Chocolate may decrease CAD risk

 This is observational only so don't run out and start consuming chocolate. You'll have to wait at least 50 years or your death before clinical studies will occur.

Chocolate may decrease CAD risk

Consuming chocolate at least once per week reduces the risk for CAD, researchers found.
“We somewhat know from prior research that eating chocolate may reduce blood pressure,” Chayakrit Krittanawong, MD, physician-scientist at Baylor College of Medicine in Houston, told Healio. “Lower blood pressure can prevent and reduce the risks of heart diseases. We found that consumption of chocolates at least once a week is probably associated with a reduction in the risk of coronary artery disease (eg, heart disease).”

Regular chocolate consumption may reduce the risk for CAD by 8%.

In a systematic review and meta-analysis published in the European Journal of Preventive Cardiology, researchers analyzed data from 336,289 participants from six prospective studies with an exposure of interest of chocolate consumption. These studies also assessed outcomes that included combined CAD, ACS and acute MI.
High chocolate consumption was defined as more than one time per week or more than 3.5 times per month. Follow-up was conducted for a median of 8.78 years.
Participants in this review had 21,777 diseases including CAD (n = 14,043), MI (n = 4,667), HF (n = 332) and cerebrovascular accidents (n = 2,735).
Participants with higher chocolate consumption had a decreased risk for CAD compared with those with low chocolate consumption (pooled RR = 0.92; 95% CI, 0.86-0.99; I² = 48.6%).
When excluding a study that used a cutoff of more than 3.5 times per month for chocolate consumption, participants who consumed chocolate more than one time per week had a decreased risk for CAD (pooled RR = 0.9; 95% CI, 0.84-0.97; I² = 46.6%). In a sensitivity analysis when excluding a study that was presented as an abstract, the pooled RR was 0.94 (95% CI, 0.85-1.03; I² = 52.2%).

Chayakrit Krittanawong

“This is an observational study, meaning we cannot conclude the causal relationship that eating chocolate can prevent or reduce heart disease,” Krittanawong said in an interview. “There are many confounders that we don’t have in this study. We have to ensure the results were not from those confounders before we implement it into the clinical practice. For example, people who love eating chocolate may eat more fruit and vegetables than people who don’t like chocolate.”

For more information:

Chayakrit Krittanawong, MD, can be reached at chayakrit.krittanawong@bcm.edu; Twitter: @krittanawongmd.

ORIGINAL ARTICLE How physical therapists instruct patients with stroke: an observational study onattentional focus during gait rehabilitation after stroke

Well, NO reporting on the actual results from this. So completely useless.

How physical therapists instruct patients with stroke: an observational study on attentional focus during gait rehabilitation after stroke

Elmar Kal, Henrieke van den Brink, Han Houdijk, John van der Kamp, PaulienHelena Goossens, Coen van Bennekom & Erik Scherder

To cite this article:

 Elmar Kal, Henrieke van den Brink, Han Houdijk, John van der Kamp, PaulienHelena Goossens, Coen van Bennekom & Erik Scherder (2017): How physical therapists instructpatients with stroke: an observational study on attentional focus during gait rehabilitation after stroke, Disability and Rehabilitation, DOI: 10.1080/09638288.2017.1290697

To link to this article:

http://dx.doi.org/10.1080/09638288.2017.1290697

Elmar Kal, Henrieke van den Brink, Han Houdijk, John van der Kamp, Paulien Helena Goossens, Coen van Bennekom & show all

Pages 1154-1165 | Received 20 Jul 2016, Accepted 31 Jan 2017, Published online: 24 Feb 2017

• Download citation
• https://doi.org/10.1080/09638288.2017.1290697

Abstract

Purpose: People without neurological impairments show superior motor learning when they focus on movement effects (external focus) rather than on movement execution itself (internal focus). Despite its potential for neurorehabilitation, it remains unclear to what extent external focus strategies are currently incorporated in rehabilitation post-stroke. Therefore, we observed how physical therapists use attentional focus when treating gait of rehabilitating patients with stroke.
Methods: Twenty physical therapist-patient couples from six rehabilitation centers participated. Per couple, one regular gait-training session was video-recorded. Therapists’ statements were classified using a standardized scoring method to determine the relative proportion of internally and externally focused instructions/feedback. Also, we explored associations between therapists’ use of external/internal focus strategies and patients’ focus preference, length of stay, mobility, and cognition.
Results: Therapists’ instructions were generally more external while feedback was more internal. Therapists used relatively more externally focused statements for patients with a longer length of stay (B = −0.239, p = 0.013) and for patients who had a stronger internal focus preference (B = −0.930, p = 0.035).
Conclusions: Physical therapists used more external focus instructions, but more internally focused feedback. Also, they seem to adapt their attentional focus use to patients’ focus preference and rehabilitation phase. Future research may determine how these factors influence the effectiveness of different attentional foci for motor learning post-stroke.

Heart attack patients prescribed antidepressants have worse one-year survival

What is it for stroke? Antidepressants improve stroke recovery.  Is your doctor giving you all the information needed to make the best choices for your recovery?

Antidepressants may help people recover from stroke even if they are not depressed

https://www.alphagalileo.org/ViewItem.aspx?ItemId=184127&CultureCode=en

01 March 2018 European Society of Cardiology (ESC)

• Under embargo until 03 March 2018 09:00 GMT

More research needed to identify reasons for higher mortality
Heart attack patients prescribed antidepressants have lower one-year survival rates, according to research presented today at Acute Cardiovascular Care 2018, a European Society of Cardiology congress.1
The observational study of nearly 9,000 patients found that those prescribed antidepressants at discharge from hospital after a heart attack had a 66% greater risk of mortality one year later than patients not prescribed the drugs, although they noted the cause is not necessarily related directly to the antidepressants.
Lead author Ms Nadia Fehr, a medical student at the University of Zurich, Switzerland, said: “Previous studies have suggested that cardiovascular disease may increase the likelihood of being depressed. On the other hand, depression appears to increase the probability of developing cardiovascular risk factors. However, little is known about the impact of depression on outcome after a heart attack.”
This study assessed the association of antidepressant prescription at hospital discharge with the one-year outcomes of patients with acute myocardial infarction (heart attack).
Data from AMIS Plus, the Swiss nationwide registry for acute myocardial infarction, were used to analyse 8,911 heart attack patients admitted to hospitals in Switzerland between March 2005 and August 2016. Patients were followed up by telephone 12 months after discharge.
The researchers compared patients who received antidepressant medication at discharge with those who did not with regard to baseline characteristics and one-year outcomes including mortality, a subsequent heart attack, and stroke.
A total of 565 (6.3%) patients received antidepressants at discharge from hospital. Compared to those who did not receive the drugs, patients prescribed antidepressants were predominantly female, older, and more likely to have hypertension, diabetes, dyslipidaemia, obesity and comorbidities. They were less likely to undergo percutaneous coronary intervention or receive P2Y12 blockers or statins, and stayed in hospital longer.
After adjusting for baseline characteristics the researchers found that the rates of stroke and subsequent heart attacks were similar between the two groups, but patients prescribed antidepressants had significantly worse survival. The rate of all-cause mortality at one-year after discharge was 7.4% in patients prescribed antidepressants compared to 3.4% for those not prescribed antidepressants (p<0.001).
Antidepressant prescription was an independent predictor for mortality, and increased the odds by 66% (odds ratio: 1.66; 95% confidence interval: 1.16 to 2.39).
“This was an observational study so we cannot conclude that antidepressants caused the higher death rate,” noted Ms Fehr.
She concluded: “Our study showed that many patients are treated with antidepressants after a heart attack. More research is needed to pinpoint the causes and underlying pathological mechanisms for the higher mortality we observed in this patient group.”

• Full bibliographic informationThe abstract ‘Impact of prescribed antidepressants in acute myocardial infarction patients on survival 1 year after discharge’ will be presented during Moderated Poster Session 1 – Acute Coronary Syndromes on 3 March from 10:00 to 11:00 CET in Moderated Poster Area A.

Can grapefruit stop stroke?

This is an analysis of the overblown headline in the Daily Mail- UK.  Observational studies are just that, observational, they don't prove anything, they suggest lines of research . 

Can grapefruit stop stroke?

A couple lines here; rest at the link.
But on the basis of this study alone, there is no evidence that women who eat citrus fruits will reduce their risk of stroke.
The Daily Mail does not accurately represent the findings of the study. Its headline, “How eating oranges and grapefruit can cut the risk of a stroke”, contradicts the finding that there was no significant association between intake of citrus fruits and juices and risk of stroke.
Cohort studies such as this aren't ideal for showing cause and effect.

A Primer on the Language of Observational Studies

I know I point to a lot of observational studies. This blogger explains why most of them are wrong.
http://www.medpagetoday.com/GarySchwitzer/31553
As a friend of mine wrote, the rooster crowing in the morning does not make the sun come up, even though a statistical association between the two coinciding is high.
But this is a message about messages -- inaccurate news stories and other messages about observational studies that use causal language where it is inappropriate.
One recent week we saw stories about citrus fruits protecting women from stroke. The very next week it was stories about “sleeping pills could kill 500,000.” And then we also had stories about “omega-3 fatty acids protecting the aging brain“… and about “Vitamin A may slash melanoma risk.” Sometimes it’s stories about lower risk (or protection), sometimes it’s stories about higher risk.
One thing is in common: almost all of the stories are simply wrong, using inaccurate language to describe the kinds of studies in question.
More at the link.
This comic has a good take on correlation vs. causation.
 http://xkcd.com/552/