Smokers’ taste buds ‘do not allow them to taste bitterness of coffee’

April_Part 1_Dentistry

Though conventional pairing has cigarettes and coffee going together, researchers have found that the toxic chemicals in tobacco may hamper taste bud regeneration, resulting in smokers not being able to adequately taste the bitterness of their regular cup of joe.

The researchers, led by Nelly Jacob of the Pitié-Salpêtrière Hospital APHP in France, published results of their study in the journal Chemosensory Perception.

They note that tobacco’s chemicals are already known to cause a loss of taste in smokers, as well as structural changes to the fungiform papillae of the tongue – where taste buds are found.

What has been unknown is to what extent smokers’ taste range is affected, whether it returns to normal upon quitting smoking and if so, how long that takes.

Taste buds are largely responsible for conveying sweet, sour, bitter, salty and metallic sensations. According to the Centers for Disease Control and Prevention (CDC), the responsibilities of the taste system include:

  • Triggering digestive systems that change secretions of saliva, stomach acid and pancreatic juices

  • Enhancing feelings of pleasure and satiety when eating

  • Determining quality of foods and determining “good” tasting foods from “bad” ones, which could have potential toxins.

To further investigate the changes in taste buds caused by smoking, Jacob and colleagues tested the ability of 451 study participants to recognize and rate intensity of the four basic tastes – sweet, sour, bitter and salty.

Tobacco product accumulation could impede taste bud regeneration


Dividing the participants into three groups (smokers, non-smokers and former smokers), the team conducted the voluntary tests during three separate and consecutive “World No-Tobacco Days.”

A person’s ability to recognize salty, sweet or sour tastes was not influenced by smoking status, the researchers say. However, smoking status did affect their ability to taste the bitterness in caffeine.

While bitter receptors in the tongue are normally able to detect this sensation in even low concentrations, nearly 20% of smokers were not able to correctly identify the taste.

Of the former smokers, 26.5% were not able to identify the taste, while only 13.4% of the non-smokers were unable to correctly identify the bitter samples.

Speaking about their findings, Jacob says:

“We consider that the perception of bitter taste should be examined more closely, both as a tool for smoking cessation or for preventing smoking initiation. More generally, it should be worthwhile to consider the role of chemosensory perceptions in smoking behavior.”

The team believes the accumulation of some tobacco products in the body could impede taste buds regenerating, which could still affect a person’s ability to recognize certain tastes after they have quit smoking.

In the world of taste bud research, Medical News Today recently reported on a digital taste simulator that can produce the four main elements of taste. Researchers say it could one day be used to improve or regenerate sense of taste in cancer patients whose taste buds have been impaired by chemotherapy.

Written by Marie Ellis



To motivate patients on peritoneal dialysis, first motivate staff


Asking patients to perform their own dialysis can be a tall order, even when you provide the needed training. It may take some motivation on the part of the patient—and sometimes on the part of your staff.

(Defining key elements in promoting peritoneal dialysis to patients)

In their poster, “Thriving on PD,” presented at the Annual Dialysis Conference this past week, Mary Jo Miller-Grandfield, RN, BSN, and her dialysis team at Renal Venture Management’s Fort Dodge/Storm Lake, Iowa clinic, set out to spread the word about the value of home dialysis in their mainly rural community. They focused on peritoneal dialysis as the modality choice, saying in the abstract, “There are many misconceptions related to PD therapies and outcomes, both with existing dialysis patients and the medical community.” So the team, with the help of Baxter Health Care, developed a campaign to highlight the positive quality of life improvements for patients going on PD.

The group developed the “We don’t just survive, we thrive,” campaign. That effort include several components, as detailed by Miller-Grandfield:

  • “Removal of the word ‘no’ from our vocabulary: all needs, wishes, goals … even prescription changes…are met with an open mind and the patient’s quality of life as a priority.”

  • The dialysis team accommodated patient schedules. “…We became very flexible. We arranged our schedule to accommodate the needs of the patients.” The staff trained working patients in the evening and opened early evening lab draws to accommodate work schedules. They became the only program in the area to train nursing home staff on peritoneal dialysis.

  • Get patients to talk about the outcomes.  The dialysis team empowered patients “to not only focus on their quality of life but to document that quality via testimonials, pictures and postcards.”

(The benefits of offering extended-hour dialysis shifts)

The results of this positive thinking? After 2.5 years, the Fort Dodge/Storm Lake facility grew their peritoneal dialysis program from five patients to 37, divided between two clinics. “Our goal is to continue to promote PD (and the quality of life benefits) to surrounding physicians and the medical community,” wrote Miller-Grandfield.


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Medicare proposes coverage for hepatitis C screening

Internal Medicine

Medicare officials propose to cover screening for hepatitis C virus for adults at high risk of infection as well as a one-time screening for Baby Boomers.

The plan, announced in a coverage memo on March 4, would provide Medicare coverage for all screening tests approved by the Food and Drug Administration when they are ordered by a primary care physician or other primary care clinician.

Officials at the Centers for Medicare & Medicaid Services initially floated the idea of hepatitis C (HCV) screening coverage last September. The response was overwhelmingly positive, with nearly all of the 65 public comments advocating in favor of coverage.

HCV screening is already recommended by the U.S. Preventive Services Task Force and the American Academy of Family Physicians. The AAFP recommends screening for HCV infection in high-risk adults. But the 2013 USPSTF recommendation goes further, calling on physicians to screen high-risk adults as well as to provide a one-time screening to all patients born between 1945 and 1965.

The Medicare proposal echoes the USPSTF recommendations.

For the proposal, the CMS deems the following patients as at high risk for HCV infection: adults who use illicit injection drugs or have a history of such drug use, as well as individuals who had blood transfusions before 1992. The proposal calls for coverage of an initial screening test for high-risk adults, followed by annual rescreening for those who continue to use illicit injection drugs after the first test.

“We acknowledge the limited evidence concerning health outcomes of HCV screening,” agency officials wrote in the coverage memo. “However, CMS believes that screening for HCV infection provides an opportunity for appropriate interventions to benefit the infected person by permitting for the early detection of, and potentially the prevention of, HCV-related liver disease.”

Treatment options for hepatitis C are expanding, the CMS noted in its coverage memo. Over the past several years, the FDA has approved three protease inhibitors, boceprevir (Victrelis), telaprevir (Incivek), and simeprevir (Olysio), for the treatment of patients with genotype 1 infection. Each of these three drugs can be used in combination with pegylated interferon and ribavirin for the treatment of genotype 1 infection.

Last year, the FDA approved sofosbuvir (Sovaldi), which is indicated for the treatment of hepatitis C infection from genotypes 1, 2, 3, or 4. But access to that drug could be impacted by its hefty price tag, which is $1,000 a pill or about $84,000 for a 12-week course of treatment.

Comments on the CMS screening proposal can be made until April 3. The CMS is scheduled to issue a final decision on coverage in June.

On Twitter @maryellenny



Beta-blocker use associated with better outcomes after insular cortex infarcts

Internal Medicine


SAN DIEGO – Prior beta-blocker use may improve outcomes following insular ischemic strokes, according to a prospective, observational study of 1,014 consecutive stroke patients at Massachusetts General Hospital in Boston.

Favorable outcomes, defined by modified Rankin Scale (mRS) scores of 0-2 at 3 months – occurred with significantly greater likelihood among patients with infarcts of the insular or surrounding opercular cortex who used beta-blockers (BBs) within 24 hours before stroke onset, after researchers controlled for underlying cardiovascular and other risk factors on multivariate analysis (odds ratio, 2.21; 95% confidence interval, 1.03-4.75; P = .04).

“A lot of people have studied the effect” of BBs on stroke, and have found that “indiscriminate use in acute stroke patients is not beneficial, and may be associated with harm,” said senior author Dr. Hakan Ay of the departments of neurology and radiology at Massachusetts General.

But previous studies lumped strokes together, regardless of infarct location. “This is the first study that links response to a specific brain site. What this tells us is if you find the right patient, you can get benefit” from BBs, although the finding must be confirmed by randomized trial, Dr. Ay said at the International Stroke Conference, sponsored by the American Heart Association.

The 402 BB users and 612 nonusers in the study, about evenly split between men and women, were admitted within 3 days of stroke onset.

BB patients were older (mean 74 years vs. 65 years) and more often had risk factors such as coronary artery disease (33% vs. 13%), atrial fibrillation (40% vs. 17%), and heart failure (12% vs. 4%).

The National Institutes of Health Stroke Scale score was higher in the BB group (mean 5 vs. 3). Twenty-three percent of BB patients and 18% of nonusers got intravenous thrombolysis (P = .06).

Overall, about two-thirds of patients in the study did well, with mRS scores of 0-2 at 3 months. BB patients did a bit worse, with just 57% achieving the score. Univariate analyses revealed a decreased probability of good outcome in the BB patients, as expected given their poorer baseline health (OR 0.72; 95% CI 0.55-0.93).

After adjustment for that baseline difference on multivariate analysis, prior BB use did not predict good or bad outcomes when all strokes were considered (OR 1.33; 95% CI 0.90-1.96; P = .16), which might indicate that while insular patients seemed to benefit, prior BB use may have contributed to worse outcomes in other stroke types, Dr. Ay said.

The benefit emerged when multivariate analysis was limited to BB patients and nonusers who had insular strokes. The investigators did not report how many were in each group.

There’s biological plausibility for the finding; insular injury is associated with autonomic dysregulation, leading to increases in blood pressure and other problems that likely affect outcomes. BBs might moderate the effect, Dr. Ay said.

The investigators had no relevant disclosures. The work was funded by the National Institute of Neurological Disorders and Stroke.


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Annual mammography at age 40-59 provides no survival benefit

Internal Medicine

Annual mammography in women aged 40 to 59 years was no more effective than was physical examination or usual care for reducing breast cancer mortality when adjuvant therapy for breast cancer is readily available, according to 25-year findings from the Canadian National Breast Screening Study.

During a 5-year screening period beginning in 1980, 666 invasive breast cancers were detected in 44,925 women randomized to receive annual mammography and annual physical breast examinations, and 524 were detected in 44,910 women randomized to receive a single physical breast examination followed by usual care in the community. Of these, 180 and 171 in the mammography and control arms, respectively, died of breast cancer during up to 25 years of follow-up (mean of 22 years), Dr. Anthony B. Miller of the University of Toronto, and his colleagues reported.

The 25-year cumulative mortality from breast cancer detected during the screening period was similar between the women in the mammography arm and the control arm (hazard ratio, 1.05), the investigators reported Feb. 11 in BMJ.

After the screening period, an additional 2,584 breast cancers were detected in the mammography arm and 2,609 in the control arm during the follow-up period. Overall, 1,005 women died from breast cancer during follow-up, including 351 who were diagnosed during the screening period.

Of the breast cancers detected in the mammography arm during the initial screening period, 484 were screen detected, 176 were interval cancers, and 6 were lacking data. The mean size of cancers diagnosed in the mammography arm was 1.91 cm vs. 2.10 cm in the control arm, they said.

“In the mammography arm, 30.6% of cancers were node positive and 68.2% were palpable. In the control arm, 32.4% of the cancers were node positive and all were palpable …on average, palpable cancer were larger than cancers that were detected only by mammography (2.1 cm v 1.4 cm) and were more likely to be node positive (34.7% vs. 16.5%),” the investigators wrote (BMJ 2014 Feb.11;348 [doi:10.1136/bmj.g366]).

Although 25-year survival was better for those with tumors less than 2 cm vs. greater than 2 cm, those with breast cancer detected in the mammography vs. the control arm, and for those in the mammography arm with nonpalpable vs. palpable tumors (HR, 0.46, 0.79, and 0.58, respectively), the overall 25-year cumulative mortality from breast cancer was similar between women in the mammography arm and control arm, (HR, 0.99), the investigators wrote.

The findings were nearly identical for those aged 40-49 years, and those aged 50-59 years, the investigators noted.

Notably, at the end of the screening period, an excess of 142 breast cancers were detected in the mammography group, compared with the control group, and at 15 years, that excess remained at 106, implying that 22% of the screen-detected invasive cancers in the mammography arm were overdiagnosed, meaning that the cancer might not otherwise have become clinically apparent during the patient’s lifetime.

“This represents one overdiagnosed breast cancer for every 424 women who received mammography screening in the trial. Assuming that nearly all overdiagnosed cancers in the Canadian National Breast Screening Study were nonpalpable, 50% of mammogram detected, nonpalpable cancers were overdiagnosed,” they said.

The Canadian National Breast Screening Study was supported by the various Canadian health agencies and advocacy groups. Dr. Miller was supported in part by a national health scientist award from Health and Welfare Canada.


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Sound Off: How do you determine the appropriate interval for follow-up visits?

Family Medicine_January2Total United States health care costs could be lowered by billions of dollars per year if evidence-based guidelines for follow-up patient visits are established, according to the authors of a commentary in the January issue of the American Journal of Managed Care.

In addition, new standards for follow-up visits would improve access and maximize the quality of the visits without compromising or restricting care, wrote Emilia Javorsky of the University of Massachusetts and her associates.

“Scheduling habits may be unnecessarily contributing to the problems of limited access, excessive utilization, and excessive costs, without improvement in health care outcomes,” the authors wrote. “The same scientific rigor that guides therapeutic decision making should be used to optimize chronic disease management.”

They searched the PubMed database for studies discussing evidence-based guidelines for follow-up intervals for the Top 5 chronic conditions – mental disorders, back problems, arthritis, chronic obstructive pulmonary disease/asthma, and hypertension – in 2010. Out of 330 studies, only 8 recommended evidence-based follow-up intervals.

To illustrate the point, Ms. Javorsky and her associates crunched the numbers for follow-up treatment of hypertension, with patient visits typically occurring every 6 months. Hypertension management accounted for $47.4 billion in 2008, with $13.0 billion coming from outpatient visits. If follow-up visits were extended from 6 to 7 months, the authors argued, there would be a 15% decrease in the number of visits in 1 year, with cost savings predicted to be nearly $682 million/year.

In addition, many patients with hypertension could see even more effective care with new standards, as recent studies have suggested that more time is needed to reflect accurate therapy-induced changes in blood pressure.

How do you determine the appropriate interval for follow-up visits? Please leave your comments below.

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Multiple medication use ‘not always hazardous,’ say researchers

General Practitioner_January1New research finds that patients with a single illness who take multiple drugs – referred to as “polypharmacy” – have a higher risk of hospital admission, compared with polypharmacy patients with multiple health conditions, who have a “near-normal” admission risk.

This is according to a study published in the British Journal of Clinical Pharmacology.

The study researchers, led by Dr. Rupert Payne of the Cambridge Centre for Health Services Research in the UK, say that their findings suggest a need for doctors to take “more sophisticated approaches” when prescribing medications to patients.

The incidence of polypharmacy is growing, according to the investigators, mainly because the number of elderly people is increasing and more people are being diagnosed with multiple illnesses.

However, the researchers note that increasing numbers of prescribed medications have been associated with a series of adverse health outcomes.

“These include high-risk prescribing, adverse drug reactions and death. Excessive numbers of medicines may contribute to poorer medication adherence, as well as being associated with lower quality of life,” the study authors write.

To determine how pharmacology impacts the risk for hospital admission, the research team analyzed Scottish National Health Service (NHS) primary care data for 180,815 adults aged 20 years or older who had long-term medical conditions.

They assessed the number of medications each person was receiving and linked this to the number of times each patient was admitted to a hospital the following year.

Assumption that polypharmacy is always hazardous is ‘misleading’

The analysis revealed that just under 50% of patients were prescribed at least one regular medication, while 25.2% were prescribed one to three medications, 11% were prescribed four to six, 5.9% were prescribed seven to nine, and 4.6% were prescribed 10 or more medications.

The researchers found that patients who had a single illness who were taking 10 or more medications were three times more likely to have an unplanned admission to the hospital, compared with patients with a single illness who took one to three medicines.

However, on analyzing patients who had six or more illnesses who used 10 or more medications, the researchers found they only increased their risk of hospital admission by 1.5 times, compared with patients with six or more illnesses who took one to three medicines.

Commenting on the findings, Dr. Payne says:

“The commonly held assumption that polypharmacy is always hazardous and represents poor care is misleading. Our work shows that we need more sophisticated approaches to assessing the appropriateness of each patient’s set of medicines.”

He adds that these improved approaches are particularly relevant to medication prescribing in general practice, as it is in this environment where most of the long-term clinical care is carried out, and where clinicians prescribe drugs for long periods.

“It is particularly important at times when doctors are caring for older patients and those with multiple medical conditions in whom multiple medications are often used,” Dr. Payne adds.

The research team notes that the findings of this study are strong, as they directly analyzed the interaction between morbidity and medication burden – something they say other studies looking at polypharmacy have failed to do.

Dr. Payne adds that future research that measures the impact of pharmacology should adopt more “sophisticated and nuanced approaches.”

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