Latest / Morning Medical with Dr. Chow / Childhood air pollution, AI in breast cancer screening, and the benefits of a protein-rich vegan diet

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Childhood air pollution, AI in breast cancer screening, and the benefits of a protein-rich vegan diet · Morning Medical with Dr. Chow

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  Good morning, and welcome to another episode of Morning Medical with Doctor Chow.
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  I am your host, Doctor Chining Chow.
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  Today, We have an array of fascinating topics to discuss, starting with a new study that
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  links childhood air pollution to bronchitis symptoms in adulthood.
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  This is a critical issue that affects many of us and the findings are both alarming and eye
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  opening.
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  So let's dive right into it.
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  Exposure to air pollution and childhood has been directly associated with bronchitic
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  symptoms in adulthood.
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  According to findings from a decades long study conducted in California.
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  The study led by Erica Garcia, PHD, MPH from the Keck School of Medicine at the University
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  of Southern California in Los Angeles found that each standard deviation increase in mean
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  childhood exposure to nitrogen dioxide a common byproduct of fossil fuel combustion was
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  associated with a 51% higher odds of experiencing cough flamb, and bronchitis
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  symptoms in adulthood.
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  Similarly, each standard deviation increase in mean exposure to particulate matters smaller
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  than 10 micrometers in diameter, which can stem from pollen, wildfire ash, dust, and other
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  sources was linked with a 69% higher odds of bronchitic symptoms later in life.
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  These findings were published in the American Journal regulatory and critical care medicine
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  and largely persisted even after adjusting for asthma and bronchitic symptoms in childhood.
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  A result that surprised the study authors.
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  Doctor Garcia noted in a press release that the results suggest childhood air pollution
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  exposure has more subtle effects on our respiratory system that still impact us in
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  adulthood.
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  Few studies have examined the long term impacts of childhood air pollution exposure on adult
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  respiratory health, although research from Norway, Sweden, and the Netherlands has shown
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  links between childhood pollution and later life asthma.
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  This study adds valuable evidence to the existing literature by providing a pathway from
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  childhood air pollution exposure to adult respiratory outcomes that are not solely
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  related to prior childhood respiratory effects.
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  Interestingly, the study also found that participants who had asthma in childhood had an
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  even greater odds of bronchitis symptoms in adulthood with increasing exposure to air
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  pollution.
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  Specifically, for each standard deviation, increase in childhood exposure to nitrogen
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  dioxide, the odds ratio was 2.27.
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  And for particulate matters smaller than 10 micrometers in diameter, The odds ratio was
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  2.34.
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  This underscores the importance of lowering air pollution, particularly during the critical
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  period of childhood.
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  Doctor Itau Garcia emphasized that protecting children from the adverse effects of air
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  pollution is better addressed at the policy level as there is only so much individuals can
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  do to control their exposure.
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  Notably, the average childhood exposure to nitrogen dioxide for participants who later
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  reported bronchitis symptoms as adults was only a little more than half of the annual limits
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  set by the Environmental Protection Agency in 1971.
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  Commenting on the study, doctor Elizabeth Gibb from the University of California, San
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  Francisco Benioff, Children's hospitals in Oakland explained that air pollution can cause
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  airway inflammation, impaired mucociliary clearance, and direct injuries to the
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  respiratory epithelium.
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  These changes can lead to airway remodeling over time, resulting in long term effects on
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  the airways as adults.
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  Doctor Lisa Patel from Stanford Medicine Children's Health also emphasized the need to
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  move toward renewable energy and incorporate air pollution counseling in clinical practice.
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  Especially for infants, young children, and those with respiratory conditions.
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  For their study, Garcia and colleagues used data from 3 cohorts in the decades long USC
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  Children's Health study, including 1308 participants recruited as children from 16
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  communities across Southern California.
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  Air Pollution Exposure was assessed based on residential histories during childhood, and
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  participants needed to have completed an online survey during adulthood with bronchitic
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  symptoms recorded for inclusion.
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  The study adjusted for various factors, including age, income, education, race, or
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  ethnicity, smoking, or mold in the childhood home, maternal smoking during pregnancy, recent
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  smoking status, and body mass index in adulthood.
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  During adulthood, 49% of participants reported having allergies 18% were smokers and 25%
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  reported bronchitic symptoms in the past 12 months.
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  The most common symptoms were congestion or bringing up phlegm followed by cough throughout
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  the day, cough first thing in the morning, and having previously had bronchitis.
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  Limitations of the study included recording adult bronchitic symptoms at a single moment in
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  time.
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  The inability to adjust for current air pollution levels and limited monitoring of
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  particulate matters smaller than 2.5 micrometers during the baseline and follow-up
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  questionnaires.
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  This study was supported by funding from the National Institutes of Health and the National
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  Institute of Environmental Health Sciences.
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  The findings highlight the urgent need for policies aimed at reducing air pollution,
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  particularly for protecting children during their critical developmental years.
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  As we continue to understand the long term impacts of air pollution, it becomes
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  increasingly clear that immediate action is necessary to safeguard the health of future
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  generations.
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  Introduction of artificial intelligence into screening mammography for breast cancer has
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  significantly improved screening performance while reducing radiologists workload according
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  to a large retrospective cohort study.
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  The study showed that recall and false positive rates decreased significantly while cancer
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  detection, positive predictive value and detection of small cancers increased.
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  The rate of invasive cancer decreased as well.
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  Using artificial intelligence to eliminate the need for dual radiologist review of negative
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  scans helped decrease workload by 33.5%.
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  According to Andreas Lauritzen, PhD of the University of Copenhagen, and co authors.
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  They reported these findings in the journal Radiology.
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  All screening performance indicators improved except for node negative rate, which did not
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  differ while the reading workload decreased the authors wrote in summary.
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  When the artificial intelligence examination score threshold for defining likely normal
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  screenings, was increased from 5 to 7 on a scale of 1 to 10, the recall rate, false
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  positive rate, and rate of node negative cancers all decreased significantly.
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  In other words, with a higher threshold, fewer women were recalled and recalls more frequently
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  resulted in a breast cancer this.
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  The findings are important because other recently reported studies of artificial
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  intelligence in mammography have come from Sweden.
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  The Danish study provides some reassurance that the results hold up in other countries, said
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  Laura Hicock MD of NYU, Langoni Health in New York City.
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  How artificial intelligence influences screening, mammography in the United States
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  remains to be seen.
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  In Europe, all mammograms are read by 2 radiologists, doctor Hicock explained if they
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  disagree They then have a consensus meeting where they make a joint decision.
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  This is different from the United States where 1 radiologist reads the mammogram.
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  Using artificial intelligence as a second reader decreased mammography reading workload
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  by 33.5%.
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  Which allowed those radiologists to do other needed radiology tasks instead, such as
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  procedures and looking at other studies waiting for a read He caught continued.
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  And switching 1 of the 2 readers to artificial intelligence, increased cancer detection rates,
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  reduced false positives, so it improved patient care.
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  The extra cancer detected by artificial intelligence tended to be smaller, which meant
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  patients are more likely to have good treatment outcomes.
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  A limitation is that they found slightly more pre invasive cancers The Danish results are
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  similar to or slightly better than the previously published Swedish trials she added.
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  Follow-up data from the Swedish trials are not yet available, but the studies showed that the
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  use of artificial intelligence as a second reader did not have a negative effect on
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  patient care.
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  Artificial intelligence systems, similar to the 1 in the Danish study, have already been
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  installed in more than 50 sites in 5 states, and the district of Columbia said Wei Yang, MD
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  of the University of Texas, MD Anderson Cancer Center in Houston.
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  The combination of increased breast cancer detection rate, lower false positive rate,
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  fewer callbacks, and reduced radiologist workload is compelling, said doctor.
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  How this data will play out in the United States where screening mammography is performed
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  annually without double reads versus every 2 to 3 years with double reading in Europe will be
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  interesting.
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  Lawrence and colleagues reported findings from an analysis of mammographic data for women who
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  underwent biennial breast cancer screening in Denmark during 2020 to 2022.
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  The study population comprised 60,751 women who were screened prior to the implementation of
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  the artificial intelligence system and 58246 afterward.
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  Historically, All mammograms in Denmark had been read by 2 radiologists.
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  After the implementation of the artificial intelligence system in November 2021, initial
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  reading was performed by 1 radiologist and the artificial intelligence system.
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  Mammograms considered likely normal by a radiologist and artificial intelligence were
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  accepted as normal.
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  Higher risk mammograms were evaluated by 2 radiologists with artificial intelligence
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  support.
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  The definition of likely normal initially was a score of 5 or less which was increased to 7 or
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  less in May 2022.
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  Comparing outcomes before and after implementation, The use of artificial
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  intelligence yielded lower recall rates, fewer false positives, and increased positive
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  predictive value.
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  Specifically, the recall rate decreased from 3.09percentto2.46percent.
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  False positives decreased from 2.39percent to 1.63% and positive predictive value increased
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  from 22.6 percent to 33.6 percent.
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  The cancer detection rate increased from 0.70percentto0.82percent, and the detection of
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  small tumors defined as 1 centimeter or smaller increased from 36.6 percent to 44.9 percent.
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  The rate of invasive cancers decreased from 84.9 percent to 79.6%.
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  The incidence of node negative cancers did not change significantly remaining at around 77%.
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  The radiology workload was decreased for 38900 and 77 of a 116,492 reads.
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  The study adds to the Danish team's previous simulation study of the artificial intelligence
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  system.
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  But is of greater interest to radiologists because it reflects the true impact of
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  artificial intelligence in a real life clinical practice.
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  Wrote Amy Lee, MD, of the University of California, San Francisco, and Sarah
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  Friedewald, MD, of Northwestern University in Chicago, in an accompanying editorial.
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  This is a welcome addition to the limited available studies evaluating prospective
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  implementation of artificial intelligence support tools in actual clinical practice.
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  Lee and Friedewald noted.
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  The results are consistent with those of 2 recent studies from Sweden.
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  1 study showed that double reading by radiologists with artificial intelligence
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  support was superior to double reading.
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  The other showed that reading by 1 radiologist and an artificial intelligence system was
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  superior to reading by 2 radiologists.
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  Lawitzen and co authors acknowledged several limitations to their research.
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  The median screening interval was longer with artificial intelligence due to the COVID 19
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  pandemic, lack of radiologists and waiting time, which probably contributed to higher
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  cancer detection rates.
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  The study also was not able to assess the individual effects of artificial intelligence
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  screening stratification and artificial intelligence assisted decision support.
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  Radiologists who performed single readings were not blinded to the fact that the artificial
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  intelligence system had categorized these screenings as likely normal.
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  The study also did not provide data on radiologists degree of agreement with
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  artificial intelligences markings, and it had insufficiently long follow-up on interval
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  cancers after the implementation of artificial intelligence.
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  This study was supported in part by Eurostars and by the pioneer center for artificial
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  intelligence.
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  Law Ritzen reported support from the capital region of Denmark.
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  Co authors reported multiple relationships with industry.
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  Hecock and Yang reported no relevant financial disclosures.
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  Lee disclosed a patent, royalty, or intellectual property interest.
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  Fried of all disclosed a relationship with Hologic.
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  Weight gain has long been a common side effect of antidepressants.
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  But some of them are more likely to add pounds than others according to a new study.
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  The study published on Monday in the journal annals of internal medicine analyzed the
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  electronic health records of more than 183,000 United States patients who were considered
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  first time anti depressant users and tracked their weight for 24 months.
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  After 6 months, patients who took Lexapro, Paxil, or Cymbalta, had a higher risk 10 to 15%
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  of gaining a clinically significant amount of weight defined as at least 5% of their baseline
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  weight.
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  Compared with users of Zoloft.
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  Those taking Wellbutrin were less likely to experience this type of weight gain.
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  The study included both the brand name and generic forms of each medication.
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  A lot of patients are concerned about gaining excess weight when they are taking an
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  antidepressant, said Joshua Petamar, who is an assistant professor of population medicine at
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  Harvard Medical School, and the Harvard Pilgrim Healthcare Institute, and the lead author of
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  the study that may be especially true of patients with a pre existing health condition
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  like diabetes, In addition, some patients might stop taking their antidepressant, even if it is
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  effective, because they do not like that they have gained weight.
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  That also can kind of lead to a host of adverse outcomes like increased risk of hospitalization
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  or relapse of symptoms.
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  Doctor Petamar said.
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  In the study, at 6 months, The patients who took Lexapro or Paxel gained about a pound more
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  on average than those who took Zoloft, which was the most commonly prescribed among the 8
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  antidepressants that were tracked.
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  People who took Cymbalta, efixo, or Celexa, also initially put on more weight than did
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  users of Zoloft But in each case, it was less than a pound.
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  Those who took Wellbutrin, however, put on less weight than those who took Zoloft.
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  Our final topic today delves into the health benefits of a protein rich vegan diet, a
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  subject that has garnered significant attention in recent years.
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  According to a comprehensive review of meta analyses conducted by researchers from the
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  University of Bologna, in Italy, and Stanford University School of Medicine, vegetarians and
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  vegans are significantly less likely to develop cardiovascular disease and cancer compared to
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  those who consume meat and poultry.
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  The findings highlight the potential long term health benefits of adopting a plant based diet.
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  The review, which pulled data from 48 meta analysis spanning from 2000 to 2023, revealed
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  that individuals following vegetarian or vegan diets tend to have better cardio metabolic
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  health overall.
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  This includes lower levels of inflammation, reduced blood pressure, lower cholesterol
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  levels, and leaner body mass indices.
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  These benefits are attributed to the high intake of fiber, vitamins, and antioxidants
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  found in plant based foods, which are often lacking in diets heavy in animal products.
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  1 of the most persistent myths about vegan diets is that they are deficient in protein.
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  However, as noted by leading nutrition researchers like doctor Christopher Gardener,
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  from Stanford University, all plants contain the essential amino acids required to form
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  complete proteins.
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  While some plants have higher concentrations than others, a varied vegan diet can easily
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  meet all protein needs.
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  Without the harmful effects associated with animal proteins.
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  According to the review, the average American consumes about twice as much protein as
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  necessary with most of it coming from animal sources.
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  This excess protein is often stored as fat, contributing to obesity and other health
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  issues.
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  In contrast, plant based proteins come without the added baggage of saturated fats,
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  cholesterol, and inflammatory compounds like TMAO.
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  Which are prevalent in animal products.
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  Moreover, plant based proteins offer an additional benefit.
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  Fiber.
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  The average fiber intake in the United States is only about 15 grams per day, whereas the
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  recommended amount is closer to 40 grams.
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  Fiber is crucial for digestive health and has been shown to reduce the risk of chronic
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  diseases such as heart disease diabetes, and certain cancers.
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  By consuming a diet rich in vegetables, fruits, whole grains, legumes, nuts, and seeds,
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  individuals can significantly boost their fiber intake while also meeting their protein
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  requirements.
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  The review also addressed common misconceptions about vegan diet such as the belief that they
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  can lead to bone fractures or deficiencies in essential nutrients.
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  While it is true that vegans need to be mindful 12 intake, which is not naturally found in
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  plant foods, this can be easily managed with supplements.
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  The overall health benefits of a well planned vegan diet far outweigh these concerns as
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  evidenced by the longer life expectancy and lower incidence of chronic diseases among
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  vegans compared to those who follow a standard American diet.
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  In conclusion, the evidence strongly supports the adoption of a protein rich vegan diet for
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  long term health benefit.
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  By focusing on a diverse range of plant based foods, individuals can meet their nutritional
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  needs while reducing their risk of chronic diseases and improving overall health.
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  As always, it is important to consult with health care professionals when making
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  significant dietary changes to ensure all nutritional requirements are met.
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  That wraps up today's episode of Morning Medical with Doctor Chow.
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  Thank you for joining us as we explore these critical health topics.
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  Remember, your health is your wealth, so take good care of it.
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  Have a great day, and we will see you next time.