Articles: ninos.
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Military body fat standards were implemented in the 1980s to prevent obesity and associated poor military readiness. In the past 2 decades, enforcement of existing Army body composition standards has been eroded by the steady increase in national obesity rates, the demand for new recruits especially during the 2007 surge in Iraq, and the COVID epidemic in 2020. The diminishing qualified recruit pool puts a new focus on accession standards. The purpose of accession standards is to ensure that recruits will meet soldier standards, but accession standards have been relaxed to improve recruitment with an assumption that most recruits will achieve the retention standards during initial entry training. A new method of percent body fat estimation (%BF) adopted by the Army in 2024 further liberalizes both accession and retention standards. This study examined the impact of current accession and retention %BF standards on the proportion of the US population that would be disqualified from Army service. ⋯ Army body composition standards are generous, extending to the limits of increased metabolic health risks and providing underestimates of actual %BF based on the behavior of circumference-based methods of body fat estimation. However, current standards do not accurately select or track physical readiness, especially for women, and should be updated. Modernization of physical readiness standards to meet the needs of the Army of 2030 could include adoption of new technologies that directly assess central adiposity, adequate muscle mass, and replace fitness testing with cardiac output metrics. With half of US adults projected to be obese by 2030, it is time for a review of the strategic goals of modernized military readiness standards.
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Comment Observational Study
Postmarketing Surveillance of Inferior Vena Cava Filters Among US Medicare Beneficiaries: The SAFE-IVC Study.
Inferior vena cava filters (IVCFs) are commonly used to prevent pulmonary embolism in selected clinical scenarios, despite limited evidence to support their use. Current recommendations from professional societies and the US Food and Drug Administration endorse timely IVCF retrieval when clinically feasible. Current IVCF treatment patterns and outcomes remain poorly described. ⋯ In this large, US real-world analysis, IVCF insertion declined, yet retrievals remained low. Strategies to increase timely retrieval are needed, as nonretrieved IVCFs may have long-term complications.
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Biologics approved by the US Food and Drug Administration (FDA) receive 12 years of guaranteed protection from biosimilar competition compared with 5 years of protection from generic competition for new small-molecule drugs. Under the 2022 Inflation Reduction Act, biologics are exempt from selection for Medicare price negotiation for 11 years compared with 7 years for small-molecule drugs. Congress codified these differing legal protections on the premise that biologics require more time and resources to develop and have weaker patent protection, necessitating additional protections for manufacturers to recoup their development costs and generate adequate returns on investment. ⋯ There is little evidence to support biologics having longer periods of market exclusivity or protection from negotiation. As a result of differential treatment, US law appears to overly reward the development of biologics relative to small-molecule drugs.
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Comment Randomized Controlled Trial Multicenter Study Comparative Study
A Digital Health Behavior Intervention to Prevent Childhood Obesity: The Greenlight Plus Randomized Clinical Trial.
Infant growth predicts long-term obesity and cardiovascular disease. Previous interventions designed to prevent obesity in the first 2 years of life have been largely unsuccessful. Obesity prevalence is high among traditional racial and ethnic minority groups. ⋯ A health literacy-informed digital intervention improved child weight-for-length trajectory across the first 24 months of life and reduced childhood obesity at 24 months. The intervention was effective in a racially and ethnically diverse population that included groups at elevated risk for childhood obesity.
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Randomized Controlled Trial Multicenter Study
Early, Individualized Recommendations for Hospitalized Patients With Acute Kidney Injury: A Randomized Clinical Trial.
Acute kidney injury (AKI) is a common complication during hospitalization and is associated with adverse outcomes. ⋯ Among patients hospitalized with AKI, recommendations from a kidney action team did not significantly reduce the composite outcome of worsening AKI stage, dialysis, or mortality, despite a higher rate of recommendation implementation in the intervention group than in the usual care group.