death relative to a traditional venture, although not significantly (0.63, 0.37 to 1.09, P = 0.100). Choice of peak was clearly associated with altered odds of death (omnibus P<0.001); year of expedition was associated with a significant trend toward reduced odds of death (0.98, 0.96 to 0.99, P = 0.011). CONCLUSIONS: No net survival benefit is associated with increased Himalayan experience or participation in a traditional (versus commercial) venture. The incremental decrease in risk associated with calendar year suggests that cumulative, collective knowledge and general innovation are more important than individual experience in improving the odds of survival.