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Journal: Journal of internal medicine


Women with active sunlight exposure habits experience a lower mortality rate than women who avoid sun exposure; however, they are at an increased risk of skin cancer. We aimed to explore the differences in main causes of death according to sun exposure.

Concepts: Epidemiology, Ultraviolet, Mortality rate, Demography, Actuarial science, Melanoma, Skin cancer, Sunscreen


OBJECTIVE: Different healthy food patterns may modify cardiometabolic risk. We investigated the effects of an isocaloric healthy Nordic diet on insulin sensitivity, lipid profile, blood pressure and inflammatory markers in people with metabolic syndrome. DESIGN: We conducted a randomised dietary study lasting for 18 to 24 weeks in individuals with features of metabolic syndrome (mean age 55 years, BMI 31.6 kg/m(2) , 67% women). Altogether 309 individuals were screened, 200 started the intervention after 4-weeks run-in period, and 96 (proportion of dropouts 7.9%) and 70 individuals (dropouts 27%) completed the study, in the Healthy diet and Control diet groups, respectively. Healthy diet included whole grain products, berries, fruits and vegetables, rapeseed oil, three fish meals per week, and low fat dairy products. An average Nordic diet served as a Control diet. Compliance was monitored by repeated 4-d food diaries and fatty acid composition of serum phospholipids. RESULTS: Body weight remained stable, and no significant changes were observed in insulin sensitivity or blood pressure. Significant changes between the groups were found in non HDL cholesterol (-0.18, 95% CI -0.35;-0.01, p= 0.04), LDL- to HDL cholesterol (-0.15, -0.28;-0.00, p=0.046) and apolipoprotein B to apolipoprotein A1 ratios (-0.04, -0.07; -0.00, p=0.025) favouring the Healthy diet. IL-1Ra increased during the Control diet (difference -84,-133;-37 ng/l, p=0.00053). Intakes of saturated fats (beta estimate 4.48, 0.02; 8.53, p=0.049) and magnesium (-0.23, -0.41;-0.05, p=0.012) were associated with IL-1Ra. CONCLUSIONS: Healthy Nordic diet improved lipid profile and had a beneficial effect on low-grade inflammation. © 2013 The Association for the Publication of the Journal of Internal Medicine.

Concepts: Cholesterol, Nutrition, Fatty acid, Atherosclerosis, Obesity, Fat, High-density lipoprotein, Lipid


Coffee is widely consumed and contains many bioactive compounds, any of which may impact pathways related to disease development.

Concepts: Epidemiology, Clinical trial, The Canon of Medicine, Avicenna,, Coffee


Since 2006, human papillomavirus (HPV) vaccines have been introduced in many countries worldwide. Whilst safety studies have been reassuring, focus has been on the primary target group, the young adolescent girls. However, it is also important to evaluate safety in adult women where background disease rates and safety issues could differ significantly.

Concepts: Immune system, Medicine, Cancer, Disease, Infectious disease, Human papillomavirus, Papillomavirus, HPV vaccine


Coffee drinking has been implicated in mortality and a variety of diseases but potential mechanisms underlying these associations are unclear. Large-scale systems epidemiological approaches may offer novel insights to mechanisms underlying associations of coffee with health.

Concepts: Epidemiology, Infectious disease, Demography


Patients with psoriasis are prone to premature atherosclerosis and increased risk of cardiovascular disease events. However, the prevalence and extent of atherosclerosis in patients with psoriasis are unknown.

Concepts: Disease, Myocardial infarction, Atherosclerosis, Medical terms, Blood vessel, Cardiovascular disease, Low-density lipoprotein, Non-infectious disease


In this issue of the Journal of Internal Medicine, Lewis and colleagues [1] provide compelling data for a novel subgroup within the chronic fatigue syndrome (CFS) population. They show that approximately 13% (24/179) of CFS patients have postural orthostatic tachycardia syndrome (POTS), a form of dysautonomia implying that when patients change their body position from supine to upright, their heart rate will increase abnormally (tachycardia). POTS is associated with several symptoms often seen in CFS patients: fatigue, lightheadedness, dizziness, neurocognitive deficits and exercise intolerance. Importantly, this was a confirmatory study of a previously published pilot study that found a prevalence rate for POTS of 29% in a smaller sample (n=63) of CFS patients [2]. Another significant finding is the differences in fatigue severity, depressive thoughts, and daytime hypersomnolence between CFS patients with and without POTS, providing evidence for the clinical importance of POTS in CFS. © 2013 The Association for the Publication of the Journal of Internal Medicine.

Concepts: Central nervous system, Nervous system, Brain, Cardiology, Neurology, Fatigue, Chronic fatigue syndrome, Postural orthostatic tachycardia syndrome


At present, the severity of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a focal point.


The diuretic hydrochlorothiazide is among the most frequently prescribed drugs in the United States and Western Europe, but there is suggestive evidence that hydrochlorothiazide use increases the risk of lip cancer.

Concepts: European Union, United States, United Kingdom, Republic of Ireland, Eastern Europe, Western culture, Russia, Hydrochlorothiazide


Hypertension is highly prevalent in older age and accounts for a large proportion of cardiovascular (CV) morbidity and mortality worldwide. Isolated systolic hypertension is more common in the elderly than younger adults and associated with poor outcomes such as cerebrovascular disease and acute coronary events. International guidelines are inconsistent in providing recommendations on optimal blood pressure targets in hypertensive elderly patients as a result of the limited evidence in this population. Evidence from clinical trials supports the use of antihypertensive drugs in hypertensive elderly patients due to benefits in reducing CV disease and mortality. However, elderly participants in these trials may not be typical of elderly patients seen in routine clinical practice, and the potential risks associated with use of antihypertensive drugs in the elderly are not as well studied as younger participants. Therefore, the purpose of this review was to provide a comprehensive summary of the benefits and risks of the use of antihypertensive drugs in elderly patients (aged ≥65 years), highlighting landmark clinical trials and observational studies. We will focus on specific outcomes relating to the benefits and risks of these medications in hypertensive elderly patients, such as CV disease, cognitive decline, dementia, orthostatic hypotension, falls, fractures, cancer and diabetes, in order to provide an update of the most relevant and current evidence to help inform clinical decision-making.

Concepts: Death, Hypertension, Blood pressure, Old age, Ageing, Orthostatic hypotension, Hypotension, Cardiovascular diseases