Latest / Morning Medical with Dr. Chow / Rise in Myopia, Antibiotic Resistance, and AI's Role in Healthcare

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Rise in Myopia, Antibiotic Resistance, and AI's Role in Healthcare · Morning Medical with Dr. Chow

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Good morning and welcome to another episode of Morning Medical with Dr.
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Chow.
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I’m your host, Dr.
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Chi-Ming Chow.
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Today, we’re diving into some pressing health issues making headlines around the world.
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Our first topic is a concerning trend that’s affecting children globally: the rise in
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nearsightedness, or myopia.
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A new study published in the British Journal of Ophthalmology has issued a warning about the
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declining eye health of children worldwide.
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According to the study, nearly one in three children were nearsighted in 2023, and this
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number is expected to increase in the next two decades.
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The study analyzed data from 276 studies, involving more than 5.4 million children across
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50 countries and six continents.
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The numbers are quite alarming.
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The prevalence of nearsightedness rose from 24 percent in 1990 to almost 36 percent as of last
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year.
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And if the projections by the study’s researchers are accurate, we could be looking
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at nearly 40 percent of children being nearsighted by the year 2050.
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While the rise in myopia has been gradual, the study highlights a notable increase after the
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height of the COVID-19 pandemic.
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The researchers point to lockdowns and the shift to online learning as significant
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contributing factors.
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These changes led to extended periods of staying indoors, a decrease in outdoor
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activities, and an increase in screen time—all of which are detrimental to eye health.
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So, what exactly is myopia, and who is most at risk?
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Nearsightedness, or myopia, is a condition where near objects are seen clearly, but
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distant objects appear blurry.
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According to the Canadian Association of Optometrists, myopia typically starts in early
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childhood and tends to worsen as individuals grow older.
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Younger children are particularly susceptible due to environmental factors.
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The study also found that children in urban areas are at a higher risk of developing
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myopia.
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Interestingly, girls are more likely than boys to become nearsighted.
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Depending on the region, the prevalence of myopia varies, with Asia showing the highest
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rates at about 35 percent, while Latin America and the Caribbean have the lowest, sitting at
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almost four percent.
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Among the countries with available data, Japan has the highest rate of myopia at 86 percent,
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followed by the Republic of Korea at 74 percent, and Russia at 46 percent.
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In contrast, Canada has a relatively lower rate of about 17 percent.
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So, what can parents do to help prevent nearsightedness in their children?
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Researchers emphasize the importance of developing eye-protective habits from a young
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age.
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Increasing physical activity and reducing screen time are crucial steps.
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Governments also need to play a role by implementing policies that reduce the burden of
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excessive homework and off-campus tutoring on young students.
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Regular physical examinations and early detection and treatment are also essential.
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For children diagnosed with myopia, glasses or contact lenses are the most common forms of
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vision correction.
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However, as they grow, some may consider surgical options like LASIK or artificial lens
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implants, although these are typically available only after the age of eighteen.
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The Alberta government advises that if your vision does not significantly impact your daily
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life, surgery may not be necessary.
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But if glasses or contact lenses are inconvenient, surgical options could be
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considered, weighing the risks and costs involved.
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In summary, the rise in nearsightedness among children is a global concern that requires
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immediate attention.
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From increasing outdoor activities to reducing screen time and implementing supportive
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policies, multiple strategies need to be employed to combat this growing issue.
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As always, early detection and intervention are key.
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Stay tuned as we continue to explore more health topics on Morning Medical with Dr.
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Chow.
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The global threat of antibiotic resistance is one of the most pressing health issues of our
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time.
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On Thursday, global health officials gathered at the United Nations to discuss the
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multifaceted challenges posed by antimicrobial resistance.
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This slow-motion health emergency has traditionally been framed as a problem of
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excess, where the overconsumption and misuse of antibiotics render them less effective.
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This has led to the unnecessary deaths of millions, many of whom are from poorer regions
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of the world.
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However, there is a growing movement among experts to expand our understanding of the
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issue.
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Dr.
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Ramanan Laxminarayan, an economist and epidemiologist, has been a vocal advocate for
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this new approach.
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He argues that the problem should not only be about resistance but also about entitlement.
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According to Dr.
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Laxminarayan, millions of people around the world have never even taken an antibiotic
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because they simply cannot afford them.
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This disparity in access needs to be addressed if we are to tackle antimicrobial resistance
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effectively.
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The new approach to antimicrobial resistance emphasizes preventing treatable infections
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through improved sanitation, higher vaccination rates, and increased access to anti-infective
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drugs in lower-income countries.
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It’s a delicate balance: promoting greater access to antibiotics in some areas while
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seeking to limit their use in others.
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This nuanced strategy aims to thread the needle between overuse and underuse of these
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lifesaving drugs.
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Since the United Nations held its first high-level meeting on antimicrobial resistance
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eight years ago, the world has become increasingly aware of the threats posed by
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untreatable infections.
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The challenge now is to implement a global strategy that ensures everyone has access to
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effective antibiotics while also curbing their misuse.
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This dual approach could help mitigate the devastating impact of antimicrobial resistance
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on global health.
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In summary, the fight against antimicrobial resistance requires a multifaceted approach
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that includes improving sanitation, increasing vaccination rates, and ensuring equitable
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access to antibiotics.
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It also involves educating the public and healthcare providers about the dangers of
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antibiotic misuse.
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Only through a comprehensive and balanced strategy can we hope to address this global
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health crisis effectively.
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The data are clear: patients regain weight after stopping GLP-1 drugs.
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This is the conclusion of several clinical trials that have investigated the long-term
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efficacy of these medications.
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Without staying on the drugs, there is no evidence-based strategy to maintain weight
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loss, experts say.
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Dr.
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Nate Wood, from Yale School of Medicine, explained that the expectation is for patients
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to regain at least some, if not all, of the weight they lost once they discontinue the
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medication.
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"We really think about obesity as a chronic disease.
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And chronic diseases require chronic treatment," Dr.
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Wood stated.
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Clinical trials like the STEP 1 extension trial have shown significant weight regain after
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stopping GLP-1 drugs.
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In this trial, participants who had been taking weekly semaglutide, along with a lifestyle
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intervention, regained two-thirds of the weight they had lost a year after stopping the drug.
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In the first phase of the STEP 1 trial, which involved almost two thousand adults with
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overweight or obesity who did not have diabetes, those on semaglutide lost an average
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of 14.9 percent of their body weight after 68 weeks.
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In contrast, those on a placebo lost only 2.4 percent of their body weight.
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A subset of participants continued into an extension phase, and those who stopped
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semaglutide regained 11.6 percentage points of weight loss, compared with just 1.9 percentage
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points for the placebo group.
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John Wilding, from Aintree University Hospital in Liverpool, who was the corresponding author
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for the STEP 1 extension trial, noted that it is "not really surprising that medicines do not
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continue to work after people stop taking them." He compared the situation to treatments
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for other long-term conditions, such as high cholesterol or high blood pressure, where
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continuous medication is expected.
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The STEP 4 trial also studied the effects of semaglutide withdrawal among adults with
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overweight or obesity who did not have diabetes.
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About 800 people who had mean weight loss of 10.6 percent after 20 weeks on semaglutide were
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randomized to either a maintenance dose or placebo, along with continued lifestyle
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intervention.
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Those who stayed on the drug for another 48 weeks continued to lose weight, an additional
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7.9 percent on average, while those switched to placebo gained back 6.9 percent of their lost
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weight.
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The SURMOUNT-4 trial focused on withdrawal from tirzepatide, a combined GLP-1 and
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glucose-dependent insulinotropic polypeptide agonist.
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After 36 weeks on the drug, patients had a mean weight loss of 20.9 percent.
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They were then randomized to stay on the drug or switch to placebo, with continued lifestyle
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intervention.
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Those who continued on treatment lost more weight, while those switched to placebo
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regained some weight, ending up with a mean weight loss of 25.3 percent and 9.9 percent,
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respectively, at 88 weeks.
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Dr.
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Robert Kushner, from Northwestern University Feinberg School of Medicine, emphasized that in
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both the STEP 4 and SURMOUNT-4 trials, participants were blindly randomized to
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continue taking the drug or stop it.
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He highlighted how this aspect is "very powerful." Participants who stayed on the
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medication continued to lose weight, whereas those who were switched to placebo regained
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weight despite their optimism and regular counseling.
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These findings underscore the underlying biology of obesity and the role of medication
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in managing the disease.
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However, there are challenges associated with long-term use of GLP-1 drugs.
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Dr.
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Sarah Armstrong, from Duke University School of Medicine, pointed out that the challenges are
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similar to those of taking any long-term medication, such as the need to manage
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prescriptions while traveling and tolerating potential side effects.
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Gastrointestinal issues are commonly reported side effects of GLP-1 drugs.
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Dr.
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Wood mentioned that switching between GLP-1 drugs might help some patients if they can
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tolerate one drug better than another.
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It is also crucial to titrate the medications carefully to avoid rapid weight loss, which can
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lead to side effects like excess muscle loss or gallstones.
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Dr.
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Wood also cautioned about the mental health toll associated with stopping these drugs.
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The body's response to stopping the medication can lead to extreme cravings and the perception
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of starvation, making it difficult for patients to manage their weight without the drugs.
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Dr.
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Armstrong noted that there is a lack of data on strategies to mitigate weight regain after
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stopping GLP-1 drugs.
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She emphasized the need for more research to find out what the next steps should be once an
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ideal body mass index is achieved.
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Dr.
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Kushner advised clinicians to individualize their conversations with patients who want to
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stop taking GLP-1 drugs.
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He suggested dose tapering, intermittent therapy, or switching to older, more
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cost-effective weight loss medications, along with significant lifestyle changes, as
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potential strategies.
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In summary, while GLP-1 drugs are effective for weight loss, maintaining that weight loss after
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stopping the medication remains a significant challenge.
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More research is needed to develop evidence-based strategies for long-term weight
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management.
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Patients should continue to see their healthcare providers to manage their weight
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effectively.
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Prompt engineering is becoming an essential skill for medical students.
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A recent letter published in Academic Medicine argues that doctors, especially those still in
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medical school, should receive training in prompt engineering to optimize the use of
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generative artificial intelligence in medicine.
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This training could help future physicians better utilize AI tools for various
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applications, from drafting patient messages to generating accurate medical information.
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Interestingly, AI chatbots are playing an increasingly significant role in healthcare.
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According to a report in the New York Times, these chatbots are now involved in generating
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patient-facing medical information and even answering direct medical questions.
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In the United Kingdom, a study published in BMJ Health & Care Informatics revealed that one in
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five primary care physicians reported using AI chatbots in their practice.
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This trend indicates a growing acceptance and reliance on AI technologies in everyday medical
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practice.
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Another fascinating development is the emergence of the 'AI scientist,' a system
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capable of writing and reviewing its own research papers.
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However, its usefulness is still under scrutiny, as discussed in a recent Nature
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article.
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While the concept is groundbreaking, experts are debating whether AI can match the nuanced
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understanding and critical thinking of human researchers.
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In clinical settings, AI continues to show promise.
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At the European Respiratory Society Congress, a study demonstrated that ChatGPT version 3.5
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outperformed trainee doctors in assessing complex respiratory illnesses in children.
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This finding suggests that AI could become a valuable tool in diagnosing and managing
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pediatric respiratory conditions.
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Scientists are also using AI to crack the 'olfactory code,' helping to unravel the
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mysterious biology of smell.
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This research, published in Nature, aims to better understand how our sense of smell works,
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potentially leading to new treatments for olfactory disorders.
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AI-powered clinical documentation tools are another area where artificial intelligence is
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making an impact.
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A small trial published in JAMA Network Open found that about half of the clinicians
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reported time management benefits from using these tools.
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However, a significant proportion said that the tools had no impact on their overall electronic
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health record experience, highlighting the need for further refinement and user training.
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Machine learning is also improving electronic detection of potential diagnostic errors.
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Another study in JAMA Network Open demonstrated that machine learning algorithms could enhance
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the accuracy of diagnostic processes, potentially reducing medical errors and
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improving patient outcomes.
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In the realm of drug development, researchers writing in Nature Medicine have developed a
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much-improved model for using AI in drug repurposing.
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This model aims to identify existing drugs that could be effective for new indications,
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accelerating the drug development process and potentially bringing new treatments to market
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more quickly.
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Finally, an AI-based early warning system has shown promise in reducing non-palliative
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hospital deaths among high-risk patients.
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A study published in the Canadian Medical Association Journal found that implementing
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this system led to fewer deaths than before its use.
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This finding underscores the potential of AI to significantly improve patient outcomes in
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critical care settings.
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Parents ‘should be seen and not heard’ when it comes to kids and their friendships.
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This is the conclusion drawn from the recent C.S.
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Mott Children’s Hospital National Poll on Children’s Health.
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The poll reveals that one in five parents worry their elementary school-age child has no
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friends or not enough friends.
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This concern is shared by many parents who fear social isolation and lonely weekends for their
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children.
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Michelle Icard, a parenting author, has been traveling the country speaking at schools about
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the complex social changes that occur during adolescence.
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She often encounters parents who are anxious about their children's social lives and want to
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know how to help them make more friends.
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While there are things parents can do to facilitate connections, Icard suggests that
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less intervention is usually better.
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Icard spoke with Sarah Clark, codirector of the C.S.
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Mott Children’s Hospital National Poll on Children’s Health, to discuss the recent
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findings.
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Clark, who is also a research scientist in the department of pediatrics at the University of
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Michigan in Ann Arbor, explained that the poll aimed to explore key topics at the beginning of
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the school year.
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Friendship, it turns out, is a significant concern for many parents.
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Interestingly, the poll found no difference in the number of friends between boys and girls or
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across different grade levels.
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Clark suggested that the pandemic might have disrupted the usual day-to-day interactions
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that help parents stay informed about social opportunities for their children.
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This lack of information could be contributing to parents' concerns.
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Another intriguing finding from the poll was that two-thirds of parents wanted their
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children to be friends with kids from similar families.
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Clark noted that while it is understandable for parents to want friends with similar parenting
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styles, this preference can cross a line into exclusivity.
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Such attitudes could limit children's social experiences and hinder their ability to
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function well in diverse environments.
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Clark also found it surprising that only 30 percent of parents with kids in kindergarten
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through fourth grade wanted to befriend the parents of their child’s friends.
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This percentage dropped to 17 percent for parents of kids in grades five through eight.
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Additionally, one in five parents felt their children did not have enough friends, a
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statistic that Clark found higher than expected.
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The poll revealed that 90 percent of parents believe their child would like to make new
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friends.
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However, Icard pointed out that sometimes parents project their own anxieties onto their
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children.
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A child might be perfectly content with a small circle of friends, while the parent worries
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unnecessarily.
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Social media also plays a role in modern friendships.
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About 23 percent of parents of kids in fifth through eighth grades are likely to allow their
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children to use social media to make friends.
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Clark noted that this trend might be due to the lack of physical spaces where kids can hang
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out, making social media a convenient alternative.
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When it comes to younger children, Clark recommended that parents intervene in playdate
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or friendship issues only when safety is a concern.
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Parents should allow their children to resolve verbal disagreements on their own to help them
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develop conflict resolution skills.
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By modeling positive social interactions themselves, parents can teach their children
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how to build and maintain friendships without direct intervention.
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In conclusion, while parents naturally worry about their children's social lives, it is
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often better to take a step back and allow kids to navigate their own friendships.
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Creating opportunities for social interaction is important, but over-involvement can be
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counterproductive.
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As always, leading by example is one of the best ways parents can support their children's
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social development.
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That wraps up today’s episode of Morning Medical with Dr.
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Chow.
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Thank you for joining me as we explored these pressing health issues.
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Stay tuned for more updates on the latest in medical and health news.
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Have a great day, and remember to take care of your health!